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| Uroflowmetric analysis and derivation of nomograms for normal paediatric Indian population between 5 to 15 years of age |
Abhay D. Mahajan*( ),Lakshman P. Singh,Prashant P. Darakh,Sandeep T. Bathe,Martand G. Patil,Arpit R. Sharma
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| Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, Maharashtra, India |
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Abstract Objective: We aimed to established normal uroflowmetric values and subsequently derived nomograms of maximum flow rate (Qmax) and average flow rate (Qavg) against voided volume (VV) in children aged 5-15 years at our institute. Methods: A total of 440 children underwent uroflowmetric evaluation with no history of urological, renal, psychiatric, or neurological disorder between 5 and 15 years of age. Each subject data regarding Qmax, Qavg, VV, time to Qmax, and flow time, as well as age, sex, height, and weight were recorded. Of the 440 children, around 300 (68.18%) children could produce a normal flow rate at VV of more than 50 mL. Of the remaining 140 (31.82%) children, 50.00% voided less than 50 mL, and remaining 50.00% had abnormal voiding pattern, staccato or interrupted (21.43% each) and plateau or tower shaped (3.57% each). Cases were divided into two age groups (5-9 years and 10-15 years), and uroflowmetric analysis was done between boys and girls in both age groups to derive nomograms of Qavg and Qmax. Results: Qmax and Qavg flow nomograms were plotted for boys and girls. Mean Qmax for boys was 16.68 mL/s and for girls 20.69 mL/s. The mean Qavg values were 11.04 mL/s and 8.60 mL/s for girls and boys, respectively. The Qmax and Qavg values were higher in girls. There were significant increases in flow rates with increasing age, body surface area, and VV in both sexes. Conclusions: Nomograms for Qmax and Qavg may be a useful tool in evaluation of lower urinary tract disturbances in children.
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Received: 28 September 2020
Available online: 20 April 2022
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Corresponding Authors:
Abhay D. Mahajan
E-mail: drabhaymahajan@gmail.com
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| Uroflow pattern | Frequency, n | Percentage (%) | | Normal flow rate | 300 | 68.18 | | Abnormal flow rate | 140 | 31.82 | | Voided volume <50 mL | 70 | 50.00 | | Staccato | 30 | 21.43 | | Interrupted | 30 | 21.43 | | Plateau | 5 | 3.57 | | Tower | 5 | 3.57 |
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Distribution of uroflow pattern in all the evaluated children.
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| Variable | Boy, n (%) | Girl, n (%) | Total, n (%) | | Voided volume <50 mL | | 5-9 years | 30 (71.43) | 20 (71.43) | 50 (71.43) | | 10-15 years | 12 (28.57) | 8 (28.57) | 20 (28.57) | | Staccato pattern | | 5-9 years | 14 (66.67) | 6 (66.67) | 20 (66.67) | | 10-15 years | 7 (33.33) | 3 (33.33) | 10 (33.33) | | Interrupted | | 5-9 years | 13 (59.09) | 7 (87.50) | 20 (66.67) | | 10-15 years | 9 (40.91) | 1 (12.50) | 10 (33.33) | | Plateau | | 5-9 years | 2 (66.67) | 1 (50.00) | 3 (60.00) | | 10-15 years | 1 (33.33) | 1 (50.00) | 2 (40.00) | | Tower pattern of voiding | | 5-9 years | 1 (100.00) | 3 (75.00) | 4 (80.00) | | 10-15 years | 0 (0.00) | 1 (25.00) | 1 (20.00) |
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Distribution of excluded children according to sex and age.
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| Uroflowmetry parameter | Boy | Girl | p-Value | | Qmaxa, mL/s | 16.68±4.48 | 20.69±5.08 | <0.0001 | | Qavga, mL/s | 8.60±2.29 | 11.04±2.72 | <0.0001 | | VVa, mL | 137.68±64.66 | 154.43±97.51 | 0.55 | | Time to Qmaxa, s | 5.78±2.20 | 5.50±1.88 | 0.23 | | Flow timea, s | 13.03±4.38 | 13.31±7.50 | 0.062 |
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Mean uroflowmetry parameters by gender.
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| Uroflowmetry parameter | Aged 5-9 years | Aged 10-15 years | | Boys | Girls | p-Value | Boys | Girls | p-Value | | Qmaxa, mL/s | 15.12±4.09 | 19.34±3.48 | <0.0001 | 19.06±4.01 | 23.57±4.45 | <0.0001 | | Qavga, mL/s | 8.05±2.06 | 10.25±1.52 | <0.0001 | 9.43±2.38 | 11.64±3.31 | <0.0001 | | VVa, mL | 135.32±70.71 | 116.21±49.24 | 0.272 | 141.27±54.46 | 187.35±115.6 | 0.058 | | Time to Qmaxa, s | 5.47±2.14 | 4.88±1.64 | 0.037 | 6.25±2.22 | 6.03±1.92 | 0.645 | | Flow timea, s | 13.14±4.59 | 11.98±4.94 | 0.017 | 12.87±4.06 | 14.45±9.03 | 0.453 |
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Mean uroflowmetry parameters according to age groups and sexes.
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Correlations of Qmax and Qavg with age and BSA in girls. (A) Correlation of Qmax with age; (B) Correlation of Qavg with age; (C) Correlation of Qmax with BSA; (D) Correlation of Qavg with BSA. Qmax, maximum flow rate; Qavg, average flow rate; BSA, body surface area.
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Correlations of Qmax and Qavg with age and body surface area in boys. (A) Correlation of Qmax with age; (B) Correlation of Qavg with age; (C) Correlation of Qmax with BSA; (D) Correlation of Qavg with BSA. Qmax, maximum flow rate; Qavg, average flow rate; BSA, body surface area.
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Nomograms for Qmax and Qavg in girls aged 5-15 years. (A) Nomogram for Qmax rate in girls age 5-15 years; (B) Nomogram for Qavg in girls aged 5-15 years. The quintile regression method was used to establish the percentile levels (5th, 10th, 25th, 50th, 75th, 90th, and 95th). Qmax, maximum flow rate; Qavg, average flow rate; VV, voided volume.
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Nomograms for Qmax and Qavg in boys aged 5-15 years. (A) Nomogram for Qmax flow rate in boys aged 5-15 years; (B) Nomogram for Qavg in boys aged 5-15 years. The quintile regression method was used to establish the percentile levels (5th, 10th, 25th, 50th, 75th, 90th, and 95th). Qmax, maximum flow rate; Qavg, average flow rate; VV, voided volume.
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