![]() There are no published randomized controlled trials in men with LUTS that compare the standard investigations such as symptom score or uroflowmetry (UFM) with UDS. To our knowledge, there have been no randomized studies regarding the usefulness of UDS for guiding clinical application in male LUTS. However, most of those recommendations are supported by very low level of evidences (LEs) (all LE = 3). In this regard, most guidelines recommend UDS for male LUTS evaluation only in specific situations such as, prior to surgery, previous unsuccessful treatment, functional cystometric capacity 300mL, patient too young ( 80 years) for surgery, or maximal flow rate (Q max) > 10mL/s (relative BOO). The urodynamic study (UDS) is the only gold standard for the diagnosis of BOO however, invasiveness, cost, and morbidity of UDS limit its clinical use. Enlarged prostate tissue causes obstruction and increases the urethral resistance to flow, and therefore requires higher intravesical pressure to void. The mechanism for surgery is based on the classic bladder outlet obstruction (BOO) model. The most recent international treatment guidelines commonly recommend that a surgical intervention should be considered in BPH patients with failure to treatment with oral medications or with complicated LUTS. To ensure a better outcome, proper indicators for surgical intervention should be selected. Surgery is the most invasive option for BPH treatment which can cause irreversible complications. Traditionally, the primary goal of treatment of benign prostatic hyperplasia (BPH) has been to lessen the bothersome lower urinary tract symptoms (LUTS) caused by prostatic enlargement. The funders had no role in the design and conduct of the study the collection, analysis, and interpretation of the data or the preparation, review, or approval of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: This study was supported by grant no 23-2015-0050 from Seoul National University Hospital Research Fund. ![]() Received: SeptemAccepted: FebruPublished: February 27, 2017Ĭopyright: © 2017 Kim et al. PLoS ONE 12(2):Įditor: Robert Hurst, University of Oklahoma Health Sciences Center, UNITED STATES However, there was no clear evidence of publication bias in this meta-analysis.Ĭitation: Kim M, Jeong CW, Oh S-J (2017) Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate: Systematic review and meta-analysis. ![]() Some comparisons showed between-study heterogeneity despite the strict selection criteria of the included studies. In urodynamic bladder outlet obstruction (BOO) positive patients, the pooled mean difference (MD) was significant for better improvement of the International Prostate Symptom Score (IPSS) (pooled MD, 3.48 95% confidence interval, 1.72–5.24 p < 0.01 studies, 16 participants, 1726), quality of life score (QoL) (pooled MD, 0.56 95% CI, 0.14–1.02 p = 0.010 studies, 9 participants, 1052), maximal flow rate (Q max) (pooled MD, 3.86 95% CI, 2.17–5.54 p < 0.01 studies, 17 participants, 1852), and post-void residual volume (PVR) (pooled MD, 32.46 95% CI, 23.34–41.58 p < 0.01 studies, 10 participants, 1219) compared with that in non-BOO patients. Of the 19 studies, 15 conducted conventional transurethral prostatectomy (TURP), and 7 used other or multiple modalities. The eligible studies included a total of 2321 patients with a median number of 92 patients per study (range: 12–437). ![]() A total of 19 articles met the eligibility criteria for this systematic review.
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