International Prostatic Symptom Score — Voiding/Storage Subscore Ratio in Association with Total Prostatic Volume and Maximum Flow Rate Is Diagnostic of Bladder Outlet-Related Lower Urinary Tract Dysfunction in Men with Lower Urinary Tract Symptoms

Yuan-Hong Jiang,Chun-Hou Liao,Victor Chia-Hsiang Lin,Hann-Chorng Kuo,Utpal Sen

doi:10.1371/journal.pone.0059176

Yuan-Hong Jiang, Chun-Hou Liao + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0059176

Copy DOI

Abstract

ObjectivesThe aim of this study was to investigate the predictive values of the total International Prostate Symptom Score (IPSS-T) and voiding to storage subscore ratio (IPSS-V/S) in association with total prostate volume (TPV) and maximum urinary flow rate (Qmax) in the diagnosis of bladder outlet-related lower urinary tract dysfunction (LUTD) in men with lower urinary tract symptoms (LUTS).MethodsA total of 298 men with LUTS were enrolled. Video-urodynamic studies were used to determine the causes of LUTS. Differences in IPSS-T, IPSS-V/S ratio, TPV and Qmax between patients with bladder outlet-related LUTD and bladder-related LUTD were analyzed. The positive and negative predictive values (PPV and NPV) for bladder outlet-related LUTD were calculated using these parameters.ResultsOf the 298 men, bladder outlet-related LUTD was diagnosed in 167 (56%). We found that IPSS-V/S ratio was significantly higher among those patients with bladder outlet-related LUTD than patients with bladder-related LUTD (2.28±2.25 vs. 0.90±0.88, p<0.001). TPV was similar between the two groups; however, in contrast to patients with bladder-related LUTD, patients with bladder outlet-related LUTD had higher detrusor voiding pressure, lower Qmax values, and greater postvoid residual volumes. The combination of TPV30 ml and Qmax10 ml/sec had a PPV of 68.8% and a NPV of 53.5% for bladder outlet-related LUTD. When IPSS-T12 or IPSS-T15 was considered as an additional criterion, PPV increased to 75.0% and 78.5%, respectively, and the NPV decreased to 50.9% and 50.2%, respectively. When IPSS-V/S>1 or >2 was factored into the equation instead of IPSS-T, PPV were 91.4% and 97.3%, respectively, and NPV were 54.8% and 49.8%, respectively.ConclusionsCombination of IPSS-T with TPV and Qmax increases the PPV of bladder outlet-related LUTD. Furthermore, including IPSS-V/S>1 or >2 into the equation results in a higher PPV than IPSS-T. IPSS-V/S>1 is a stronger predictor of bladder outlet-related LUTD than IPSS-T.

Highlights

Lower urinary tract symptoms (LUTS), including voiding, storage, and post-micturition symptoms, are highly prevalent in men [1]
We investigated whether International Prostate Symptom Score (IPSS-T) or IPSS-V/S in association with total prostate volume (TPV) and Qmax could increase the diagnostic accuracy of bladder outlet-related lower urinary tract dysfunction (LUTD) in men with LUTS
Bladder outlet-related LUTD was diagnosed in 167 patients (56.0%), including benign prostatic obstruction (BPO) in 88 (29.5%) patients, bladder neck dysfunction (BND) in 39 (13.1%) patients, and poor relaxation of the urethral sphincter (PRES) in 32 (13.4%) patients

Summary

Introduction

Lower urinary tract symptoms (LUTS), including voiding, storage, and post-micturition symptoms, are highly prevalent in men [1]. LUTS can result from a complex interplay of pathophysiologic features that can include bladder dysfunction and bladder outlet dysfunction such as benign prostatic obstruction (BPO), bladder neck dysfunction (BND) or poor relaxation of the urethral sphincter (PRES) [2].Urodynamically proven bladder outlet obstruction (BOO) is found in 48–53% of men with LUTS, only 29.4% of them show evidence of BPO [2,3]. Treatment of LUTS in men depends on the etiology of the symptoms. Current guidelines suggest that antimuscarinic monotherapy can be used for men with storage LUTS, those without voiding LUTS, and those without voiding BOO [7,8,9]

Objectives

Methods

Results

Conclusion