Long-term predictive role of urodynamics: An 8-year follow-up of prostatic surgery for lower urinary tract symptoms

Objective To investigate the long-term predictive value of urodynamics for the outcome of patients undergoing prostatic surgery for lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOG) and to determine the long-term effectiveness on symptoms, maximum now rate and the rate of re-operation. Patients and methods Of 139 elderly men who had undergone prostatic surgery, selected without reference to urodynamic assessment but having extensive (blinded) urodynamic testing included in their evaluation, 79 were followed for 8 years using a history, symptom score analysis, uroflowmetry and review of their records. Results Comparing the results in groups of men with a pre-operative maximum now rate < or greater than or equal to 15 mL/s, there was a similar difference in the rate of success to that noted 6 months post-operatively. Similar results were obtained when comparing those with BOO or a normal bladder outlet function. However, although the tendency was clear it was not statistically significant because of the small sample size (type-2 error). There was a significant reduction in all symptom scores from those assessed pre-operatively and during the 8 years (P<0.001). The median pre-operative maximum flow rate was 8.5 mL/s, compared with 12.5 mL/s after 8 years (P<0.001). Of the 79 patients, 14 (18%) had 28 re-operations during the 8-year follow-up, 12 being repeat resections of the prostate, giving a repeat resection rate of 1.8% per year and a success rate of 71%. During the 8 years, 82% of the patients had an unchanged overall evaluation of the post-operative outcome. In general, those having an unsatisfactory outcome were slightly younger than the whole group. Conclusion Uroflowmetry and pressure-now studies can predict to some degree the long-term result after prostatic surgery. There was a durable effect on symptom scores and maximum now rates after the operation. The annual rate of repeat resection (1.8%) was relatively low.