Update evaluation of benign prostatic hyperplasia: when should we offer prostatectomy?

OBJECTIVE: To investigate correlations between traditional and urodynamic criteria in the evaluation of prostatism and to try to establish an update evaluation of patients with benign prostatic hyperplasia (BPH) with the aim of preventing unnecessary prostatectomies. PATIENTS AND METHODS: The series constituted 96 patients aged 43-86 years (mean 63.41 +/- 9.25) with prostatism and BPH. All were assessed by symptom analysis, digital rectal examination, residual urine determination, uroflowmetry and further multichannel urodynamic testing (medium fill cystometry, pressure flow study). RESULTS: Residual urine determination was not a reliable criterion for selection of patients for surgery. A striking statistically significant correlation was evident when symptomatology and the results from multichannel urodynamic study were compared. No correlation was found between irritative symptoms and detrusor instability. CONCLUSION: A significant proportion (23%) of the whole patient population was classified as a urodynamically unobstructed group to which we think prostatectomy should not be offered. We recommend that a pressure-flow study is performed in all patients with BPH with dominant irritative symptoms to identify those who are unobstructed.