LAUSR

available at http://www.ncbi.nlm.nih.gov/pubmed/28631835 Editorial Comment: This approach, which seems to be successful, was first described by Nitti and Raz in 1994, and the first series was published by Petrou et al in 1999. The only addition here seems to be the use of a Martius flap. Although in this article the authors state, “We believe the Martius flap interposition is critical to preventing the current fixation of the urethra to the pubic bones and thus achieving improved voiding,” to my knowledge no such problems were reported as long-term consequences in the 2 prior articles. Alan J. Wein, MD, PhD (hon) References 1. Nitti VW and Raz S: Obstruction following anti-incontinence procedures: diagnosis and treatment with transvaginal urethrolysis. J Urol 1994; 152: 93. 2. Petrou SP, Brown JA and Blaivas JG: Suprameatal transvaginal urethrolysis. J Urol 1999; 161: 1268. Re: Developing and Validating a New Nomogram for Diagnosing Bladder Outlet Obstruction in Women E. Solomon, H. Yasmin, M. Duffy, T. Rashid, E. Akinluyi and T. J. Greenwell University College London Hospitals NHS Trust, Imperial College Healthcare NHS Trust, Charing Cross Hospital, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom Neurourol Urodyn 2018; 37: 368e378. doi: 10.1002/nau.23307 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28666055available at http://www.ncbi.nlm.nih.gov/pubmed/28666055 Editorial Comment: These authors get credit for tackling what is among the most difficult issues in neurourology, ie urodynamically diagnosing bladder outlet obstruction (BOO) in women. They cite 7 different methodologies in their level of agreement in table 3 in the article. They state that a female BOO index can be calculated mathematically using the formula, BOOIf [ Pdet.Qmax e 2.2*Qmax, where BOOIf is female BOO index, Pdet.Qmax is maximum detrusor pressure and Qmax is maximum flow rate. A value of less than 0 yields a less than 10% probability of obstruction, greater than 5 a 50% probability and greater than 18 almost certain obstruction (greater than 90% probability). The authors should certainly be recognized for bringing up this topic once again but it should be pointed out that bladder outlet obstruction (validation) was based on what was considered to be radiographic evidence of BOO as defined by Nitti et al in 1999. The authors also specify that “the proposed nomogram does not allow for the diagnosis of BOO in the presence of detrusor underactivity.” The authors indicate that they calculated the sensitivity and specificity of the formula at 0.86 and 0.93, respectively, and that their nomogram shows excellent agreement with the radiographic definition by Nitti et al (Cohen kappa 0.80, p <0.01). Alan J. Wein, MD, PhD (hon) Reference 1. Nitti VW, Tu LM and Gitlin J: Diagnosing bladder outlet obstruction in women. J Urol 1999; 161: 1535. VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY 865 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.