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Neurourol Urodyn. 2020 Feb 28. doi: 10.1002/nau.24327. [Epub ahead of print]

The role of bladder wall thickness in the evaluation of detrusor underactivity: Development of a clinical nomogram.

Author information

1
Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
2
Department of Urology, London Clinic, London, UK.
3
Department of Surgical Sciences, University of L'Aquila, L'Aquila, Italy.

Abstract

AIMS:

The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).

METHODS:

A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H2 O. A nomogram was developed based on the multivariable logistic regression model.

RESULTS:

Overall 448 patients with a mean age of 66 ± 11 years were enrolled. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30-0-66; P = .001) and Qmax (OR: 0.75 per mL/s; 95% CI, 0.70-0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer-Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%.

CONCLUSIONS:

According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS.

KEYWORDS:

bladder wall thickness; detrusor underactivity; lower urinary tract symptoms; pressure flow studies

PMID:
32110842
DOI:
10.1002/nau.24327

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