Prostatic enlargement, symptomatology and pressure/flow evaluation: interrelations in patients with symptomatic BPH.
BACKGROUND
Benign prostatic hyperplasia (BPH) is the most common pathologic condition to afflict the aging male. Many patients with symptomatic BPH undergo prostatectomy without rigorous evaluation. Three concepts should be considered before any treatment of a patient with symptomatic BPH; Prostatic enlargement, symptomatology and bladder outflow obstruction.


METHODS
The study comprised 188 consecutive patients with symptomatic BPH, all eligible after pressure/flow examination. One-hundred-seventy-four of the patients answered the DAN-PSS questionnaire, 140 of the patients had their prostate size measured by transrectal ultrasonography. One-hundred-fifty-three patients were able to perform a free flow measurement upon arrival. Uroflowmetry, symptomatology and prostate size were matched with the results of pressure/flow examination.


RESULTS
Neither uroflowmetry, symptomatology nor prostate size correlated well with bladder outlet obstruction. The positive predictive value for infravesical obstruction was 88% if a maximum flow rate under 10 ml/s was used. Symptomatology could not be used to differentiate between patients with bladder outlet obstruction and patients without obstruction. The positive predictive value for infravesical obstruction was 76% if a prostate volume over 40 ml was chosen.


CONCLUSIONS
The purpose of diagnostic evaluation in patients with BPH, is to identify precisely the pathophysiology underlying the patients condition, so that rational therapy can be selected.


CONCLUSIONS
The disease entity of BPH is characterized by the interaction of prostate enlargement, the subjective symptom complex of prostatism, and urodynamic infravesical obstruction. Since it is impossible to interpolate from one to another of these conditions, a comprehensive evaluation of a patient with symptomatic BPH should include an assessment of all of these conditions.
Poulsen
A L
AL
Department of Urology/Urological Laboratory, Herlev Hospital, Denmark.
Schou
J
J
Puggaard
L
L
Torp-Pedersen
S
S
Nordling
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011470:Prostatic Hyperplasia / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D016055:Urinary Retention / Q000175:diagnosis; D014554:Urination; D014563:Urodynamics