Analysis of Correlation and Agreement between the Uroflowmetry and the International Prostate Symptom Score (IPSS) in Patients after Retropubic Radical Prostatectomy: A Multicenter Prospective Study

Torres Castellanos L1, Puerto Niño A2, Bravo-Balado A3, Acuña M4, Sánchez J F4, Bejarano O5, Cataño J G1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 744
Non Discussion Abstracts
Scientific Non Discussion Abstract Session 36
Male Questionnaire Surgery Voiding Dysfunction Bladder Outlet Obstruction
1. Department of Urology, Hospital Universitario San Ignacio and Pontificia Universidad Javeriana School of Medicine, Bogotá D.C., Colombia., 2. Pontificia Universidad Javeriana School of Medicine, Bogotá D.C., Colombia., 3. Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia., 4. Department of Urology, Fundación Cardioinfantil, Bogotá D.C., Colombia., 5. Department of Urology, Hospital Universitario San Ignacio, Bogotá D.C., Colombia
Links

Abstract

Hypothesis / aims of study
Patients undergoing retropubic radical prostatectomy (RRP) may suffer from lower urinary tract symptoms (LUTS) different from urinary incontinence (UI).(1) There are several studies reporting improvement of LUTS after RRP by improving bladder outlet obstruction, while others have reported the development of LUTS by factors inherent to the surgery (2,3). To date, the proper way to evaluate these symptoms in this specific type of patients has not been established. We aim to characterize LUTS and to evaluate the correlation and agreement between the uroflowmetry and the IPSS in patients after RRP in two reference centers.
Study design, materials and methods
An observational multicenter prospective study was conducted between December 2015 and September 2016. Patients with at least 12-month follow-up after RRP were included; these were evaluated with uroflowmetry and the IPSS. We used descriptive statistics as well as Pearson correlation coefficient (r) and Cohen's kappa coefficient (k) to evaluate association.
Results
A total of 90 patients were included.  Mean follow-up was 54.6 months (SD 27.52) and mean age was 65 (SD 6.85) years old. Mean IPSS was 7.41 (SD 6.29) with 60% (n = 54) of patients asymptomatic or with mild symptoms, 33.3% (n = 30) with moderate and 6.7% (n = 6) with severe symptoms. Fifty per cent (n = 45) of patients had normal uroflowmetry, while 12.2% (n = 11) had an abnormal result; in the rest of the patients the result was equivocal. Patients with an abnormal/equivocal result in the uroflowmetry had a mean of 9.31 (SD 7.03) points in the IPSS vs. 5.51 (SD 4.82) in patients with a normal uroflowmetry result (p <0.01). Pearson correlation coefficient between the IPSS and Qmax was -0.30 (p = 0.02) (Figure 1), between IPSS and mean urinary flow rate of -0.29 (p = 0.03), and between IPSS and voided volume of -0.026 (p = 0.07). The level of agreement between mild vs. moderate-to-severe LUTS and normal uroflowmetry vs. abnormal/equivocal was 61.1% (k = 0.22, p = 0.04). In addition, sensitivity tests were performed to determine the cut-off point in which the best agreement between the Qmax and IPSS was obtained. We found that a score ≥10 in the IPSS had a level of agreement of 65.6% (k = 0.31, p = 0.0004).
Interpretation of results
Most of the patients after RRP were asymptomatic or had mild LUTS, and half had normal uroflowmetry. Patients with an abnormal/equivocal result in the uroflowmetry had a mean IPSS in the range of moderate LUTS compared to patients with a normal uroflowmetry who had a mean IPSS in the range of mild symptoms. The IPSS and the uroflowmetry were inversely and weakly correlated, but the agreement between these tests was acceptable.
Concluding message
We consider that, although the IPSS cannot replace the uroflowmetry and vice versa, these tests are complementary and may be useful tools in the evaluation of patients with LUTS after RRP.
Figure 1
References
  1. Song C, Lee J, Hong JH, et al. Urodynamic interpretation of changing bladder function and voiding pattern after radical prostatectomy: a long-term follow-up. BJU Int. 2010;106:681-686.
  2. Gomha MA, Boone TB. Voiding patterns in patients with post-prostatectomy incontinence: urodynamic and demographic analysis. J Urol. 2003 May;169(5):1766-9.
  3. Giannantoni A, Mearini E, Zucchi A, et al. Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study. Eur Urol. 2008;54:657-664.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Hospital Universitario San Ignacio Helsinki Yes Informed Consent Yes
27/03/2024 16:46:49