Prostate Surgery for Men with Lower Urinary Tract Symptoms: Do We Need Urodynamics to Find the Right Candidates? Exploratory Findings from the UPSTREAM Trial.

Autor: Young GJ; Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK., Metcalfe C; Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK., Lane JA; Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK., Lewis AL; Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK., Abrams P; Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK., Blair PS; Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK., Ito H; Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK., Chapple C; Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK., Drake MJ; Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK. Electronic address: marcus.drake@bristol.ac.uk.
Jazyk: angličtina
Zdroj: European urology focus [Eur Urol Focus] 2022 Sep; Vol. 8 (5), pp. 1331-1339. Date of Electronic Publication: 2021 Dec 16.
DOI: 10.1016/j.euf.2021.11.010
Abstrakt: Background: Identifying men whose lower urinary tract symptoms (LUTS) may benefit from surgery is challenging.
Objective: To identify routine diagnostic and urodynamic measures associated with treatment decision-making, and outcome, in exploratory analyses of the UPSTREAM trial.
Design, Setting, and Participants: A randomised controlled trial was conducted including 820 men, considering surgery for LUTS, across 26 hospitals in England (ISCTRN56164274).
Intervention: Men were randomised to a routine care (RC) diagnostic pathway (n = 393) or a pathway that included urodynamics (UDS) in addition to RC (n = 427).
Outcome Measurements and Statistical Analysis: Men underwent uroflowmetry and completed symptom questionnaires, at baseline and 18 mo after randomisation. Regression models identified baseline clinical and symptom measures that predicted recommendation for surgery and/or surgical outcome (measured by the International Prostate Symptom Score [IPSS]). We explored the association between UDS and surgical outcome in subgroups defined by routine measures.
Results and Limitations: The recommendation for surgery could be predicted successfully in the RC and UDS groups (area under the receiver operating characteristic curve 0.78), with maximum flow rate (Q max ) and age predictors in both groups. Surgery was more beneficial in those with higher symptom scores (eg, IPSS >16), age <74 yr, Q max <9.8 ml/s, bladder outlet obstruction index >47.6, and bladder contractility index >123.0. In the UDS group, urodynamic measures were more strongly predictive of surgical outcome for those with Q max >15, although patient-reported outcomes were also more predictive in this subgroup.
Conclusions: Treatment decisions were informed with UDS, when available, but without evidence of change in the decisions reached. Despite the small group sizes, exploratory analyses suggest that selective use of UDS could detect obstructive pathology, missed by routine measures, in certain subgroups.
Patient Summary: Baseline clinical and symptom measurements were able to predict treatment decisions. The addition of urodynamic test results, while useful, did not generally lead to better surgical decisions and outcomes over routine tests alone.
(Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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