Factors predicting success of medical therapy in the management of clinical benign prostatic hyperplasia: role of position–related changes in urine flow rates

Mayur Bandawar

Volume : VIII, Issue : V, May - 2018

Factors predicting success of medical therapy in the management of clinical benign prostatic hyperplasia: role of position–related changes in urine flow rates

Mayur Bandawar

Abstract :

Introduction:

We examined the role of voiding position–specific flow rates in predicting success ofthe medical therapyfor clinical benign prostatic hyperplasia (BPH).

Material and methods:

Treatment naïve men older than 50years with bothersome lower urinary tractsymptoms (LUTS) defined as IPSS score >7 and global quality of life (QOL) score >2were enrolled. Men with diseases other than BPH affecting LUT–function wereexcluded. Participants were asked to void in digitaluroflowmeter three times, all onseparate occasions, once in each of the standing, sitting and squatting positions.Post–void residue (PVR) was measured using ultrasound. The study was repeated inthe same manner12weeks after starting medical management for BPH (tamsulosinwith/without dutasteride), whose success was defined as IPSS≤ 7 or QOL ≤ 2.

Results:

Thirty men with mean age 65.4±7.0y, IPSS 23±8, QOL 4±1 & prostate volume38.8±14.8cc completed the protocol. Volume–corrected maximum flow rates (cQmax)were highest in standing position in 11, sitting in 5 and squatting in 14 patients. Asignificant improvement was observed in flow–rates and PVR with treatment(p<0.05). Baseline prostate size <30 (p=0.016), maximum cQmax in squattingposition (p=0.009) and QOL (p=0.017) predicted success in terms of QOL. Theformer also predicted the success in terms of IPSS (p=0.008).

Conclusion:

Men with symptomatic BPH tend to have highest flow rates in squatting position,irrespective of preferred voiding position. The outcome of medical therapy for BPHcan be predicted bybaseline QOL, prostate size <30gm and finding of highestcQmax in squatting position.