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

Abstract

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.

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

“…These results indicate that PCT is able to improve the prediction of outcomes after TURP. This result was reinforced in a more recent study in which 94% of patients achieved good results after TURP or holmium laser enucleation of the prostate when they were categorized with obstruction using a PCT, versus 70% who were categorized as unobstructed using a PCT [25]. The present study highlights that PCT is a non-invasive and useful diagnostic tool for decision-making prior to the execution of PVP in patients with BOO related to BPH.…”

Correlation between penile cuff test and pressure-flow study in patients candidates for trans-urethral resection of prostate

“…Thus it could be used to run a selection of non-obstructed patients suspected for an eventual IDC condition. Indeed, such patients are the most critical ones in BPO surgery [ 25 ], with some papers reporting about one forth of them showing no symptoms improvement after a surgical treatment [ 24 , 26 ].…”

Use of the penile cuff test to diagnose bladder outlet obstruction: A systematic review and meta‐analysis

“…Studies 1‐17 12‐28 were conducted from 2002 to 2020 (Table 1). The individual study sample sizes ranged from 19 to 179 men, with ages ranging from 20 to 89 years.…”