Introduction & Objectives
The role of invasive urodynamics (iUDS) before surgery for benign prostatic obstruction (BPO) is debated. The UPSTREAM trial (1) showed that adding iUDS to the routine care does not decrease the number of patients who will undergo surgery nor ensure better outcomes after surgery. Recent data coming from the same patients (2) show that patients could be divided in two cathegories according to their IPSS and Qmax: Those with a favourable and those with an unfavourable outcome after surgery. Aims of this retrospective study was to find how many patients investigated
with iUDS in a single center before possible surgery for BPO present with the favourable characteristics and what are the iUDS findings in the others.
Materials & Methods
This is a retrospective study, including consecutive male patients affected by lower urinary tract symptoms (LUTS), eligible to surgery for BPO, investigate at our center. Patients with neurologic diseases, with previous lower urinary tract surgery or with incomplete data were excluded. We collected information about age, IPSS score (including QoL), uroflowmetry and iUDS data, with particular regard to the Bladder Outlet Obstruction Index (BOOI) and Bladder Contractility Index (BCI). All patients were divided into two groups defined using the criteria by Ito and coworkers (2): Favourable outcome (IPSS>16, IPSS QoL>4, Qmax<10 mL/sec, age< 74 years old), unfavourable outcome (presenting at least one of the unfavourable parameters). BOOI and BCI were evaluated in the patients with an unfavourable outcome, assuming respectively a cut-off of 48 and 123 above which outcomes after surgery should be favourable (2); the traditional cut-offs of 40 and 100,
respectively were also considered.
Results
212 patients were included in this study. Mean age was 59.1 years. Mean IPSS and IPSS QoL were 20.5 and 4.6. Mean Qmax was 6.4 mL/sec. 81 patients (38.2%) were included in the “favourable outcome” group, whilst 131 (61.8%) had at least one unfavourable criterion. In the group with “unfavourable outcome”, 97 patients (74%) showed a BCI<123 (112 patients -85.5%- showed a BCI<100); 63 patients (48.1%) showed a BOOI<48 (75 patients -57.3%- showed a BOOI<40); 59 patients (45%) showed both a BCI<123 and a BOOI<48 (66 -50.4%- both a BCI<100 and a BOOI<40).
Conclusions
According to our findings, patients with parameters suggesting a favourable outcome after surgery for BPO seem to be a minority (38.2%). In the remaining patients iUDS seem to provide possibly useful informations, considering that 74-85.5% show detrusor underactivity, 48.1-57.3% show no or mild obstruction and 45-50.4% both urodynamic observations, related to a worse post-operative outcome.
