Poster Abstract #174 · VALSALVA´S MANOEUVER IN OBSTRUCTED MEN DO NOT IMPROVE Q MAX AS IT WAS...
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VALSALVA´S MANOEUVER IN OBSTRUCTED MEN DO NOT IMPROVE Q MAX AS IT WAS THOUGHT Cobreros C., Del Villar M., Sarotto N., Garcia Penela E., Bechara A. División de Urología, Hospital Carlos G. Durand, Buenos Aires, Argentina INTRODUCTION RESULTS MATERIALS AND METHODS CONCLUSIONS REFERENCES • Main Aim: In men with urodynamic outlet obstruction, the QMAX flow rate does not improve with valsalva´s manoeuvre. In fact, it diminishes. • Valsalva´s manoeuvre does not modify detrusor pressure. • The pressence of a 6Fr catheter during voiding decreases Qmax per se, regardless of valsalva´s manoeuvre. 1 Abdominal straining in benign prostatic hyperplasia. Jensen KM, Bruskewitz RC, Iversen P, Madsen PO. J Urol. 1983 Jan;129(1):44-7. 2 Estudios urodinámicos sobre la utilización de la Maniobra de Valsalva en la micción de los hombres con hernia inguinal superior a los 50 años Yuan Ting H, Tavares Pinheiro R, Dambros M, Palma P. Actas Urol Esp. 2007;31(7):771-775 3 Hernia y próstata: ¿existe alguna relación entre ambas patologías?, Dres. Romano Salomón V.; Marino Ruiz Julio;Solari Juan José. Rev. Arg. de Urol. · Vol. 72 (2) 2007 4 The Standardisation of Terminology of Lower Urinary Tract Function Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A.Joint publication: Neurourol.Urodyn 21(2):167-178 (2002 Wiley) Urology 61: 37-49 • N=61 • Mean age 64.71 years (38-89y) • Mean IPSS 19.19 (9-30). Mean Qol 4.3 (2-6). • Qmax did not show improvement under valsalva´s maneuver. But the difference proved to be statistically significant in the detriment of Qmax. • It was historically believed that patients with outlet obstruction, improved their urine flow rate with valsalva´s manoeuver. And moreover, that this was related to the etiopathogenesis of inguinal hernia. This has been proven inaccurate with the work of Jensen et al., where they demonstrate the lack of relationship between increased abdominal pressure and outlet obstruction 1,2,3 . • Aim of study: Verify that in a cohort of obstructed men the use Valsalva manoeuver during the voiding phase does not improve Qmax. • From January 2014 to February 2016, we performed a prospective trial, informed conset were obtained, and during that period of time 195 urodynamic studies were performed. 171 patients accept to participated, and after: • Inclusion criteria: - IPSS >=7. - Qmax in the Freeflow <=10 ng/ml. • Exclusion Criteria: - Pdet <40cmH20 during the pressure/flow study (to avoid underactive bladder patients). - altered bladder compliance - bladder hyperactivity. To determine if Valsalva´s Maneuver was useful in obstructed men, we asked all men to perform two Valsalva´s Manoeuver during micturition, of at least five second each, while the contraction of the detrusor has been started. Statistyc method: nule hypothesis (Wilcoxon signed rank test) using the T-test satistic messure, as the population cannot be assumed to be normally distributed comparing: Qmax1 Qmax2 QmaxCW QMAXCV1- QMAXCW QMAXCV2- QMAXCW Z -5,384 -5,197 Sig. Asintot. (bilateral) ,000 ,000 MIN MAX AVERAGE PdetQmax UDS 40 149,70 76,09 PdetQmax 1 18,6 197,70 75,61 PdetQmax 2 25,4 161,10 80,17 P>0,005 DIFFERENCE F Qmax VS Qmax UDS 41% Qmax UDS VS Qmax 1 64% Qmax UDS VS Qmax 2 67% F Qmax VS Qmax 1 131% F Qmax VS Qmax 2 135% Qmax 1- QmaxF Qmax 2- QmaxF Qmax 1- Qmax UDS Qmax 2- Qmax UDS Z -6,397 -6,347 -5,589 -5,528 Sig. Asintot.(bil ateral) ,000 ,000 ,000 ,000 Qmax UDS (the Qmax with a 6 Fr catheter in the urethra during the voiding phase) Qmax1-2 (Qmax with same catheter in urethra in the voiding phase obtained during the Valsalva´s Manoeuvers) N=61 171 F Qmax F (Free Qmax obtained in uroflowneter prior urodynamic assesment)
Transcript of Poster Abstract #174 · VALSALVA´S MANOEUVER IN OBSTRUCTED MEN DO NOT IMPROVE Q MAX AS IT WAS...
VALSALVA´S MANOEUVER IN OBSTRUCTED MEN DO NOT IMPROVE Q MAX AS IT WAS THOUGHT
Cobreros C., Del Villar M., Sarotto N., Garcia Penela E., Bechara A.División de Urología, Hospital Carlos G. Durand, Buenos Aires, Argentina
INTRODUCTION RESULTS
MATERIALSANDMETHODS
CONCLUSIONS
REFERENCES
• Main Aim: In men with urodynamicoutlet obstruction, the QMAX flow ratedoes not improve with valsalva´smanoeuvre. In fact, it diminishes.
• Valsalva´s manoeuvre does not modifydetrusor pressure.
• The pressence of a 6Fr catheter duringvoiding decreases Qmax per se,regardless of valsalva´s manoeuvre.
1 Abdominal straining in benign prostatic hyperplasia. Jensen KM, Bruskewitz RC, Iversen P, Madsen PO. J Urol. 1983 Jan;129(1):44-7.2 Estudios urodinámicos sobre la utilización de la Maniobra de Valsalva en la micción de los hombres con hernia inguinal superior a los 50 años Yuan Ting H, Tavares Pinheiro R, Dambros M, Palma P. Actas Urol Esp. 2007;31(7):771-7753 Hernia y próstata: ¿existe alguna relación entre ambas patologías?, Dres. Romano Salomón V.;Marino Ruiz Julio;Solari Juan José. Rev. Arg. de Urol. · Vol. 72 (2) 20074 The Standardisation of Terminology of Lower Urinary Tract Function Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A.Joint publication: Neurourol.Urodyn 21(2):167-178 (2002 Wiley) Urology 61: 37-49
• N=61• Mean age 64.71 years (38-89y)• Mean IPSS 19.19 (9-30). Mean Qol 4.3 (2-6).
• Qmax did not show improvement under valsalva´smaneuver. But the difference proved to bestatistically significant in the detriment of Qmax.
• It was historically believed that patients with outletobstruction, improved their urine flow rate withvalsalva´s manoeuver. And moreover, that this wasrelated to the etiopathogenesis of inguinal hernia. Thishas been proven inaccurate with the work of Jensen etal., where they demonstrate the lack of relationshipbetween increased abdominal pressure and outletobstruction1,2,3.
• Aim of study: Verify that in a cohort of obstructed menthe use Valsalva manoeuver during the voiding phasedoes not improve Qmax.
• FromJanuary2014toFebruary2016,weperformedaprospectivetrial,informedconsetwereobtained,andduringthatperiodoftime195urodynamicstudieswereperformed.171patientsaccepttoparticipated,andafter:
• Inclusioncriteria:- IPSS>=7.- QmaxintheFreeflow<=10ng/ml.• ExclusionCriteria:- Pdet<40cmH20duringthepressure/flowstudy(to
avoidunderactivebladderpatients).- alteredbladdercompliance- bladderhyperactivity.
To determine if Valsalva´s Maneuver was useful in obstructed men, we asked all men to perform two Valsalva´s Manoeuver during micturition, of at least five second each,
while the contraction of the detrusor has been started.
Statistycmethod:nulehypothesis(Wilcoxonsignedranktest)usingtheT-testsatisticmessure,asthepopulationcannotbeassumedtobenormallydistributedcomparing:
Qmax1 Qmax2
QmaxCW
QMAXCV1-QMAXCW
QMAXCV2-QMAXCW
Z -5,384 -5,197
Sig.Asintot.(bilateral)
,000 ,000
MIN MAX AVERAGE
PdetQmax UDS 40 149,70 76,09
PdetQmax 1 18,6 197,70 75,61
PdetQmax 2 25,4 161,10 80,17
P>0,005
DIFFERENCE
FQmax VS Qmax UDS 41%
Qmax UDS VS Qmax 1 64%
Qmax UDS VS Qmax 2 67%
FQmax VS Qmax 1 131%
FQmax VS Qmax 2 135%
Qmax 1-QmaxF
Qmax 2-QmaxF
Qmax 1-QmaxUDS
Qmax 2-QmaxUDS
Z -6,397 -6,347 -5,589 -5,528
Sig.Asintot.(bilateral)
,000 ,000 ,000 ,000
QmaxUDS(theQmaxwitha6Frcatheterintheurethraduringthevoidingphase)Qmax1-2(QmaxwithsamecatheterinurethrainthevoidingphaseobtainedduringtheValsalva´sManoeuvers)
N=61171
FQmaxF(FreeQmaxobtainedinuroflowneterpriorurodynamicassesment)
