Statistical analysis plan for the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM)

Grace Young, Amanda Lewis, J. Athene Lane, Helen Winton, Marcus Drake, Pete Blair

Research output: Contribution to journalArticle (Academic Journal)peer-review

12 Citations (Scopus)
411 Downloads (Pure)



Current management for men with lower urinary tract symptoms (LUTS) is a pathway that results in prostate surgery in a significant proportion. While helpful in relieving benign prostatic obstruction (BPO), surgery may be ineffective for men suffering from difficulties not relating to BPO. The UPSTREAM trial started recruitment in October 2014 with the aim of establishing whether a care pathway including urodynamics (a diagnostic tool for BPO and thus an indication of whether surgery is needed) is no worse for men, in terms of symptomatic outcome, than one without (routine care).


This analysis plan outlines the main outcomes of the study as well as specific design choices, such as non-inferiority margins. The trial is currently recruiting in 26 hospitals across the UK, randomising men to either urodynamics or routine care, with recruitment set to end on the 31st of December 2016. All outcomes will be measured 18 months after randomisation to allow sufficient time for surgical procedures and recovery. The primary outcome is based on a non-inferiority design with a margin of 1 point on the International Prostate Symptom Score (IPSS) scale. The key secondary outcome for this trial is surgery rate per arm, which is estimated to be at least 18% lower in the urodynamics arm. Surgery rates, adverse events, flow rate, urinary symptoms and sexual symptoms are secondary outcomes to be assessed for superiority. This is an update to the UPSTREAM protocol which has already been published in this journal.


This a priori statistical analysis plan aims to reduce reporting bias by allowing access to the trial’s objectives and plans in advance of recruitment end. The results of the trial are expected to be published soon after the trial end date of 30th September 2018.

Trial registration

Trial registered 8 April 2014; ISRCTN registry (ISRCTN56164274).
Original languageEnglish
Article number455
Number of pages7
Publication statusPublished - 3 Oct 2017

Structured keywords

  • Centre for Surgical Research
  • BRTC
  • BTC (Bristol Trials Centre)


  • Statistical analysis plan
  • Randomised controlled trial
  • Urodynamics
  • Lower urinary tract symptoms
  • Non-inferiority trial


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