Prognostic value of a combination of IPSS, flow rate and residual urine volume compared to pressure-flow studies in the preoperative evaluation of symptomatic BPH.
OBJECTIVE
Evaluate the predictive value of a combination of IPSS, uroflowmetry and ultrasound determination of residual urine volume in the determination of bladder outflow obstruction (BOO) and in predicting treatment outcome.


METHODS
Forty-five out of a group of 60 BPH symptomatic patients were included. Preoperative evaluation: urine culture, PSA, uroflowmetry with sonographic measurement of post-void residual urine, DRE, IPSS with quality of life questions and pressure-flow study. Selection criteria for surgery were IPSS > 16 and Qmax < 10 ml/s. Transurethral resection of the prostate was performed in these patients; the control visit was performed at 3 months. Treatment success was defined as Qmax above 15 ml/s, residual urine of less than 100 ml, a 50% reduction in IPSS and absence of urinary retention.


RESULTS
Urodynamic abnormalities were found in 42 patients (93.3%): 19 had detrusor instability, 5 patients showed impaired contractility, 37 patients had proven BOO, and 8 patients were unobstructed or mildly obstructed. The overall success rate was 86% when measured by the IPSS. Its preoperative value was 16.9, and dropped significantly to 4 (P = 0.005). The score improved significantly after surgery only in the obstructed group compared to the non-obstructed group (P = 0.001), however preoperative IPSS did not correlate with objective treatment results.


CONCLUSIONS
A high proportion of patients successfully operated (71.1%) had a combination of IPSS > 16 and Qmax < 10 ml/s, although BOO could not be accurately predicted with non-invasive methods alone. Patients with no or mild infravesical obstruction had only minimal improvement of IPSS and uroflowmetry following surgery.
Divisione Urologia, Policlinico S. Matteo, Piazzale Golgi 2, Pavia 27100, Italy. danieleporru@tin.it
D
D
Porru
H
H
Jallous
V
V
Cavalli
F
F
Sallusto
B
B
Rovereto
D000368:Aged; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011470:Prostatic Hyperplasia / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000503:physiopathology; D014563:Urodynamics