title: Is multichannel urodynamic assessment necessary before considering a surgical treatment of BPH? Pros and cons.
abstract: OBJECTIVE
  Lower urinary tract symptoms (LUTS) are common in middle-aged men and could be consequences of multiple etiologies responsible for bladder outlet obstruction (BOO), detrusor underactivity (DUA) and/or overactive bladder. When LUTS are suggestive of BOO secondary to benign prostatic hyperplasia, a surgical treatment can sometimes be consider. Even if multichannel urodynamic study (UDS) is currently the gold standard to properly assess LUTS, its use in non-neurogenic men is still a matter of controversy. Here, we aim to explore the evidence supporting or not the use of systematic multichannel UDS before considering an invasive treatment in men LUTS.
  
  
  METHODS
  The debate was presented with a "pro and con" structure. The "pro" side supported the systematic use of a multichannel UDS before considering a surgical treatment in men LUTS. The "con" side successively refuted the "pro" side arguments.
  
  
  RESULTS
  The "pro" side mainly based their argumentation on the poor correlation of LUTS and office-based tests with BOO or DUA. Furthermore, since a multichannel UDS could allow selecting men that will most benefit of a surgical procedure, they hypothesized that such an approach could reduce the overall morbidity rate and cost associated with. The "con" side considered that, in most cases, medical history and symptoms were reliable enough to consider surgery. Finally, they underlined the UDS limitations and the frequent lack of alternative to surgery in this context.
  
  
  CONCLUSIONS
  Randomized clinical trials are being conducted to compare these two approaches. Their results would help the urological community to override this debate.
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University, 3755 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Biardeau
authors.affiliation: McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University, 3755 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
authors.forename: Shachar
authors.initials: S
authors.lastname: Aharony
authors.affiliation: McGill University Health Center, McGill University, Montreal, QC, Canada.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Elhilali
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University, 3755 Chemin de la côte Sainte-Catherine, Montreal, QC, H3T 1E2, Canada. jcorcosmd@yahoo.com.
authors.forename: Jacques
authors.initials: J
authors.lastname: Corcos
mesh_terms: D003657:Decision Making; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011470:Prostatic Hyperplasia / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics / Q000502:physiology*
keywords: Lower urinary tract symptoms; Men; Pressure-flow study; Prostatectomy