Neurourology and urodynamics
October 12, 2026 · via Europe PMC
Bladder Contractility Classification Before Bladder Outlet Surgery: Do BCI, Wmax and the Maastricht-Hannover Nomogram Agree and Does It Matter for Outcome?
Palthe S, van Merode NAM, Kolenburg J, Marcelissen T, Steffens MG, van Koeveringe GA, Heesakkers JP, Witte LPW.
AI summary — for doctors, generated from the abstract only
Three bladder contractility classifications showed only limited agreement and none predicted short-term outcomes after bladder outlet surgery.
What was studied
Multicentre retrospective cohort of 133 men (median age 69) who had bladder outlet surgery in 2010-2016 with baseline urodynamics and 6-week flowmetry, comparing the bladder contractility index (BCI), Maximum Watt's factor (Wmax) and the Maastricht-Hannover nomogram.
Key findings
- Agreement was highest between BCI and Wmax (78.9%, kappa 0.61)
- Agreement was weak between Wmax and the nomogram (48.9%, kappa 0.31) and negligible between BCI and the nomogram (37.6%, kappa 0.05)
- All subgroups improved in Qmax and PVR after surgery, with no significant association with preoperative contractility grade
Clinical relevance
The classifications are not interchangeable, and preoperative contractility grade should not by itself exclude men from outlet surgery; shared decision-making is supported.
Who should care
Limitations
Retrospective with short 6-week follow-up. The abstract's subgroup threshold definitions are partly garbled in the source text, so exact cut-offs cannot be restated.
A consensus urodynamic definition of detrusor underactivity is needed, since current tools disagree.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
The aim of this study was to assess the concordance between three classification systems (bladder contractility index, Maximum Watt's factor and Maastricht-Hannover nomogram) in allocating men to bladder contractility subgroups. Secondary aim was to explore whether preoperative contractility classification was associated with short-term flowmetry outcomes after BOP.
Materials and methods
This multicenter retrospective cohort study included men who underwent BOP (2010-2016) for lower urinary tract symptoms with available baseline urodynamic study and 6-week postoperative flowmetry. Patients were classified according to BCI, Wmax and MH-nomogram into very weak (BCI 100, Wmax > 10, MH-nomogram > 25th percentile) subgroups. Concordance was quantified using percentage agreement and Cohen's linear weighted kappa (κ). Postoperative flowmetry outcomes were compared between subgroups within each classification and pre-postoperative differences were determined for each subgroup.
Results
One hundred and thirty three patients were included (median age 69 years). Agreement was highest between BCI and Wmax (78.9%, κ = 0.61, substantial), while agreement was weak between Wmax and MH-nomogram (48.9%, κ = 0.31) and negligible between BCI and MH-nomogram (37.6%, κ = 0.05). All subgroups showed improvement Qmax and PVR parameters after BOP, with no significant association found between preoperative contractility grade and postoperative outcomes.
Conclusions
BCI, Wmax and the MH-nomogram show only limited concordance, particularly involving the MH-nomogram, and cannot be regarded as interchangeable. Contractility classification was not associated with postoperative outcomes, and all subgroups improved after BOP. These findings underscore the need for a clinically relevant urodynamic consensus definition of DU and support shared decision-making over classification-based patient selection alone.
DOI
10.1002/nau.70489
PMID
42861763
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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