Garbas Karolina, Zapała Łukasz, Ślusarczyk Aleksander, Piecha Tomasz, Radziszewski Piotr
Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland.
Urodynamic Lab of Private Hospital "Prostalith", 25-613 Kielce, Poland.
J Clin Med. 2025 May 23;14(11):3674. doi: 10.3390/jcm14113674.
: Detrusor underactivity (DU) and bladder outlet obstruction (BOO) are common causes of voiding dysfunction in women with lower urinary tract symptoms (LUTS). However, differentiating between them remains challenging due to overlapping clinical presentations and a reliance on invasive urodynamic studies (UDS). This study aimed to develop a non-invasive, office-based clinical prediction model to distinguish DU from BOO in women with non-neurogenic LUTS. : We conducted a retrospective analysis of 88 women who underwent pressure-flow studies at two outpatient clinics between 2012 and 2022. DU was defined using a projected isovolumetric pressure 1 (PIP1) < 30 cm HO, and BOO was defined by a Female-Specific Bladder Outlet Obstruction Index (BOOIf) > 18. Clinical symptoms, uroflowmetry (UFL) parameters, and pelvic organ prolapse staging (POP-Q) were evaluated. A multivariate logistic regression model was constructed using a stepwise selection procedure. : Of the 88 patients, 38 (43.2%) were diagnosed with DU and 50 (56.8%) with BOO. Four predictors were retained in the final model: hesitancy (OR = 2.06, = 0.18), incomplete emptying (OR = 3.52, = 0.02), POP-Q < 3 (OR = 0.15, = 0.02), and longer time to Qmax on UFL (OR = 1.05, = 0.004). The model achieved a Harrell's Concordance Index (C-index) of 0.779. Using a probability cutoff of 0.3, the model demonstrated a sensitivity of 86.8%, specificity of 46.0%, positive predictive value of 55.0%, and negative predictive value of 82.1%. : We present a novel non-invasive prediction model incorporating clinical symptoms, UFL metrics, and pelvic exam findings that may aid in differentiating DU from BOO in women with LUTS.
逼尿肌活动低下（DU）和膀胱出口梗阻（BOO）是下尿路症状（LUTS）女性排尿功能障碍的常见原因。然而，由于临床表现重叠以及依赖侵入性尿动力学研究（UDS），区分这两者仍然具有挑战性。本研究旨在开发一种基于门诊的非侵入性临床预测模型，以区分非神经源性LUTS女性的DU和BOO。我们对2012年至2022年间在两家门诊接受压力流研究的88名女性进行了回顾性分析。DU定义为预计等容压力1（PIP1）<30 cm H₂O，BOO定义为女性特异性膀胱出口梗阻指数（BOOIf）>18。评估了临床症状、尿流率（UFL）参数和盆腔器官脱垂分期（POP-Q）。使用逐步选择程序构建多变量逻辑回归模型。在88例患者中，38例（43.2%）被诊断为DU，50例（56.8%）被诊断为BOO。最终模型保留了四个预测因素：排尿犹豫（OR = 2.06，P = 0.18）、排空不全（OR = 3.52，P = 0.02）、POP-Q<3（OR = 0.15，P = 0.02）以及UFL上达到最大尿流率（Qmax）的时间更长（OR = 1.05，P = 0.004）。该模型的Harrell一致性指数（C指数）为0.779。使用概率截断值0.3时，该模型的敏感性为86.8%，特异性为46.0%，阳性预测值为55.0%，阴性预测值为82.1%。我们提出了一种新的非侵入性预测模型，该模型纳入了临床症状、UFL指标和盆腔检查结果，可能有助于区分LUTS女性的DU和BOO。
