MP35-18 NOT A VOLUME BUT A STRUCTURAL VARIATION OF THE PROSTATIC URETHRA WITHIN THE PROSTATE PREDICT THE DEGREE OF OBSTRUCTIVE SYMPTOM: A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY

Abstract

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in older men and there is increasing awareness of the impact of the underactive bladder (UAB) in the elderly. We assessed symptoms suggestive of UAB and voiding parameters in a group of community-dwelling elderly men over a period of 5 years. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects are re-assessed after two years and five years with repeat survey and clinical assessment. UAB symptoms were assessed based on the IPSS-voiding subscore (IPSSV) and correlated with voiding parameters at baseline and five year follow-up. RESULTS: 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had deceased). 275 men with prostate cancer and 302 men with previous surgical treatment for BPH were omitted from analyses. Men with significant overactive bladder symptoms (IPSSstorage subscore >5) were excluded leaving 870 men for analysis. 93% had low IPSS-V scores (0-6),6% intermediate IPSS-V (7-13) and 1% high IPSS-V(14-20). Mean peak flow rates at baseline for men with low, intermediate and high IPSS-V scores were 13.3 mls/sec, 10.9mls/ sec and 10.1mls/sec respectively (P<0.001) but there was no significant change at 5 years (12.5mls/s, 10.6mls/s, 10.8mls/s). Mean post void residual volume for men with low, intermediate and high IPSS-V scores at baseline were 66.9mls, 78.4mls and 92.6mls respectively (P1⁄40.001) and there was no significant change at 5 years. Increased total IPSS-V correlated with reduced peak flow and increased post void residual (P<0.001), but not with age. Only 18 (2%) men had surgery for LUTS between baseline and 5 years. The risk of undergoing surgery correlated with intermediate/high IPSS-V scores (P1⁄40.014). CONCLUSIONS: Both UAB symptoms and voiding parameters of uroflowmetry and post void residual volume remain relatively stable over a five year period in elderly, community-dwelling men. UAB symptoms correlated with elevated postvoid residual urine and reduced urinary flow rates although the number of men requiring surgical intervention was low.