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Non‐invasive urodynamics predicts outcome prior to surgery for prostatic obstruction
Author(s) -
Losco Giovanni,
Keedle Lucy,
King Quinten
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12382
Subject(s) - medicine , nomogram , lower urinary tract symptoms , surgery , enucleation , international prostate symptom score , urodynamic testing , gold standard (test) , bladder outlet obstruction , prostate , urology , urinary incontinence , cancer
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 P almerston N orth H ospital had pre‐operative non‐invasive urodynamics and completed an I nternational P rostate S ymptom S core ( 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.