VALUE OF INVASIVE AND NON-INVASIVE INVESTIGATION IN THE PREOPERATIVE EVALUATION OF BPH. PROSPECTS OF PROGNOSTIC ANALYSIS ON CLINICAL EVOLUTION OF BENIGN PROSTATIC HYPERPLASIA

Abstract
Aim: Evaluate the predictive value of a combination of IPSS, uroflowmetry and ultrasound determination of residual urine volume compared to pressure-flow study in the determination of bladder outflow obstruction (BOO) and in predicting treatment outcome. Methods: Forty-five out of a group of 60 BPH symptomatic patients were evaluated. Selection criteria for surgery were IPSS>16 and Qmax<10 ml/s. Transurethral resection of the prostate (TURP) was performed. Treatment success was defined as Qmax above 15 ml/s, residual urine of less than 100 ml, a 50% reduction in IPSS and absence of urinary retention. Results: Urodynamic abnormalities were found in 93.3% of patients: 19 had detrusor instability, 5 patients showed impaired contractility, 37 patients had proven BOO, and 8 patients were unobstructed or mildly obstructed. The overall success rate was 86% when measured by the IPSS. Its value dropped significantly (P=0.005). The score improved significantly after surgery only in the obstructed group compared to the non-obstructed group (P=0.001).Conclusions: A high proportion of patients successfully operated (71.1%) had a combination of IPSS>16 and Qmax<10 ml/s, although BOO could not be accurately predicted with non-invasive methods alone. Patients with no or mild infravesical obstruction had only minimal improvement of IPSS and uroflowmetry following surgery. Content main subject: Diagnostic evaluation of BPH.

Key words
uroflowmetry, IPSS, residual urine volume, BOO, BPH, pressure-flow study

Bibliografía del artículo

1. M. Emberton, D.E. Neal and N. Black , The National Prostatectomy Audit: the clinical management of patients during hospital admission. Br. J. Urol. 75 (1995), pp. 301-316.
2. O.W. Hakenberg, C.B. Pinnock and V.R. Marshall , Does evaluation with the International Prostate Symptom Score predict the outcome of transurethral resection of the prostate. J. Urol. 158 (1997), pp. 94-99.
3. W. Schäfer, F. Waterbar, P.H. Langen and F.J. Deutz , A simplified graphic procedure for detailed analysis of detrusor and outlet function during voiding. Neurourol. Urodynam. 8 (1989), pp. 405-407. Abstract-ScienceDirect Navigator
4. N.R. Netto, Jr., C.A.L. D'Ancona and M.L. de Lima , Correlation between the International Prostate Symptom Score and a pressure-flow study in the evaluation of symptomatic benign prostatic hyperplasia. J. Urol. 155 (1996), pp. 200-204.
5. K. Ameda, G.S. Steele, M.P. Sullivan et al., Detrusor contraction duration as a urodynamic parameter of bladder outlet obstruction for evaluating men with lower urinary tract symptoms. J. Urol. 160 (1998), pp. 482-487.
6. P.H. Abrams, D.J. Farrar, W.R.T. Turner, C.G. Whiteside and R.C.L. Feneley , The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J. Urol. 121 (1979), pp. 640-643.
7. D.E. Neal, P.D. Ramsden, L. Sharples, A. Smith, P.H. Powell, R.A. Styles et al., Outcome of elective prostatectomy. Br. Med. J. 299 (1989), pp. 762-764.
8. M.J.F.J. Barry, Jr., M.P. O'Leary, R.C. Bruskewitz, H.L. Holtgrewe and W.K. Mebust , Cockett ATK and the Measurement Committee of the American Urological Association symptom index for benign prostatic hyperplasia. J. Urol. 148 (1992), pp. 1549-1552.
9. Horninger W, Janetschek G, Pointner J, Watson G, Bartsch G. Are TULIP interstitial laser and contact laser superior to TURP. J Urol 1995;153(part 2):413A [Abstract 738].
10. M.J. Barry, A.T.K. Cockett, H.L. Holtgrewe, J.D. McConnell, S.A. Sihelnik and H.N. Winfield , Relationship of symptoms of prostatism of commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia. J. Urol. 150 (1993), pp. 351-354.
11. G.S. Steele, M.P. Sullivan, D.J. Sleep and S.V. Yalla , Combination of symptom score, flow rate and prostate volume for predicting bladder outflow obstruction in men with lower urinary tract symptoms. J. Urol. 164 (2000), pp. 344-348. Abstract-ScienceDirect Navigator
12. J.L.K.R. Bosch, W.C.J. Hop, W.J. Kirkels and F.H. Schroder , The International Prostate Symptom Score in a community-based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age prostate volume flow rate and residual urine volume. Br. J. Urol. 75 (1995), pp. 622-626.
13. Koyanagi T, Artibani W, Correa R, et al. Initial diagnostic evaluation of men with lower urinary tract symptoms. In: Denis L, Griffiths K, Koury S, et al., editors. Proceedings of the Fourth International Consultation on Benign Prostatic Hyperplasia (BPH), vol. 4. United Kingdom: Plymbridge Distributors Ltd., 1998. p. 209.
14. McConnell JD, Roehrborn CG, Slawin KM, et al. Baseline measures predict the risk of benign prostatic hyperplasia clinical progression in placebo-treated patients. Program and abstracts of the American Urological Association 98th Annual Meeting; April 26-May 1, 2003; Chicago, Illinois. Abstract 1287.
15. Roehrborn CG, Boyle P, Nickel JC. PSA is a significant predictor of objective parameters in men at risk for BPH progression. Program and abstracts of the American Urological Association 98th Annual Meeting; April 26-May 1, 2003; Chicago, Illinois. Abstract 1361.
16. Roehrborn CG, McConnell J, Bonilla J, et al. Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. J Urol. 2000;163:13-20.
17. Kaplan SA, Roehrborn CG, McConnell JD, et al. Baseline symptoms, uroflow, and post-void residual urine as predictors of bph clinical progression in the medically treated arms of the MTOPS trial. Program and abstracts of the American Urological Association 98th Annual Meeting; April 26-May 1, 2003; Chicago, Illinois. Abstract 1289.
18. Kirby RS, Roehrborn C, Boyle P, et al. Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the prospective European doxazosin and combination therapy (PREDICT) trial. Urology. 2003;61:119-126.
19. Roehrborn CG. Proportion of patients from the PREDICT trial with at least a 4-point rise in international prostate symptom score at 1 year. Program and abstracts of the American Urological Association 98th Annual Meeting; April 26-May 1, 2003; Chicago, Illinois. Abstract 1291.
20. Boyle P, Robertson C, Wilson TH, et al. Predictive model for acute urinary retention in men with benign prostatic hyperplasia. Program and abstracts of the American Urological Association 98th Annual Meeting; April 26-May 1, 2003; Chicago, Illinois. Abstract 1293.
21. Kattan MW, Wilson TH, Roehrborn CG, et al. Development of a nomogram to predict bph progression with or without dutasteride therapy. Program and abstracts of the American Urological Association 98th Annual Meeting; April 26-May 1, 2003; Chicago, Illinois. Abstract 1781.

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