Objective
To analyze the benefit of voiding chain cystourethrography (VCC) [placing a radiographic opaque chain into the urethra and bladder and asking the patient to void under fluoroscopy] in the urodynamic evaluation of female bladder outlet obstruction (BOO).
Materials and Methods
Females with post anti-incontinence operation voiding dysfunction who underwent urodynamic evaluation augmented with VCC and later had urethrolysis were identified. Six diagnostic criteria for obstruction were applied to each patient: (11. Akikwala TV, Fleischman N, Nitti VW: Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006; 176: 2093-7.) VCC ( obstructed: chain was angulated and could not be voiding out) (22. Blaivas JG, Groutz A: Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000; 19: 553-64.) Video urodynamic study (VUDS) (detrusor contraction combined with radiographic obstruction) (33. Barnes AC: The roentgenologic study of urethral sphincter strength in the female. J Urol. 1942; 47: 694-701.) maximum flow (Qmax) ≤ 15 cc/sec, detrusor pressure (pDet)@ Qmax ≥ 20 cm H20 (44. Nitti VW, Tu LM, Gitlin J: Diagnosing bladder outlet obstruction in women. J Urol. 1999; 161: 1535-40.) Qmax ≤ 11 cc/sec, pDet@ Qmax ≥ 25 cm H20 (55. Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE: Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998; 51: 408-11.) Qmax ≤ 12 cc/sec, pDet@ Qmax ≥ 25 cm H20 (66. Lemack GE, Zimmern PE: Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol. 2000; 163: 1823-8.) Blaivas-Groutz (B-G) nomogram. Urethrolysis results were reviewed. Agreement in assessment of BOO criteria was assessed by estimating the proportion of pair-wise agreements along with an exact binomial 95% confidence interval (CI) and by estimating kappa along with a 95% CI.
Results
Twenty-one patients were identified. Twenty of the 22 urethrolyses (91%) were clinically successful. Diagnosis of BOO was most common for VCC (86%) and then B-G Nomogram (67%). Agreement with the VCC was relatively poor for each of the five other methods (14%-62%) with the video urodynamic study (VUDS) being the best. Three patients with successful urethrolysis were diagnosed only by the VCC. All of kappa values regarding agreement with the VCC were low; the highest value of 0.15 was observed for VUDS.
Conclusion
VCC may augment selection criteria for urethrolysis.
Female; Ureteral Obstruction; Urodynamics; Urinary Incontinence
