Research On The Diagnosis Of Female Bladder Outlet Obstruction

Background and objective: Female bladder outlet obstruction is a series of diseaseswhich has the similar appearance caused by various origin of a disease. In the past, FBOOwas considered as rare disease. In recent years, FBOO attracted more and more attention, and got better identified. There are 19.4%～25.5% of the women who present with lowerurinary tract symptoms (LUTS) and 6.5%～9.6% of the women who go to urologist wereclassified as FBOO.Because of the characteristics of FBOO and the lack of clinical research, there is tillmuch confusion and disputation in definition,evaluation and diagnosis. And, the lack of aGolden Standard for diagnosis makes a lot of difficulty for diagnostics research. Urologistsall over the world have made much effort in this domain, and various diagnostics criterionwas offered. But, up to now, none of them has been generally accepted. So, morediagnostics research is still needed.In recent years, Evidence based medicine (EBM) is being developed rapidly, and getmore and more widely accepted. Evidence based diagnostics offers some new theory andmethod which ought to improve the FBOO diagnostics research.In this research, we retrospectively analyzed the data of the patient we treated 2000～2005 and collected a control group of 29 normal asymptomatic female volunteers. ROCcurve, discriminant analysis, and Kappa agreement analysis are used to study theimportance and usage of the UDS parameters and the ICS P-Q monogram, Scheafermonogram and Blaivas—Groutz monogram existing.Methods: By follow-up investigation, patients are divided into three groups: significant efficacious, efficacious and inefficacious according to the therapeutic effect.Significant efficacious and efficacious is used as the evidence which proves the clinicaldiagnosis made before treatment was correct. In this way, FBOO patients are identifiedfirmly. 29 normal asymptomatic female volunteers are included as control. ROC curveanalysis and discfiminant analysis are used to analyze UDS data. Monograms are estimate by Kappa agreement analysis.Results:1. 68 patients are investigated, and 50 of them replied. 26 of them get significantefficacious therapeutic effect, 15 efficacious and 9 inefficacious. 83% of the patientsreplied get more them efficacious therapeutic effect.2. Patients who get inefficacious therapeutic effect have lower PdetQmax and Pdetmaxthan the patients in other groups. Patients who get significant efficacious therapeutic effecthave higher A-G number and LIRA.3. FBOO group show significant more DI than control group.4. AUC of the parameters: P-FS Qave: 0.844,P-FS Qmax: 0.826,PdetQmax: 0.826 FreeQmax: 0.891,FreeQave: 0.8235. Cutoffs calculated by ROC curve: FreeQmax≤20ml/s (TPF=76%, TNF=80%) FreeQave≤8.5ml/s (TPF=76%, TNF=80%) P-FS Qmax≤15ml/s (TPF=87%, TNF=81%) P-FS Qave≤7.5ml/s (TPF=69%, TNF=81%) PdetQmax≥28.5cmH20 (TPF=76%, TNF=72%)6. Discriminant analysis functions: score=P-FS Qavex0.103+P-FS Qmaxx0.091-PdetQmaxx0.042-0.769 score=Pdetmaxx0.032—FreeQmaxx0.092—FreeQavex0.004+0.735The diagnose accuracy using functions is 88%和78.9%7. Kappa value calculated from the monograms is: ICSP-Q: 0.468 Scheafer(Ⅰ/Ⅱ): 0.306 Blaivas—Groutz: 0.435 Scheafer(0/Ⅰ): 0.550Conclusion:1. PdetQmax,Pdetmax,A-G number and URA may influence the therapeutic effect.2. DI may signify the diagnosis of FBOO3. P-FS Qmax,P-FS Qave,PdetQmax,FreeQmax and FreeQave are useful in thediagnosis of FBOO, the cutoffs of the parameters are: FreeQmax≤20ml/s (TPF=76%, TNF=80%) FreeQave≤8.5ml/s (TPF=76%, TNF=80%) P-FS Qmax≤15ml/s (TPF=87%, TNF=81%) P-FS Qave≤7.5ml/s (TPF=69%, TNF=81%) PdetQmax≥28.5cmH20 (TPF=76%, TNF=72%)4. The discriminant analysis function is an effective method to combine multipleparameters, and may play important role in the diagnosis of FBOO in the future.5. The monograms existing can not be used in the diagnosis of FBOO effectively.