Q: Analyse this urodynamic report and comment A: I now have all the information needed from the images and the textbook references to provide a comprehensive analysis. Let me compile the full interpretation. --- Urodynamic Report Analysis — Rao, Jayesh Male, 57 years, DOB: 23/12/1968 Study: Pressure-flow study Date: 30/04/2026 Centre: Sujay Urological Hospital Investigator: Dr. Ajay Bhandarkar --- 1. Patient Demographics & Study Overview Parameter Value ------ Age 57 years, Male Study type Pressure-flow urodynamics 4-channel Channels EMG, Pves, Pabd, Pdet, Qura --- 2. Filling Phase Analysis Volumes Parameter Value Interpretation --------- Infused volume 409 ml — Volume lost through leakage 16 ml Small leak noted Effective bladder filling MCC 393 ml Low-normal Bladder Sensations Sensation Volume ml Comment --------- First sensation 119 ml Normal typically 100–200 ml First desire 203 ml Normal Normal desire 295 ml Normal Strong desire 388 ml Normal Urgency 392 ml Near capacity — urgency only at MCC MCC 393 ml Low-normal capacity Comment: Sensations are preserved and proportionately scaled. Urgency appearing only at MCC 392/393 ml is consistent with a compliant bladder that fills adequately but has difficulty emptying. Detrusor Pressures During Filling - Pdet values during filling remain low 5–18 cmH₂O range with no significant spontaneous rise - No detrusor overactivity DO is demonstrated during the filling phase — the Pdet trace is flat - The 16 ml leakage likely represents stress or positional leak, not DO-related urgency incontinence Compliance - Compliance result linear regression: Pdet slope = 67.8 ml/cmH₂O Begin 2 ml → End 100 ml - Normal bladder compliance normal 20 ml/cmH₂O; values 40 are very good - The bladder fills at low pressure — no impaired compliance --- 3. Voiding Phase Analysis — THE KEY FINDING Voiding Phase Results Parameter Value Normal Interpretation ------------ Total bladder capacity 393 ml — Normal Qmax 4.2 ml/s 15 ml/s Severely reduced Time to Qmax 105 s 30 s Grossly prolonged Pdet.Qmax 28 cmH₂O — See below Voided volume 1 ml 393 ml expected Near-complete retention Flow time 12 s — — Voiding time 155 s — — Hesitancy 110 s 10 s Markedly prolonged Average flow rate 0.1 ml/s 10 ml/s Critically low Computed residual urine 392 ml 50 ml Massive PVR — near total retention This is the dominant finding: The patient voided only 1 ml out of 393 ml bladder capacity, leaving a post-void residual PVR of 392 ml. This represents near-complete urinary retention or severely impaired voiding. --- 4. Nomogram & Obstruction Classification Siroky Nomogram - Both Qmax 4 ml/s and average flow rate 0 ml/s plot well below −3 SD hatched zone - This confirms severely abnormal voiding function Liverpool Nomogram - The voided volume of 1 ml at Qmax of 4 ml/s plots in the lowest percentile 5th percentile - Severely below normal for a bladder volume of 393–600 ml ICS Detrusor-Flow Plot Abrams-Griffiths / BOOI - BOOI = PdetQmax − 2Qmax = 28 − 24.2 = 28 − 8.4 = 19.6 - BOOI interpretation: ≥40 = Obstructed, 20–40 = Equivocal, ≤20 = Unobstructed - BOOI of 20 falls at the equivocal/unobstructed boundary - The obstructed slope = 6.50 cmH₂O/ml/s; A/G number = 20 equivocal - The tracing on the ICS plot shows the voiding point is in the equivocal zone, not clearly obstructed Critical Interpretation of the Pressure-Flow Paradox - Qmax is severely reduced 4.2 ml/s but Pdet.Qmax is only moderately raised 28 cmH₂O - This combination — low flow + low/moderate detrusor pressure — is the hallmark of detrusor underactivity DU rather than pure bladder outlet obstruction BOO - If BOO were the dominant cause, one would expect high Pdet with low Qmax - Here, the detrusor fails to generate adequate pressure to overcome even normal urethral resistance Primary diagnosis: Detrusor Underactivity Impaired Detrusor Contractility with near-complete urinary retention --- 5. EMG Assessment - The EMG channel surface/sphincter shows artefact-heavy traces but no overt dyssynergia pattern is clearly identifiable - No definitive Detrusor-External Sphincter Dyssynergia DESD is evident, though artefact limits full interpretation --- 6. Cough Tests Quality Control Cough markers show: - Pves and Pabd spikes are concordant rise together — confirming correct catheter placement - Pdet artefacts are near-zero during coughs — good catheter calibration and placement - Study quality is satisfactory --- 7. Summary Interpretation Domain Finding ------ Filling phase Normal — no detrusor overactivity, good compliance 67.8 ml/cmH₂O Bladder capacity Low-normal MCC of 393 ml Sensations Normal and preserved Voiding phase Catastrophic failure — voided only 1 ml, PVR 392 ml Qmax Severely reduced at 4.2 ml/s Pdet.Qmax Low-normal at 28 cmH₂O BOOI A/G number 20 — equivocal, not clearly obstructed ICS nomogram Equivocal zone Primary diagnosis Detrusor Underactivity / Acontractile or Underactive Detrusor Obstruction Cannot be excluded but not the primary mechanism --- 8. Clinical Implications & Recommendations 1. Urinary retention management: Given PVR of 392/393 ml, clean intermittent catheterisation CIC is the immediate priority. Indwelling catheter may be needed short-term. 2. Neurological evaluation: Detrusor underactivity at 57 years in a male warrants evaluation for: - Diabetic cystopathy if diabetic - Spinal cord pathology lumbar canal stenosis, cauda equina - Peripheral neuropathy - Post-obstructive decompensation chronic BPH causing bladder fatigue 3. PSA + prostate evaluation: Despite equivocal BOOI, BPH/prostate pathology should be assessed — even if not the primary cause, a significant outlet component can worsen DU 4. Alpha-blockers: A trial may help reduce outlet resistance to assist the weakened detrusor; however, if detrusor is acontractile, benefit will be limited 5. Repeat urodynamics after catheterisation-based bladder rest may be considered — decompression of a chronically over-distended bladder can sometimes partially restore contractility 6. Avoid surgery e.g., TURP unless outlet obstruction is confirmed, as operating on a patient with DU without obstruction carries risk of worsening retention --- Reference BOOI calculation and nomogram interpretation per ICS provisional nomogram Griffiths et al., 1997; Lim and Abrams, 1995 — Campbell-Walsh-Wein Urology, Chapter 114.
