How correlated is BOO with different objective parameters commonly used in evaluation of BPH: a prospective study
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UROLOGY - ORIGINAL PAPER
How correlated is BOO with different objective parameters commonly used in evaluation of BPH: a prospective study Bassem S. Wadie1 Received: 18 July 2020 / Accepted: 2 November 2020 © Springer Nature B.V. 2020
Abstract Objectives The use of non-intubated uroflowmetry, PVR, prostate volume, and I-PSS are the most commonly used tools for the evaluation of patients with BPH. In this prospective study, we elucidated the correlation between BOO as rated by pressure-flow study in men with LUTS attributed to BPH and those parameters. Methods Over a period of 2 years 460 men above the age of 45 years old (mean age 60.46 ± 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, prostate-specific antigen, and transrectal ultrasound were done. The urodynamic evaluation included uroflowmetry, filling cystometry, and voiding cystometry with the plotting of pressure-flow study according to Lin-PURR (Schäfer’s nomogram). The correlation coefficient was calculated between these variables. Results The correlation of other objective parameters with total score was not much better. The Spearman’s correlation coefficient were − 0.09, 0.07 and − 0.1 for prostate weight, post voiding residual urine and maximum free flow rate respectively. Correlations between Schäfer’s grade and Qmax, PVR and prostate volume were found to be weak to fair correlation (r values were − 0.4, 0.18, and 0.39 respectively). Conclusion Objective non-invasive parameters most commonly used in the evaluation of men with LUTS attributed to BPH have limited correlation with obstruction, as diagnosed by pressure flow nomogram. Keywords BPH · LUTS · Objective · BOO · Parameters Abbreviations BPH Benign prostatic hyperplasia LUTS Lower urinary tract symptoms BOO Bladder outflow obstruction I-PSS International prostate symptom score Qmax Maximum flow rate Pdet Qmax Detrusor pressure at maximum flow Lin PURR Linear passive urethral resistance relation PVR Post-voiding residual urine TRUS Transrectal ultrasound DRE Digital rectal examination PSA Prostate-specific antigen
* Bassem S. Wadie [email protected]; [email protected] 1
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
Introduction The evaluation of men with BPH involves multiple noninvasive tests. Garraway et al. [1], suggested a clinical definition of BPH as prostate weight over 20 gm., maximum flow rate less than 15 ml/s, and presence of symptoms of urinary dysfunction. Based on this definition, the prevalence of BPH was estimated to be 25.3% in men in the community, 13.8% in men between 40 and 49 years and 43% between 60–69 years. Benign prostatic hyperplasia (BPH) is the most common cause of BOO in elderly males [2]. Qmax of 10 ml/s has been recognized as a cutoff for BOO, with a specificity of 70%, and a sensitivity of 47%, while a 15 ml/s cutoff was associated with a specificity of 38%, and a sensitivity of 82% in a large multi-center study [
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