BPH treatment: urodynamic preoperative assessment and evaluation.

Originally prostatectomy was performed for complications to infravesical obstruction. Today 70% are performed because of lower urinary tract symptoms which might be due to obstructive BPH, but also might be a consequence of detrusor weakness or other age-related functional changes in the lower urinary tract. Of patients operated for uncomplicated BPH, approximately 30% are urodynamically unobstructed. Traditional urological measures like residual urine volume, endoscopic impression of prostate and bladder, as well as prostate size and even urinary flow rate measurements, are not able to separate this group. The symptomatic outcome after surgery is statistically significantly worse in the urodynamically unobstructed group, while urodynamic improvement is only marginal. As pressure/flow studies are the only method to diagnose infravesical obstruction, this should therefore be considered before more invasive procedures intended to treat suspected infravesical obstruction are performed.