The UPSTREAM study led by Marcus J Drake and his research team aimed to develop a novel validated prediction model for prostate surgery outcomes. The UPSTREAM algorithm demonstrates how standard clinical assessments can be utilized to predict outcomes of prostate surgery for bothersome lower urinary tract symptoms (LUTS) in men. Preoperative predictions for outcomes can be made by using age, incontinence questionnaires, total International Prostate Symptom Score (IPSS) score, and uroflowmetry data. Favourable indicators for good symptom outcomes include high symptom severity and bothersome LUTS, as well as a Qmax <10 ml/s. On the contrary, if the LUTS are not affecting quality of life and the baseline maximum flow rate (Qmax) is ≥13 ml/s, prostate surgery may lead to worsening of LUTS. For men with Qmax values between 10 and 13 ml/s, urodynamic studies might offer valuable insights like bladder outlet obstruction.
Q max on the Minze uroflowmeter
Minze Health offers a new-generation uroflowmeters for both in hospital (Hospiflow) and home (Homeflow) use. It connects to a clinician platform, integratable in the electronic medical record, capturing different uroflow data points over time, making it useful for treatment monitoring and disease progression in men suffering from LUTS.
A recent study by Lola Bladt et al. revealed that Hospiflow measurements tend to underestimate Qmax compared tothe Homeflow Qmax, likely due to unnatural bladder volumes . Given the pivotal role that Qmax plays in the prediction model for prostate surgery outcomes, a series of Homeflow measurements could offer a more precise assessment, particularly for patients who encounter challenges in generating accurate uroflow data within a hospital environment.
The roles of bladder diaries
The UPSTREAM study also investigated the use of bladder diaries data. The inclusion of bladder diary data could potentially enhance the accuracy of predictions and improve their overall effectiveness. Specifically, the total urgency frequency score and bladder diary sensation scale exhibited promise in forecasting outcomes for prostate surgery. Nevertheless, the study also developed models without bladder diary data, recognizing the practical challenges associated with ensuring comprehensive completion of paper-based bladder diaries in clinical practice.
New take on bladder diary with Minze Diary Pod
Minze Health has introduced an innovative solution known as the Diary Pod. This automated bladder diary device simplifies the process of tracking voided volume over a specified time frame. The Diary Pod seamlessly connects to the Flow App via Bluetooth, allowing for the collection of all essential bladder diary data. Furthermore, it offers valuable assistance and reminders to patients, ensuring the creation of high-quality bladder diaries.
Interested why automated bladder diaries are better than pen and paper? Read more in this article.
In summary, the UPSTREAM study highlights the importance of uroflowmetry in evaluating prostate surgery candidates with LUTS. Uroflowmetry, combined with the IPSS score, age, and quality of life assessments, helps healthcare providers offer personalized counselling, avoiding unnecessary surgeries and invasive tests while reducing the risk of worsening LUTS post-surgery. Uroflowmetry is a valuable tool for assessing urinary symptoms in men with prostate issues and tailoring treatment accordingly. Also bladder diary data could support in predicting prostate surgery outcomes. Unfortunately, due to the challenges of completing a comprehensive paper bladder diary in clinical practice, the current prediction model excluded bladder diary data. However, it’s essential to note that this conclusion doesn’t diminish the crucial role of BDs in assessing storage LUTS and nocturia, as recommended by the guidelines.
Ito H, Drake MJ, et al. Eur Urol Focus. 2023;14;S2405-4569(23)00154-2.