536 DOI: 10.26717/BJSTR.2017.01.000239 Tim Idzenga. Biomed J Sci & Tech Res Research Article Open Access Assessing the Quality of Perineal Auscultation for A Noninvasive Diagnosis of Urinary Bladder Outlet Obstruction Geert Geleijnse 1 , Jan Groen 1 , Ron van Mastrigt 1 and Tim Idzenga 1,2* 1 Department of Urology, Erasmus Medical Center, Rotterdam, Netherlands 2 Department of Urology, Academic Medical Center, Amsterdam, Netherlands Received: July 18, 2017; Published: July 31, 2017 *Corresponding author: Tim Idzenga, Erasmus Medical Center, Department of Urology, PO BOX 20403000 CA Rotterdam, Netherlands, Tel: ; Fax: ; E-mail: Introduction In men the prostate generally increases in size with age, most often as a result of Benign Prostatic Enlargement (BPE). The latter may lead to Bladder Outlet Obstruction (BOO). Men with BOO generally have Lower Urinary Tract Symptoms (LUTS), including a weak urinary stream, frequent voiding (also nocturnal) and residual urine in the bladder after voiding. The current standard method for diagnosing BOO is a pressure-flow study (PFS) which is part of a (video) urodynamic examination (VUDE). The pressure flow study consists of a urinary flow measurement while simultaneously recording the detrusor pressure using a catheter inserted in the bladder and a second catheter in the rectum. This method is time- consuming, costly, uncomfortable to the patient and potentially harmful (it may lead to serious side-effects).This poses a threshold for preoperative testing. To lower this threshold, easy-to-use non- invasive urodynamic testing methods have been developed such as the Doppler flow metry method [1], the condom-catheter method [2], the penile cuff method [3], bladder wall thickness measurement [4] and most recently perineal auscultation [5-6]. All of these methods have some drawbacks. The latter technique records the sound generated by the urinary flow through the urethra with Cite this article: Geert G, Jan G, Ron v M, *Tim I. Assessing the Quality of Perineal Auscultation for A Noninvasive Diagnosis of Urinary Bladder Outlet Obstruction. Biomed J Sci & Tech Res 1(2)-2017. BJSTR. MS.ID.000239. DOI: 10.26717/BJSTR.2017.01.000239 Abstract Objectives: The current standard method for diagnosing bladder outlet obstruction in patients with Lower Urinary Tract Symptoms (LUTS) is a pressure-flow study. Electronic perineal auscultation, i.e. recording sound with a contact microphone behind the scrotum during voiding, might be an easy-to-use non-invasive alternative. Of major importance for the clinical applicability of perineal auscultation is the quality of the sound recording. Methods: In a clinical population of 74 male LUTS patients we studied two measures for assessing the quality of electronic perineal auscultation: a Normalized Correlation Coefficient (NCC) and Signal-To-Noise Ratio (SNR). We compared these measures with the visual assessment of the electronic auscultatory signal by three experienced observers. The agreement between the experienced observers was expressed using the Weighted Kappa statistic. Both quality measures were compared to the combined visual assessments using the Kruskal Wallis test and the usefulness was evaluated using ROC-analysis. Results: The Weighted Kappa values between the three observers were 0.73, 0.66 and 0.76 (p<.05).For recordings classified as ‘good’ by the observers, the NCC was significantly higher than for the ‘medium’ and ‘poor’ quality recordings (p<.05). The areas under the ROC curve were 0.84 and 0.66 (both significant, p<.05) for NCC and SNR, respectively. Conclusion: We developed quality criteria to assess the quality of electronic perineal auscultation in patients with LUTS. These quality measures can be used to select auscultatory measurement signals that are suitable for further analysis and for improving the perineal auscultation setup. Keywords: Bladder outlet obstruction; Noninvasive; Normalized cross correlation; Perineal auscultation; Quality measure Abbreviations: LUTS: Lower Urinary Tract Symptoms; NCC: Normalized Correlation Coefficient; SNR: Signal To Noise Ratio; BPE: Benign Prostatic Enlargement; BOO: Bladder Outlet Obstruction; LUTS: Lower Urinary Tract Symptoms; PFS: Pressure-Flow Study; VUDE: Video Uro Dynamic Examination; NCC: Normalized Correlation Coefficient; SNR: Signal-To-Noise Ratio; ROC: Receiver Operator Characteristic; NOW: Netherlands Organization for Scientific Research ISSN: 2574-1241