Materials and methods: Uroflowmetry studies were obtained in 296 women who participated in an observational cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for interrater reliability. A random subset of 50 tracings was re-reviewed by each investigator for intrarater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous fluctuating, interrupted, and prolonged. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters is summarized with kappa (k) statistics and percentage where at least three raters agreed.
Results: The mean age of participants was 44.8 ± 18.3 years. Participant age categories were 18-24 years: 20%; 25-34 years: 17%; 35-64 years: 42%; 65+ years: 18%. Nine percent described their race as Asian, 31% Black, 62% White, and 89% were of non-Hispanic ethnicity. The interrater reliability was highest for the continuous flow category (k = 0.65), 0.47 for prolonged, 0.41 for continuous fluctuating, and 0.39 for interrupted flow curves. Agreement among at least three raters occurred in 74.3% of uroflow curves (69% for continuous, 33% for continuous fluctuating, 23% for interrupted, and 25% for prolonged). For intrarater reliability, the mean k was 0.72 with a range of 0.57-0.85.
Conclusions: Currently accepted uroflowmetry pattern categories have fair to moderate interrater reliability, which is lower for flow curves that do not meet "continuous" criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use in research and as a screening tool for LUTS and voiding dysfunction.
Trial registration: Parent trial: Validation of Bladder Health Instrument for Evaluation in Women (VIEW); ClinicalTrials.gov ID: NCT04016298.
Leslie M Rickey,1 Elizabeth R Mueller,2 Diane K Newman,3 Alayne D Markland,4 Chloe Falke,5 Kyle Rudser,5 Ariana L Smith,6 Margaret G Mueller,7 Jerry L Lowder,8 Emily S Lukacz,9 Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium
- Department of Urology & Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA.
- Department of Obstetrics and Gynecology, Loyola University Chicago, Chicago, Illinois, USA.
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA.
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA.
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
- Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, Illinois, USA.
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
- Division of Female Pelvic Medicine & Reconstructive Surgery, UC San Diego, San Diego, California, USA.
Source: Rickey LM., Mueller ER., Newman DK. et al. Reliability of Uroflowmetry Pattern Interpretation in Adult Women. Neurourol Urodyn. 2024 Sep 12. doi: 10.1002/nau.25584.