Urodynamic effects of various treatment modalities for benign prostatic hyperplasia

PURPOSE

I studied the effects of various treatments for benign prostatic hyperplasia on urethral resistance.

MATERIALS AND METHODS

I reviewed the literature on urodynamic effects of treatments for benign prostatic hyperplasia. Articles that reported pretreatment and posttreatment values of relevant urodynamic parameters were analyzed. Average before and after treatment values of maximum flow rate and detrusor pressure at maximal flow rate for every study were plotted on an Abrams-Griffiths nomogram and classified as obstructed, equivocal or nonobstructed. Average values of maximum flow rate and detrusor pressure at maximal flow rate were calculated for the total number of patients treated by a certain modality.

RESULTS

Based on this analysis, the rank order of urodynamic efficacy was that open prostatectomy is more effective in reducing urethral resistance than is transurethral prostatectomy. These treatments diminish obstruction better than laser treatment or transurethral incision of the prostate, which again are more effective than balloon dilation, alpha-blockers or transurethral microwave thermotherapy. Finally, androgen deprivation performs better than placebo treatment.

CONCLUSIONS

The rank order of urodynamic efficacy as determined in this analysis shows a high level of agreement with reported rank order of symptomatic efficacy of various modalities. After placebo treatment there is no significant change in urethral resistance. This finding indicates that pressure-flow studies are a sensitive way to compare active to placebo treatment and that pressure-flow studies have excellent long-term reproducibility.

Outpatient visual laser-assisted prostatectomy under local anesthesia

OBJECTIVE

Visual laser-assisted prostatectomy (VLAP) with a noncontact right-angle delivery system recently has been introduced as a new treatment option for symptomatic outlet obstruction secondary to benign prostatic hyperplasia. The right-angle laser technology has numerous potential advantages over traditional transurethral resection of the prostate. These advantages include the feasibility of performing the VLAP procedure under local anesthesia without bleeding. We summarize our experience with VLAP performed with local anesthesia administered with periprostatic block.

METHODS

This technique was employed in 46 men with symptomatic BPH as an outpatient procedure. All men were evaluated prior to surgery with flow rates, residual volume determinations, and AUA-6 symptom score analyses. Follow-up occurred at three and six months and included repeat measures of flow rates, residual volumes, and symptom scores.

RESULTS

Mean AUA symptom scores and uroflow parameters significantly improved with six months' follow-up. No significant complications were encountered.

CONCLUSIONS

VLAP under local anesthesia as an outpatient procedure is a promising treatment alternative for men with symptomatic benign prostatic hyperplasia.

Subjective and objective evaluation of patients with prostatism and infravesical obstruction treated with both intraprostatic spiral and transurethral prostatectomy

In order to evaluate the effect of intraprostatic spiral and subsequent transurethral prostatectomy (TURP) on obstructive benign prostatic hyperplasia, 9 men were evaluated with symptom scores and urodynamic studies at inclusion after 4 months of spiral treatment and 4 months after TURP. Six patients in a control group were evaluated at inclusion after an observation period of 4 months and 4 months after TURP. After treatment with spiral the symptom score decreased in 7 patients, increased in 1, and was unchanged in 1. After the observation period in the control group the symptom score decreased in 4 patients, increased in 1, and was unchanged in 1. After TURP the symptom score decreased even further in all patients, but one. After spiral treatment the urethral resistance decreased in 8 of 9 patients, but according to Abrams and Griffith's [(1979): Br J Urol 51:129-134] definition, only 2 were unobstructed. Five patients in the control group were unchanged obstructed after the observation period, while one was unobstructed. After TURP, the patients in both groups were all unobstructed. Intraprostatic spirals decrease the severity of symptoms and reduce the urethral resistance, but TURP in the same patient was much more effective.

Correlation of the AUA symptom index with urodynamics in patients with suspected benign prostatic hyperplasia

The AUA symptom index is widely used to access patients with suspected benign prostatic hyperplasia (BPH). In order to determine how well symptoms as assessed by this index correlate with urodynamic findings, we evaluated 83 patients referred to our urology clinics with symptoms of BPH. All patients completed the AUA symptom index and then underwent a multichannel urodynamic evaluation. Patients were classified as obstructed, unobstructed, or equivocal according to the Abrams Griffiths nomogram. The AUA symptom index was recorded as the total score and, for purposes of symptom classification, further subdivided into an obstructive score (questions 3, 5, and 6) and an irritative score (questions 1, 2, 4, and 7). The mean age of the 83 patients was 67 (45-84). The mean total AUA symptom score was 16.6 (6-34), mean obstructive score was 6.1 (0-15), and the mean irritative score 10.4 (3-20). Pressure flow analysis using the Abrams-Griffiths nomogram classified 28 patients (34%) as obstructed, 17 (20%) as unobstructed, and 38 (46%) as equivocal. Using the analysis of variance procedure (ANOVA) there was no statistically significant difference in the mean total (P = 0.446), obstructive (P = 0.979), or irritative (P = 0.136) scores. Detrusor instability was present in 45 patients (54%). While total and obstructive scores were not significantly different in patients with detrusor instability vs. those with stable bladders, irritative scores were higher in patients with instability (P = 0.028) using the T-test procedure. Using ANOVA, the difference in post void residual (PVR) between the groups was not quite statistically significant (P = 0.057).(ABSTRACT TRUNCATED AT 250 WORDS)