Urologic Principles and Practice by Christopher R. Chapple & William D. Steers & Christopher P. Evans

Author:Christopher R. Chapple & William D. Steers & Christopher P. Evans
Language: eng
Format: epub
ISBN: 9783030285999
Publisher: Springer International Publishing

Optional or Investigational Tests

Pressure flow studies are considered an optional test by several international guidelines. The gold standard for the diagnosis of BOO is represented by invasive urodynamics, however discomfort and complications may limit its use. Pressure-flow study has the unique capacity to diagnose BPO, detrusor overactivity and detrusor underactivity. According to EAU guidelines, in patients younger than 50 or older than 80, patients who have had previous un-successful invasive treatments, who cannot void more than 150 cc, who have Qmax>10 ml/s or in men who have post void urine volume (PVR) > 300 cc should undergo PFs.

Endoscopy is an optional test in all guidelines in patients with BPH, considering that it cannot diagnose BOO. The test could be useful in the evaluation of patients with LUTS but is appropriate in men with a history of microscopic or gross haematuria, urethral stricture, bladder cancer, or prior lower urinary tract surgery. It should not be performed whenever watchful waiting or medical therapy has been proposed as the treatment of choice and it remains optional in patients scheduled for surgery.

Some other non-invasive tests have been proposed however none of them can substitute invasive urodynamics. The penile-cuff test (PCT) and the external condom test have been introduced as a non-invasive alternative to PFS to determine the isovolumetric bladder pressure and also flow rate. This method, in which flow is interrupted to estimate isovolumetric bladder pressure, shows promising data, with good test repeatability and interobserver agreement. Bladder, detrusor wall thickness and bladder weight can be measured simply with suprapubic ultrasound. Overall some evidence suggests good accuracy of this measurements in diagnosing BOO due to BPH however the lack of standardization, and lack of evidence to indicate which measurement (BWT/DWT) is preferable render the test still investigational. Ultrasound measurement of IPP assesses the distance between the tip of the prostate median lobe and bladder neck in the midsagittal plane, using a supra-pubically positioned US scanner, with a bladder volume of 150–250 mL; grade I protrusion is 0–4.9 mm, grade II is 5–10 mm and grade III is >10 mm. Although the available evidence suggests a good performance in diagnosing BOO, the lack of standardization, and of data on inter-intra observer variability and learning curve still render the test investigational. According to the latest systematic review performed by the EAU non neurogenic LUTS guidelines panel and although all these tests have shown promising results for the noninvasive assessment of BOO, invasive urodynamics remain the gold standard [24].

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