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Interpretation

Before interpreting uroflowmetry, the scale should be adjusted to 1ml/sec on the vertical axis and
1sec/ml on the horizontal axis. The variables that recorded during uroflometry study are voided
volume, peak flow rate (Q max), flow time, average flow rate (Q mean), time to maximum flow,
voiding time, and flow pattern. Among those variable, voided volume, Q max and the shape of
uriflow curves are the most important for interpretation.
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Voided volume
The Peak Flow Rate (PFR) and Post Void Residual urine (PVR) are both affected by the voided
volume. Bladder overdistension defined as voided volume > 100% Estimated Bladder Capacity
(EBC), or bladder capacity >115% EBC. Normally, EBC is about 500 ml. Optimal bladder
capacity defined as voided volume between 50% and 100% EBC. Bladder overdistension is
associated with high rates of incomplete emptying and abnormal flow pattern.
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Peak Flow Rate
PFR is an important parameter in evaluation of adult voiding function, but it doesnt apply well
in children.
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It is defined as Qmax, the maximum measured value of the flow rate. Normal
values are 20-25 ml/sec in male and 25-30 ml/sec in female. Suspect obstruction if the flow rate
less than 15 ml/sec and defined obstruction if the flow rate less than 10 ml/sec.
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Flow Time
The time needed when the measurable flow actually occurs, it is 30 seconds in adult male and 20
seconds in adult female mostly.
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Average Flow Rate
Written down as Qmean, and its defined as the voided volume in a time of measurement. Qmean
can be calculated by dividing voided volume by the flow time. The calculation must meet the
condition of continuous flow and without terminal dribbling. Normal Qmax with high Qmean
indicates a sphincteric dysfunction.
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Time to Maximum Flow
The time elapsed until the PFR, the flow pattern must be described when flow time and average
flow rate measured.
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Voiding Time
It is defined as total duration of micturition including the interruption. When there are no
interruptions during voiding, then voiding time will be equal to flow time.
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Flow Pattern
International Childrens Continence Society recommends to classify 5 types of uroflowmetry
curves; bell, tower, plateau, staccato, and interrupted. Only bell shaped curves are regarded as
normal. Tower shaped curves are defined as high amplitude short duration curves or Qmax/flow
time > 2 (Figure 1A). Staccato curves are defined as continuous curves with sharp peaks and
through with fluctuations larger than square root of Qmax, and suggestive of sphincter
overactivity (Figure 1B). Interrupted or fractionated curves are defined as curves separated by
zero flow rates and are suggestive of detrusor underactivity (Figure 1C). Palateau curves are
defined as even flowmetry curves with low amplitude, suggestive of anatomical bladder outlet
obstruction (Figure 1D).
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Figure1. (A) Tower Shaped Curve, (B) Staccato Shaped Curve, (C) Interrupted curve, (D) Plateau shaped
curve







References
1. Yang SSD, Chiang IN and Chang SJ. Interpretation of Uroflowmetry and Post-Void
Residual Urine in Children: Fundamental Approach to Pediatric Non-neurogenic Voiding
Dysfunction. Incont Pelvic Floor Dysfunct; 2012; 6(1):9-12
2. Salam MA. Outlines of urodynamic studies and its clinical application (Review Article).
The ORION; 2001; 10:1-13

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