COMBINATIONS OF MAXIMUM URINARY FLOW-RATE AND AMERICAN-UROLOGICAL-ASSOCIATION SYMPTOM INDEX THAT ARE MORE SPECIFIC FOR IDENTIFYING OBSTRUCTIVE AND NONOBSTRUCTIVE PROSTATISM

Uroflowmetry and the American Urological Association symptom index (AU ASI) are often used clinically to evaluate patients with benign prosta tic hyperplasia (BPH). Since results from these tests may be used to d etermine a treatment course, including surgical intervention, we inves tigated if specific combinations of uroflowmetry and AUASI parameters could better predict urodynamically confirmed prostatic obstruction. D ata from 134 men (mean age: 67.8 +/- 8.9 years) with prostatism were a nalyzed. The patients underwent uroflowmetry in the standing position after completing the AUASI; the post-void residual volume (PVR) was de termined. The presence and severity of prostatic obstruction was asses sed by video urodynamics, which included micturitional urethral pressu re profilometry (MUPP). Of the 134 total patients, 66 were found to be obstructed by MUPP. Correlations of maximum urinary flow rate (Q(max) ), PVR, and AUASI with the degree of obstruction were poor and not sub stantially improved using combinations of these parameters. Threshold values of Q(max) and AUASI, when used in combination, allowed accurate prediction of obstruction or non-obstruction in a small subset of the patient population. Of 14 men with both Q(max) < 10 ml/s and AUASI gr eater than or equal to 20, 13 were obstructed (specificity = 98%). Eig ht of 9 men with both Q(max) greater than or equal to 15 ml/s and AUAS I < 10 were non-obstructed. The combined Q(max) and AUASI criteria cat egorized only 20% of the patients as obstructed or non-obstructed. Onc e other causes of urinary dysfunction are ruled out, use of these crit eria will enable the urologist to make an accurate diagnosis of obstru ction, select a treatment more likely to benefit the patient, and make further diagnostic testing unnecessary in this small subset of patien ts. In a large volume clinical practice of adult male voiding dysfunct ions, diagnosis of even this small proportion of patients using this s imple approach can reduce patient care costs. (C) 1996 Wiley-Liss, Inc .