<p><strong>Clinicians may offer invasive or non-invasive pressure flow testing/UDS and/or cystoscopy in patients with LUTS/BPH if there is a worsening of LUTS/BPH during follow-up. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>Most patients report improvement in LUTS/BPH parameters after intervention. If this is not the case and patients have persistent or worsening symptom scores or worsening objective parameters such as PVR or uroflowmetry, UDS, PCT, and cystoscopy are reasonable options to determine the cause. These tests could also be offered to patients who have improved but not to their satisfaction, or to those that are resistant to further therapy and want to better understand their condition.</p>
<p>While UDS is not usually indicated for the evaluation of uncomplicated LUTS/BPH, patients who have been followed and have worsening parameters are by definition, complicated. As such, further advanced testing may be recommended. Persistent or de novo OAB are common reasons for UDS and should be offered if adequate time has passed since initiating treatment (e.g., six months after initiating combination AB and 5-ARI therapy). Non-invasive pressure flow testing could be offered where persistent BOO is suspected.</p>
<p>Cystoscopy is important in patients with subjective worsening of urinary stream, or those with new-onset hematuria. This is particularly useful to rule out bladder neck contracture in patients with worsening stream soon after surgical intervention for LUTS/BPH.</p>
<p>Lower urinary tract imaging also has a role in patients with persistent LUTS, particularly if it has not been performed prior to initiating treatment. For example, an IPP might be a reason for inadequate response to medical therapy or a large residual prostate after TURP and could be a reason for inadequate response to surgical therapy.</p>