Pressure-flow studies for patient selection in the treatment of symptomatic BPH--a one-year follow-up study

Many different treatments for lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO) are available today. To select the most suitable method for each patient is therefore a delicate task. The aim of this study has been to use a standardised systematic investigation schedule including pressure flow studies (pQS) in order to try to use graded treatment according to obstruction.

Ninety-nine patients were systematically examined with routine investigations and pQS to select between 3 treatment options, TURP, TUMT 2.0 (low energy) and watchful waiting (WW). Patients with severe BOO were recommended TURP, patients with moderate BOO were treated with TUMT and patients with no or minor BOO were recommended WW.

TURP produced the best improvement in maximum free flow (Q-max), IPS-score and PVR, but only TURP had serious complications. TUMT treatment produced a more moderate improvement in flow rate, IPS-score and PVR, and all of the complications were minor. WW did not improve PVR or Q-max but the IPS-score decreased significantly. One UTI was the only complication in the WW group.

pQS can be used to allocate patients with LUTS due to suspected BOO into different treatment arms; TURP, TUMT, WW, all with known different effects of BOO and with different severity of complications. Good symptomatic effect in Q-max, PVR and IPS-score with less serious complications and at low failure rate can thereby be obtained.