Urethral pressure profile in women with voiding dysfunction – reproducibility and inter-observer error

Toia B1, Axell R1, Yasmin H1, Pakzad M1, Hamid R1, Greenwell T1, Ockrim J1

Research Type

Clinical

Abstract Category

Urodynamics

Abstract 91
ePoster 2
Scientific Open Discussion Session 8
On-Demand
Urodynamics Techniques Voiding Dysfunction Bladder Outlet Obstruction
1. UCLH
Presenter
B

Bogdan Toia

Links

Abstract

Hypothesis / aims of study
Urethral pressure profilometry (UPP) is used to identify increased sphincter tone in women with voiding dysfunction. However, the repeatability of urethral pressure profile (UPP) measurement in this patient population has not been documented, and the inter observer error of UPPs is yet unknown.
Study design, materials and methods
We performed a retrospective review of 50 consecutive UPP reports from women with voiding dysfunction, suspected of having high tone non-relaxing sphincter. The investigations were performed in 2019 by two clinical scientists using a T-DOC dual sensor 7fr bladder catheter in the supine position without general anaesthetic or sedation. There were no variations of the speed of catheter withdrawal by the mechanical pulley or the installation of fluid though the catheter. All investigations were performed in the supine position. At least three measurements were recorded during each investigation and the average maximum urethral closure pressure (MUCP) was obtained. A further trace interpretation was performed blindly to assess inter-observer error. Statistical significance was assessed using one anova or paired t-tests and p<0.05 was considered statistically significant .
Results
The 50 women were aged 19 - 69 (mean 40.2) at the time of the investigation. During each investigation they had between 3 and 6 measurements (mean 3.22) performed by the operator, depending on the variation observed during testing . 

42 / 50 (84%) women had an elevated MUCP, defined as per Edwards et al (MUCP  value greater then 92-age) (1). The mean intra test repeatability error in this group was 4.9cmH2O with a standard deviation of 5.1 (p= 0.3535). In contrast, the 8/50 (16%) of women with normal or reduced UPP had less variation with the intra test repeatability error of mean 3.3cmH2O and a standard deviation of 2.8 (p=0.629) .

Inter-observer error was generally negligible 1.43cmH2O (82.07cmH2O vs 83.51cmH2O, p =0.000557). In 47 / 50 (94%) the difference in mean MUCP <5cmH2O. The 3 patients who had greater variability (mean differences 5.6, 5.7 and 16cmH2O) were also the ones who had the greatest intra test variability and up to 6 repeated UPP measurements .
Interpretation of results
The urethral pressure profile has good intra test repeatability, but internal consistency deteriorates in women with elevated MUCP, above the reference levels .
Concluding message
This variation of internal consistency in women with elevated UPP may have important implications for the diagnosis of high tone non-relaxing sphincter (Fowlers) syndrome and repeated measurements should be performed. More research is required to ensure reliable diagnosis of this condition .
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References
  1. EDWARDS, L. and MALVERN, J. (1974), The Urethral Pressure Profile: Theoretical Considerations and Clinical Application. British Journal of Urology, 46: 325-335. doi:10.1111/j.1464-410X.1974.tb03834.x
Disclosures
Funding No funding was required for this study Clinical Trial No Subjects Human Ethics not Req'd Ethical committee approval was not required for this retrospective review of data collected during standard care. Helsinki Yes Informed Consent No
27/03/2024 14:36:08