Five-year Follow-up of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods-A...

Lower urinary tract symptoms (LUTS) are a key indication for surgery in older men. The Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) study evaluated the diagnostic pathway for men considering surgery to treat LUTS and reported the outcomes at 18 mo. This long-term follow-up study reports the symptoms and rates of prostate surgery at 5 yr.

UPSTREAM participants who had consented to long-term follow-up received postal questionnaires at 5 yr after randomisation (October 2019-December 2021). The primary outcome was the patient-reported International Prostate Symptom Score (IPSS, scale 0-35). Rates of surgery, derived from the National Health Service (NHS) England routine data, were a key secondary outcome. An intention-to-treat analytic approach was utilised.

At 5 yr, 211/427 (49.4%) participants in the intervention group and 204/393 (51.9%) in the routine care group completed the questionnaires, with routine data obtained for 801/820 (97.7%). The mean IPSS at 5 yr did not differ between randomised groups (adjusted difference 0.41, 95% confidence interval -1.10, 1.93), nor did the rates of surgery (0.96 [0.71, 1.28]). Urinary and sexual symptoms also showed no differences between the randomised groups. The main limitation is the reduced numbers of men in follow-up. In UPSTREAM, men were randomised to routine care diagnostic tests plus invasive urodynamics (intervention) or routine care only for LUTS. Treatment choice was made by the participants, advised by their clinicians.

Five-year follow-up does not support the routine use of invasive urodynamics in reducing LUTS or rates of prostate surgery. Urodynamics should be used selectively in the evaluation of uncomplicated LUTS.