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Post-voided residual urine ratio as a predictor of bladder outlet obstruction in men with lower urinary tract symptoms: development of a clinical nomogram

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Abstract

Purpose

To confirm the correlation between post-void residual urine ratio (PVR-R) and BOO diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS) and to develop a clinical nomogram.

Methods

A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment for BOO including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies, suprapubic ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BTW). PVR-R was defined as follows: PVR-R = (PVR/total Bladder Volume [BV]) × 100). Logistic regression analysis was used to investigate predictors of pathological bladder emptying (BOO) defined as Schafer > II. A nomogram to predict BOO based on the multivariable logistic regression model was then developed.

Results

Overall 335 patients were enrolled. Overall, 131/335 (40%) presented BOO on PFS. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 2.21 per mm; 95% confidence interval [CI], 1.57–3.09; p = 0.001), PVR-R (OR: 1.02 per %; 95% CI, 1.01–1.03; p = 0.034) and prostate volume (OR: 0.97 per mL; 95% CI, 0.95–0.98; p = 0.001) were significant predictors for BOO. The model presented an accuracy of 0.82 and a clinical net benefit in the range of 10–90%.

Conclusions

The present study confirms the important role of PVR-ratio in the prediction of BOO. For the first time, we present a clinical nomogram including PVR-ratio for the prediction of BOO.

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Data and material are available upon request.

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Authors and Affiliations

  1. Department of Urology, Ospedale Sant’Andrea, La Sapienza University, Rome, Italy

    Antonio Cicione, Riccardo Lombardo, Antonio Nacchia, Beatrice Turchi, Giacomo Gallo, Filippo Zammitti, Nicola Ghezzo, Alessio Guidotti, Antonio Franco, Lorenzo Maria Rovesti, Carmen Gravina, Elisa Mancini, Sara Riolo, Giorgia Tema, Andrea Tubaro & Cosimo De Nunzio

  2. Department of Urology, London Clinic, London, UK

    Simon Carter

  3. Department of Surgical Sciences, University of L’Aquila, L’Aquila, Italy

    Carlo Vicentini

  4. ICOT Latina, Latina, Italy

    Antonio Pastore

Authors
  1. Antonio Cicione
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  2. Riccardo Lombardo
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  8. Alessio Guidotti
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  9. Antonio Franco
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  11. Carmen Gravina
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  15. Giorgia Tema
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  16. Simon Carter
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  17. Carlo Vicentini
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  18. Andrea Tubaro
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  19. Cosimo De Nunzio
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Contributions

AC: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CDN: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AN: substantial contributions to the acquisition, analysis, and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CG: substantial contributions to the acquisition, analysis, and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BT: substantial contributions to the acquisition, analysis, and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GG: substantial contributions to the interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AT: substantial contributions to the interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FZ: substantial contributions to the interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NG: substantial contributions to the interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AF: substantial contributions to the interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LMR: substantial contributions to the interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AG: substantial contributions to the interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RL: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GT: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EM: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SR: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AP: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SC: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CV: substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AT—substantial contributions to the conception and design of the work; drafting the work, final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Cosimo De Nunzio.

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The authors do not have any conflict of interest to disclose.

Ethics approval

The study was approved by a local ethical committee and was conducted in accordance with the principles of the Declaration of Helsinki.

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Informed consent was signed by all patients participating in the study on the relation between PVR and bladder outlet obstruction, which has been published by some of the co-authors of our study (Manieri et al. 1988).

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Cicione, A., Lombardo, R., Nacchia, A. et al. Post-voided residual urine ratio as a predictor of bladder outlet obstruction in men with lower urinary tract symptoms: development of a clinical nomogram. World J Urol 41, 521–527 (2023). https://doi.org/10.1007/s00345-022-04259-x

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