Prognostic value of a combination of IPSS, flow rate and residual urine volume compared to pressure-flow studies in the preoperative evaluation of symptomatic BPH

Abstract Objective: Evaluate the predictive value of a combination of IPSS, uroflowmetry and ultrasound determination of residual urine volume 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 included. Preoperative evaluation: urine culture, PSA, uroflowmetry with sonographic measurement of post-void residual urine, DRE, IPSS with quality of life questions and pressure-flow study. Selection criteria for surgery were IPSS>16 and Q max Q max above 15ml/s, residual urine of less than 100ml, a 50% reduction in IPSS and absence of urinary retention. Results: Urodynamic abnormalities were found in 42 patients (93.3%): 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 preoperative value was 16.9, and dropped significantly to 4 ( P =0.005). The score improved significantly after surgery only in the obstructed group compared to the non-obstructed group ( P =0.001), however preoperative IPSS did not correlate with objective treatment results. Conclusions: A high proportion of patients successfully operated (71.1%) had a combination of IPSS>16 and Q max