Correlation of the AUA symptom index with urodynamics in patients with suspected benign prostatic hyperplasia

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Abstract
The AUA symptom index is widely used to access patients with suspected benign prostatic hyperplasia (BPH). In order to determine how well symptoms as assessed by this index correlate with urodynamic findings, we evaluated 83 patients referred to our urology clinics with symptoms of BPH. All patients completed the AUA symptom index and then underwent a multichannel urodynamic evaluation. Patients were classified as obstructed, unobstructed, or equivocal according to the Abrams Griffiths nomogram. The AUA symptom index was recorded as the total score and, for purposes of symptom classification, further subdivided into an obstructive score (questions 3, 5, and 6) and an irritative score (questions 1, 2, 4, and 7). The mean age of the 83 patients was 67 (45–84). The mean total AUA symptom score was 16.6 (6–34), mean obstructive score was 6.1 (0–15), and the mean irritative score 10.4 (3–20). Pressure flow analysis using the Abrams‐Griffiths nomogram classified 28 patients (34%) as obstructed, 17 (20%) as unobstructed, and 38 (46%) as equivocal. Using the analysis of variance procedure (ANOVA) there was no statistically significant difference in the mean total (P = 0.446), obstructive (P = 0.979), or irritative (P = 0.136) scores. Detrusor instability was present in 45 patients (54%). While total and obstructive scores were not significantly different in patients with detrusor instability vs. those with stable bladders, irritative scores were higher in patients with instability (P = 0.028) using the T‐test procedure. Using ANOVA, the difference in post void residual (PVR) between the groups was not quite statistically significant (P = 0.057). The AUA symptom score does not appear to correlate with urodynamic obstruction. However, higher irritative symptom scores are associated with detrusor instability. It is likely that in many men with “BPH,” symptoms are not caused by outlet obstruction and may be related to changes in the aging bladder.