Neurourology and Urodynamics Uroflowmetry in Healthy Women: A Systematic Review Marique R. Sorel, 1 * Hans J. B. Reitsma, 2 Peter F. W. M. Rosier, 1 Ruud J. L. H. R. Bosch, 1 and Laetitia M. O. de Kort 1 1 Department of Urology, University Medical Center, Utrecht, The Netherlands 2 Department of Epidemiology, University Medical Center, Utrecht, The Netherlands Background: Although uroflowmetry is a widely used diagnostic test, reference values of uroflowmetry parameters in women are lacking making it difficult to interpret the test results. Aim: To quantify the range of results in uroflowmetry parameters in healthy women based on a systematic review. Methods: A search was made in the International Continence Society standardization articles, PubMed, Embase and the Cochrane Library (from inception to 27 February 2014). Studies on uroflowmetry in healthy women were included. The selected articles were examined using a critical appraisal process based on the QUADAS-2 tool and the Critical Appraisal Skills Program. Results: Mean values of uroflowmetry parameters in healthy women (mean age 37.1 years) were: voided volume (VV) 338 ml (SD 161), maximum flow rate (Qmax) 23.5 ml/s (SD 10), average flow rate (Qave) 13 ml/s (SD 6), postvoid residual (PVR) 15.5 ml (SD 25), voiding time (VT) 29 sec (SD 17), and time to maximum flow rate (time to Qmax) 8 sec (SD 6). Qmax was dependent on VV. There was no clear relationship between Qmax and age, and no correlation between parity and Qmax. A normal shape of the uroflowmetry curve was seen in 70–80% of the flows. Conclusion: This systematic review provides an overview of the range of results of uroflowmetry parameters in healthy women. Neurourol. Urodynam. # 2016 Wiley Periodicals, Inc. Key words: flow curve; healthy women; reference value; uroflowmetry INTRODUCTION Uroflowmetry is a widely used diagnostic test in urology practice. This test gives objective and quantitative information, which helps to understand voiding symptoms. Furthermore, because it is non-invasive and relatively inexpensive, it is an obligatory screening test for patients with suspected lower urinary tract (LUT) dysfunction. However, for a reliable quantification of abnormality it is necessary to establish the range of results of uroflowmetry parameters in healthy persons. Despite extensive research on the diagnostic application of uroflowmetry in men, few studies are available in women. Moreover, research in women is limited by a lack of absolute values defining normal limits 1 and lack of data on the incidence of an abnormal shape of the curve in healthy women. The International Continence Society (ICS) has not defined normal voiding ranges according to maximum flow rate (Qmax) in healthy women. 2 The ICS defined a normal, intermittent and multiple peak flow, 3 but there is considerable room for various interpretations of these definitions. Haylen et al. 4 composed the Liverpool Nomogram, which offers reference ranges for Qmax and average flow rate (Qave) and covers a wide range of voided volumes (VVs). Reference values for a minimum flow rate in relation to a particular VV need to be validated. Barapatre et al. 5 also composed a flow-volume nomogram. There is a significant difference when plotting their mean data in the Liverpool nomogram. Although considerable uroflowmetry data have been col- lected to create nomograms, there is no clarity regarding reference values in healthy women, their variations, and which factors are influencing these values. Therefore, the present study investigates data on reference values of uroflowmetry parameters and the shape of the curve in healthy women based on a systematic review of the literature. METHODS This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Appendix S1 PRISMA check list). A literature search was made (up to 27 February 2014) in the ICS standardization articles, PubMed, Embase and the Cochrane Library. Various synonyms were used for ‘‘woman’’ and ‘‘uroflowmetry.’’ Two investigators (LdK and MS) independently screened the titles and abstracts of all the retrieved articles. Types of Studies, Participants, and Interventions Studies were included in this review if they met the following criteria: (i) randomized controlled trials, prospective compara- tive studies, retrospective comparative studies, case-control studies, case series, observational studies or guidelines, and written in the English language with abstract available, (ii) subjects were healthy female volunteers who performed a free flow in a sitting position. Excluded were (i) animal studies and (ii) reviews, overviews, and opinions. Abbreviations: ICS, International Continence Society; PVR, postvoid residual; Qave, average flow rate; Qmax, maximum flow rate; SD, standard deviation; Time to Qmax, time to maximum flow rate; VT, voiding time; VV, voided volume. Dr. Fred Milani led the peer-review process as the Associate Editor responsible for the paper. Potential conflicts of interest: Dr. Bosch reports grants and personal fees from Astellas, grants and personal fees from GSK, personal fees from AstraZeneca, personal fees from Ferring, outside the submitted work; Dr. Rosier reports grants from Astellas, grants from Laborie/MMS/Tdoc, grants from ONO-Pharma, outside the submitted work; Dr. Sorel has nothing to disclose; Dr. Reitsma has nothing to disclose; Dr. de Kort has nothing to disclose.  Correspondence to: Marique Sorel, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. E-mail: m.r.sorel-3@umcutrecht.nl Received 29 December 2015; Accepted 23 May 2016 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.23051 # 2016 Wiley Periodicals, Inc.