Rubilotta E1, Trabacchin N1, Tiso L1, Gubbiotti M2, Giannantoni A3, Illiano E4, Costantini E4, D'Amico A1, Balzarro M1

Research Type


Abstract Category


Abstract 169
E-Poster 1
Scientific Open Discussion ePoster Session 7
Wednesday 4th September 2019
12:35 - 12:40 (ePoster Station 11)
Exhibition Hall
Urodynamics Techniques Physiology Voiding Dysfunction
1.Dept. Urology AOVR Verona Italy, 2.Università di Perugia, Dip. di Scienze Chirurgiche e Biomediche - Istituto Serafico di Assisi, Centro di Ricerca "InVita" Italy, 3.Università di Siena, Dip. di Scienze Mediche, Chirurgiche e Neuroscienze Italy, 4.Dept. of andrology and urogynecology, Santa Maria Hospital Terni, University of Perugia Italy

Emanuele Rubilotta




Hypothesis / aims of study
The emotional condition of patients before uroflowmetry (UF) may affect the micturition and consequently the results of the examination. Limited literature data are available on the correlation between anxiety levels and uroflowmetry1. Aim of this study was to assess the correlation between emotional condition of the patients at UF and whether anxiety/embarrassment may affect patient’s micturition.
Study design, materials and methods
This is a prospective multicenter ongoing study started on July 2018. Patients were enrolled during an office uroflowmetry. Data recorded were: demographics (sex, age, educational level), urological history (therapy, surgical urological treatment), International Prostate Symptoms Score (IPSS) questionnaire in males, and ICIQ-FLUTS questionnaire in females. General anxiety level of the patient was evaluated by the General Anxiety Disorder - 7 (GAD - 7) questionnaire2 considering the levels of severity as following: scores <5 no anxiety, scores 5-9 mild anxiety, scores 10-14 moderate anxiety, scores 15-21 severe anxiety. Moreover, to better understand the anxiety level related to UF we applied questions #4-6 of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).3 Levels of severity were considered as follow: scores 3-6 no anxiety, scores 7-10 moderate anxiety, scores 11-15 severe anxiety. Specific linker-type scales assessed the subjective micturition satisfaction/reproducibility and the discomfort using a threshold score of 60. A dedicated nurse measured post-void residual (PVR) urine by bladder-scan immediately after the examination. Statistical analysis was performed using one-way ANOVA test, and Mann-Whitney test.
Patients enrolled in the study were 125 (mean age 65+ 13 yrs): 85 men (68%) and 40 women (32%).  Voided volumes, Qmax, PVR, and discomforts did not correlate with higher level of anxiety. However, greater anxiety negatively influenced the subjective satisfaction and the UF reproducibility. Patients with higher anxiety levels showed greater symptomatology questionnaires. Table 1 shows results according to GAD scores and APAIS modified scores. A general high level of anxiety was assessed by GAD in 41,6% (52/125) of the cohort, while a high level of UF-related anxiety was recorded by APAIS in 42,4% (53/125). Women reported GAD score >5 in the 87.5% (35/40), and APAIS score >6 in the 70% (28/40). GAD score > 5 and APAIS modified score >6 were documented in males in 44,7% (38/85) and 29% (25/85) respectively. The relation between GAD - APAIS levels and satisfaction/reproducibility and discomforts of the patient are reported in Table 2. A low satisfaction/reproducibility of the exam was reported by 31.2% of the patients (39/125): 38.5% males and 45% females. High discomforts were recorded in 51.2% (74/125) of the population: 56.5% men and 65% women.
Interpretation of results
Most factors may influence UF outcomes, but the level of anxiety has been poorly investigated. In our study a high levels of general, and UF-related anxiety was found in 4/10 patients. Surprisingly, we found a severe discrepancy of anxiety levels between genders. Women were mostly affected by high general and UF-related high anxiety. Quite the reverse, in men an impaired emotional condition was documented in less than a half of the cases. Moreover, the higher levels of anxiety mainly influenced the subjective satisfaction/reproducibility of the UF. However, no significant differences were found among the objective outcomes (VV/Qmax/PVR). Patients with higher anxiety levels showed worst results at the symptomatology questionnaires. The emotional condition poorly influenced the UF discomforts.
Concluding message
A relevant rate of patients showed high anxiety levels. This study demonstrated that UF, although is a simple and not invasive test, has an important impact on the emotional condition of the patients, mostly in women. This issue should be considered in the counseling of the patients. Anxiety influenced the subjectivity of the patients leading to the sensation of not having reproduced the normal urinary pattern. Therefore, a proper counseling may lower anxiety levels obtaining more physiological results at UF.
Figure 1
Figure 2
  1. HONG WS, Ham SY, Kim TW, Seo JS, Yang AK Usefulness of sonographic bladder scan for uroflowmetry and the evaluation of the anxiety level associated with uroflowmetry Korean J Urol 2007,48:633-637.
  2. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008 Mar;46(3):266-74.
  3. Buonanno P, Laiola A, Palumbo C, Spinelli G, Terminiello V, Servillo G. Italian validation of the Amsterdam Preoperative Anxiety and Information Scale. Minerva Anestesiol. 2017 Jul;83(7):705-711.
Funding None Clinical Trial No Subjects Human Ethics not Req'd Approval not required by internal ethical committee Helsinki Yes Informed Consent Yes