Can Staccato and Interrupted/Fractionated Uroflow Patterns Alone Correctly Identify the Underlying Lower Urinary Tract Condition?

• Published in: The Journal of urology Vol. 187; no. 6; pp. 2188 - 2194
• Main Authors: Wenske, Sven, Combs, Andrew J, Van Batavia, Jason P, Glassberg, Kenneth I
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Electromyography; Female; Humans; lower urinary tract symptoms; Lower Urinary Tract Symptoms - diagnosis; Lower Urinary Tract Symptoms - etiology; Male; Medical sciences; Nephrology. Urinary tract diseases; Pelvic Floor - physiopathology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; urination; urination disorders; Urination Disorders - diagnosis; Urination Disorders - physiopathology; Urodynamics; urologic diseases; Urology; Young Adult; PBND; PVR; urination; DU; DV; IDOD; Qmax; maximum uroflow rate; uroflow with pelvic floor electromyography; LUTC; lower urinary tract symptoms; primary bladder neck dysfunction; dysfunctional voiding; EMG; urologic diseases; idiopathic detrusor overactivity disorder; VUDS; ICCS; videourodynamics; LUTS; urination disorders; lower urinary tract conditions; International Children's Continence Society; electromyography; detrusor underactivity; ICS; Qave; post-void residual urine; uroflow/EMG; International Continence Society; average uroflow rate; Voiding dysfunction; Nephrology; Lower urinary tract; Urinary system disease; Disease; Micturition; Urinary tract disease; Lower urinary tract symptoms; Urology
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2012.01.126

Purpose Worldwide, uroflowmetry without simultaneous electromyography is often the only testing performed during the initial assessment of children with lower urinary tract symptoms. Various alterations in uroflow pattern are thought to indicate particular types of lower urinary tract conditions, specifically staccato uroflow indicating dysfunctional voiding and intermittent/fractionated uroflow indicating detrusor underactivity. We determined how reliable uroflow pattern alone is as a surrogate for simultaneously measured pelvic floor electromyography activity during voiding, and how well staccato and interrupted uroflow actually correlate with the diagnoses they are presumed to represent. Materials and Methods We reviewed uroflow/electromyography studies performed during the initial evaluation of 388 consecutive neurologically and anatomically normal patients with persistent lower urinary tract symptoms. We identified those with staccato, interrupted/fractionated and mixed uroflow based on current International Children's Continence Society guidelines. Results A total of 69 girls (58.5%) and 49 boys (41.5%) met inclusion criteria. Staccato uroflow was noted in 60 patients, interrupted/fractionated uroflow in 28 and a combination in 30. An active electromyography during voiding confirmed the diagnosis of dysfunctional voiding in 33.3% of patients with staccato, 46.4% with interrupted/fractionated and 50% with mixed uroflow patterns. Conclusions Diagnoses based on uroflow pattern appearance without simultaneous electromyography to support them can be misleading, and reliance on uroflow pattern alone can lead to overdiagnoses of dysfunctional voiding and detrusor underactivity. When assessing patients with uroflow, an accompanying simultaneous pelvic floor electromyography is of utmost importance for improving diagnostic accuracy and thereby allowing for the most appropriate therapy.