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EDITORIAL COMMENTS

This article Presents several interesting hdings. First, among consecutive men with prostatism referred for urodynamies, a careful history and Physical e x e a t i o n Were able to Patients into 2 groups with different probabilities of physiological obstruction. Men without co-morbidities had physiological obstruction 80% of the time, while men with co-morbidities raising the probability of alter- nate diagnoses had Obstlvdion only 58% Of the time. This finding supports the importance of a Careful clinical assessment of such patients, as recommended by the recently released BPH guidelines. Presumably, however, there were reasons these men were referred for WOdyn-Cs, Which may make them different from ConSe~tiVe men seen in a general urological Setting.

Moreover, amOng both groupS W P b m levels as measured with the AuA index could not te between men with and without obstruction, or for that matter, between men with and without detrusor overactivity. Separathg the index into obstructive and irritative sub- scales did no better. While time honored, the d i 6 o n of lower urinary tract Symptoms *to Obstructive and irritative -PS aPpearS invalid and PmbablY should be abandoned.

Assuming that men with neurological co-morbidities or residual symptoms after treatment are more likely to benefit from physiolog- ical study, should full urodynamics be recommended for men without clinical evidence of problems other than BPH? Two types of studies are needed to answer this question. To prove reliable results can be obtained outside of a few specialty centers, a group of community urnlogists should be trained to perform the various tests and a group of older men with lower urinary tract Symptom Should be examined twice a few days apart, with different blinded examiners. The test (if my) that yields the most reliable results can then be used in a clinical trial to determine whether patient outcomes are improved at reasodde cost with routine urodyn-c Study compared to care. Such a study would have to be large, since any improvement in outcomes for men without co-morbidities would be generated by offering (presumably) more effective treatment for only 1 of 5 men Who Proved not to have PhYsiolO@cal obstruction.

observations in male subjects and

Michael J. Barry Medical Pmctices Eualuatwn Center

224, 1988. 19. DuBeau, C. E., Sullivan, M. P., Venegas, J. G., Resnick, N. M.

and Yalla, S. V.: Correlations between pressure-flow and mic- turitional urethral pressure profile parameters. J. Urol., part 2, 161: 324A, abstract 385, 1994.

20. Abrams, P., Blaivas, J. G., Stanton, S. L. and Andersen, J. T.: Standardisation of terminology of lower urinary tract function. Neurourol. Urodynam., 7: 403,1988.

21. Rollema, H. J. and van Mastrigt, R.: Improved indication and

Massachusetts Gene& Hospital Boston, Massachusetts

This carefully done study demonstrates minimal correlation be- tween symptoms (measured by the AUA symptom index) and urody- namic obstruction (measured by micturitional urethral pressure pro- filometry). Previous studies have shown poor correlation amow symptoms, uroflowmetry, post-void residual urine and pressure-flow d y n a m i c studies in men with presumed BPH. Many Urodynamic