Comparison of Penile Cuff Test and Conventional Urodynamic Study Prior to Photoselective Vaporization of Prostate for Benign Prostate Hyperplasia Using a 120 W GreenLight High Performance System Laser.

Kang Sup Kim,Sae Woong Kim,Ji Youl Lee,Sung-Hoo Hong,Woong Jin Bae,Yong Sun Choi,Hyuk Jin Cho

doi:10.3390/jcm9041189

Abstract

Background: We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). Methods: Fifty-nine patients with voiding lower urinary tract symptoms (LUTS) underwent a simultaneous PCT and conventional UDS before PVP. The modified International Continence Society (ICS) nomogram was used to confirm bladder outlet obstruction after measuring maximum urinary flow rate and highest pressure at flow interruption. The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared. Their sensitivities, specificities, and positive and negative predictive values were calculated. Results: Thirty-six patients were diagnosed as obstructed and 23 as non-obstructed/equivocal using the modified ICS nomogram during the PCT. All 36 of the first group were confirmed as obstructed by UDS. Of the 23 diagnosed as non-obstructed/equivocal by the PCT, 14 were confirmed to be non-obstructed by UDS, with nine diagnosed as obstructed. The PCT showed a sensitivity of 80% and a specificity of 100%. The positive and negative predictive values were 100% and 60.9%, respectively. Conclusions: In conclusion, despite our small number of patients, the PCT’s high sensitivity and specificity suggest that it may provide diagnostic information about bladder outlet obstruction before PVP for patients with voiding LUTS. Evidently, the PCT has the potential to be used for some patients as a screening alternative to invasive UDS.

Highlights

The penile cuff test (PCT) has the potential to be used for some patients as a screening alternative to invasive urodynamic study (UDS)
A urodynamic study (UDS) for bladder pressure measurement is regarded as the gold standard for the clinical evaluation of bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) [1]
Since our institution began performing minimally invasive prostate surgeries, such as photoselective vaporization of the prostate (PVP) or holmium laser enucleation of the prostate, instead of transurethral prostatectomy (TURP) for treating BOO related to benign prostate hyperplasia (BPH), several years ago [15,16], determining appropriate minimally invasive diagnostic tools for evaluating and discriminating between BOO and impaired detrusor contractility has become mandatory in order to minimize inconvenience and complications caused by conventional UDS

Summary

Introduction

A urodynamic study (UDS) for bladder pressure measurement is regarded as the gold standard for the clinical evaluation of bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) [1]. Conventional UDS has disadvantages, including its inconvenience, invasiveness, cost, and the risk of urinary tract infection [4] It requires skilled staff and specialized equipment [5]. For these reasons, in some centers, UDS is not routinely performed for patients with lower urinary tract symptoms (LUTS) and is used only in select cases [5]. We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared Their sensitivities, specificities, and positive and negative predictive values were calculated.

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Results

Discussion

Conclusion