How to Make the Diagnosis of Benign Prostatic Disease

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction

INTRODUCTION

The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research.

METHODS

This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent.

RESULTS

A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated.

CONCLUSION

A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.

How correlated is BOO with different objective parameters commonly used in evaluation of BPH: a prospective study

OBJECTIVES

The use of non-intubated uroflowmetry, PVR, prostate volume, and I-PSS are the most commonly used tools for the evaluation of patients with BPH. In this prospective study, we elucidated the correlation between BOO as rated by pressure-flow study in men with LUTS attributed to BPH and those parameters.

METHODS

Over a period of 2 years 460 men above the age of 45 years old (mean age 60.46 ± 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, prostate-specific antigen, and transrectal ultrasound were done. The urodynamic evaluation included uroflowmetry, filling cystometry, and voiding cystometry with the plotting of pressure-flow study according to Lin-PURR (Schäfer's nomogram). The correlation coefficient was calculated between these variables.

RESULTS

The correlation of other objective parameters with total score was not much better. The Spearman's correlation coefficient were - 0.09, 0.07 and - 0.1 for prostate weight, post voiding residual urine and maximum free flow rate respectively. Correlations between Schäfer's grade and Q_max, PVR and prostate volume were found to be weak to fair correlation (r values were - 0.4, 0.18, and 0.39 respectively).

CONCLUSION

Objective non-invasive parameters most commonly used in the evaluation of men with LUTS attributed to BPH have limited correlation with obstruction, as diagnosed by pressure flow nomogram.

Can Bladder and Prostate Sonomorphology Be Used for Detecting Bladder Outlet Obstruction in Patients With Symptomatic Benign Prostatic Hyperplasia?

OBJECTIVE

To investigate the accuracy of the bladder and prostate sonomorphologic parameters for the diagnosis of bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

First-visit men, aged ≥ 50 years, with LUTS/BPH were prospectively enrolled. Added to the initial basic evaluation, all patients underwent pelvic ultrasonography and pressure flow study. The pressure flow study was used as a reference standard for BOO, and according to its results, patients were divided into BOO and non-BOO groups. The sonomorphologic findings were compared between both groups, and the diagnostic accuracy of the significant parameters was determined.

RESULTS

In total, 157 patients were included. Of these, 48 (30.57%) had BOO and 109 (69.43%) did not. Bladder wall thickness (BWT), ultrasound estimated bladder weight (UEBW), and intravesical prostatic protrusion (IPP) were the sonomorphologic parameters that differed significantly between both groups (P < .001). By receiver operating characteristic curve analysis, the optimal cutoff values distinguishing patients with BOO were BWT of 3.7 mm (area under the curve [AUC]: 0.940), UEBW of 31.5 g (AUC: 0.835), and IPP of 10.9 mm (AUC: 0.874). The sensitivity, specificity, and accuracy of BWT, UEBW, and IPP were 95.00%, 90.91%, and 93.55%; 75.44, 57.97%, and 65.62%; and 87.90%, 76.43%, and 82.17%, respectively.

CONCLUSION

BWT, UEBW, and IPP measurements can be used to detect BOO in LUTS/BPH patients. The simple estimation of these sonomorphologic parameters by suprapubic approach makes these measurements potentially suitable methods to judge BOO noninvasively during the routine clinical evaluation of BPH.

Urodynamic Features and Significant Predictors of Bladder Outlet Obstruction in Patients With Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Small Prostate Volume

OBJECTIVE

To investigate the clinical and urodynamic features of patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) according to their prostate size.

MATERIALS AND METHODS

We analyzed 2039 LUTS/BPH patients who underwent urodynamic study between October 2004 and August 2013. We divided the patients into three groups according to their prostate size: small (≤30 mL), moderately enlarged (31-80 mL), and large prostate (≥81 mL) groups. We compared the groups regarding age, International Prostatic Symptom Score, maximal flow rate (Qmax), postvoided residual (PVR), serum prostate-specific antigen, prostate volume measured by ultrasonography, and urodynamic findings.

RESULTS

Patients with a small prostate had better urodynamic outcomes than those with larger prostates in overall population. Although the total prostate volume significantly correlated with the bladder outlet obstruction (BOO) index (r  =  0.51), BOO patients with a small prostate had similar Qmax, higher PVR, and lower voiding efficiency, compared to those with larger prostates. Moreover, urodynamic parameters indicating bladder abnormalities, including low compliance and involuntary detrusor contraction positivity, were similar among the groups in BOO patients. A higher proportion of detrusor underactivity was also observed in the small prostate group in BOO patients. Finally, when adjusting for potential confounding variables, we identified serum prostate-specific antigen levels (odds ratio, 1.34) and Qmax (odds ratio, 0.77) as significant predictors for BOO in LUTS/BPH patients with a small prostate.

CONCLUSION

BOO patients with a small prostate showed higher PVR and poor voiding efficiency, as well as similar urodynamic bladder abnormalities, compared to those with moderately enlarged and large prostates.

Predictors of short-term overactive bladder symptom improvement after transurethral resection of prostate in men with benign prostatic obstruction

OBJECTIVES

To investigate the correlation of preoperative overactive bladder symptoms and urodynamic parameters to the improvement of overactive bladder symptoms after transurethral resection of the prostate.

METHODS

A retrospective study was carried out in 128 patients with urodynamically proven benign prostatic obstruction that underwent transurethral resection of the prostate. All patients had preoperative urgency symptoms. The patients were divided into groups according to overactive bladder symptom severity and preoperative urodynamic parameters (presence and type of detrusor overactivity, degree of obstruction, bladder contractility). The 3-month postoperative changes in overactive bladder symptoms were then compared between the groups.

RESULTS

Overall, there was a statistically significant improvement in mean overactive bladder symptoms score from 9.6 to 2.7 (P < 0.001). However, patients with preoperative mild overactive bladder symptoms had significantly lower postoperative overactive bladder symptoms scores than those with moderate or severe symptoms (P < 0.05). Patients with preoperative terminal detrusor overactivity had significantly higher overactive bladder symptoms scores compared with patients with phasic and no detrusor overactivity (P < 0.05), and were more likely to have persistent urge incontinence. Preoperative detrusor contractility and severity of obstruction did not affect postoperative overactive bladder symptom improvement.

CONCLUSIONS

Most patients with benign prostatic obstruction and overactive bladder symptoms experience an improvement in their symptoms after transurethral resection of the prostate. The presence of preoperative terminal detrusor overactivity might be negatively associated with this improvement. The preoperative severity of overactive bladder symptoms, detrusor contractility and degree of bladder outlet obstruction do not appear to have an effect.