GRADING OF BENIGN PROSTATIC OBSTRUCTION CAN PREDICT THE OUTCOME OF TRANSURETHRAL PROSTATECTOMY

Purpose: We investigate whether urodynamic grading of benign prostatic obstruction and detrusor contractility predicts the outcome of transu rethral prostatectomy. Materials and Methods: A total of 53 patients w ho were suitable candidates for transurethral prostatectomy completed an assessment protocol before and 3 months after surgery, which includ ed International Prostate Symptom Score, uroflowmetry, ultrasonography (prostatic size and residual urine volume) and standard pressure flow study, The results of the pressure flow study were analyzed to grade obstruction (unequivocal, equivocal or no obstruction) and detrusor co ntractility (weak or normal) using our simplified pressure flow nomogr am. Results: Analysis of the pressure flow study data demonstrated tha t the efficiency of detrusor contraction was weak in 6 of 27 men with unequivocal, 11 of 23 with equivocal and 2 of 3 with no obstruction. T reatment outcome was significantly better in patients with unequivocal obstruction and normal detrusor contractility, Treatment failure occu rred in 80% of patients with equivocal obstruction and impaired detrus or contractility, and 100% of the unobstructed group. Urodynamic gradi ng of obstruction and detrusor contractility predicted treatment outco me with a sensitivity of 87%, specificity 93% and positive predictive value 95%. Conclusions: Urodynamic grading of benign prostatic obstruc tion and detrusor contractility can reliably predict treatment outcome and, therefore, enable the urologist to identify a subgroup of patien ts who would not benefit from surgery.