Urodynamic Studies Don't Reduce Prostate-Surgery Rates

By Will Boggs MD

July 31, 2020

NEW YORK (Reuters Health) - Urodynamic studies do not reduce prostate-surgery rates in men with lower-urinary-tract symptoms (LUTS), according to results from the UPSTREAM trial.

"A well-done assessment without using urodynamics can achieve the most important information for deciding on treatment recommendations," Dr. Marcus J. Drake of Bristol Urological Institute and Bristol Medical School, University of Bristol, in the U.K., told Reuters Health by email.

LUTS can arise from benign prostate obstruction (BPO) and detrusor underactivity (DU), and urodynamics uses pressure flow studies to differentiate the two. Only BPO is likely to benefit from prostate surgery.

Dr. Drake and colleagues in 26 hospitals in England investigated whether a care pathway using urodynamic studies would reduce surgery without increasing urinary symptoms in their pragmatic, noninferiority, randomized trial of men with bothersome LUTS in whom surgery was an option.

In the analyzable group of 641 men, there was no significant difference in the International Prostate Symptom Score (IPSS) at 18 months after randomization, the primary outcome, the researchers report in European Urology.

During the 18-month period, 38% (153/408) of men in the urodynamic study arm underwent prostate surgery, compared with 36% (138/384) of men in the routine care arm. There was no difference in the proportions of men offered surgery in the two groups (49% vs. 48%, respectively).

There was no clinically important difference between the groups in quality of life scores at 18 months, and other urinary outcomes were similar, with general improvement of all symptoms by 18 months.

There was no evidence to suggest that one study arm was superior to the other in terms of adverse events per individual or related serious adverse events.

"We hypothesized that by identifying DU, urodynamics would reduce surgery rates, but such a reduction was not identified," the authors note.

"The results of this study do not support routine use of urodynamics for men with suspected benign outlet obstruction," they conclude. "However, the large number of men who saw modest symptom change or evident deterioration suggests the need to interrogate the diagnostic pathway further, particularly for predictive features, to identify men at risk of poor outcome."

"We need to ensure a focus on doing all the assessments well," Dr. Drake said. "While urodynamics may not always be needed, failure to do the other assessments properly is a considerable risk, and urodynamics can be a safeguard to reinforce the quality of overall assessment."

SOURCE: https://bit.ly/2ANpjlj European Urology, online June 30, 2020.