Does anamnestic symptom evaluation or clinical examination give enough information to evaluate the severity of obstruction in benign prostatic hyperplasia?

Clinical diagnosis of bladder outlet obstruction in men with lower urinary tract symptoms: reliability of commonly measured parameters and the role of idiopathic detrusor overactivity

AIMS

There is no generally accepted consensus how to evaluate patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO). We have tried to determine whether the most frequently used objective variables as prostate volume, IPS-score, maximum flow rate, residual urine volume, functional bladder capacity, and pressure-flow study are reliable for diagnosis of BOO and we investigated the influence of idiopathic detrusor overactivity (IDO) on this condition.

METHODS

A total of 153 men with LUTS and suspected BOO were systematically examined with routine investigation including digital rectal examination, transrectal ultrasound (TRUS), post-void residual urine volume measurement, uroflowmetry, and pressure-flow study. All patients completed IPS-score. Patients were divided into groups based on Schäfer's grade of obstruction and incidence of IDO and clinical and urodynamical variables were compared.

RESULTS

At baseline, 45.8% of the patients were urodynamically moderately obstructed and 37.9% were found to be severely obstructed. The grade of obstruction did not correlate with age. Prostate volume, post-void residual volume (PVR), and maximum flow rate correlated significantly with the degree of obstruction. The mean IPS-score remained almost unchanged throughout all obstruction groups. The incidence of IDO was 40.5% and increased from 16% in the minor obstruction group to 38.6% and 53.4% in the moderate and severe obstruction group, respectively. The patients with IDO were older, had larger prostates and were more obstructed. There was no impact of IDO on symptomatology of BOO.

CONCLUSIONS

These data indicate that IPS-score does not achieve sufficient diagnostic accuracy and its role in the assessment of BOO is limited. The grade of obstruction is more related to prostate volume, PVR, and maximum flow rate. BOO and IDO seem to be related and have numerous mutual interactions.

How to select patients suitable for transurethral microwave thermotherapy: a systematic evaluation of potentially predictive variables

OBJECTIVE

To identify clinical variables useful in predicting outcome after transurethral microwave thermotherapy (TUMT) of the prostate with Prostasoft v. 2.0.

PATIENTS AND METHODS

Thirty-eight men with symptomatic benign prostatic hyperplasia (BPH) were treated with TUMT using the Prostatron device with the low-energy (v. 2.0) software. Before and 6 months after treatment symptoms were evaluated using the Madsen-Iversen (M-I) symptom score, a clinical examination and suprapubic pressure-flow measurement, free urinary peak flow rate (Qmax) and determination of post-void residual urine volume (PVR). Bladder outlet obstruction was assessed from urodynamic pressure-flow studies using the classification of Abrams and Griffiths, the obstruction grading of Schäfer, and calculation of other published factors, e.g. the urethral resistance, an obstruction index and the detrusor adjusted mean passive urethral resistance factor (DAMPF). Categories of M-I score (total, irritative and obstructive), PVR and Qmax were investigated to determine whether any could predict the outcome after low-energy TUMT. The values after treatment and changes in Qmax, M-I score and PVR were used as efficacy variables.

RESULTS

Variables describing infravesical obstruction had predictive characteristics that may be useful in selecting patients for TUMT v. 2.0 and significantly better results were obtained in patients with a low to moderate obstruction as graded using the DAMPF classification of obstruction. The results also indicated that patients with a high irritative M-I score or a Qmax of 7-14 mL/s were those who fared best after TUMT.

CONCLUSIONS

Variables expressing the obstruction grade seem to be useful in predicting outcome after TUMT (v. 2.0). Patients with a high obstruction index are probably unsuitable for TUMT (v. 2.0).