Objective  To explore the relationship between uroflow variables and lower urinary tract symptoms (LUTS); to define performance statistics (sensitivity, specificity, positive and negative predictive values) for maximum urinary flow rate (Qmax ) with respect to bladder outlet obstruction (BOO) at various threshold values; and to investigate the diagnostic value of low‐volume voids. Patients and methods  The study comprised 1271 men aged between 45 and 88 years recruited from 12 centres in Europe, Australia, Canada, Taiwan and Japan over a 2‐year period. Symptom questionnaires, voiding diaries, uroflowmetry and pressure‐flow data were recorded. The relationship between uroflow variables and symptoms, Qmax and BOO, and the diagnostic performance of low volume voids were analysed. Results  The relationship between symptoms and uroflow variables was poor. The mean difference between home‐recorded and clinic‐recorded voided volumes was −48 mL. Qmax was significantly lower in those with BOO (9.7 mL/s for void 1) than in those with no obstruction (12.6 mL/s; P<0.001) and Qmax was negatively correlated with obstruction grade (Spearman’s correlation coefficient −0.3, P<0.001), even when controlling for the negative correlation between age and Qmax (Spearman’s partial correlation coefficient −0.29, P<0.001). A threshold value of Qmax of 10 mL/s had a specificity of 70%, a positive predictive value (PPV) of 70% and a sensitivity of 47% for BOO. The specificity using a threshold Qmax of 15 mL/s was 38%, the PPV 67% and the sensitivity 82%. Those voiding <150 mL (n=225) had a 72% chance of BOO (overall prevalence of BOO 60%). In those voiding >150 mL the likelihood of BOO was 56%. The addition of a specific threshold of 10 mL/s to these higher volume voiders improved the PPV for BOO to 69%. Conclusion  While uroflowmetry cannot replace pressure‐flow studies in the diagnosis of BOO, it can provide a valuable improvement over symptoms alone in the diagnosis of the cause of lower urinary tract dysfunction in men presenting with LUTS. This study provides performance statistics for Qmax with respect to BOO; such statistics may be used to define more accurately the presence or absence of BOO in men presenting with LUTS, so avoiding the need for formal pressure‐flow studies in everyday clinical practice, while improving the likelihood of a successful outcome from prostatectomy. This study also shows that low‐volume uroflowmetry can provide useful diagnostic information and that, as such, the data from such voids should not be discarded.

Objectives To determine the eBcacy and costs of extraureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone-free rates, corporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid-and re-treatment rates, time to become stone-free, complications and costs. lower ureteric calculi. Patients and methods The records of patients treatedResults ESWL for mid-and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 compared with 96% and 99% for URS. However, patients treated with URS were stone-free within men and 21 women, mean age 52 years, range 23-78, 19 mid-and 44 lower ureteric calculi). All 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, achieved with stones of <50 mm2. The costs of URS were higher than those for ESWL. with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed-dye laser lithoConclusions ESWL provides a noninvasive, simple and safe option for the management of mid-and lower tripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 mm fibre. All ureteroscopies ureteric calculi, provided that the stones are <50 mm2; larger stones are best treated by URS. were performed with the patient under general (n= 17) or spinal (n=87) anaesthesia in a mean treatment Keywords Ureteric calculi, extracorporeal shock-wave lithotripsy, ureteroscopy duration of 34 min. Stones were located in the mid-URS, and controversy about the optimal treatment

It is not yet conclusively determined whether preoperative MR staging is appropriate, but results of decision analysis suggest that MR staging is cost-effective for men with moderate or high prior probability of extracapsular disease.

No abstract

No abstract