The subjective assessment and pressure-flow study of outcome of surgical treatment for patients with prostatism and high voiding pressure.
BACKGROUND
In 1992, the International Continence Society (ICS) began to conduct an international multicenter study to correlate the symptoms and urodynamics in patients with BPH. Our institute was invited to participate this ICS-BPH study, and the preliminary (phase I) results have revealed poor correlation between preoperative symptoms and parameters of the pressure-flow study. This phase II study continued the phase I ICS-BPH study to assess the changes of subjective symptoms and objective parameters of pressure-flow study before and after TURP.


METHODS
Fifty-two patients with prostatism, aged from 56 to 80, were evaluated using the ICS-BPH questionnaire, free urine flow rate and pressure-flow study. According to the criteria of maximum urine flow rate (Qmax) 15 ml/sec and voiding intravesical pressure at Qmax (Pves at Qmax) 100 cm H2O, low flow-high pressure (LFHP) was proved in 20 patients (38%), high flow-high pressure (HFHP) in 22 (42%), low flow-low pressure (LFLP) in 3 (6%), and high flow-low pressure (HFLP) in 7 (14%). Transurethral resection of the prostate (TURP) was performed for 33 of 42 patients with high voiding pressure (LFHP and HFHP groups).


RESULTS
The weight of the TURP specimen was 28 +/- 6.3 gm. Sixteen patients repeated the questionnaire and pressure-flow study 9.0 +/- 2.1 months after surgery. Both irritative and obstructive symptom scores decreased in 15 (94%) of the 16 patients (p < 0.001). The opening intravesical pressure (openPves) and Pves at Qmax improved from 136 +/- 34 and 124 +/- 30 cm H2O preoperatively to 89 +/- 25 and 94 +/- 22 cm H2O postoperatively respectively (p < 0.004). However, UFRmax, 16.7 +/- 6.0 ml/sec preoperatively and 19.3 +/- 6.4 postoperatively, showed no statistical difference. If the HFHP and LFHP groups were compared separately, the degree of improvement in symptomatology or parameters of pressure-flow study was similar, although changes in HFHP group appeared more evident. UFRmax in LFHP group changed significantly from 11.9 +/- 2.8 preoperatively to 22.1 +/- 6.7 ml/sec postoperatively. For the patients with high flow obstruction (HFHP group), although UFRmax did not increase after TURP, the symptom score, openPves and Pves at Qmax, decreased as much as the LFHP group did.


CONCLUSIONS
Based on the analysis of the pressure flow study, TURP not only offers an advantage to the patient with classical obstruction (LFHP group), but also to patients with high flow obstruction (HFHP group). However, this does not suggest that a pressure-flow study should be performed routinely for a male with prostatism. It is advised only for patients with Qmax > 15 ml/sec but exhibiting typical symptoms.
Hung
C T
CT
Department of Surgery, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Lin
A T
AT
Chen
K K
KK
Chang
L S
LS
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011470:Prostatic Hyperplasia / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D014554:Urination