VALOR DE LA INVESTIGACION INVASIVA Y NO INVASIVA EN LA EVALUACION PREOPERATORIA DE LA HIPERPLASIA PROSTATICA BENIGNA. PERSPECTIVAS DEL ANALISIS PRONOSTICO EN LA EVALUACION CLINICA DE LA HIPERPLASIA PROSTATICA BENIGNA





VALOR DE LA INVESTIGACION INVASIVA Y NO INVASIVA EN LA EVALUACION PREOPERATORIA DE LA HIPERPLASIA PROSTATICA BENIGNA. PERSPECTIVAS DEL ANALISIS PRONOSTICO EN LA EVALUACION CLINICA DE LA HIPERPLASIA PROSTATICA BENIGNA

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A través del puntaje del International Prostate Symptoms Score y de la medición de Qmáx sería posible predecir el resultado de la cirugía de resección transuretral de la próstata.
porru9.jpg Autor:
Porru D
Columnista Experto de SIIC
Artículos publicados por Porru D
Coautores
Salvatore Stancati MD*  Giovanni L. Giliberto MD*  Matteo Gerardini MD*  Bruno Rovereto MD* 
Divisione Urologia, IRCCS Policlinico S. Matteo, Pavia, Italia*
Recepción del artículo
12 de Febrero, 2004
Primera edición
1 de Abril, 2004
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Objetivo. Evaluar el valor predictivo de la combinación del International Prostate Symptoms Score (IPSS), la flujometría de orina y la ecografía para la determinación de la obstrucción al flujo vesical (OFV) y la predicción de resultado. Métodos. Fueron evaluados 45 individuos de un grupo de 60 pacientes con hiperplasia prostática benigna. Los criterios de selección para la cirugía fueron IPSS < 16 y Qmáx <10 ml/seg. Se realizó resección transuretral de la próstata (RTUP). Se definió como éxito en el tratamiento al Qmáx por encima de 15 ml/seg, volumen residual de orina de menos de 100 ml, reducción del 50% en IPSS, y ausencia de retención urinaria. Resultados. Se encontraron anomalías urodinámicas en 93.3% de los pacientes: 19 tenían inestabilidad del detrusor, 5 deterioro de la contractilidad, 37 OFV comprobado, y 8 obstrucción leve o ausente. La tasa general de éxito fue del 86% cuando se midió a través de IPSS. Su valor cayó en forma significativa (p = 0.005). El puntaje mejoró significativamente luego de la cirugía sólo en el grupo con obstrucción comparado con el grupo sin obstrucción (p = 0.001). Conclusiones. Una alta proporción de pacientes operados en forma exitosa (71.1%) tenía la combinación de IPSS >16 y Qmáx < 10 ml/seg, si bien la OFV no pudo ser predicha con precisión usando sólo métodos no invasivos. Los pacientes con obstrucción infravesical leve o ausente sólo tuvieron una mejoría mínima del IPSS y de la flujometría de orina luego de la cirugía.

Palabras clave
Flujometría de orina, IPSS, volumen residual de orina, obstrucción al flujo vesical, hiperplasia prostática benigna, estudio de presión de flujo


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Abstract
Aim: Evaluate the predictive value of a combination of IPSS, uroflowmetry and ultrasound determination of residual urine volume compared to pressure-flow study in the determination of bladder outflow obstruction (BOO) and in predicting treatment outcome. Methods: Forty-five out of a group of 60 BPH symptomatic patients were evaluated. Selection criteria for surgery were IPSS>16 and Qmax<10 ml/s. Transurethral resection of the prostate (TURP) was performed. Treatment success was defined as Qmax above 15 ml/s, residual urine of less than 100 ml, a 50% reduction in IPSS and absence of urinary retention. Results: Urodynamic abnormalities were found in 93.3% of patients: 19 had detrusor instability, 5 patients showed impaired contractility, 37 patients had proven BOO, and 8 patients were unobstructed or mildly obstructed. The overall success rate was 86% when measured by the IPSS. Its value dropped significantly (P=0.005). The score improved significantly after surgery only in the obstructed group compared to the non-obstructed group (P=0.001).Conclusions: A high proportion of patients successfully operated (71.1%) had a combination of IPSS>16 and Qmax<10 ml/s, although BOO could not be accurately predicted with non-invasive methods alone. Patients with no or mild infravesical obstruction had only minimal improvement of IPSS and uroflowmetry following surgery. Content main subject: Diagnostic evaluation of BPH.

Key words
uroflowmetry, IPSS, residual urine volume, BOO, BPH, pressure-flow study


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Especialidades
Principal: Urología
Relacionadas: Diagnóstico por Imágenes, Medicina Interna



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Bibliografía del artículo
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