Non-invasive method aids LUTS surgery decisions

Researchers say that non-invasive urodynamics could be used to assess prostatic obstruction and inform the decision to operate in men with lower urinary tract symptoms (LUTS).

Giovanni Losco and colleagues from the Palmerston North Hospital in New Zealand believe the penile cuff test, which involves a small, inflatable cuff being placed around the penile shaft while the patient voids, could be a viable alternative to the current gold standard of invasive urodynamics.

In their study of 62 patients with voiding-type LUTS, 41 patients were defined as having a good clinical outcome, according to the International Prostate Symptom Score, following transurethral resection (n=38) or holmium laser enucleation of the prostate (n=24).

Of these 41 patients with good outcome, 33 (80.5%) had been predicted as having prostatic obstruction using the penile cuff test compared with just three (9.5%) of the 21 patients with a poor clinical outcome.

On the reverse, 33 (94.3%) of the 35 patients predicted to have obstructions had a good clinical outcome, compared with just eight (29.6%) of the 27 patients predicted to have no obstruction.

Writing in BJU International, the team says that their results show “that men who are proven to be obstructed on the pre-operative non-invasive urodynamic study/cuff test are likely to have an excellent outcome after surgery.”

They add: “Furthermore, the cuff test can easily and simply be performed in the clinic setting at the time of initial urological review, greatly aiding decision-making and improving the patient journey towards surgery.”

They also note that 30% of men not predicted to have obstructions still had a good outcome after surgery, which is comparable to the rate seen with invasive urodynamics.

“Our study shows that the cuff test, a non-invasive alternative, is a viable option… with outcomes that are comparable to the current gold standard,” they write.

“This is an exciting development in the investigation and management of male lower urinary tract symptoms.”

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