Editorial Comment: Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals

Abstract

Clinical evaluation of lower urinary tract symptoms (LUTS) in males includes: medical history, symptom score questionnaires, frequency charts and bladder diaries, physical examination, urinalysis, prostatic specific antigen, and in some cases assessment of the renal function, postvoid residual measurement and uroflowmetry. There has been a debate about the use of pressure flow studies (PFS) in this population, the major goal of urodynamics is to explore the functional mechanisms of LUTS, to identify risk factors for adverse outcomes and to provide information for shared decision-making. However, the guidelines recommendations are for PFS only in individual patients for specific indications prior to invasive treatment or when evaluation of the underlying pathophysiology of LUTS is warranted. (With a weak Strength rating) (1). The ideal information to answer this question should came from a randomized controlled trial (RCT) in which the expected outcomes could be surgical results, change the offered treatment and cost benefit comparing regular clinical work up versus UDS (in theory with better outcomes due to a more detailed information).UPSTREAM is, noninferiority, randomised controlled trial in men with bothersome LUTS, in whom surgery was an option. The primary outcome was the International Prostate Symptom Score (IPSS) 18 mo after randomisation, with a noninferiority margin of 1 point. Urological surgery rates were a key secon-