Urodynamic diagnosis of subvesical obstruction – significance of bladder outlet obstruction index and bladder contractility index

Dimitrije  Jeremić; Saša Vojinov; Stevan Stojanović; Ivan  Levakov; Mladen  Popov; Miloš Maletin; Ines Kalači; Zoran Ružić; Tanja Lakić; Filip Dožić; Dragan Grbić

doi:10.2298/VSP250304071J

Dimitrije Jeremić University of Novi Sad, Faculty of Medicine, Department of Veterinary Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Saša Vojinov University of Novi Sad, Faculty of Medicine, Department of Veterinary Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Stevan Stojanović University of Novi Sad, Faculty of Medicine, Department of Veterinary Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Ivan Levakov University of Novi Sad, Faculty of Medicine, Department of Veterinary Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Mladen Popov University of Novi Sad, Faculty of Medicine, Department of Veterinary Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Miloš Maletin University of Novi Sad, Faculty of Medicine, Department of Veterinary Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Ines Kalači University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Zoran Ružić University of Novi Sad, Faculty of Agriculture, Novi Sad, Serbia
Tanja Lakić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Center for Pathology and Histology, Novi Sad, Serbia
Filip Dožić University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia
Dragan Grbić University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP250304071J

Keywords: male;, ureteral obstruction;, urinary bladder;, urination disorders

Abstract

Background/Aim. The bladder outlet obstruction (BOO) index (BOOI) is used during urodynamic testing to diagnose BOO. The bladder contractility index (BCI) is a urodynamic parameter used inconsistently. The aim of this study was to examine the correlation between BOOI and BCI. Methods. A retrospective study was conducted from 2021 to 2023, including 176 male patients. Using the t-test, analysis of variance, and correlation analysis, BOOI and BCI were analyzed. Results. High BOOI values (40–80) and weaker bladder contractility (BCI < 100), as potential causes of lower urinary tract symptoms (LUTS), can coexist in 11.37% of cases. A high BCI value (> 150) is associated with a significant number of patients (7.39%) with high BOOI values (> 40), acting as a compensatory mechanism that masks the true causes of LUTS. Patient groups with BCI < 100 and > 150 show an inverse correlation with BOOI, as expected. Values of BOOI 20–39 and BCI 101–149 can be considered a “gray zone”. The correlation between P_detQ_max and Q_max was not statistically significant (r = -0.2006), making BOO a factor that can influence this relationship. Additionally, the intraurethral catheter positioned during urodynamic testing can significantly affect this correlation. As expected, a negative correlation can be observed between Q_max and BOOI (r = -0.44841, p < 0.001), while BCI and Q_max have a positive linear correlation (R² = 0.2255, p < 0.001). The correlation between the two observed indices, BOOI and BCI, shows a positive linear correlation, presenting a physiological mechanism for BOO compensation (R² = 0.3292, p < 0.001). Conclusion. In combination with BCI, BOOI is sufficient for establishing a definitive diagnosis in the analyzed patient groups. It is recommended that BOOI, BCI, and Q_max always be used in combination. Q_max, as a measure mostly valued on uroflow, may be insufficient for diagnosis in unequivocal clinical cases.

Author Biography

Mladen Popov, University of Novi Sad, Faculty of Medicine, Department of Veterinary Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Urology Clinic, Novi Sad, Serbia

-0002-1825-0097").

References

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21(2): 167–78.

Lee CL, Kuo HC. Pathophysiology of benign prostate enlarge-ment and lower urinary tract symptoms: Current concepts. Tzu Chi Med J 2017; 29(2): 79–83.

Matsukawa Y, Naito Y, Ishida S, Matsuo K, Majima T, Gotoh M. Two types of detrusor underactivity in men with nonneuro-genic lower urinary tract symptoms. Neurourol Urodyn 2023; 42(1): 73–9.

Drake MJ, Lewis AL, Young GJ, Abrams P, Blair PS, Chapple C, et al. Diagnostic Assessment of Lower Urinary Tract Symp-toms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals. Eur Urol 2020; 78(5): 701–10.

Abrams P. Bladder outlet obstruction index, bladder contrac-tility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 1999; 84(1): 14–5.

Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, et al. Prev-alence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women. Korean J Urol 2012; 53(5): 342–8.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61(1): 37–49.

D’Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 2019; 38(2): 433–77.

Thomas AW, Cannon A, Bartlett E, Ellis-Jones J, Abrams P. The natural history of lower urinary tract dysfunction in men: min-imum 10-year urodynamic followup of transurethral resection of prostate for bladder outlet obstruction. J Urol 2005; 174(5): 1887–91.

Al-Hayek S, Thomas A, Abrams P. Natural history of detrusor contractility--minimum ten-year urodynamic follow-up in men with bladder outlet obstruction and those with detrusor. Scand J Urol Nephrol Suppl 2004; (215): 101–8.

Jiang YH, Lee CL, Kuo HC. Urothelial dysfunction, suburothe-lial inflammation and altered sensory protein expression in men with bladder outlet obstruction and various bladder dys-functions: Correlation with urodynamics. J Urol 2016; 196(3): 831–7.

Averbeck MA, De Lima NG, Motta GA, Beltrao LF, Abboud Filho NJ, Rigotti CP, et al. Collagen content in the bladder of men with LUTS undergoing open prostatectomy: A pilot study. Neurourol Urodyn 2018; 37(3): 1088–94.

Kim M, Jeong CW, Oh SJ. Effect of preoperative urodynamic detrusor underactivity on transurethral surgery for benign prostatic hyperplasia: a systematic review and meta-analysis. J Urol 2018; 199(1): 237–44.

Wang J, Ren L, Liu X, Liu J, Ling Q. Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives. Int J Mol Sci 2023; 24(21): 15517.

Santos-Pereira M, Charrua A. Understanding underactive blad-der: A review of the contemporary literature. Porto Biomed J 2020; 5(4): e070.

Kim SJ, Kim J, Na YG, Kim KH. Irreversible Bladder Remodel-ing Induced by Fibrosis. Int Neurourol J 2021; 25(Suppl 1): S3–7.

Yang J, Song H, Zhan H, Ding M, Luan T, Chen J, et al. The in-fluence of preoperative urodynamic parameters on clinical re-sults in patients with benign prostatic hyperplasia after tran-surethral resection of the prostate. World J Urol 2023; 41(12): 3679–85.

Reynard JM, Yang Q, Donovan JL, Peters TJ, Schafer W, de la Ro-sette JJ, et al. The ICS-'BPH' Study: uroflowmetry, lower uri-nary tract symptoms and bladder outlet obstruction. Br J Urol 1998; 82(5): 619–23.

Malde S, Nambiar AK, Umbach R, Lam TB, Bach T, Bachmann A, et al. Systematic Review of the Performance of Noninva-sive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms. Eur Urol 2017; 71(3): 391–402.

Tammela TL, Schäfer W, Barrett DM, Abrams P, Hedlund H, Rollema HJ, et al. Repeated pressure‐flow studies in the evalu-ation of bladder outlet obstruction due to benign prostatic en-largement. Finasteride Urodynamics Study Group. Neurourol Urodyn 1999; 18(1): 17–24.

El Khoury J, Hermieu N, Chesnel C, Xylinas E, Teng M, Ouzaid I, et al. Primary bladder neck obstruction in men: The im-portance of urodynamic assessment and cystourethrography in measuring its severity. Neurourol Urodyn 2024; 43(4): 874–82.

Rosier PFWM, Gammie A, Valdevenito JP, Speich J, Smith P, Sin-ha S. ICS‐SUFU standard: Theory, terms, and recommenda-tions for pressure‐flow studies performance, analysis, and re-porting. Part 2: Analysis of PFS, reporting, and diagnosis. Neurourol Urodyn 2023; 42(8): 1603–27.

Van Dort W, Rosier PFWM, van Steenbergen TRF, Geurts BJ, de Kort LMO. Constrictive versus compressive bladder outflow obstruction in men: does it matter? Neurourol Urodyn 2024; 43(8): 2178–84.

Marshall SJ, Wang D, Fung YC, Blaivas J. Urodynamic findings that are most impactful for patients with neurogenic bladder and the literature that supports this. Curr Bladder Dysfunct Rep 2024; 19(2): 211–29.

Croghan SM, Skolarikos A, Jack GS, Manecksha RP, Walsh MT, O'Brien FJ, et al. Upper urinary tract pressures in endourology: a systematic review of range, variables and implications. BJU Int 2023; 131(3): 267–79.