On investigations of patients with lower urinary tract symptoms due to suspected bladder outlet obstruction

Abstract

Lower urinary tract symptoms (LUTS) are caused by a variety of different diseases, including cancer in the urinary tract, overactive bladder (OB) and bladder outlet obstruction (BOO). In order to find the most plausible cause of the patientís LUTS, a number of different investigations have been developed. The standard investigations recommended by the WHO for a patient with LUTS include routine lab. tests like s-PSA, urinary sticks and urine culture, symptom score, a voiding diary, digital rectal examination, transrectal ultrasound, office uroflowmetry and measurement of residual urine. However, BOO can only be accurately diagnosed by the urodynamic assessment of pressure and flow studies (pQS). OB is revealed by cystometry.The first aim of the present study was to determine if home uroflowmetry can give more information than ìtraditionalî office uroflowmetry, and whether home uroflowmetry can reflect the results of pQS. BOO commonly coexists with OB in patients with LUTS. The second aim was to describe and quantify this phenomenon by a standardised investigation including cystometry and pQS and to elucidate differences between patients with ìpureî BOO and patients with BOO combined with OB.The natural history of BOO due to BPE is poorly understood. The aim of the third study was to investigate a group of patients who themselves preferred WW and to follow the development of symptoms and the frequency of failure and complications during four years.pQS has been proposed as a useful instrument for selection of graded treatment of BOO. We have also used pQS for selected treatment in three arms: TURP, TUMT and WW, and then studied the results after 1 year. In this study, the patients were treated as minimally invasively as possible.In the fifth study, we have used biodegradable PGA stents to judge the risk of post-TURP incontinence in patients with a combination of BOO and OB. With home uroflowmetry, it is possible in 50% of cases to reveal if the patient has a minor or severe BOO. pQS seems useful for selection to different treatments according to their BOO. The prevalence of OB increases with increasing BOO, suggesting that BOO can be a cause of OB. We observed that the failure rate in WW increased with increasing obstruction, but the complication rate of WW was minor.BOO combined with OB is present in 45% of the patients. In 30% of the patients there is a risk of post-TURP urgency incontinence. A PGA-stent seems very useful to judge the risk of post-TURP incontinence in patients with a combination of BOO and severe OB. None of the patients who remained continent during the stent period became incontinent after TURP