La relación entre la sensación de vaciado incompleto y un residuo posmiccional elevado

espanolAntecedentes Algunos estudios han demostrado que los sintomas de vaciado no correlacionan con el residuo posmiccional elevado. Es importante contar con herramientas clinicas que permitan tomar decisiones prontas y efectivas en la primera consulta. Objetivo Evaluar la validez y el grado de concordancia entre la sensacion de vaciado incompleto y el residuo posmiccional elevado. Material y metodos Estudio transversal de pacientes a los que se les realizo uroflujometria (UFM) y medicion de residuo posmiccional (RP) por sintomas urinarios inferiores con determinacion simultanea de IPSS, ICIQ-FLUTS o ICIQ-MLUTS durante los anos 2014-2015. Analizamos la relacion entre estos datos con el volumen del residuo posmiccional. Resultados Se incluyeron 303 pacientes: 75 (24,8%) mujeres y 228 (75,2%) hombres, con una edad media de 60,9 anos (DE 15,8) y un Qmax medio de 14,47 ml/s (DE 9,6); 60 (19,8%) presentaron RP elevado. Se detectaron 240 (79,2%) pacientes con sensacion de vaciado incompleto (SVI) y su presencia no se asocio a RP elevado en la poblacion. Para la SVI, la sensibilidad, la especificidad, el valor predictivo positivo y negativo, y los cocientes de probabilidad positivos y negativos fueron de 81,6%, 21,3%, 20,4%, 82,5%, 1,03 y 0,85, respectivamente. El area bajo la curva para la frecuencia de SVI fue de 0,52 (IC 95%, 0,44-0,60, p = 0,5). El grado de concordancia entre SVI y RP elevado fue de 0,014 (p = 0,6). En el cuestionario ICIQ-MLUTS correlaciono RP con intermitencia (Rho = 0,132, p = 0,043) y no con SVI (Rho = 0,09, p = 0,15). En el ICIQ-FLUTS la frecuencia de incontinencia urinaria correlaciono positivamente con el RP (Rho = 0,216, p = 0,026). Conclusiones La sensacion de vaciado incompleto no se asocia a un residuo posmiccional elevado. Otras variables, como severidad de los sintomas, esfuerzo miccional y puntuacion total de sintomas de vaciado, pueden asociarse con una orina residual elevada. EnglishBackground Studies have shown that voiding symptoms do not correlate with a high postvoid residual volume. It is important to have clinical tools that help make early and effective decisions during the initial consultation. Objective To assess the validity and degree of concordance between the sensation of incomplete voiding and high postvoid residual volume. Material and methods Cross-sectional study of patients who underwent uroflowmetry (UFM) and postvoid residual volume (PVR) measurement due to lower urinary tract symptoms, with simultaneous scoring of International Prostate Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) or Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) during 2014-2015. We analysed the relationship between these data and the postvoid residual volume. Results The study included 303 patients, 75 (24.8%) of whom were women and 228 (75.2%) of whom were men. The mean age was 60.9 years (SD, 15.8), and the mean Qmax was 14.47 mL/s (SD, 9.6). Sixty (19.8%) patients had a high PVR. We detected 240 (79.2%) patients with sensations of incomplete voiding (SIV), but its presence was not associated with a high PVR in the population. For the SIV, the sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were 81.6%, 21.3%, 20.4%, 82.5%, 1.03 and 0.85, respectively. The area under the curve for the frequency of SIV was 0.52 (95% CI, 0.44-0.60, P = .5). The degree of concordance between SIV and high PVR was 0.014 (P = .6). In the ICIQ-MLUTS, PVR correlated with intermittence (Rho = 0.132, P = .043) but not with SIV (Rho = 0.09, P = .15). In the ICIQ-FLUTS, the frequency of urinary incontinence was positively correlated with PVR (Rho = 0.216, P = .026). Conclusions The sensation of incomplete voiding is not associated with a high postvoid residual volume. Other variables such as symptom severity, urinary effort and total score for voiding symptoms can be associated with a high residual urine volume.