138 randomly selected (from our ‘BPH-database’) men aged 64,6y (s.d. 10,2) with IPSS 17,8 (6,7) and QuOL 3,4 (1,4) at referral, had prostate size 70,0 cm3 (30,5) and (free flow) Qmax 10,4 mL/s (6,2) and a voided volume of 159,0 mL (128,7) with PVR of 79.0 mL (104). Most patients (81; 58,7%) had pharmacological treatment at referral. (32%: alpha-blocker only, 12% others had used these, but stopped; and 8% had polypharmacy for various reasons). 75 (54,3%) men were not satisfied with their LUTS- medication. 34 (24,6%) had not received earlier specific treatment for their LUTS. Some had UTI, pain or AUR in the past and 4 (2%) had prostate carcinoma and LUTS during expectative management for their prostate carcinoma. Two patients were initially referred with erythrocyturia.
UDI was performed according to the 2006 ICS standard with a 7F double lumen catheter and, a water filled external pressure recording system. Voiding was allowed in privacy and in the preferred (usually standing) position with the flowmeter funnel near to the meatus.
Pressure flow study (PFS) resulted in mean outflow obstruction grade URA: 37,9 cmH2O (s.d. 20,4) and BOOI 52,7 (34,1). Also, a mean detrusor voiding contraction grade Wmax of 15,0 w/m2 (10,6) and BCI 116,0 (32,0) were measured. 40 patients had no BOO (ICS nomogram) and normal contraction; 37 had no BOO and weak contraction; 53 had BOO with normal contraction and 8 had BOO and weak contraction. Prostate volume correlated weak but significant with age (Pearson r: 0,302). Free flow Qmax correlated with URA (r: -0,326) and (weak) with (PFS) PVR (r: -0,261). (PFS-) PVR correlated with URA and Wmax (r: 0,468 and r: -0,320). No correlations were found with IPSS apart from a weak but significant total-IPSS with (IPSS-)QuOL (r:0,497).
After second-line diagnosis, the patients without BOO were offered continuation or adaptation /personalization of medication or conservative management. Of note: 111 (55%) had DO during cystometry and medication was adapted for this in a proportion of patients. The other patients, with BOO were offered surgery or, as the alternative: to start, change, or continue medication or conservative management.