Skip to main content

Advertisement

SpringerLink
Log in

The influence of intubation on urinary flow parameters in pressure-flow study and its significance for urodynamic diagnosis

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Transurethral catheterization in pressure-flow study (PFS) may interfere with the function of the lower urinary tract and produce an incorrect urodynamic diagnosis. We aimed to investigate the influence of a 7F catheter on urinary flow parameters in PFS and its significance for urodynamic diagnosis. Our hypothesis was that intubation causes adverse effects on urinary flow rate and further influences the urodynamic diagnosis.

Methods

We reviewed a urodynamic database of men and women referred for evaluation of lower urinary tract symptoms. The urinary flow parameters of PFS and free flow (FF) were compared. The influence of intubation on urodynamic diagnosis was determined by re-evaluating bladder outlet obstruction (BOO) and detrusor underactivity (DU), with the maximum flow rate of PFS (Qmax.P) being replaced by Qmax of FF (Qmax.F).

Results

We initially screened 1,791 patients and included 1,144 for the analysis. Overall, PFS had a lower Qmax (p < 0.001), longer flow time (p < 0.001), and a similar voided volume (p > 0.05). However, Qmax.P displayed inconsistent changing directions: Qmax.P decreased in 72.8% of male patients and 83.5% of female patients but increased in 14.7% of male patients and 9.5% female patients. Qmax.P was unchanged in the remaining patients. The urodynamic diagnosis of BOO and DU changed correspondingly in both the decreased group and the increased group when Qmax.P was replaced by Qmax.F.

Conclusions

Compared with Qmax.F, the changing directions and magnitude of Qmax.P varied with each individual, which could have a significant impact on urodynamic diagnosis. Thus, when a similar volume is voided in FF and PFS, and Qmax.P differs obviously from Qmax.F, replacing Qmax.P with Qmax.F for evaluating BOO and DU may be a sensible choice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data

If requested, the corresponding author will provide data or will cooperate fully in obtaining and providing the data on which the manuscript is based for examination by the editors or their assignees.

References

  1. Drake MJ, Doumouchtsis SK, Hashim H, Gammie A. Fundamentals of urodynamic practice, based on international continence society good urodynamic practices recommendations. Neurourol Urodyn. 2018;37(S6):S50–60. https://doi.org/10.1002/nau.23773.

    Article  PubMed  Google Scholar 

  2. Harding C, Horsburgh B, Dorkin TJ, Thorpe AC. Quantifying the effect of urodynamic catheters on urine flow rate measurement. Neurourol Urodyn. 2012;31(1):139–42. https://doi.org/10.1002/nau.21188.

    Article  PubMed  CAS  Google Scholar 

  3. Scaldazza CV, Morosetti C. Effect of different sized transurethral catheters on pressure-flow studies in women with lower urinary tract symptoms. Urol Int. 2005;75(1):21–5. https://doi.org/10.1159/000085922.

    Article  PubMed  Google Scholar 

  4. Sharma AK, Poonawala A, Girish GN, et al. A quantitative comparison between free uroflow variables and urodynamic data, and the effect of the size of urodynamic catheters on its interpretation. Arab J Urol. 2013;11(4):340–3. https://doi.org/10.1016/j.aju.2013.06.004.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Valentini FA, Robain G, Hennebelle DS, Nelson PP. Decreased maximum flow rate during intubated flow is not only due to urethral catheter in situ. Int Urogynecol J. 2013;24(3):461–7. https://doi.org/10.1007/s00192-012-1856-2.

    Article  PubMed  Google Scholar 

  6. Klingler HC, Madersbacher S, Schmidbauer CP. Impact of different sized catheters on pressure-flow studies in patients with benign prostatic hyperplasia. Neurourol Urodyn. 1996;15(5):473–81. https://doi.org/10.1002/(SICI)1520-6777.

    Article  PubMed  CAS  Google Scholar 

  7. Groutz A, Blaivas JG, Sassone AM. Detrusor pressure uroflowmetry studies in women: effect of a 7Fr transurethral catheter. J Urol. 2000;164(1):109–14. https://doi.org/10.1016/S0022-5347(05)67460-5.

    Article  PubMed  CAS  Google Scholar 

  8. Reynard JM, Lim C, Swami S, Abrams P. The obstructive effect of a urethral catheter. J Urol. 1996;155(3):901–3. https://doi.org/10.1016/S0022-5347(01)66341-9.

    Article  PubMed  CAS  Google Scholar 

  9. Di Grazia E, Bartolotta S, Nicolosi F, Nicolosi D. Detrusor pressure uroflowmetry studies in women: effect of 4 Fr transurethral. Arch Ital Urol Androl. 2002;74(3):134–7.

    PubMed  Google Scholar 

  10. Lose G, Thunedborg P, Jørgensen L, Colstrup H. A comparison of spontaneous and intubated urinary flow in female patients. Neurourol Urodyn. 1986;5(1):1–4. https://doi.org/10.1002/nau.1930050102.

    Article  Google Scholar 

  11. Haylen BT, Cerqui A, Law M, Dietz P. Effect of a size 7Fr urethral catheter on urine flow rates in urogynaecology patients. Int Urogynecol J Suppl. 1999;10:S98.

    Google Scholar 

  12. Ryall RL, Marshall VR. The effect of a urethral catheter on the measurement of maximum urinary flow rate. J Urol. 1982;128(2):429–32. https://doi.org/10.1016/s0022-5347(17)52953-5.

    Article  PubMed  CAS  Google Scholar 

  13. Klausner AP, Galea J, Vapnek JM. Effect of catheter size on urodynamic assessment of bladder outlet obstruction. Urology. 2002;60(5):875–80. https://doi.org/10.1016/S0090-4295(02)01873-3.

    Article  PubMed  Google Scholar 

  14. Richard P, Ordonez NI, Tu le M. The effect of a 6 Fr catheter on flow rate in men. Urol Ann. 2013;5(4):264–8. https://doi.org/10.4103/0974-7796.120303.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Axelrod SL, Blaivas JG. Bladder neck obstruction in women. J Urol. 1987;137(3):497–9. https://doi.org/10.1016/S0022-5347(17)44086-9.

    Article  PubMed  CAS  Google Scholar 

  16. Gammie A, Kaper M, Dorrepaal C, Kos T, Abrams P. Signs and symptoms of detrusor underactivity: an analysis of clinical presentation and urodynamic tests from a large Group of Patients Undergoing Pressure Flow Studies. Eur Urol. 2006;69(2):361–9. https://doi.org/10.1016/j.eururo.2015.08.014.

    Article  Google Scholar 

  17. Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64. https://doi.org/10.1002/1520-6777.

    Article  PubMed  CAS  Google Scholar 

  18. Duckett J, Cheema K, Patil A, Basu M, Beale S, Wise B. What is the relationship between free flow and pressure flow studies in women? Int Urogynecol J. 2013;24(3):447–52. https://doi.org/10.1007/s00192-012-1883-z.

    Article  PubMed  Google Scholar 

  19. Koraitim M. Catheter as source of error in urodynamic study. Urol. 1982;20(2):223–5. https://doi.org/10.1016/0090-4295(82)90371-5.

    Article  PubMed  CAS  Google Scholar 

  20. Suskind AM, Smith PP. Evidence of a functional effect of transient transurethral catheterization on micturition in women. Int Urogynecol J. 2012;23(9):1245–8. https://doi.org/10.1007/s00192-011-1646-2.

    Article  PubMed  Google Scholar 

  21. Walker RM, Di Pasquale B, Hubregtse M, St Clair Carter S. Pressure-flow studies in the diagnosis of bladder outlet obstruction: a study comparing suprapubic and transurethral techniques. Br J Urol. 1997;79(5):693–7. https://doi.org/10.1046/j.1464-410x.1997.00143.x.

    Article  PubMed  CAS  Google Scholar 

  22. Trumbeckas D, Milonas D, Jievaltas M, Danilevicius M, Matjosaitis AJ. Influence of catheter on urinary flow during urodynamic pressure-flow study in men with symptomatic benign prostatic hyperplasia. Medicina (Kaunas). 2006;42(1):15–21.

    Google Scholar 

  23. Malde S, Nambiar AK, Umbach R, et al. Systematic review of the performance of noninvasive tests in diagnosing bladder outlet obstruction in men with lower urinary tract symptoms. Eur Urol. 2017;71(3):391–402. https://doi.org/10.1016/j.eururo.2016.09.026.

    Article  PubMed  Google Scholar 

  24. Belal M, Abrams P. Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 2: noninvasive urodynamics and combination of measures. J Urol. 2006;176(1):29–35. https://doi.org/10.1016/S0022-5347(06)00570-2.

    Article  PubMed  Google Scholar 

  25. Swavely NR, Speich JE, Stothers L, Klausner AP. New diagnostics for male lower urinary tract symptoms. Curr Bladder Dysfunct Rep. 2019;14:90–7. https://doi.org/10.1007/s11884-019-00511-0.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Costantini E, Mearini L, Biscotto S, Giannantoni A, Bini V, Porena M. Impact of different sized catheters on pressure-flow studies in women with lower urinary tract symptoms. Neurourol Urodyn 2005;24:106–10

    Article  Google Scholar 

Download references

Funding

No funding for this study.

Author information

Authors and Affiliations

  1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People’s Republic of China

    Yu Cheng, Shengfei Xu, Jiang Chen, Xiaoyu Wu, Zhong Chen & Guanghui Du

Authors
  1. Yu Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shengfei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaoyu Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guanghui Du
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors listed below have made substantial contributions to the intellectual content of the paper in the various sections described below. G.H. Du and Y. Cheng: protocol/project development, manuscript writing/editing and data analysis; S. Xu, J. Chen, X. Wu, and Z. Chen: data collection or management.

Corresponding author

Correspondence to Guanghui Du.

Ethics declarations

Ethics approval

The study protocol was performed in line with the principles of the Declaration of Helsinki and was approved by the Tongji Hospital Research Ethics Committee and the Institutional Review Board.

Conflicts of interest

The authors declare that they have no conflicts of interest regarding this work.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheng, Y., Xu, S., Chen, J. et al. The influence of intubation on urinary flow parameters in pressure-flow study and its significance for urodynamic diagnosis. Int Urogynecol J 33, 3103–3110 (2022). https://doi.org/10.1007/s00192-022-05082-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-022-05082-z

Keywords

Search

Navigation