Objective To establish and recognize typical signal patterns (TSP) by analyzing cys-tometry data,and to verify their roles in real-time qualitative quality control. Methods Totally,582 datasets of free flow,filling and voiding cystometry from181 males(age range,43 -86 years)in a strictly quality-controlled study were analyzed.TSPs for the traces of Pves,Pabdand Pdetduring filling and voiding phases wererecognized and described. The TSP of pressures was classified into 4 types, ie, type Ⅰ: fine structure(noise);Ⅱ:minimal dynamic changes caused by breathing,talking and moving (microscopic changes);Ⅲ:major changes due to regular cough tests;Ⅳ:typical macroscopic changes related to straining,detrusor insta-bility,rectal contractions and detrusor contractions.TSPs were compared among Pves,Pabdand Pdettracings atbeginning of filling,during filling,before,during and after voiding respectively. Results At beginning offilling,91.8%(534/582) of traces showed the identical fine structure and microscopic changes with“live”signals;74.8%(435/582) of traces had the equal pressure changes corresponding to the test-coughs;3.1%(18/582) had the macroscopic changes of straining and rectal contractions.During filling,98.3%(572/582) of traces showed the identicalⅠ andⅡ types of TSP;98.5%(573/582) had the equal or similarchanges corresponding to the test-coughs;8.3%(48/582) of traces showed straining;33.7% (196/582)showed detrusor instability;and 17.4%(101/582),rectal contractions.Before voiding,94.0%(547/582) oftraces had the equal rises in Pvesand Pabdcorresponding to cough tests.During voiding,91.2%(531/582) oftraces showed the“live”signals;95.2%(554/582) of traces had the typical pattern of detrusor contraction;53.3%(310/582) showed straining,2.1%(12/582) showed rectal contractions;and 15.3%(89/582)showed relaxation of pelvic floor.After voiding,91.2%(531/582) of traces showed the“live”signals;87.5%(509/582) had the equal response to cough tests. Conclusions TSP is a powerful tool for the re-al-time qualitative quality control for urodynamic investigation.Combined with typical value ranges,they allowdefinitive quality control for urodynamic data.The familiarity and identification for the described TSP arehelpful for performing the qualitative quality control in clinical urodynamic practice.

Objective To establish typical value ranges (TVR) by analyzing cystometry data,andto verify their roles in real-time quantitative quality control. Methods Totally,582 data sets of free flow,filling,and voiding from cystometry 181 males(age range,43 -86 years)in a strictly quality-controlled studywere analyzed for Pves,Pabdand Pdetbefore,at beginning and end of filling,and after voiding,cystometric ca-pacity (MCC),Qmaxand Vvoid,and compliance.The mean values,standard deviation,median and variousTVRs of these parameters were calculated.Technical errors related to TVR were classified and examples giv-en. Results 50% TVRs for initial resting Pves,Pabdand Pdetwere 31 -42,28 -39 and 0 -4 cm H2O(1 cm H2O=0.098 kPa),respectively.Various technical errors were classified into typeⅠ:normal initialPdet,but both Pvesand Pabdwere wrong;typeⅡ:negative initial Pdet;and typeⅢ:too high initial Pdet.The in-cidences of typesⅠ,Ⅱ andⅢ errors were 9.8%(57/582),4.5%(26/582) and 1.4%(8/582),respec-tively.50% TVRs for MCC and compliance were 157 -345 ml and 26.6 -70.8 ml/cm H2O;50% TVRs forQmax.p,Pdet.Qmaxand Vvoidwere 5.5 -9.0 ml/s,57 -92 cm H2O and 167 -315 ml,respectively.Qmaxand Vvoidin free flow were 8.0 -9.2 ml/s and 167 -301 ml.During and after voiding,3 typical errors were found:typeⅣ:negative Pabd;typeⅤ: Pvesand Pdetafter voiding still high;typeⅥ:Pvesand Pdetnegative;the inci-dences of typesⅣ,Ⅴ andⅥ errors were 0.7%(4/582), 1.9%(11/582)and 1.4%(8/582), respective-ly. Conclusions TVRs in urodynamics are indispensable and effective tools for quantitative plausiblecheck and quality control on data.They are sensitive and reliable indicators for correct measurement and arelevant contribution to a collection of normal values.

AIMTo evaluate the effects of retrospective quality control on pressure-flow data with computer-based urodynamic systems from men with benign prostatic hyperplasia (BPH).

METHODSA total of 582 traces of pressure-flow study from 181 men with BPH was included in the study. For each trace, maximum urinary flow rate (Q(max)) and detrusor pressure at Q(max) (p(det.Qmax)) were, respectively, read from manually smoothed and corrected uroflow and detrusor pressure curves from the computer print-outs. Obstruction coefficient, International Continence Society (ICS) and Schaefer nomograms were used to detect urethral resistance and to diagnose obstruction. The results obtained by manual reading were compared with those from computer-based systems.

RESULTSAfter manual correction, Q(max) underwent a consistently significant decrease by 1.2 mL/s on average (P < 0.001), and had a change range of 0.5-10.4 mL/s. However, p(det.Qmax) underwent inconsistently intra-individual changes after correction. The obstruction coefficient increased significantly, by an average of 0.07 (P < 0.05). Using the ICS nomogram, the percentage of obstruction increased from 69.8% to 73.9%, and of the non-obstruction decreased from 8.8% to 5.3% (P < 0.05). There were 11% of traces that changed the classifications using the ICS nomogram, and 28.9% that changed the grades for the Schaefer nomogram.

CONCLUSIONSystematically significant differences in parameters from pressure-flow study between manual readings and computer recordings were demonstrated. Manual correction resulted in a consistently lower Q(max), a higher urethral resistance, and an aggravating obstruction. Manual readings can correct considerable false diagnoses for obstruction. Retrospective quality control of pressure-flow data with computer-based systems is necessary.

Adult ; Aged ; Aged, 80 and over ; Diagnosis, Computer-Assisted ; standards ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; physiopathology ; Quality Control ; Retrospective Studies ; Urethral Obstruction ; diagnosis ; etiology ; physiopathology ; Urodynamics ; physiology

AIMTo explore the interaction between bladder compliance (BC) and bladder outflow obstruction (BOO) in men with benign prostatic hyperplasia (BPH) using cross-sectional and longitudinal studies.

METHODSA total of 181 men with BPH were recruited, and 100 of them were followed for one year. Cystometry was performed in a standing or a sitting position with 30 mL/min infusion. BC was manually corrected and defined. Obstruction coefficient (OCO), linear passive urethral resistance relation and international continence society (ICS) nomogram were used to diagnose BOO. The obstructed parameters were compared between the reduced BC group and the non-reduced group. BC was compared between the first investigation at the beginning of study and the second investigation at the end of study during the one-year follow-up period.

RESULTSThe group with reduced BC had increased OCO and linear passive urethral resistance relation. BC was significantly lower in the obstructed group (55.7 mL/cm water) than that in unobstructed and equivocal one (74.9 mL/cm water, P <0.01). BC gradually reduced with the increased obstructed grade. There was a significantly weak negative correlation between BC and OCO (r = -0.132, P < 0.01). Over the one-year follow-up period in the longitudinal study, BC for all men changed from 54.4 to 48.8 mL/cm water (P >0.05), and BC for the group with BOO fell from 58.4 +/- 70.1 to 46.5 +/- 38.7 mL/cm water (P>0.05).

CONCLUSIONIn men with BPH, a significant systematic decrease occurred in BC in the obstructed group and a significant systematic increase with urethral resistance occurred in the low BC group. A longitudinal study of the tendency of BC reduction in a group with BOO is necessary in the future.

Adult ; Aged ; Aged, 80 and over ; Compliance ; Cross-Sectional Studies ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prostatic Hyperplasia ; physiopathology ; Ureteral Obstruction ; physiopathology ; Urinary Bladder ; physiopathology