以診間可取得相關指標來預測下尿路症狀男性之膀胱出口阻塞問題

劉民慶, 張天霖, 楊家誠, 郭漢崇

花蓮慈濟醫院泌尿部

Can we predict bladder outlet obstruction in male patients with LUTS based on clinical symptoms and simple office-based diagnostic tools? Analysis of BOO risk score by IPSS V/S ratio, TPV, TZI, corrected Qmax and VUDS Results

Min-Ching Liu, Tien-lin Chang, Chia-chen Yang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan

Purpose: To investigate the predictive values by combination of International Prostate Symptom Score voiding to storage subscore ratio (IPSS-V/S), total prostate volume (TPV), transitional zone index(TZI), corrected maximum flow rate (cQmax), intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA) in constructing a bladder outlet obstruction (BOO) risk score in diagnosis of BOO in men with lower urinary tract symptoms (LUTS).

Materials and Methods: This single center retrospective chart review enrolled totally 355 men with LUTS. Videourodynamic study (VUDS) was used to determine the causes of LUTS. The dataset was split to training set (N=285) and validating set (N=70). The patients were subdivided into BOO including bladder neck dysfunction and benign prostate obstruction (BPO), and non-BOO group, including poor relaxation of external sphincter, dysfunctional voiding and hypersensitive bladder. A BOO risk score was constructed by summing scores on seven prostatic and uroflowmetric parameters ranging from. Each of these parameter graded and contributed to the BOO score.

Results: Among 355 men examined, 234 (65.9%) were found to have BOO. The diagnostic parameters are shown in Table 1. The parameters were stratified as 0, 1, 2, categorized by their cut-off value in predicting BOO. A BOO risk score of 7 or greater had a sensitivity of 54.3% and a specificity of 75.2% for BOO (AUC with 95% confidence interval 0.690 [0.627-0.754]) in training group. The validating group presented the similar predictive value (AUC= 0.749 [0.622-0.875]). Furthermore, we found BOO risk score of 8 or greater had a sensitivity of 72.6% and a specificity of 80.7% for BPO(AUC with 95% confidence interval 0.825 (0.770-0.880)). Among those risk factors, patients with BOO had lower Qmax, larger TPV, TZI, IPP, and PUV angle than non-BOO group.

Conclusions: With office-based diagnostic tools collected in the uroflowetry and prostate measurements, a BOO risk score could be established. The score displayed in current study presented the accuracy of predicting BOO in men with LUTS guiding further treatment or invasive studies.