Should a patient diagnosed with Benign Prostatic Hyperplasia (BPH) undergo uroflowmetry?

From the Guidelines

Yes, a patient diagnosed with benign prostatic hyperplasia (BPH) should undergo uroflowmetry as part of their evaluation, especially if they are considering invasive therapy, as recommended by the 2019 AUA guideline amendment 1. Uroflowmetry is a simple, non-invasive test that measures the flow rate of urine during urination and provides objective data about the severity of bladder outlet obstruction. This test helps clinicians assess the functional impact of BPH on urination by measuring parameters such as maximum flow rate (Qmax), average flow rate, voided volume, and flow pattern. For BPH patients, a reduced maximum flow rate (typically less than 15 mL/second) often indicates significant obstruction. Uroflowmetry results help guide treatment decisions, whether medical therapy with alpha-blockers or 5-alpha reductase inhibitors, or surgical interventions for more severe cases. The test also establishes a baseline for monitoring disease progression and treatment response over time. Some key points to consider when performing uroflowmetry include:

• Patients should arrive with a comfortably full bladder and void at least 150mL of urine during the test.
• Uroflowmetry is often combined with post-void residual measurement to provide a more complete assessment of lower urinary tract function in BPH patients.
• The 2019 AUA guideline amendment 1 recommends uroflowmetry prior to surgical intervention for LUTS/BPH.
• The 2003 AUA guideline on management of BPH 1 also supports the use of uroflowmetry in the evaluation of patients with LUTS.
• The 2018 AUA guideline on surgical management of LUTS attributed to BPH 1 and the 2012 AUA/SUFU guideline on urodynamic studies in adults 1 provide additional guidance on the use of uroflowmetry in the evaluation and management of BPH.

From the Research

Uroflowmetry in BPH Diagnosis

• Uroflowmetry is a non-invasive and physiologic method for assessing lower urinary tract obstruction, providing objective evidence of the degree of prostatic blockage 2.
• The test measures the flow rate of urine and can help diagnose benign prostatic hyperplasia (BPH) by identifying abnormalities in urine flow.
• Studies have shown that uroflowmetry parameters, such as maximum flow rate (Qmax) and average flow rate (Qave), are correlated with the degree of prostatic obstruction and symptom severity 2, 3.

Indications for Uroflowmetry in BPH

• Uroflowmetry is a useful clinical tool in the diagnosis and follow-up of males with BPH, particularly those with voiding problems and lower urinary tract symptoms (LUTS) 2.
• The test can help identify patients with significant prostatic obstruction and those who may benefit from surgical or medical treatment.
• Uroflowmetry can also be used to monitor the effectiveness of treatment and assess changes in urine flow over time 2, 3.

Relationship between Uroflowmetry and Symptom Severity

• Studies have found a positive correlation between uroflowmetry parameters, such as peak flow rate, and LUTS severity, as measured by the International Prostate Symptom Score (IPSS) 3.
• Uroflowmetry can help identify patients with more severe symptoms and those who may require more aggressive treatment.
• However, it is essential to note that uroflowmetry is just one aspect of BPH diagnosis and management, and other factors, such as medical history, physical examination, and laboratory tests, should also be considered 4.