Scottsdale, Arizona (UroToday.com) Dr. Peter Rosier showed in this study where he analyzed 2459 men >45 year with bothersome LUTS Urodynamic grading of bladder outflow obstruction (BOO) for elderly males with prostate enlargement is (ICS) standardized since 1997. Both flowrate (including PVR) and prostate size have an intermediate sensitivity and specificity with regard to the gold standard diagnosis. Symptoms have little discriminating potential.
Urodynamic pressure flow test was done after ICS standard cytometry. Pressure flow result is shown per linearized passive urethral resistance class (LinPUR). Free flow study was performed in all patients.
The graphs show (upper left) that for the total group of patients absence of BOO (combining OBS grade 0 1 and 2, vertical) with reduced contractility (combining very weak and weak contraction classes) was present in 37.7% of patients, in 34% of all patients contraction was normal or strong, and there was no BOO (< OBS 3). BOO was confirmed in 28.7% of all these men combined with weak contractility in 4.7%. BOO was severe (grade could OBS 5 or 6) in 3.3% of the patients.
If flowrate was <10mL/s (in 457 men), again,38.7% of men had no BOO and weak contraction, and 22% of these men had no BOO and normal contraction. 39.2% of these men had BOO;5.8% in combination with weak contraction and for 6.8% the BOO was graded severe. In the group with flowrate >14mL/s (338 men), only 3 had severe grades of BOO (1%) and 85.6% of these men had no BOO and 56.2% had normal contractility.
He concluded that patients with flowrate above 14mL/s rarely (14.4%) have BOO, seldom high graded (1%). If flowrate is <14mL/s ≈35% of the patients have BOO and DU. 71% of all patients would profit from conservative measures and expectative measures because no BOO is responsible for their symptoms, however,>50% of these men without BOO have DU, for whom no specific treatment is available. 25,5% of all men could safely continue or start with medical treatment based on a moderate grade of BOO. Urodynamic stratification is helpful and would largely reduce unnecessary surgery in elderly men with lower urinary tract symptoms.
Presented by: Peter F.W.M. Rosier, MD PhD, Department of urology. University Medical Center Utrecht
Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona