title: Non-invasive urodynamics predicts outcome prior to surgery for prostatic obstruction.
abstract: OBJECTIVE
  To assess whether the penile cuff non-invasive urodynamic test serves as an effective diagnostic tool for predicting outcomes prior to disobstructive surgery for men presenting with voiding lower urinary tract symptoms. Patients with proven urodynamic obstruction do better after surgery. The current gold standard, invasive pressure-flow studies, imposes cost, resource demand, discomfort and inconvenience to patients.
  
  
  METHODS
  Patients undergoing surgery for prostatic obstruction at Palmerston North Hospital had pre-operative non-invasive urodynamics and completed an International Prostate Symptom Score (IPSS). Catheterised patients were excluded. Two months post-operatively they completed a further IPSS score. An improvement of seven or greater was defined as a clinically successful outcome. Results were compared with the outcome predicted by the nomogram supplied with the urodynamic device.
  
  
  RESULTS
  Data was obtained for 62 patients with mean age 70 years (range 49 to 86 years; SD 9 years). Follow-up was complete for all patients. Thirty-eight patients underwent transurethral resection and 24 holmium laser enucleation of the prostate. Mean IPSS score was 21 (range 5 to 35; SD 6) pre-operatively and 11 (range 1 to 31; SD 9) post-operatively. Thirty-five patients were predicted obstructed and 27 not obstructed. 94% of those predicted obstructed had a successful outcome (p < 0.01). 70% predicted as not obstructed did not have a successful outcome after surgery (p < 0.01).
  
  
  CONCLUSIONS
  The penile cuff test is an exciting adjunct in the decision to proceed to surgery for prostatic obstruction. Patients predicted to be obstructed have an excellent likelihood of a good surgical outcome, yet 30% of those shown not to be obstructed will still do well. Whilst numbers in our study are small, outcomes compare favourably with published results on invasive urodynamic methods.
authors.affiliation: Department of Urology, Palmerston North Hospital, MidCentral DHB, Palmerston North, New Zealand.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Losco
authors.forename: Lucy
authors.initials: L
authors.lastname: Keedle
authors.forename: Quinten
authors.initials: Q
authors.lastname: King
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006695:Holmium / Q000627:therapeutic use; D006801:Humans; D053844:Lasers, Solid-State / Q000706:statistics & numerical data; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D020728:Transurethral Resection of Prostate / Q000706:statistics & numerical data; D014524:Urethral Obstruction / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology
chemical_list: D006695:Holmium
keywords: prostatic hyperplasia; transurethral resection of prostate; urethral obstruction; urinary bladder neck obstruction; urodynamics