Pressure flow study data in a group of asymptomatic male control patients 45 years old or older

Purpose: The role of pressure flow studies in the routine evaluation of pat ients with benign prostatic hyperplasia remains a controversial issue in ur ological practice. There are little data on age matched asymptomatic contro l groups. We evaluated pressure flow findings in such a group. Materials and Methods: A total of 24 male patients 47 to 80 years old (mean age 62.5) attending a general surgical clinic were recruited for study aft er ethical committee approval. The volunteers had never sought medical atte ntion for urinary symptoms and did not perceive themselves as having a urol ogical problem. Volunteers were assessed by International Prostate Symptom Score (I-PSS) and Madsen symptom score, clinical examination, free uroflowm etry, post-void residual ultrasound, repeat pressure flow studies and trans rectal ultrasonography. Pressure flow tracings were manually analyzed for s tandard urodynamic values and the degree of bladder outflow obstruction acc ording to recognized International Continence Society, Abrams-Griffith nomo gram, linear passive urethral resistance relation and urethral resistance f actor classifications. Results: Median I-PSS was 2.0 (interquartile range 1.2 to 5.7). For I-PSS q uality of life the median was 1.0 (interquartile range 0.75 to 2.0). On pre ssure flow studies 3 patients (13%) had unequivocal obstruction, 7 (29%) we re in the equivocal area and 14 (58%) had no obstruction, while 15 (63%) ha d unstable contractions on medium fill cystometry. Conclusions: The data show that a surprising number of apparently normal me n are obstructed by commonly used criteria. This finding confirms asymptoma tic obstruction, suggesting that obstruction may be less important in the d evelopment of symptoms than previously thought. Also, until the natural his tory of obstruction is more clearly defined surgery in obstructed asymptoma tic patients is probably unwise.