Prognostic Value of a Combination of IPSS, Flow Rate and Residual Urine Volume Compared to Pressure-Flow Studies in the Preoperative Evaluation of Symptomatic BPH

Porru, Daniele; Jallous, H; Cavalli, Valeria; Sallusto, F.; Rovereto, B.

doi:10.1016/s0302-2838(02)00021-0

Cited by 62 publications

(44 citation statements)

References 11 publications

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“…This figure is similar to that obtained by the current gold standard, formal invasive urodynamic studies [8,13]. This information is still useful and aids an informed pre-operative discussion with patients.…”

Section: Discussionsupporting

confidence: 82%

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Non‐invasive urodynamics predicts outcome prior to surgery for prostatic obstruction

2013

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Objective To assess whether the penile cuff non‐invasive urodynamic test serves as an effective diagnostic tool for predicting outcomes prior to disobstructive surgery for men presenting with voiding lower urinary tract symptoms. Patients with proven urodynamic obstruction do better after surgery. The current gold standard, invasive pressure‐flow studies, imposes cost, resource demand, discomfort and inconvenience to patients. Patients and Methods Patients undergoing surgery for prostatic obstruction at Palmerston North Hospital had pre‐operative non‐invasive urodynamics and completed an International Prostate Symptom Score (IPSS). Catheterised patients were excluded. Two months post‐operatively they completed a further IPSS score. An improvement of seven or greater was defined as a clinically successful outcome. Results were compared with the outcome predicted by the nomogram supplied with the urodynamic device. Results Data was obtained for 62 patients with mean age 70 years (range 49 to 86 years; SD 9 years). Follow‐up was complete for all patients. Thirty‐eight patients underwent transurethral resection and 24 holmium laser enucleation of the prostate. Mean IPSS score was 21 (range 5 to 35; SD 6) pre‐operatively and 11 (range 1 to 31; SD 9) post‐operatively. Thirty‐five patients were predicted obstructed and 27 not obstructed. 94% of those predicted obstructed had a successful outcome (p < 0.01). 70% predicted as not obstructed did not have a successful outcome after surgery (p < 0.01). Conclusion The penile cuff test is an exciting adjunct in the decision to proceed to surgery for prostatic obstruction. Patients predicted to be obstructed have an excellent likelihood of a good surgical outcome, yet 30% of those shown not to be obstructed will still do well. Whilst numbers in our study are small, outcomes compare favourably with published results on invasive urodynamic methods.

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Section: Discussionsupporting

confidence: 82%

“…The current gold standard in pre-operative diagnosis is invasive urodynamic studies [8][9][10][11]. This investigation, which measures intra-vesical pressure whilst the patient voids and generates a pressure-flow curve, has a number of drawbacks.…”

Section: Introductionmentioning

confidence: 99%

Non‐invasive urodynamics predicts outcome prior to surgery for prostatic obstruction

2013

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“…Nevertheless, most studies have indicated that preoperative storage symptoms have a negative impact on postoperative IPSS outcome [17,18]. One study in 62 BPE patients concluded that symptomatic and overall outcomes were significantly worse in patients who did not have BOO but had detrusor overactivity-related symptoms [19].…”

Section: Discussionmentioning

confidence: 99%

Prediction of Persistent Storage Symptoms after Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement

et al. 2014

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Objective: To identify the prognostic factors causing persistent storage symptoms following transurethral resection of the prostate in patients with benign prostatic enlargement (BPE). Methods: A total of 116 men with symptomatic BPE requiring surgery were enrolled in the study between January 2011 and December 2012. The patients underwent basic clinical evaluations including transrectal ultrasound, International Prostate Symptom Score and urodynamic study. After 6 months, International Prostate Symptom Score and uroflowmetry were rechecked. The definition of persistent storage symptoms was patients with storage scores >7 points. Logistic regression analysis and receiver operating characteristic analysis were conducted. Results: The 116 patients were divided into a persistent storage symptom-positive group (n = 33) and a storage symptom-negative group (n = 83). Multivariate analysis showed that the degrees of worse initial storage symptoms (odds ratio [OR] = 8.32), small bladder capacity (OR = 4.31), impaired detrusor contractility (OR = 2.96) and age (OR = 1.05) were consistently associated with persistent storage symptoms. Conclusions: This short-term study confirms the positive and consistent correlations between the baseline degree of worse initial storage symptoms, bladder capacity, detrusor contractility and age and the improvement in storage symptoms.

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“…According to the recommendations of most international guidelines, urody- namics should not be performed in the routine investigation of these patients and the presence of a small prostate volume is not considered an indication for the study [5][6][7] . Establishing the cause of the voiding dysfunction in patients with BPH seems to be important to define the management strategy, especially when surgery is being considered, since improved results are obtained in those with documented BOO [8][9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Urodynamic Evaluation of Patients with Lower Urinary Tract Symptoms and Small Prostate Volume

et al. 2008

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Introduction: The relevance of prostate size in the pathophysiology of lower urinary tract symptoms (LUTS) is controversial. We evaluated the urodynamic findings in patients with LUTS and small prostate volumes. Materials and Methods: 84 patients aged ≧50 years with LUTS and prostates <40 ml were evaluated. All had an International Prostate Symptom Score (IPSS) ≧8. Average age was 62.0 ± 8.1 years. We evaluated the impact of bladder outlet obstruction (BOO) and detrusor overactivity (DO) on the voiding symptoms and urodynamic findings. Results: Mean prostate volume was 29.2 ± 7.2 ml and mean IPSS was 13.5 ± 4.6. BOO was the main finding, affecting 42 (50.0%) patients, followed by detrusor underactivity (DU) in 41 (48.8%) and DO in 28 (33.3%) patients. Patients without BOO were significantly older than the obstructed (64.0 ± 8.8 and 60.1 ± 6.9 years, respectively; p = 0.026) and had an increased prevalence of DU (76.2 and 21.4%, respectively; p < 0.001). Comparison of patients with and without DO showed reduced bladder capacity and compliance in the DO group (p < 0.001). No other comparisons were significant. Conclusion: Half of the patients with LUTS and small prostates are not obstructed and may have DO or decreased detrusor contractility as the basis for their voiding symptoms. Our results emphasize the value of urodynamics in this population, especially when invasive treatments are being considered.

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Prognostic Value of a Combination of IPSS, Flow Rate and Residual Urine Volume Compared to Pressure-Flow Studies in the Preoperative Evaluation of Symptomatic BPH

Cited by 62 publications

References 11 publications

Non‐invasive urodynamics predicts outcome prior to surgery for prostatic obstruction

Non‐invasive urodynamics predicts outcome prior to surgery for prostatic obstruction

Prediction of Persistent Storage Symptoms after Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement

Urodynamic Evaluation of Patients with Lower Urinary Tract Symptoms and Small Prostate Volume

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