Abstract
Background and Objective:
Lower urinary tract symptoms (LUTS) are a key indication for surgery in older men. The Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) evaluated the diagnostic pathway for men considering surgery to treat LUTS, and reported outcomes at 18 months. This long-term follow-up study reports symptoms and rates of prostate surgery at five years.
Methods:
UPSTREAM participants who had consented to long-term follow-up received postal questionnaires at five years post-randomisation (October 2019-December 2021). The primary outcome was the patient reported International Prostate Symptom Score (IPSS, scale 0-35). Rates of surgery, derived from NHS England routine data, were a key secondary outcome. An intention-to-treat analytic approach was utilised.
Key Findings and Limitations:
At five years, 211/427 (49.4%) participants in the intervention group and 204/393 (51.9%) in the routine care group completed questionnaires, with routine data obtained for 801/820 (97.7 %). Mean IPSS at five years did not differ between randomised groups (adjusted difference 0.41, 95% CI -1.10, 1.93) nor did rates of surgery (0.96 (0.71, 1.28)). Urinary and sexual symptoms also showed no differences between randomised groups. The main limitation is the reduced numbers of men in follow up.
Intervention(s):
In UPSTREAM, men were randomised to routine care diagnostic tests plus invasive urodynamics (intervention) or routine care only for LUTS. Treatment choice was made by participants, advised by their clinician.
Conclusions and Clinical Implications:
Five-year follow-up does not support routine use of invasive urodynamics in reducing LUTS or rates of prostate surgery and that urodynamics should be used selectively in the evaluation of uncomplicated LUTS.
Lower urinary tract symptoms (LUTS) are a key indication for surgery in older men. The Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) evaluated the diagnostic pathway for men considering surgery to treat LUTS, and reported outcomes at 18 months. This long-term follow-up study reports symptoms and rates of prostate surgery at five years.
Methods:
UPSTREAM participants who had consented to long-term follow-up received postal questionnaires at five years post-randomisation (October 2019-December 2021). The primary outcome was the patient reported International Prostate Symptom Score (IPSS, scale 0-35). Rates of surgery, derived from NHS England routine data, were a key secondary outcome. An intention-to-treat analytic approach was utilised.
Key Findings and Limitations:
At five years, 211/427 (49.4%) participants in the intervention group and 204/393 (51.9%) in the routine care group completed questionnaires, with routine data obtained for 801/820 (97.7 %). Mean IPSS at five years did not differ between randomised groups (adjusted difference 0.41, 95% CI -1.10, 1.93) nor did rates of surgery (0.96 (0.71, 1.28)). Urinary and sexual symptoms also showed no differences between randomised groups. The main limitation is the reduced numbers of men in follow up.
Intervention(s):
In UPSTREAM, men were randomised to routine care diagnostic tests plus invasive urodynamics (intervention) or routine care only for LUTS. Treatment choice was made by participants, advised by their clinician.
Conclusions and Clinical Implications:
Five-year follow-up does not support routine use of invasive urodynamics in reducing LUTS or rates of prostate surgery and that urodynamics should be used selectively in the evaluation of uncomplicated LUTS.
| Original language | English |
|---|---|
| Journal | European Urology Focus |
| Early online date | 12 Mar 2025 |
| Publication status | E-pub ahead of print - 12 Mar 2025 |