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.
Porru
D
D
Divisione Urologia, Policlinico S. Matteo, Piazzale Golgi 2, Pavia 27100, Italy. danieleporru@tin.it
Jallous
H
H
Cavalli
V
V
Sallusto
F
F
Rovereto
B
B
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