TRIP Answers

16 January 2008 note: This question is over 2 years old and may differ to any new research.

The CKS guideline on benign prostate hyperplasia notes:

“The International Prostate Symptom Score (IPSS) is not a diagnostic tool, but allows lower urinary tract symptoms to be objectively and reproducibly graded as mild, moderate, or severe [Barry et al, 1992]. It is valuable for assessing the impact of urinary symptoms on the individual, and monitoring progress and response to treatment (see How do I assess severity of symptoms and monitor progress?).

Surgical treatment is generally reserved for men who have failed or are unable to tolerate drug treatment, or for those who have developed complications.

Transurethral resection of the prostate (TURP) is the reference surgical treatment for BPH [Leslie, 2005]. Open prostatectomy is now seldom performed for BPH.” [1]

An e-Medicine article on TURP states:

“Most men who present for surgical correction of their urinary outlet obstruction are those in whom medical therapy or alternative procedures have failed or are inappropriate for some reason. In general, patients with moderate-to-severe lower urinary tract obstructive symptoms (AUA symptom score >8) who have not responded to alpha-adrenergic blockers and/or 5-alpha reductase inhibitors are also candidates for surgical intervention.

Generally, TURP is indicated in patients with persistent, progressive, or bothersome symptoms of urinary obstruction due to prostatic hypertrophy that are refractory to medical therapy. While this is the most common indication, 70% of men undergoing the procedure have multiple indications. Patients with prostates larger than 45 grams, who present with acute urinary retention or who require operating times in excess of 90 minutes, are at increased risk of postoperative complications…” [2]

We consulted the American Urological Association’s guideline on BPH to find additional information on the AUA rating scale referred to in the e-Medicine article [2] above.

“Symptom Assessment
Recommended: The AUA Symptom Index (identical to the seven symptom questions of the International Prostate Symptom Score [IPSS]) should be used as the symptom-scoring instrument in the initial assessment of each patient presenting with BPH. Most patients who seek treatment for BPH do so because symptoms alter quality of life.
Symptom quantification is therefore of major importance in determining the severity of disease, in documenting the response to therapy, and in detecting symptom progression in men managed by watchful waiting. The AUA Symptom Index (see Appendix 1-A) or the identical IPSS is recommended for symptom assessment in each patient presenting with BPH because it is superior to an unstructured interview in quantifying symptom frequency and severity. Using seven questions that relate to associated symptoms, classification ranges from mild (0 to 7) to moderate (8 to 19) or severe (20 to 35)” [3]

References
1. CKS. Benign prostate hyperplasia. Last revised February 2006. (http://www.cks.library.nhs.uk/prostate_benign_hyperplasia/in_depth/management_issues)
2. Leslie S. Transurethral resection of the prostate. October 2006. (http://www.emedicine.com/med/topic3071.htm#section~indications
3. AUA Guideline on the Management of Benign Prostatic Hyperplasia. (http://www.auanet.org/guidelines/main_reports/bph_management/chapt_1_appendix.pdf)