Comparison of Penile Cuff Test and Conventional Urodynamic Study Prior to Photoselective Vaporization of Prostate for Benign Prostate Hyperplasia Using a 120 W GreenLight High Performance System Laser

Abstract

Background: We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). Methods: Fifty-nine patients with voiding lower urinary tract symptoms (LUTS) underwent a simultaneous PCT and conventional UDS before PVP. The modified International Continence Society (ICS) nomogram was used to confirm bladder outlet obstruction after measuring maximum urinary flow rate and highest pressure at flow interruption. The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared. Their sensitivities, specificities, and positive and negative predictive values were calculated. Results: Thirty-six patients were diagnosed as obstructed and 23 as non-obstructed/equivocal using the modified ICS nomogram during the PCT. All 36 of the first group were confirmed as obstructed by UDS. Of the 23 diagnosed as non-obstructed/equivocal by the PCT, 14 were confirmed to be non-obstructed by UDS, with nine diagnosed as obstructed. The PCT showed a sensitivity of 80% and a specificity of 100%. The positive and negative predictive values were 100% and 60.9%, respectively. Conclusions: In conclusion, despite our small number of patients, the PCT’s high sensitivity and specificity suggest that it may provide diagnostic information about bladder outlet obstruction before PVP for patients with voiding LUTS. Evidently, the PCT has the potential to be used for some patients as a screening alternative to invasive UDS.

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

“… 34 37 50 One study evaluated a similar compression index as beforementioned and found a moderate sensitivity (78%) and good specificity (84%) at an index cut-off value of 160% to predict BOO. 34 The sensitivity for the measured maximum urinary flow with the penile cuff to predict BOO was good (80% 37 and 100% 50 ) with a fair to good specificity of (56% 50 and 100% 37 ).…”

“…Then, full-text screening was performed for 152 studies, of which 61 studies met all selection criteria and were scored using the COSMIN checklist. Subsequently, 37 studies received a COSMIN score of fair, good or excellent 21–57. Twenty-four studies58–81 received ‘poor’ COSMIN scores and were therefore excluded from the best evidence synthesis.…”

“…Twenty studies evaluated the assessment methods for BOO. The reference tests were BOO-related measures (eg, obstruction grade number or maximum urine flow rate), rather than reference tests for prostate size 22–25 28 29 34 35 37–39 41 44 47 50 51 55–57. An overview of the COSMIN scores per study on BOO is provided in table 3.…”

“…Uroflowmetry using an automated inflating penile cuff was analysed by three studies 34 37 50. One study evaluated a similar compression index as beforementioned and found a moderate sensitivity (78%) and good specificity (84%) at an index cut-off value of 160% to predict BOO 34.…”

“…Based on the fair34 50 or good37 COSMIN scores for criterion validity, inconsistency of findings, number of studies (n=3) and total sample size (n=253) the level of evidence was graded as low for the validity to indicate BOO using uroflowmetry with an automated inflating penile cuff (see table 5). Measures of reliability were not reported (see online supplemental table 2B).…”