Eur Urol Focus: Is urodynamics required to screen suitable candidates for prostate surgery with lower urinary tract symptoms?

About 30% of men over the age of 65 have lower urinary tract symptoms (LUTS), and this rate is rising as the population ages
.
LUTS includes a variety of different symptoms, including voiding (eg, weak urine flow) and storage (eg, incontinence), which are often associated with bladder outlet obstruction (BOO)

In patients with lower urinary tract symptoms (LUTS), identifying men who may benefit from surgery is a challenge
.

In an exploratory analysis of the UPSTREAM trial, researchers from the United Kingdom, published in the journal Eur Urol Focus , investigated routine diagnostic and urodynamic measurements
associated with treatment decisions and outcomes .

The study was a randomized controlled trial including 820 men and considering surgery for LUTS involving 26 hospitals in England (ISCTRN56164274)
.
Participants were randomly assigned to the usual care (RC) diagnosis group (n=393) and the urodynamic (UDS) group except RC (n=427)

RESULTS: Surgical recommendations were successfully predicted in both the RC and UDS groups (area under the receiver operating characteristic curve, 0.
78), with predictors of maximum flow (Qmax) and age in both groups
.
Surgery is more favorable for those patients with higher symptom scores (eg, IPSS>16), age <74 years, Qmax <9.

Multivariate Models Predict Treatment Decisions

Taken together, UDS is a good predictor of treatment decisions , but there is no evidence that decisions reached change as a result of UDS
.
Despite the small group size, exploratory analyses suggest that selective use of UDS can detect obstructive lesions in certain subgroups that are missed by routine measures

Grace J Young, Chris Metcalfe, J Athene Lane et al.