Background: The pressure-flow study (PFS) is considered the gold standard for the detection of bladder outlet obstruction (BOO) in men. However, several studies have raised the possibility that transurethral catheterization might have an obstructive effect on PFS while others did not.
Objectives: To evaluate the effect of a 6 Fr transurethral catheter on the pressure-flow study and to evaluate its clinical implication in men.
Materials and methods: A retrospective chart review study of 515 men referred for an evaluation of lower urinary tract symptoms and who underwent an urodynamic study (UDS). Of those, 133 met our inclusion/exclusion criteria. Non invasive free-flow studies (NIFFS) were performed before every UDS. Cystometrogram and PFS were performed through a 6 Fr transurethral catheter.
Results: The maximal flow rate (Qmax) was significantly higher (P < 0.001) in the NIFFS (15.0 mL/s (range 9.0-23.0)) than in the PFS (11.0 mL/s (range 7.0-18.5)). This difference became greater (18.5 mL/s (range 10.0-30.3) vs. 13.0 mL/s (range 6.0-25.0), in favor of the NIFFS) when we analyzed only the patients (n = 34) who voided a similar volume. According to the International Continence Society (ICS) nomogram, the use of the PFS alone would have resulted in the upstaging of 14% of cases (10/71) in the overall population and 24% (4/17) in the sub-analyzed group.
Conclusion: A 6 Fr transurethral catheter significantly lowers the maximal flow rate by 4 mL/s. Its presence resulted in an upstaging on the ICS nomogram. However, further studies will be necessary to confirm this upstaging.
Keywords: Benign prostatic hyperplasia; bladder outlet obstruction; maximum flow rate; pressure-flow study.