An 82-year-old man with mixed storage and voiding LUTS is referred for urodynamics. His Qmax is 15 mL/s and a pdet at Qmax of 85 cm H20. What is the bladder outlet obstruction index for this man?
When performing urodynamics the diagnosis of bladder outlet obstruction is made by plotting the maximum flow rate (Qmax) against detrusor pressure at Qmax (pdetQmax) into the International Continence Society Nomogram. The degree of obstruction is calculated using the Bladder Outlet Obstruction Index (BOOI) equation: BOOI = pdet@Qmax – 2Qmax.
If the BOOI is >40 then the patient is obstructed, if it is below 20 then the patient is unlikely to be obstructed and between 20–40 the findings are equivocal.
An 82-year-old man with daytime frequency, urinary urgency, occasional incontinence and nocturia is treated with an anticholinergic. His incontinence worsens. Urinalysis is normal. The next step is:
LUTS in the elderly may be secondary to a number of medical conditions, including immobility, congestive cardiac failure and diabetes. Antimuscarinic agents may cause or worsen urinary incontinence in elderly patients with poor detrusor contractility. This may present with new or worsened incontinence due to overflow after the initiation of an antimuscarinic agent. This can be diagnosed with the non-invasive measurement of a PVR. Renal ultrasound is not indicated. There is no need at this point to proceed to uroflowmetry, urodynamics or cystoscopy, but these may be useful in further evaluation.
© 2010-2030 Your Doctor - Dr.Khalil Al-Yousifi - Kuwait - Contact Us