Urodynamics in Prostatism: I. Prognostic Value of Uroflowmetry

Abstract

A prospective study was undertaken to examine the prognostic value for the symptomatic outcome of prostatic surgery of preoperative urodynamic testing in patients with prostatism. The study design included selection of patients for prostatic surgery by means of classic non-urodynamic urologic investigations such as history, residual urine, serum creatinine, cystoscopy and possibly intravenous urography. In addition an extensive urodynamic work-up (uroflowmetry, cystometry and pressure-flow study with stop-test) was included. The results of the urodynamic studies were unknown to the surgeon selecting the patients for operation. This evaluation was repeated 6 months postoperatively. Totally 139 patients entered the study. The patients were classified according to the preoperative maximum flow rate (Qmax) and in spite of preoperative differences in uroflow, pressure-flow variables and symptom scores, no differences of clinical significance were noted postoperatively among the groups. However, the high-flow group (preoperative Qmax greater than or equal to 15 ml/sec) had a statistically significant lower success rate as judged by the patients subjective evaluation of the outcome of surgery. An analysis of diagnostic sensitivity and specificity indicated Qmax = 15 ml/sec as a relevant cut-off value regarding preoperative identification of patients at risk of a less favourable outcome of surgery. This group of patients was characterized by a higher incidence of persistent uninhibited detrusor contractions at follow-up and a lower incidence of preoperative infravesical obstruction. In conclusion we recommend uroflowmetry in the preoperative evaluation of patients with prostatism.

Clinical Diagnosis of Bladder Outlet Obstruction in Patients with Benign Prostatic Enlargement and Lower Urinary Tract Symptoms: Development and Urodynamic Validation of a Clinical Prostate Score for the Objective Diagnosis of Bladder Outlet Obstruction

“…Of the 55 patients with an I-PSS of 0 to 7 (mildly symptomatic) 26 (51%), of the 382 with an I-PSS of 8 to 19 (moderately symptomatic) 224 (61%) and of the 270 w ith an I-PSS of 20 or greater (severely symptom atic) 158 (63%) had obstruction. In a large group of men with benign pro static enlargement and symptoms of lower urinary tract dysfunction we confirm a poor correlation between urodynamic findings and symp toms.11-13 The correlation of the results of urodynamics with prostate size, as determined by transrectal ultrasound or free uroflowmetry, was better.14, 15 The correlation of isolated ob jective parameters is generally believed to be too inaccurate for clinical decision making. However, we combined the re sults of these noninvasive investigations to derive a clinical scoring system, This score correlated well with the results of urodynamics.…”

The urological management of men with lower urinary tract symptoms, recorded using an interactive computer program

“…Thus, further analysis of the consistency and accuracy with which the individual doctor makes methodological diÃculties. It is not possible to validate this subjective outcome of therapy, the prognostic value of diÂerent diagnostic tests is low [11][12][13][14]. The subjective the accuracy of the medical decisions recorded using the computer program; there is an intrinsic accuracy primaroutcome after TURP has a probability of about 0.8 for improvement or complete recovery and this probability ily because the decision-maker only receives the 'hard' objective data from each case and thus the method could does not seem to be related to the diagnostic process, which diÂered in the studies reported [15][16][17][18].…”

Outcome of Surgery for Benign Prostatic Hyperplasia-Is It Predictable?

“…Jensen et al, found PVR to be the second best predictor of surgical management after pressure flow studies. Larger PVR leads to chronic bladder distension, poor bladder compliance and hypotonia leading to poor detrusor function and unsatisfactory post-operative recovery following surgery [9]. In our study, we found that men with PVR of less than 60 ml undergoing surgery had better post-operative outcome as measured objectively, by maximum (7.3 to 14.8 ml/sec, p = 0.01) & average flow rates (2.9 to 5.6 ml/sec, p = 0.04) and subjectively, by the IPSS score (IPSS improved from 30 to 10, p = 0.001).…”