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Urodynamic Study Analysis — Bhatt, Sharad (Male, 63 yrs, Patient #3379)
Study: Pressure-Flow Study | Date: 11/05/2026 | Sujay Urological Hospital | Dr. Ajay Bhandarkar
Patient Demographics
- Male, DOB 31/08/1962, age 63
- Classic demographic for BPH/LUTS evaluation
FILLING PHASE
Cystometric Data
| Parameter | Value | Interpretation |
|---|---|---|
| Infused volume | 500 ml | — |
| Bladder filling | 500 ml | No leakage |
| First sensation | 82 ml | Low (normal: 100–200 ml) — early first sensation |
| First desire | 130 ml | Low (normal: 150–250 ml) |
| Normal desire | 254 ml | Normal range |
| Strong desire | 494 ml | Near maximum capacity |
| Urgency | 500 ml | At maximum |
| MCC | 500 ml | Normal (normal: 300–600 ml) |
Pdet throughout filling: Remained low (4–8 cmH₂O) — flat cystometric curve.
Bladder Compliance
- Pdet compliance (linear regression): 29.1 ml/cmH₂O (Begin 2 ml → End 100 ml)
- Normal compliance (≥20 ml/cmH₂O is the accepted lower limit)
- No detrusor overactivity (DO) was detected on the trace during filling — the Pdet trace is flat and stable throughout the filling phase despite EMG spikes (cough artefacts confirmed by simultaneous Pabd rises)
Cough Test / Artefact Analysis
- Multiple cough markers recorded; Pves and Pabd spikes are synchronous, confirming good catheter placement and signal quality
- Pdet remains low with coughs, confirming no stress incontinence leak or artefactual DO
VOIDING PHASE
Key Parameters
| Parameter | Value | Normal (Male) | Interpretation |
|---|---|---|---|
| Voided volume | 184 ml | — | Low — partial void |
| Total bladder capacity | 501 ml | — | — |
| Qmax | 6.2 ml/s | >15 ml/s | Markedly reduced |
| Time to Qmax | 21 s | — | Prolonged |
| Pdet at Qmax | 38 cmH₂O | — | Elevated |
| Average flow rate | 2.6 ml/s | >10 ml/s | Markedly reduced |
| Flow time | 70 s | — | — |
| Voiding time | 130 s | — | Prolonged (130 s vs 70 s flow time) |
| Hesitancy | 28 s | <10 s | Prolonged |
| Computed residual (PVR) | 317 ml | <50 ml | Significantly elevated |
| VOID classification | 6 / 180 / - | — | — |
NOMOGRAM ANALYSIS
ICS Bladder Outlet Obstruction Index (BOOI)
Formula: BOOI = Pdet@Qmax − 2(Qmax)
BOOI = 38 − 2 × 6.2 = 38 − 12.4 = 25.6
- BOOI ≥40 = Obstructed
- BOOI 20–40 = Equivocal
- BOOI ≤20 = Unobstructed
➡️ BOOI = 25.6 → Equivocal zone (borderline obstructed)
ICS Detrusor-Flow Plot
- The plot on page 3 confirms the data point falls in the Equivocal/borderline Obstructed region
- Obstructed slope: −1.67 cmH₂O/(ml/s); A/G number: 26 — consistent with equivocal obstruction
Bladder Contractility Index (BCI)
Formula: BCI = Pdet@Qmax + 5 × Qmax
BCI = 38 + 5 × 6.2 = 38 + 31 = 69
- BCI >150 = Strong
- BCI 100–150 = Normal
- BCI <100 = Weak
➡️ BCI = 69 → Significantly impaired detrusor contractility (Weak)
Siroky Nomogram
- Average flow rate of 3 ml/s at 184 ml bladder volume plots well below the -3 SD line → severely obstructed/poor flow
- Qmax of 6 ml/s also plots in the below -3 SD range → confirms significantly abnormal voiding
Liverpool Nomogram
- Average flow rate and Qmax both plot in the lowest percentile bands — consistent with obstructed/severely impaired voiding
INTEGRATED INTERPRETATION
Primary Findings:
-
Detrusor underactivity (DU) — the dominant finding
- BCI of 69 confirms markedly weak detrusor contractility
- Despite generating 38 cmH₂O, the bladder cannot sustain adequate flow
- Long hesitancy (28 s), prolonged voiding time (130 s vs 70 s flow time = significant abdominal straining period), interrupted voiding
-
Bladder outlet obstruction — equivocal
- BOOI 25.6 = equivocal; the ICS nomogram and A/G number of 26 place this in the equivocal zone
- Cannot confirm significant anatomical BOO (e.g., BPH obstruction) from urodynamics alone
-
Large post-void residual: 317 ml
- Only 184/501 ml voided = bladder voiding efficiency of ~37% (severely impaired; normal >90%)
- Indicates chronically underactive bladder with incomplete emptying
-
No detrusor overactivity detected
- Despite early first sensation (82 ml) and urgency at 500 ml, the cystometric trace showed no phasic DO
- Urgency without detrusor overactivity may represent sensory urgency
-
Normal bladder compliance (29.1 ml/cmH₂O)
- No upper tract risk from compliance alone
CLINICAL DIAGNOSIS
Detrusor Underactivity (Underactive Bladder) with possible equivocal Bladder Outlet Obstruction
This 63-year-old male presents with a urodynamic picture dominated by impaired detrusor contractility rather than pure bladder outlet obstruction. The equivocal BOOI leaves open the possibility of coexisting BPO (from BPH), which is common in this age group and could be contributing to the chronically elevated PVR and secondary detrusor fatigue.
CLINICAL IMPLICATIONS & MANAGEMENT
| Issue | Recommendation |
|---|---|
| Elevated PVR 317 ml | Risk of UTI, upper tract deterioration if sustained — renal function assessment (creatinine, USS renal tract) |
| DU dominant | Alpha-blocker trial to reduce outlet resistance may help even in equivocal obstruction |
| Surgical risk caution | TURP/surgical desobstruction carries risk of worsening urinary retention if DU is the dominant pathology; pre-operative counselling essential |
| Bladder retraining / CISC | If conservative management fails, clean intermittent self-catheterisation (CISC) may be required |
| Repeat UDS | Consider after alpha-blocker trial to reassess voiding parameters |
| Exclude neurological cause | Given age and DU pattern, spinal/neurological pathology should be excluded if no BPH found on imaging |
References: Campbell-Walsh-Wein Urology (11th Ed), Chapter 114 — Urodynamics; Smith & Tanagho's General Urology (19th Ed), Chapter 29 — Voiding Pressure-Flow Studies. BOOI/BCI formulae per Abrams (1999), BJU Int 84(1):14–15.
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