Skip to main content
SpringerLink
Log in

Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple

  • Published:
World Journal of Urology Aims and scope Submit manuscript

Summary

The concept of the passive urethral resistance relation (PURR) to quantify bladder outflow conditions in few parameters from the complex pressure/flow relation is generally accepted. The most simple, yet realistic, linearized format is the linear PURR (linPURR). This two-dimensional format allows clear identification of individual outflow conditions with distinction of different obstruction types. Unequivocal grading of obstruction, however, requires a one-dimensional format. Theoretical considerations show that voiding function can be completely defined by a single parameter only when detrusor strength and obstruction type are uniform. This can be achieved with a disease-specific approach such as our pressure/flow diagram, which is specific for prostatic obstruction. It allows grading of obstruction stepwise for clinical decisions making or on a continuous scale for statistical applications using the maximal flow rate with related detrusor pressure as a single data point alone. Adding the actual linPURR to the diagram offers the unique feature of inherent conceptual quality control, relevant for individual assessment. The detrusor-adjusted mean PURR factor (DAMPF) is an alternative format of reducing the PURR to a single number, excluding at least the impact of variable detrusor strength, a conceptual advantage when the obstruction type is less uniform. The voiding pressure at maximal flow is a suitable parameter for most simple obstruction grading. Its validity can be significantly enhanced only when it is used in a disease-specific format, such as our pressure/flow diagram in combination with linPURR and DAMPF. Computerization does not improve the results of manual graphical analysis. Much more important is the clear conceptual definition and transparent application. More sophisticated computer-dependent methods such the original PURR/DURR and the three-parameter model can abstract more detailed information about outflow conditions, which requires expertise in their application and perfect data quality, but this does not result in better obstruction grading.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abrams PH, Griffiths DJ (1979) The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol 127:129–134

    Google Scholar 

  2. Abrams PH, Blaivas JG, Griffiths DJ, Jenssen KM, Kayanagi T, Kondo A, Neal D, Nordling J, Schäfer W, Yalla SV (1993) The objective evaluation of bladder outflow obstruction. In: Cockett ATK, et al (eds) Proceeding of the 2nd international consultation on benign prostatic hyperplasia (BPH) Scientific Communication International Ltd, Jersey, pp 151–225

    Google Scholar 

  3. Griffiths DJ (1980) Urodynamics: the mechanics and hydrodynamics of the lower urinary tract. Adam Hilgers, Bristol

    Google Scholar 

  4. Griffiths DJ, Mastrigt R van, Bosch R (1989) Quantification of urethral resistance and bladder function during voiding, with special reference to the effects of prostate size reduction on urethral obstruction due to benign prostatic hyperplasia. Neurourol Urodyn 8:17–27

    Google Scholar 

  5. Höfner K, Kramer AEJL, Tan HK, Grünewald V, Jonas U (1993) Clinical relevance of pressure/flow analysis concepts in BPH patients. Neurourol Urodyn 12:409–410

    Google Scholar 

  6. Höfner K, Kramer AEJL, Tan HK, Grünewald V, Jonas U (1993) Chess classification of outlet obstruction based on pressure/flow analysis. Neurourol Urodyn 12:414–415

    Google Scholar 

  7. Höfner K, Tan HK, Krath H, Kuczyk M, Jonas U (1994) The clinical application of Abrams/Griffiths nomogram and linear PURR in comparison with chess-classification. Neurourol Urodyn 13:481–483

    Google Scholar 

  8. Kranse M, Mastrigt R van (1991) Fitting orthogonal polynomials to the lowest part of a pressure flow plot. Neurourol Urodyn 10:290–291

    Google Scholar 

  9. Kranse M, Mastrigt R van, Rollema HJ (1992) Resolution and specificity of parameters characterizing bladder outlet obstruction. Neurourol Urodyn 11:395–397

    Google Scholar 

  10. Lim CS, Reynards J, Cannon A, Abrams PH (1994) The Abrams/Griffiths number: a simple way to quantify bladder outflow obstruction. Neurourol Urodyn 13:475–476

    Google Scholar 

  11. Schäfer W (1983) The contribution of the bladder outlet to the relation between pressure and flow rate during micturition. In: Hinman F Jr (ed) Benign prostatic hypertrophy. Springer, New York Berlin Heidelberg, pp 470–496

    Google Scholar 

  12. Schäfer W (1983) Detrusor as the energy source of micturition mechanics. In: Hinman F Jr (ed) Benign prostatic hypertrophy. Springer, New York Berlin Heidelberg, pp 450–469

    Google Scholar 

  13. Schäfer W (1985) Urethral resistance? Urodynamic concepts of physiological and pathological bladder outlet function during voiding. Neurourol Urodyn 4:161–201

    Google Scholar 

  14. Schäfer W (1989) Editorial comment to Spangberg et al. Neurourol Urodyn 8:44–50

    Google Scholar 

  15. Schäfer W (1990) Basic principles and clinical application of advanced analysis of bladder voiding function. Urol Clin North Am 17:553–566

    Google Scholar 

  16. Schäfer W (1991) Detrusor muscle mechanics in clinical urodynamics. In: Krane RJ, Siroky MB (eds) Clinical neurourology, 2nd edn; Little, Brown, Boston, pp 109–150

    Google Scholar 

  17. Schäfer W (1992) Urodynamics in benign prostatic hyperplasia. In: Rutishauser G, Vahlensiek W (eds) Benign prostatic diseases. Thieme, Stuttgart, pp 128–143

    Google Scholar 

  18. Schäfer W (1992) Bladder outflow obstruction: definition, clinical application and grading. In: Jakse G, Bouffioux C, de Laval J, Janknegt RA (eds) Benign prostatic hyperplasia: conservative and operative management. Springer, New York Berlin Heidelberg, pp 14–28

    Google Scholar 

  19. Schäfer W (1992) Comparison of simple concepts of pressure/flow analysis: URA vs linPURR and p/Q diagram. Neurourol Urodyn 11:397–398

    Google Scholar 

  20. Schäfer W (1993) A new concept for simple but specific grading of bladder outflow conditions independent from detrusor function. J Urol 149:A574

    Google Scholar 

  21. Schäfer W, Rübben H, Noppeney R, Deutz FJ (1989) Obstructed and unobstructed “prostatic obstruction”: a plea for objectivation of bladder outflow obstruction by urodynamics. World J Urol 6:198–203

    Google Scholar 

  22. Schäfer W, Waterbär F, Langen PH, Deutz FJ (1989) A simplified graphic procedure for detailed analysis of detrusor and outlet function during voiding. Neurourol Urodyn 8:405–407

    Google Scholar 

  23. Schäfer W, Langen PH, Thörner M (1990) The real pressure/flow relation during obstruction voiding. Neurourol Urodyn 9:423–425

    Google Scholar 

  24. Schäfer W, Hermanns R, Langen PH, Abrams PH, Chapple CR, Stott M (1991) Urodynamic analysis of drug effects on bladder voiding function. Neurourol Urodyn 10:288–289

    Google Scholar 

  25. Schäfer W, Krischner-Hermanns R, Jakse G (1994) Non-invasive pressure flow measurement for ‘precise grading’ of bladder outflow obstruction. J Urol 151/5:A384

  26. Schäfer W, Rosette JJMCH de la, Höfner K, Kinn AC, Walter S, Abrams PH, the ICS-BPH Study Group (1994) The ICS-BPH study: pressure/flow studies, quality control and initial analysis. Neurourol Urodyn 13:491–492

    Google Scholar 

  27. Schäfer W, the ICS BPH Study Group (in press) Does a disease specific type of obstruction exist in BPH? J Urol

  28. Scott JES, Clayton CB, Dee PM, Simpson W (1972) Dynamic and flexible models of the urethra. In: Hinman F Jr (ed) Hydrodynamics of micturition. Charles C. Thomas, Springfield, Illinois, pp 124–132

    Google Scholar 

  29. Smith JC (1968) Urethral resistance to micturition. Br J Urol 40:125–156

    Google Scholar 

  30. Spangberg A, Teriö H, Engberg A, Ask P (1989) Quantification of urethral function based on Griffiths' model of flow through elastic tubes. Neurourol Urodyn 8:29–52

    Google Scholar 

  31. Spangberg A, Teriö H, Ask P, Engberg A (1991) Pressure/flow studies preoperatively and postoperatively in patients with BPH: estimation of the urethral pressure/flow relation and urethral elasticity. Neurourol Urodyn 10:139–167

    Google Scholar 

  32. Van Mastrigt R, Kranse M, Rollema HJ (1994) Testing the efficacy of treatment for infravesical obstruction with pressure/flow data. Neurourol Urodyn 13:392–394

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urologische Klinik der RWTH Aachea, Pauwelsstraße 30, D-52057, Aachen

    W. Schäfer

Authors
  1. W. Schäfer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schäfer, W. Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol 13, 47–58 (1995). https://doi.org/10.1007/BF00182666

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00182666

Keywords

Search

Navigation