Influence of voiding posture on uroflowmetry parameters and voiding efficacy in male adult patients

Suzuki M1, Watanabe D1, Nakamura M1, Minagawa H1, Akiyama Y1, Yamada Y1, Sato Y1, Kawai T1, Yamada D1, Kume H1

Research Type

Clinical

Abstract Category

Urodynamics

Abstract 580
Urodynamics and Best of the Rest
Scientific Podium Short Oral Session 37
On-Demand
Gerontology Male Urodynamics Techniques
1. Department of Urology, The University of Tokyo
Presenter
M

Motofumi Suzuki

Links

Abstract

Hypothesis / aims of study
Voiding posture affects uroflowmetry parameters including post-void residual (PVR) in men. Goel et al reported the impact of voiding posture on uroflowmetry parameters in men [1]. They recruited 740 men as a healthy volunteer and ask them to undergo uroflowmetry tests in the sitting and standing position. As a result, PVR among the participants aged >50 was significantly lower in the sitting voiding position, whereas voiding time (VT) was significantly longer in the sitting voiding position than the standing position. Oppositely, Yazici, et al reported PVR in men (mean age, 58.0 years old) was larger in the sitting voiding position than the standing voiding position [2]. Influence of voiding position among men for uroflowmetry parameters and PVR is still controversial. It has been still unknown that how voiding posture affect bladder voiding efficacy (BVE). Annually, we have conducted approximately 1,500 voiding tests on uroflowmetry in our outpatient clinic. In the present original study, we investigated the proportion of male patients who void on uroflowmetry in a sitting/standing voiding position and how voiding posture affected uroflowmetry parameters as well as PVR, bladder capacity and BVE.
Study design, materials and methods
We conducted a retrospective study from 20th February 2019 to 29th February 2019 including male patients who underwent uroflowmetry and PVR at our outpatient department. Prior to the uroflowmetry, we have guided the patient, “please urinate in your usual posture”. Voiding posture were automatically recorded on the uroflowmetry chart (FlowSky; TOTO AQUAENG LTD, Tokyo, Japan). We measured PVR subsequently after uroflowmetry by an ultrasound device (BVI6100; Verathon, Bothell, WA). In cases of multiple times of uroflowmetry, we selected the first data from the patient. Data of uroflowmetry included voided urine volume (VV), maximum flow rate (Qmax), average flow rate (Qave), time to Qmax, VT, time to Qmax, time of hesitancy. BVE was calculated by a following formula; VV (mL)/(VV+PVR), %. Data with insufficient voided urine volume ≤150 mL were excluded from analysis. Proportion of sitting/standing voiding posture was calculated at 10-year age intervals and evaluated using the Fisher’s exact test. The uroflowmetry parameters, PVR, bladder capacity and BVE were compared between sitting and standing voiding postures by the Wilcoxon rank sum test. BVE was calculated at 10-year age intervals and evaluated using the Dunn test. The uroflowmetry parameters, PVR, bladder capacity and BVE were also evaluated by the two age groups (≤64 and ≥65 years old).
Results
During the study period, 1,203 male patients underwent uroflowmetry and PVR measurement. After excluding the patients with VV ≤150 mL, data from 703 patients were included for analysis. Of 703 patients, proportion of voiding in the sitting position was 38.4% (270/703). Proportion of voiding in the sitting position was 0% in 20s, 33.3% in 30s, 47.1% in 40s, 38.8% in 50s, 42.5% in 60s, 36.2% in 70s, and 34.8% in the age group and ≥80 (P=0.409). Median voiding efficacy was highest in the 30s (92.2%) and gradually decreased thereafter (77.8% in the age group of ≥80). There was a significant difference between 30s and age group of ≥80 (P=0.013). Overall, median Qmax and BVE were significantly higher in the sitting voiding posture (19.9 mL/sec and 88.1%) than those in the standing voiding posture (17.0 mL/sec and 85.7%; P=0.022 and P=0.023). Median time of hesitancy was significantly longer in the sitting voiding posture (17.2 sec) than those in the standing voiding posture (12.5 sec; P<0.001). Among male patients aged ≥65, median Qmax and BVE were significantly higher in the sitting voiding posture (18.7 mL/sec and 88.3%) than those in the standing voiding posture (16.4 mL/sec and 85.5%; P=0.034 and P=0.022). Median time of hesitancy was also significantly longer in the sitting voiding posture (17.7 sec) than those in the standing voiding posture (12.5 sec; P<0.001). Among male patients aged ≤64, uroflowmetry parameters, PVR, bladder capacity or BVE were no longer significantly different.
Interpretation of results
The voiding posture influence in Qmax, time of hesitancy and BVE, especially in the elderly male patients aged 65 or older. For the elderly male patient, the sitting voiding posture is beneficial in terms of better Qmax and BVE.
Concluding message
Physicians need to pay attention to the voiding posture to evaluate the uroflowmetry parameters, PVR, bladder capacity and BVE in the elderly male patients.
Figure 1 Voiding posture and uroflowmetric parameters among the patients ≥65 years old
References
  1. Goel A, Kanodia G, Sokhal AK, Singh K, Agrawal M, Sankhwar. Evaluation of impact of voiding posture on uroflowmetry parameters in men. World J Mens Health 2017; 35: 100-106.
  2. Yazici CM, Turker P, Dogan C. Effect of voiding position on uroflowmetric parameters in healthy and obstructed male patients. Urol J 2014; 10: 1106-1113.
Disclosures
Funding None. Clinical Trial No Subjects Human Ethics Committee Ethics Committee of the University of Tokyo Hospital Helsinki Yes Informed Consent Yes
27/03/2024 14:21:23