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A one-day frequency-volume chart is representative of a 3-day chart in the assessment of lower urinary tract symptoms suggestive of bladder outflow obstruction
British Journal of Medical and Surgical Urology (2010) 3, 194—197
ORIGINAL ARTICLE
A one-day frequency-volume chart is representative of a 3-day chart in the assessment of lower urinary tract symptoms suggestive of bladder outflow obstruction Prabhakar Rajan ∗,1, Kevin J. Turner 2, Paramananthan Mariappan, Laurence H. Stewart Department of Urology, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK Received 15 August 2009 ; received in revised form 20 December 2009; accepted 30 January 2010
KEYWORDS Lower urinary tract symptoms; Nocturia; Bladder outflow obstruction; Frequency-volume charts
Summary Introduction: 24-h frequency-volume (FV) charts are often used to assess patients with lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO). There are no clear guidelines regarding the optimum chart duration. We aimed to determine whether a one-day FV chart is representative of a 3-day equivalent. Patients and methods: Men presenting with LUTS (including nocturia) were prospectively recruited and completed a 3-day FV chart. Exclusion criteria were previous bladder outflow surgery and anti-cholinergic medication. Results: 285 patients were recruited (mean age, 67 years; range 26—93 years). There were no significant inter-day differences in 24-h urine volume (24HUV) (p = 0.10) and functional bladder capacity (FBC) (p = 0.19). However, there were significant differences identified between days 1 and 2, and 1 and 3 for both nocturnal urine volume (NUV) (p < 0.001) and actual nocturnal voids (ANV) (p < 0.001) despite significant correlation of these parameters on each day with their respective 3-day means. Conclusion: Our data suggest that a one-day FV chart is representative of a 3-day equivalent for the assessment of 24HUV and FBC in patients with LUTS/BOO. Further studies are required to compare the repeatability and clinical utility of a one-day chart compared with 3- and 7-day charts, particularly in patients with nocturia. © 2010 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved.
∗ Corresponding author at: Beatson Institute for Cancer Research, Garscube Estate, Switchback Road, Bearsden, Glasgow, G61 1BD, UK. Tel.: +44 1413303658; fax: +44 1419426521. E-mail addresses: [email protected] (P. Rajan), [email protected] (K.J. Turner), [email protected] (P. Mariappan), [email protected] (L.H. Stewart). 1 Present address: Department of Urology, Royal Alexandra Hospital, Paisley, PA9 9PN, UK. 2 Present address: Department of Urology, Royal Bournemouth Hospital, Bournemouth, BH7 7DW, UK.
1875-9742/$ — see front matter © 2010 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjmsu.2010.01.009
A one-day frequency-volume chart is representative of a 3-day chart
195
Introduction
Materials and methods
Objective assessment of patients with voiding dysfunction is a clinical challenge; subjective symptoms unreliably represent the underlying diagnosis. For men with lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO), the International Prostate Symptom Score (I-PSS) is a commonly used diagnostic adjunct [1]. Invasive investigations such as pressure-flow urodynamics correlate more closely with symptom aetiology but have several drawbacks. These include high cost of specialist equipment and medical staff training. Results can be misleading due to an ‘‘artificial’’ testing environment in the clinical setting [2]. Frequency-volume (FV) charts are simple, noninvasive and objective, and often form part of the assessment of a patient with LUTS [3]. Patients record the time and volume of voiding over a 24-h period. Critically, FV charts document the most bothersome aspects of micturition (24-h urine output, frequency, nocturia and voided volumes). Nocturia is one of the most bothersome symptoms in men with LUTS/BOO, having a significant impact on health and quality of life [4]. A number of useful nocturia indices have been derived from FV charts in an attempt to differentiate underlying aetiologies [5,6]. Despite the well-reported usefulness of FV charts, there are currently no clear guidelines regarding the optimum length of assessment. At present, a 7-day FV chart is considered the gold standard for the evaluation of men with LUTS/BOO [3]. However, the completion FV charts over several days are burdensome for patients and results in reduced compliance [7]. Patients are more likely to accurately complete a shorter FV chart, but possibly at the expense of chart reliability [7]. A 3-day chart may provide the optimum compromise [8]. The aim of this study was to determine whether data from a one-day FV chart is representative of a 3-day equivalent in patients with LUTS/BOO.
Men presenting with LUTS (including nocturia) to the Western General Hospital, Edinburgh, United Kingdom, were prospectively recruited from June 2002. Patients completed the I-PSS and a 3-day FV chart, with instructions to document the time and volume of each void. Food and fluid intake was ad libitum, with no restrictions on type and timing of intake as circadian changes in the FV chart are independent of fluid intake [9]. The FV chart allowed calculation of 24-h urine volume (24HUV), daytime voids (frequency), maximal voided volume (FBC), actual nocturnal voids (ANV) and nocturnal urine volume (NUV) according to International Continence Society (2002) definitions [10]. In order to be included in the study, men needed to have completed the FV chart for 3 consecutive days, recording the voided volume and time for each void. Whilst we were unable to control for unrecorded voids, we excluded all men who had failed to record either the time or volume for any void(s) in the 3-day period. The data used in this study are a subset of a larger dataset from our LUTS database. Previous surgery and anticholinergic medication were exclusion criteria for entry into the database and consequently data were not available for this subgroup. The one-sample Kolmogorov—Smirnov test was used for assessment of the normality of data, and the Kruskal—Wallis test and Mann—Whitney U-test were used to identify differences between groups. All tests were undertaken using SPSS version 17.0 computer software (SPSS, Inc.). All tests were two-sided and a p-value of <0.05 taken to indicate statistical significance.
Results Two hundred and eighty five patients were prospectively recruited between June 2002 and July 2005. Summary statistics of recruited patients are given in Table 1. Normality testing did not reveal nor-
Table 1 Characteristic of 3-day FV-chart for each variable. (24HUV = 24-h urine volume; FBC = maximal voided volume; NUV = nocturnal urine volume; ANV = actual nocturnal voids; SD = standard deviation of mean; IQR = interquartile range.). Variable
Mean/median
SD/IQR
Range
Age (years) 24HUV (ml) FBC (ml) NUV (ml) ANV (voids)
66.3/67.5 1796.0/1700 363.8/350 495.5/445 2.0/2
13.4/20.4 816.7/940 154.2/200 338.0/405 1.3/2
26.7—93.3 250—7700 6—1000 0—2408 0—12
196 Table 2
P. Rajan et al. Correlation coefficients (-value) of 1-day FV chart variable with 3-day equivalent for each variable.
Day
3-day FV-chart variable Mean 24HUV
Mean FBC
Mean NUV
Mean ANV
1
Spearman’s p-Value
0.833 <0.001
0.865 <0.001
0.655 <0.001
0.726 <0.001
2
Spearman’s p-Value
0.856 <0.001
0.897 <0.001
0.816 <0.001
0.816 <0.001
3
Spearman’s p-Value
0.870 <0.001
0.877 <0.001
0.830 <0.001
0.830 <0.001
Table 3 Comparison of recommended FV chart durations published with present study. (MVV = mean voided volume; VF = voiding frequency; MinVV = minimum voided volume; NVF = nocturnal voiding frequency; MIBV = mean interval between voids; UV = number of urgent voids.). Population
FV chart parameters
Males with LUTS/BOO No voiding complaints Females with urge incontinence Interstitial cystitis Males with LUTS/BOO Males with BPH Females
24HUV, ANV, NUV, FBC VF, 24HUV, NUV, FBC MVV, VF, FBC, MinVV, 24HUV Nocturia, NVF VF, MVV, 24HUV Nocturia MVV, diuresis, VF, MIBV, 24HUV, nocturnal incontinence VF, incontinence
Females with detrusor instability ± sphincter incompetence Males with LUTS/BOO
24HUV, NUV, FBC, ANV, VF, UV
mally distributed groups (p > 0.05), and therefore non-parametric testing was employed for further analyses. There were no statistically significant differences in 24HUV (p = 0.10) and FBC (p = 0.19) between each day of the FV chart. However, there were significant differences identified between Days 1 and 2, and 1 and 3 for both NUV (p < 0.001) and ANV (p < 0.001). Although there was statistically significant correlation between all variables on each day with each of their respective 3-day means (p < 0.001) (Table 2), correlations for 24HUV and FBC were greater ( > 0.80) than NUV and ANV. Taken together, these data suggest greater intra-chart variability for nocturnal parameters and lesser reliability for the first day of the 3-day series.
Discussion Studies have recommended the use of FV charts in patients with different urinary tract pathologies, with optimum durations ranging from 1-day to 7days (Table 3). An incomplete FV chart is of little value, and too short a chart period will lead to inaccuracies. Schick et al. [7] suggested that patient
Recommended chart length
Study
1 1 1 1 1 3 4
Present study [15] [16] [17] [11] [18] [7]
7
[19]
>3—4
[13]
compliance follows a logarithmic curve over time; higher when chart duration is short, and decreasing with increasing time. On the other hand, reliability follows a bell-shaped curve; low when the chart period is short, rapidly increasing to a peak, and subsequently decreasing in parallel with compliance. The optimum chart length can be determined from the intersection of these two curves. Studies evaluating the optimum FV chart duration in patients with LUTS/BOO are limited. Matthiesen et al. [18] estimated that a 3-day FV chart would be sufficient to detect nocturia in patients with potential benign prostatic hyperplasia (BPH). A study of 160 men found only ‘‘negligible’’ differences at an individual level between charts completed during a 24-h period and those completed over 3 or more days [11]. In a study of 67 men, a 3-day FV chart was suggested as the best compromise with little added advantage from a chart of longer duration [8]. It was suggested that the chart should consist of both days of the weekend plus either Friday or Monday, as there was less missing data at weekends in comparison to weekdays. Yap et al. [13] suggest that a 1-day chart is insufficient for the diagnosis and monitoring of
A one-day frequency-volume chart is representative of a 3-day chart LUTS/BOO, but may be suitable for symptom stratification. Decreased nocturnal bladder capacity in BPH may occur in isolation, or in combination with detrusor overactivity and other causes of nocturia. Our data reveal poorer correlation of nocturnal indices (ANV and NUV) between one and 3-day FV charts as compared to 24HUV and FBC, and significant differences in the former parameters between the first and latter days of the 3-day chart. This may represent less accurate documentation of nocturnal voids on the first day of the chart or greater variation of nocturnal voiding pattern on a day-today basis. Furthermore, an overall average from a 3-day chart may mask significant symptoms on a particular day. Although ‘‘test—re-test’’ reliability is important [12,13] it may be difficult to undertake repeated single measurements in a clinical setting. Ascertaining whether the chart period was typical of the patients’ voiding pattern can assist the clinician to assess changes in symptoms following therapeutic intervention [14].
Conclusion FV charts are a simple, non-invasive and costeffective diagnostic adjunct in the assessment of a patient with LUTS/BOO. Our data suggest that data from a one-day FV chart is representative of a 3-day equivalent for the assessment of 24HUV and FBC in patients with LUTS/BOO. However, there are other parameters that can be obtained from a FV chart, and further studies are required to compare the repeatability and clinical utility of a single day chart compared with both 3-day and 7-day charts, particularly in the subgroup of patients with nocturnal symptoms.
Conflict of interest statement The authors declare that there are no conflicts of interest.
197
Acknowledgements We are grateful to Alan Hawes (Ferring UK) for developing the computer database used for data collection. Ferring UK was not involved in the study design, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
References [1] Barry MJ, Fowler Jr FJ, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. J Urol 1992;148:1549—57, discussion 1564. [2] Groutz A, Blaivas JG, Chaikin DC, Resnick NM, Engleman K, Anzalone D, et al. J Urol 2000;164:698—701. [3] Abrams P, Klevmark B, Scand. J Urol Nephrol Suppl 1996;179:47—53. [4] Schneider T, de la Rosette JJ, Michel MC. Int J Urol 2009;16(3):249—55. [5] Weiss JP, Blaivas JG. Urology 2002;60:28—32 [discussion 32]. [6] Weiss JP, Blaivas JG, Stember DS, Brooks MM. Neurourol Urodyn 1998;17:467—72. [7] Schick E, Jolivet-Tremblay M, Dupont C, Bertrand PE, Tessier J. Neurourol Urodyn 2003;22:92—6. [8] Belal M, Al-Hayek S, Cobby J, Swithinbank L, Abrams P.Proceedings of the 35th annual meeting of the international continence society. 2005. [9] Asplund R, Guttenbrunner C, Schreiber U. Prog Clin Biol Res 1987;227A:309. [10] van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, et al. Neurourol Urodyn 2002;21: 179—83. [11] Gisolf KW, van Venrooij GE, Eckhardt MD, Boon TA. Eur Urol 2000;38:45—52. [12] Bryan NP, Chapple CR. Eur Urol 2004;46:636—40. [13] Yap TL, Cromwell DA, Brown C, Emberton M, van der Meulen J. BJU Int 2007;100:111—5. [14] Govindaraju SK, Neilson D. Eur Urol 2005;48:171—2 [author reply 172]. [15] van Haarst EP, Heldeweg EA, Newling DW, Schlatmann TJ. BJU Int 2004;93:1257—61. [16] van Melick HH, Gisolf KW, Eckhardt MD, van Venrooij GE, Boon TA. Urology 2001;58:188—92. [17] Mazurick CA, Landis JR. J Urol 2000;163:1208—11. [18] Matthiesen TB, Rittig S, Mortensen JT, Djurhuus JC. BJU Int 1999;83:1017—22. [19] Wyman JF, Choi SC, Harkins SW, Wilson MS, Fantl JA. Obstet Gynecol 1988;71:812—7.
Available online at www.sciencedirect.com
ORIGINAL ARTICLE
A one-day frequency-volume chart is representative of a 3-day chart in the assessment of lower urinary tract symptoms suggestive of bladder outflow obstruction Prabhakar Rajan ∗,1, Kevin J. Turner 2, Paramananthan Mariappan, Laurence H. Stewart Department of Urology, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK Received 15 August 2009 ; received in revised form 20 December 2009; accepted 30 January 2010
KEYWORDS Lower urinary tract symptoms; Nocturia; Bladder outflow obstruction; Frequency-volume charts
Summary Introduction: 24-h frequency-volume (FV) charts are often used to assess patients with lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO). There are no clear guidelines regarding the optimum chart duration. We aimed to determine whether a one-day FV chart is representative of a 3-day equivalent. Patients and methods: Men presenting with LUTS (including nocturia) were prospectively recruited and completed a 3-day FV chart. Exclusion criteria were previous bladder outflow surgery and anti-cholinergic medication. Results: 285 patients were recruited (mean age, 67 years; range 26—93 years). There were no significant inter-day differences in 24-h urine volume (24HUV) (p = 0.10) and functional bladder capacity (FBC) (p = 0.19). However, there were significant differences identified between days 1 and 2, and 1 and 3 for both nocturnal urine volume (NUV) (p < 0.001) and actual nocturnal voids (ANV) (p < 0.001) despite significant correlation of these parameters on each day with their respective 3-day means. Conclusion: Our data suggest that a one-day FV chart is representative of a 3-day equivalent for the assessment of 24HUV and FBC in patients with LUTS/BOO. Further studies are required to compare the repeatability and clinical utility of a one-day chart compared with 3- and 7-day charts, particularly in patients with nocturia. © 2010 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved.
∗ Corresponding author at: Beatson Institute for Cancer Research, Garscube Estate, Switchback Road, Bearsden, Glasgow, G61 1BD, UK. Tel.: +44 1413303658; fax: +44 1419426521. E-mail addresses: [email protected] (P. Rajan), [email protected] (K.J. Turner), [email protected] (P. Mariappan), [email protected] (L.H. Stewart). 1 Present address: Department of Urology, Royal Alexandra Hospital, Paisley, PA9 9PN, UK. 2 Present address: Department of Urology, Royal Bournemouth Hospital, Bournemouth, BH7 7DW, UK.
1875-9742/$ — see front matter © 2010 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjmsu.2010.01.009
A one-day frequency-volume chart is representative of a 3-day chart
195
Introduction
Materials and methods
Objective assessment of patients with voiding dysfunction is a clinical challenge; subjective symptoms unreliably represent the underlying diagnosis. For men with lower urinary tract symptoms suggestive of bladder outflow obstruction (LUTS/BOO), the International Prostate Symptom Score (I-PSS) is a commonly used diagnostic adjunct [1]. Invasive investigations such as pressure-flow urodynamics correlate more closely with symptom aetiology but have several drawbacks. These include high cost of specialist equipment and medical staff training. Results can be misleading due to an ‘‘artificial’’ testing environment in the clinical setting [2]. Frequency-volume (FV) charts are simple, noninvasive and objective, and often form part of the assessment of a patient with LUTS [3]. Patients record the time and volume of voiding over a 24-h period. Critically, FV charts document the most bothersome aspects of micturition (24-h urine output, frequency, nocturia and voided volumes). Nocturia is one of the most bothersome symptoms in men with LUTS/BOO, having a significant impact on health and quality of life [4]. A number of useful nocturia indices have been derived from FV charts in an attempt to differentiate underlying aetiologies [5,6]. Despite the well-reported usefulness of FV charts, there are currently no clear guidelines regarding the optimum length of assessment. At present, a 7-day FV chart is considered the gold standard for the evaluation of men with LUTS/BOO [3]. However, the completion FV charts over several days are burdensome for patients and results in reduced compliance [7]. Patients are more likely to accurately complete a shorter FV chart, but possibly at the expense of chart reliability [7]. A 3-day chart may provide the optimum compromise [8]. The aim of this study was to determine whether data from a one-day FV chart is representative of a 3-day equivalent in patients with LUTS/BOO.
Men presenting with LUTS (including nocturia) to the Western General Hospital, Edinburgh, United Kingdom, were prospectively recruited from June 2002. Patients completed the I-PSS and a 3-day FV chart, with instructions to document the time and volume of each void. Food and fluid intake was ad libitum, with no restrictions on type and timing of intake as circadian changes in the FV chart are independent of fluid intake [9]. The FV chart allowed calculation of 24-h urine volume (24HUV), daytime voids (frequency), maximal voided volume (FBC), actual nocturnal voids (ANV) and nocturnal urine volume (NUV) according to International Continence Society (2002) definitions [10]. In order to be included in the study, men needed to have completed the FV chart for 3 consecutive days, recording the voided volume and time for each void. Whilst we were unable to control for unrecorded voids, we excluded all men who had failed to record either the time or volume for any void(s) in the 3-day period. The data used in this study are a subset of a larger dataset from our LUTS database. Previous surgery and anticholinergic medication were exclusion criteria for entry into the database and consequently data were not available for this subgroup. The one-sample Kolmogorov—Smirnov test was used for assessment of the normality of data, and the Kruskal—Wallis test and Mann—Whitney U-test were used to identify differences between groups. All tests were undertaken using SPSS version 17.0 computer software (SPSS, Inc.). All tests were two-sided and a p-value of <0.05 taken to indicate statistical significance.
Results Two hundred and eighty five patients were prospectively recruited between June 2002 and July 2005. Summary statistics of recruited patients are given in Table 1. Normality testing did not reveal nor-
Table 1 Characteristic of 3-day FV-chart for each variable. (24HUV = 24-h urine volume; FBC = maximal voided volume; NUV = nocturnal urine volume; ANV = actual nocturnal voids; SD = standard deviation of mean; IQR = interquartile range.). Variable
Mean/median
SD/IQR
Range
Age (years) 24HUV (ml) FBC (ml) NUV (ml) ANV (voids)
66.3/67.5 1796.0/1700 363.8/350 495.5/445 2.0/2
13.4/20.4 816.7/940 154.2/200 338.0/405 1.3/2
26.7—93.3 250—7700 6—1000 0—2408 0—12
196 Table 2
P. Rajan et al. Correlation coefficients (-value) of 1-day FV chart variable with 3-day equivalent for each variable.
Day
3-day FV-chart variable Mean 24HUV
Mean FBC
Mean NUV
Mean ANV
1
Spearman’s p-Value
0.833 <0.001
0.865 <0.001
0.655 <0.001
0.726 <0.001
2
Spearman’s p-Value
0.856 <0.001
0.897 <0.001
0.816 <0.001
0.816 <0.001
3
Spearman’s p-Value
0.870 <0.001
0.877 <0.001
0.830 <0.001
0.830 <0.001
Table 3 Comparison of recommended FV chart durations published with present study. (MVV = mean voided volume; VF = voiding frequency; MinVV = minimum voided volume; NVF = nocturnal voiding frequency; MIBV = mean interval between voids; UV = number of urgent voids.). Population
FV chart parameters
Males with LUTS/BOO No voiding complaints Females with urge incontinence Interstitial cystitis Males with LUTS/BOO Males with BPH Females
24HUV, ANV, NUV, FBC VF, 24HUV, NUV, FBC MVV, VF, FBC, MinVV, 24HUV Nocturia, NVF VF, MVV, 24HUV Nocturia MVV, diuresis, VF, MIBV, 24HUV, nocturnal incontinence VF, incontinence
Females with detrusor instability ± sphincter incompetence Males with LUTS/BOO
24HUV, NUV, FBC, ANV, VF, UV
mally distributed groups (p > 0.05), and therefore non-parametric testing was employed for further analyses. There were no statistically significant differences in 24HUV (p = 0.10) and FBC (p = 0.19) between each day of the FV chart. However, there were significant differences identified between Days 1 and 2, and 1 and 3 for both NUV (p < 0.001) and ANV (p < 0.001). Although there was statistically significant correlation between all variables on each day with each of their respective 3-day means (p < 0.001) (Table 2), correlations for 24HUV and FBC were greater ( > 0.80) than NUV and ANV. Taken together, these data suggest greater intra-chart variability for nocturnal parameters and lesser reliability for the first day of the 3-day series.
Discussion Studies have recommended the use of FV charts in patients with different urinary tract pathologies, with optimum durations ranging from 1-day to 7days (Table 3). An incomplete FV chart is of little value, and too short a chart period will lead to inaccuracies. Schick et al. [7] suggested that patient
Recommended chart length
Study
1 1 1 1 1 3 4
Present study [15] [16] [17] [11] [18] [7]
7
[19]
>3—4
[13]
compliance follows a logarithmic curve over time; higher when chart duration is short, and decreasing with increasing time. On the other hand, reliability follows a bell-shaped curve; low when the chart period is short, rapidly increasing to a peak, and subsequently decreasing in parallel with compliance. The optimum chart length can be determined from the intersection of these two curves. Studies evaluating the optimum FV chart duration in patients with LUTS/BOO are limited. Matthiesen et al. [18] estimated that a 3-day FV chart would be sufficient to detect nocturia in patients with potential benign prostatic hyperplasia (BPH). A study of 160 men found only ‘‘negligible’’ differences at an individual level between charts completed during a 24-h period and those completed over 3 or more days [11]. In a study of 67 men, a 3-day FV chart was suggested as the best compromise with little added advantage from a chart of longer duration [8]. It was suggested that the chart should consist of both days of the weekend plus either Friday or Monday, as there was less missing data at weekends in comparison to weekdays. Yap et al. [13] suggest that a 1-day chart is insufficient for the diagnosis and monitoring of
A one-day frequency-volume chart is representative of a 3-day chart LUTS/BOO, but may be suitable for symptom stratification. Decreased nocturnal bladder capacity in BPH may occur in isolation, or in combination with detrusor overactivity and other causes of nocturia. Our data reveal poorer correlation of nocturnal indices (ANV and NUV) between one and 3-day FV charts as compared to 24HUV and FBC, and significant differences in the former parameters between the first and latter days of the 3-day chart. This may represent less accurate documentation of nocturnal voids on the first day of the chart or greater variation of nocturnal voiding pattern on a day-today basis. Furthermore, an overall average from a 3-day chart may mask significant symptoms on a particular day. Although ‘‘test—re-test’’ reliability is important [12,13] it may be difficult to undertake repeated single measurements in a clinical setting. Ascertaining whether the chart period was typical of the patients’ voiding pattern can assist the clinician to assess changes in symptoms following therapeutic intervention [14].
Conclusion FV charts are a simple, non-invasive and costeffective diagnostic adjunct in the assessment of a patient with LUTS/BOO. Our data suggest that data from a one-day FV chart is representative of a 3-day equivalent for the assessment of 24HUV and FBC in patients with LUTS/BOO. However, there are other parameters that can be obtained from a FV chart, and further studies are required to compare the repeatability and clinical utility of a single day chart compared with both 3-day and 7-day charts, particularly in the subgroup of patients with nocturnal symptoms.
Conflict of interest statement The authors declare that there are no conflicts of interest.
197
Acknowledgements We are grateful to Alan Hawes (Ferring UK) for developing the computer database used for data collection. Ferring UK was not involved in the study design, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
References [1] Barry MJ, Fowler Jr FJ, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. J Urol 1992;148:1549—57, discussion 1564. [2] Groutz A, Blaivas JG, Chaikin DC, Resnick NM, Engleman K, Anzalone D, et al. J Urol 2000;164:698—701. [3] Abrams P, Klevmark B, Scand. J Urol Nephrol Suppl 1996;179:47—53. [4] Schneider T, de la Rosette JJ, Michel MC. Int J Urol 2009;16(3):249—55. [5] Weiss JP, Blaivas JG. Urology 2002;60:28—32 [discussion 32]. [6] Weiss JP, Blaivas JG, Stember DS, Brooks MM. Neurourol Urodyn 1998;17:467—72. [7] Schick E, Jolivet-Tremblay M, Dupont C, Bertrand PE, Tessier J. Neurourol Urodyn 2003;22:92—6. [8] Belal M, Al-Hayek S, Cobby J, Swithinbank L, Abrams P.Proceedings of the 35th annual meeting of the international continence society. 2005. [9] Asplund R, Guttenbrunner C, Schreiber U. Prog Clin Biol Res 1987;227A:309. [10] van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S, et al. Neurourol Urodyn 2002;21: 179—83. [11] Gisolf KW, van Venrooij GE, Eckhardt MD, Boon TA. Eur Urol 2000;38:45—52. [12] Bryan NP, Chapple CR. Eur Urol 2004;46:636—40. [13] Yap TL, Cromwell DA, Brown C, Emberton M, van der Meulen J. BJU Int 2007;100:111—5. [14] Govindaraju SK, Neilson D. Eur Urol 2005;48:171—2 [author reply 172]. [15] van Haarst EP, Heldeweg EA, Newling DW, Schlatmann TJ. BJU Int 2004;93:1257—61. [16] van Melick HH, Gisolf KW, Eckhardt MD, van Venrooij GE, Boon TA. Urology 2001;58:188—92. [17] Mazurick CA, Landis JR. J Urol 2000;163:1208—11. [18] Matthiesen TB, Rittig S, Mortensen JT, Djurhuus JC. BJU Int 1999;83:1017—22. [19] Wyman JF, Choi SC, Harkins SW, Wilson MS, Fantl JA. Obstet Gynecol 1988;71:812—7.
Available online at www.sciencedirect.com