Diagnostic value of urodynamic study for benign prostatic hyperplasia patients who are considering transurethral surgery: systematic review and meta-analysis

Abstract

Purpose: To investigate the diagnostic value of urodynamic study (UDS) for benign prostatic hyperplasia (BPH) patients who are considering transurethral surgery. Methods: We systematically searched online Pubmed, Embase, and Cochrane Library database from January 1989 to June 2014. Results: A total of 22 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 2,578 patients with a median number of 83 patients per study (range: 12-437). Of the 22 studies, 15 conducted conventional transurethral prostatectomy (TURP), 7 performed the other ore multiple modalities. In patients with urodynamic bladder outlet obstruction (BOO) positive patients, the pooled mean difference (MD) was significant for the better improvement of International Prostatic Symptom Score (IPSS) (pooled MD, 3.48

95% confidence interval [CI], 1.72-5.24

studies, 16

participants, 1726), quality of life score (QoL) (pooled MD, 0.56

95% CI, 0.14-1.02

studies, 9

participants, 1052), maximal flow rate (Qmax) (pooled MD, 3.86

95% CI, 2.17-5.54

studies, 17

participants, 1852), and post-void residual volume (PVR) (pooled MD, 32.46

95% CI, 23.34-41.58

studies, 10

participants, 1219) compared to non-BOO patients. In patients with detrusor underactivity (DUA), pooled MDs were significant for the poorer improvement of IPSS (pooled MD, -5.83

95% CI, -7.18--4.49

studies, 6

participants, 340) and Qmax (pooled MD, -3.86

95% CI, -4.93--2.80

studies, 5

participants, 355), but not in that of QoL and PVR. On the other hands, urodynamic detrusor overactivity (DO) did not correlate with improvement of all outcome parameters. Some comparisons showed between-study heterogeneity in spite of strict selection criteria of included studies. However, there was no clear evidence of publication bias in this meta-analysis. Conclusions: Our meta-analysis results showed significant association between urodynamic BOO and better improvements of all parameters of treatment outcomes. Urodynamic DUA was correlated with poorer improvement of IPSS and Qmax. However, urodynamic DO was not associated with surgical outcomes. Preoperative UDS may add insight into postoperative outcomes after surgical treatment of BPH.