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Non-invasive urodynamics predicts outcome prior to surgery for prostatic obstruction - PowerPoint PPT Presentation


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No. 037. Non-invasive urodynamics predicts outcome prior to surgery for prostatic obstruction. Giovanni Losco, Lucy Keedle, Quinten King Department of Urology, Palmerston North Hospital, Palmerston North, New Zealand. Posters Proudly Supported by: . Results

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Non invasive urodynamics predicts outcome prior to surgery for prostatic obstruction

No. 037

Non-invasive urodynamics predicts outcome prior to surgery for prostatic obstruction

Giovanni Losco, Lucy Keedle, Quinten King

Department of Urology, Palmerston North Hospital, Palmerston North, New Zealand

Posters Proudly Supported by:

  • Results

  • Data was obtained for 62 patients with a mean age of 70 years (range 49 to 86 years; SD 9 years).

  • Follow-up was complete for all patients.

  • 38 patients underwent TURP and 24 underwent HoLEP.

  • Mean IPSS score was 21 (range 5 to 35; SD 6) pre-operatively and 11 (range 1 to 31; SD 9) post-operatively.

  • 35 patients were predicted obstructedand 27 not obstructed.

  • 94% of those predicted obstructed had a clinically successful outcome after surgery (p < 0.01).

  • 70% predicted as not obstructed did not have a clinically successful outcome after surgery (p < 0.01).

  • Introduction

  • Non-invasive urodynamics, using a penile cuff, allows estimation of bladder pressure whilst flow rate is recorded.

  • Patients with proven urodynamic obstruction do better after surgery.

  • The current gold standard, invasive pressure-flow studies, imposes cost, resource demand, discomfort and inconvenience to patients.

  • The search is on for a simpler device that aids treatment decisions and predicts outcomes for men presenting with obstructive lower urinary tract symptoms.

  • Aim

  • Our objective was to assess whether the penile cuff serves as an effective diagnostic test for this purpose.

Modified IPSS nomogram for the penile cuff device. Patients falling into the pink zone are predicted to be obstructed whereas patients falling into the green zone are predicted to be not obstructed.

  • Methods

  • Patients recruited were undergoing surgery for prostatic obstruction at Palmerston North Hospital.

  • Pre-operative non-invasive urodynamics were performed and International Prostate Symptom Score (IPSS) obtained. Catheterised patients were excluded.

  • Two months post-operatively a further IPSS score was obtained.

  • An improvement of seven or greater was defined as a clinically successful outcome.

  • Results were compared with the outcome predicted by the nomogram supplied with the urodynamic device.

The diagram demonstrates the principle of the penile cuff device. The pressure at which flow stops (urethral closure pressure) is a surrogate marker of vesical pressure.

The table shows the total number of patients predicted by the penile cuff test as obstructed or not obstructed, and whether they had a good or a poor clinical outcome (p = 0.002).

  • Conclusions

  • The penile cuff test is a useful adjunct in the decision to proceed to surgery for prostatic obstruction.

  • Patients predicted to be obstructed have an excellent likelihood of a good surgical outcome

  • Despite this, 30% of those shown not to be obstructed will still do well.

  • Whilst numbers in our study are small, outcomes compare favourably with published results on invasive urodynamic methods.

  • References

  • Harding C, Robson W, Drinnan M et al. Predicting the outcome of prostatectomy using noninvasive bladder pressure and urine flow measurements. Eur Urol 2007;52:186-92.

  • Griffiths CJ, Harding C, Blake C et al. A nomogram to classify men with lower urinary tract symptoms using urine flow and non-invasive measurement of bladder pressure. J Urol 2005;174:1323-6.