Bedside risk score for medical therapy failure in small-volume BPH: Temporal validation

Area of Science:

• Urology
• Men's Health
• Medical Informatics

Background:

• Medical therapy is the primary treatment for lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH).
• Predictors of treatment failure in men with small prostate volume (<30ml) are not well-defined.
• Accurate risk stratification is needed for optimal management of BPH patients with small prostates.

Purpose of the Study:

• To develop and validate a simple bedside risk score for predicting medical therapy failure in men with small prostate volume BPH.
• To identify key clinical parameters that predict treatment failure in this specific patient subgroup.
• To enable early identification of patients likely to experience treatment failure.

Main Methods:

• Retrospective cohort study of 201 men (≥50 years) with LUTS/BPH and prostate volume <30ml.
• Treatment failure defined as surgery, acute urinary retention, or IPSS worsening by ≥4 points.
• Multivariable logistic regression identified predictors; a risk score was derived and temporally validated.

Main Results:

• 66 patients (32.8%) experienced treatment failure over a median 24-month follow-up.
• Predictors included higher IPSS, BPH Impact Index, intravesical prostatic protrusion, lower Qmax, higher PVR, and diabetes.
• The risk score effectively stratified patients into low (11.0%), moderate (32.9%), and high-risk (77.5%) failure categories (AUC 0.789).

Conclusions:

• A novel bedside risk score accurately predicts medical therapy failure in small-volume BPH.
• The score utilizes readily available clinical parameters for practical application.
• This tool can facilitate early risk stratification and timely interventions, especially in diabetic populations.