|Year : 2016 | Volume
| Issue : 4 | Page : 293-295
Uroflow nomogram for healthy, 15-40 year old Indian men
Naveen Diwanand Thakur, Abhirudra Ramkrishna Mulay, Vikram Pramod Satav, Deepak Anandrao Mane, Vilas Pandurang Sabale, Sharad Kumar Kankalia
Department of Urology, Dr. D.Y. Patil Medical College, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||28-Sep-2016|
Naveen Diwanand Thakur
Department of Urology, Dr. D.Y. Patil Medical College, Sant Tukaram Nagar, Pimpri, Pune - 411 018, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Uroflowmetry is the objective method of measuring rate of urine flow. Nomograms are required to observe the change in flow rates at different voided volumes (VVs) and the use of which overcomes the limitation of referencing flow rates to any single VV. The purpose of the present study was to construct the Indian uroflow nomogram for adult healthy males between 15-40 years of age.
Methods: A total of 1000 healthy males between 15 and 40 years of age were included in the study. Exclusion criteria were any urinary symptoms or urological intervention. Parameters analyzed statistically were age, peak flow rate (Q max ), average flow rate (Q avg ), and VV. A nomogram was drawn for the fitted regression model.
Results: The mean age was 27.26 6.71 years. The mean Q max , Q avg , and VV were 24.32 3.50 ml/s, 9.45 2.55 ml/s, and 420.93 97.89 ml, respectively. The correlation between flow rates and VV was statistically significant, indicating that the higher the VV, the higher the flow rates. A negative significant correlation of Q max with age was seen in our study. We observed a decline of Q max by 1 ml/s/decade. The relationship of Q max with VV is in linear progression up to 600 ml, and then it becomes a plateau and with higher VV it declined.
Conclusion: Q max exhibits significant correlation with VV and age. A nomogram was constructed to attain normal reference values of flow rate over different VVs.
Keywords: Average flow rate, nomogram, peak flow rate, uroflow, voided volume
|How to cite this article:|
Thakur ND, Mulay AR, Satav VP, Mane DA, Sabale VP, Kankalia SK. Uroflow nomogram for healthy, 15-40 year old Indian men. Indian J Urol 2016;32:293-5
| Introduction|| |
Uroflowmetry is the objective method of measuring rate of urine flow; peak flow rate (Q max ), average flow rate (Q avg ), and voided volume (VV) are important parameters recorded for interpretation. , It is an easy and noninvasive procedure.  It can be repeated easily and hence useful for diagnosis and monitoring treatment results. , Nomograms help to observe the change in flow rates at different VVs and their use overcomes the limitations of referencing flow rates to any single VV.  In addition, age has a significant impact on micturition. A nomogram in centile form was constructed to attain normal reference values of flow rates over different VVs in various age groups. ,,,,, Since flow rates may vary with populations, we constructed a uroflow nomogram for Indian men. We aimed to establish normal reference values of flow rates over wide range of VVs in healthy Indian men between 15 and 40 years of age, to evaluate the effects of age and VV over urinary flow parameters, and to construct a flow rate-VV nomogram in centile form.
| Methods|| |
Institutional Ethical Committee approval was obtained prior to the commencement of the study. Between October 2013 and September 2015, 1000 healthy male individuals who accompanied patients visiting the urology outpatient department (OPD) were included in the study. Subjects with a history of neurological disease, psychological disease, diabetes mellitus, urological disease (lower urinary tract symptoms, urinary tract infection, bladder and urethral stones, bladder cancer, meatal stenosis, etc.,) and those with ongoing medical treatment that affected lower urinary system function (such as anticholinergics, alpha-blockers, 5-alpha reductase inhibitors, alpha stimulants, and antibiotics) were excluded from the study. Informative and interactive sessions for the subjects were taken prior to the study and written informed consent was obtained from each participant who was willing for the study. Relevant history and clinical examination were performed to evaluate the health of the participant.
Uroflowmetry was performed using Solar urodynamic apparatus (Medical Measurements System, Enschede, The Netherlands) in the urology OPD at a separate room to ensure complete privacy. Participants were instructed to present with a full bladder (holding urine), and the test was performed when they had the normal sensation to urinate. They were asked to void in their usual way. The test was explained to all the participants before the session. Uroflowmetry was performed using a gravimetric uroflowmeter. The uroflowmeter was calibrated at regular intervals to ensure consistency using an internal self-calibration program. The parameters evaluated were age, Q max , Q avg , and VV.
At the end of the study, a statistical analysis was done. We used Karl Pearson's correlation coefficient to find the correlation between the variables. We used linear regression model for Q max and Q avg as responses with age and VV as independent variables. A nomogram was drawn for the fitted regression model. The softwares used were R - 3.2.1, Minitab 16, and Stata. (R is free software environment for Statistical computing The R Foundation USA, Minitab Ltd Brandon Court Conventry CV3 2TE United Kingdom and Stata Corp LP Texas USA.)
| Results|| |
The result of different parameters of the study group is shown in [Table 1]. The mean age was 27.26 ± 6.71 years. The mean Q max , Q avg , and VV were 24.32 ± 3.50 ml/s, 9.45 ± 2.55 ml/s, and 420.93 ± 97.89 ml, respectively. The correlation of Q max and Q avg with VV was statistically significant (Pearson's correlation coefficient r = 0.31 and r = 0.18, P < 0.0001, respectively). The correlation between Q max and age was found to be significant (Pearson's correlation coefficient r = −0.21, P < 0.0001), but Q avg was not significantly correlated with age (Pearson's correlation coefficient r = −0.013 and P = 0.681). There was decline of Q max observed by 1 ml/s/decade (F = 20.832 and P < 0.0001; [Table 2]). Q max increases with VV up to 600 ml, followed by plateau phase up to 750 ml, and above 750 ml, decline in Q max was observed (F = 26.381 and P < 0.0001) as shown in [Table 3]. The regression equation for peak and Q avg based on VV and age is given in Box 1. The nomogram plotted in centile form for Q max and VV is shown in [Figure 1].
|Figure 1: Uroflowmetry nomogram of peak flow rate in 15-40 years old male population in India|
Click here to view
| Discussion|| |
Nomograms have been constructed to attain normal reference values of flow rates over different VVs in centile form.  Siroky et al. were among the first to develop such a nomogram.  The mean Q max of healthy adult males between 15 and 40 years of age in our study was 24.32 ± 3.50 ml/s. The mean Q max of our study was greater than the study done by Kumar et al. on Indian population but lower than the Austrian and Thai population as shown in [Table 4]. ,, The disparity of the results maybe due to difference in age groups. In our study, healthy males between 15 and 40 years of age were included in the study while the age group of healthy male population in the study of Kumar et al. was 16-50 years.  However, the Austrian study had included younger males of 18 years while in the Thai population study, males between 18 and 30 years of age were included. ,
The correlation between Q max and Q avg with VV was found statistically significant (Pearson's correlation coefficient r = 0.31 and r = 0.18, P < 0.0001, respectively), indicating that the higher the VV, the higher the flow rates, as also seen in various studies. ,, A negative but significant correlation of Q max with age was seen in our study (Pearson's correlation coefficient r = −0.21, P < 0.0001); similar negative correlations between Q max and age were observed in other studies. ,, We observed the decline of Q max by 1 ml/s/decade (F = 20.832 and P < 0.0001), and similar results were reported by Drach et al. in their study.  Kumar et al. also noted a decline of 1 ml/s/decade in Q max in their study. 
The relationship of Q max with VV is in linear progression up to 600 ml, and then it becomes a plateau, with higher VV it declines (F = 26.381 and P < 0.0001). A similar correlation was reported by Kumar et al. at 700 ml.  A similar study was conducted by Pernkopf et al., who found a positive correlation of VV and Q max up to 350 ml, from 350 to 550 ml, Q max remains same and a decrease in Q max after 550 ml.  Bross et al. in their investigations proved experimentally a decrease of intravesical pressure at supraphysiological volumes. 
| Conclusion|| |
Q max and Q avg exhibit significant positive correlation with VV while age is inversely proportional to Q max and Q avg in healthy Indian males between 15 and 40 years of age. A nomogram was constructed to attain normal reference values of flow rate over different VVs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumar V, Dhabalia JV, Nelivigi GG, Punia MS, Suryavanshi M. Age, gender, and voided volume dependency of peak urinary flow rate and uroflowmetry nomogram in the Indian population. Indian J Urol 2009;25:461-6.
Gupta DK, Sankhwar SN, Goel A. Uroflowmetry nomograms for healthy children 5 to 15 years old. J Urol 2013;190:1008-13.
Siroky MB, Olsson CA, Krane RJ. The flow rate nomogram: I. Development. J Urol 1979;122:665-8.
Pernkopf D, Plas E, Lang T, Daha K, Kubin K, Treu T, et al.
Uroflow nomogram for male adolescents. J Urol 2005;174 (4 Pt 1):1436-9.
Suebnukanwattana T, Lohsiriwat S, Chaikomin R, Tantiwongse A, Soontrapa S. Uroflowmetry in normal Thai subjects. J Med Assoc Thai 2003;86:353-60.
Haylen BT, Ashby D, Sutherst JR, Frazer MI, West CR. Maximum and average urine flow rates in normal male and female populations - The Liverpool nomograms. Br J Urol 1989;64:30-8.
Drach GW, Layton TN, Binard WJ. Male peak urinary flow rate: Relationships to volume voided and age. J Urol 1979;122:210-4.
Bross S, Schumacher S, Scheepe JR, Zendler S, Braun PM, Alken P, et al.
Effects of acute urinary bladder overdistension on bladder response during sacral neurostimulation. Eur Urol 1999;36:354-9.
[Table 1], [Table 2], [Table 3], [Table 4]
|This article has been cited by|
||A new nomogram of urinary flow rate and volume based on multiple measurements per healthy adult Japanese men using a portable uroflowmeter (P-Flowdiary®)
| ||Masatake Shinohara, Kazumasa Torimoto, Chie Matsushita, Daisuke Gotoh, Hisashi Yoshida, Toshihisa Saka, Yoshihiko Hirao, Akihide Hirayama, Kiyohide Fujimoto |
| ||BMC Urology. 2022; 22(1) |
|[Pubmed] | [DOI]|
||Comparing Mathieu and Tubularized Incised-Plate Urethroplasties for Repairing Distal Penile Hypospadias: A Single-Center Experience with Long-term Outcome
| ||Leily Mohajerzadeh, Arash Dooghaie Moghadam, Ahmad Khaleghnejad Tabari, Mohsen Rouzrokh, Nadiya Moghimi |
| ||Iranian Journal of Pediatrics. 2021; 31(3) |
|[Pubmed] | [DOI]|