Delta Q Value to Discriminate Detrusor Underactivity From Bladder Outlet Obstruction

Study Overview
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Brief Summary
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To determine the significance of delta Q value (Qmax - Qave) in discrimination between BOO and DU, to avoid invasive studies (pressure flow studies (PFSs)) and replace them with noninvasive study (uroflowmetry).

Detailed Description
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lower urinary tract symptoms (LUTS) in old male patients are usually secondary to prostatic hyperplasia. However, it is becoming clear nowadays that prostatic enlargement is not always the cause of male LUTS, and other factors could cause male LUTS in the presence of benign prostate enlargement (BPE). Two clinical situations are common in elderly patients like Bladder Outlet Obstruction (BOO) and Detrusor underactivity (DU) they affect the voiding phase in elderly men markedly. To distinguish one from another may be challenging and could be only done by urodynamic study (UDS), which is the gold standard for diagnosis. A urodynamic study is an invasive procedure, with side effects of pain and urinary tract infection, and the need for special equipment and expertise has limited its widespread use and made it very stressful for the patients. On the other hand, Uroflowmetry is a non-invasive procedure that could be used in patients' assessments. A term of Delta Q is being used that focuses on the difference between (Qmax) and (Q-average). The hypothesis is that Delta Q would be lower in Detrusor underactivity because of the undermined detrusor function decreasing both average and maximum urine flow rate, but it is higher in BOO, which has normal detrusor contraction during the voiding phase. Based on the concept uroflow can be used to replace urodynamic studies to differentiate between these 2 entities and hence to determine the proper management plan and to be a prognostic factor before surgical intervention.

Official Title
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Uroflowmetry Parameter (Delta Q Value) as a Noninvasive Tool to Discriminate Detrusor Underactivity From Bladder Outlet Obstruction

Conditions
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Urinary Obstruction, Detrusor Underactivity

Intervention / Treatment
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* Diagnostic Test: Uroflowmetry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: male patients aged over 50 years complaining of voiding symptoms International Prostatic Symptom Score (IPSS) 8 points or more, serum prostate-specific antigen (PSA) below 4 ng/ml no hematuria or pyuria. Exclusion Criteria: Patients who were unable to complete the voiding study were deemed not eligible to participate in this review. patients with neurological causes of voiding dysfunction history of urinary tract abnormalities/lithiasis, lower urinary tract surgeries, urinary tract malignancy. acute UTI were excluded.

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Usage of Uroflowmetry to distinguish between bladder outlet obstruction and detrusor hypo-contractility
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: detrusor underactivity<br>according to urodynamic, patients with weak urine stream were evaluated into 2 groups, either detrusor underactivity or bladder outflow obstruction From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), post void residual urine (PVR), and value of Qmax minus Qave (DeltaQ) were obtained. | Diagnostic Test: Uroflowmetry<br>* according to urodynamic, patients with weak urine stream were evaluated into 2 groups, either detrusor underactivity or bladder outflow obstruction From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), post-void residual urine (PVR), and value of Qmax minus Qaverage (DeltaQ) were obtained.<br>|
| Experimental: bladder out flow obstruction<br>according to urodynamic, patients with weak urine stream were evaluated into 2 groups, either detrusor underactivity or bladder outflow obstruction From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), post void residual urine (PVR), and value of Qmax minus Qave (DeltaQ) were obtained. | Diagnostic Test: Uroflowmetry<br>* according to urodynamic, patients with weak urine stream were evaluated into 2 groups, either detrusor underactivity or bladder outflow obstruction From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), post-void residual urine (PVR), and value of Qmax minus Qaverage (DeltaQ) were obtained.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Q average | Q average it represents the difference between Qmax and Q average in ml/sec as shown in uroflowmetry | preoperative test, it is done only once and comparative evaluation with other parameters will be done | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Q max | uroflowmetry finding of maximum flow of urine in ml/sec | preoperative test, it is done only once and comparative evaluation with other parameters will be done | 
| Q Average | uroflowmetry finding of average flow of urine in ml/sec | preoperative test, it is done only once and comparative evaluation with other parameters will be done | 
| post voiding residual urine | amount of urine remains in the bladder after voiding as shown by Ultrasound in ml | preoperative test, it is done only once and comparative evaluation with other parameters will be done |