Symptom indices in bladder outlet obstruction.
BPH, the most common benign tumour that affects men, is a disease that mostly causes morbidity through its associated LUTS. Symptom indices are instruments that allow the objective measurement of these symptoms. Analysis of the data they provide allows symptom severity to be measured and the changes that occur in symptoms with time to be monitored. Measurement of symptom severity and assessment of disease progression are important parameters when treatment decisions are being made. After treatment, measurement of LUTS using symptom indices allows efficacy to be judged as well as providing an ongoing assessment of patients. Data from symptom indices allow patients to be compared with each other and may provide useful epidemiological information when groups of patients are assessed. However, it should be stressed that symptom indices are not reliable for screening populations for disease and should not be used for case-finding. Many new treatments for BPH/BPO are being developed and assessed in clinical trials. The measurement of symptoms using symptom indices has had a central role in these trials and will continue to do so. A considerable volume of published work presenting data from these trials is now accumulating. Comparing new treatments with the 'gold standard' of TURP is facilitated by symptom indices, as is the comparison with other novel modes of treatment. The AUA-7 index remains the best scientifically validated index used in patients with symptomatic BPO, although other indices, e.g. the Boyarsky, Madsen-Iversen and MMAP, when compared with the AUA-7 have been found to perform similarly. However, it would be preferable if the validation process of current indices included validation against pathophysiological processes such as proven BOO and detrusor instability. The current use of symptom indices will add to data supporting their reliability and validity. It is to be anticipated that symptom indices will be used increasingly both in clinical practice and clinical trials and that trust will be placed in the data they provide. It is essential that the limitations of these indices are borne in mind, and that the indices are applied correctly so that the information they produce remains valid and reliable.
Hines
J E
JE
Department of Surgery, Hammersmith Hospital, London, UK.
D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000175:diagnosis / Q000628:therapy; D012720:Severity of Illness Index; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy