Symptoms and Diagnostics in Clinical BPH : quantitative analyses of interactions among symptom scores, quality of life score, voiding data and urodynamic findings

Abstract

Benign prostatic hyperplasia (BPH) is a common disease of men beyond middle age. In a lot of these men, BPH is associated with lower urinary tract symptoms (LUTS). Depending on the degree of bothersomeness of these LUTS, the patient will seek medical treatment. As BPH progresses, the hyperplastic tissue may obstruct the urinary flow during voiding. The lifetime probability of surgical treatment of men for BPH is about 30%. Accurate diagnosis of BPH and patient classification should result in improvements in treatment for this disease. The aims of this thesis were to evaluate different diagnostic methods and their associations in well-defined groups of men with LUTS suggestive of BPH. Besides, we estimated the prevalence and bothersomeness of LUTS and their impact on well being, and quantified the diagnostic value and overlap of the different diagnostic investigation methods and combination of methods. We evaluated 565 patients with LUTS suggestive of BPH who visited the outpatient clinic of Urology in the period 1993 until 2000. Also 14 healthy volunteers without LUTS and 17 volunteers with LUTS were involved in the study. The following evaluations were performed: medical history, physical examination including digital rectal examination, urinalysis and renal function assessment, uroflowmetry and residual urine estimation, quantification of symptoms, bothersome and quality of life with questionnaires, determination of the prostate size by transrectal ultrasound, and urodynamic investigations (filling cystometry and pressure-flow studies). Besides, patients were asked to complete voiding diaries for (at least) three 24-hour periods. Reporting correctly on frequency-volume charts during just 24 hour is sufficient to gain insight into the voiding habits of a patient with LUTS suggestive of BPH. Symptoms and their bothersomeness and urodynamic evaluations show different aspects of BPH and complement each other. Usual urodynamic findings in patients with LUTS were also found in healthy volunteers without LUTS. We excluded men with severe and prolonged obstruction, because of resulting (starting) decompensation of the bladder. In de included patients we found a decreasing bladder capacity and an increasing residual volume at increasing obstruction grade. As a result the effective bladder capacity decreased remarkably. The "shrinking bladder" plays a prominent role in the bothersomeness of men with (starting) BPH. Urodynamic investigations improve diagnosis. Because urodynamic investigations are in the urologic world not always performed in men with LUTS suggestive of BPH, a "Bladder Outlet Obstruction Number" (BOON) was introduced, based on three easily available, non-invasive, parameters. BOON can be used to predict the possibility of the presence or absence of infravesical obstruction.