Abstract

One of the most important and specific symptoms of infravesical obstruction in benign prostatic hyperplasia is hesitancy. However, this symptom does not reflect the severity of obstruction quantitatively, as it is completely subjective. We investigated if hesitancy would serve as a quantitative diagnostic tool using a newly developed scoring system.

A total of 55 patients with prostatism symptoms aged between 24-72 were assessed in terms of international prostate symptom score (IPSS), uroflowmetry and residual urine. Patients with hearing difficulties, urinary infection and who are hardly cooperable were excluded. Uroflowmetry was performed with a computer-based urodynamics (Laborie), and residual urine was assessed with a 10 Fr. Nelaton catheter. Hesitancy was accepted as the time needed to initiate the urine flow after the order of “void”. Spearman correlation analysis was performed to investigate the relation of hesitancy scores with IPSS, uroflowmetric results or the residual urine volume.

Significant correlation of the obtained hesitancy scoring was seen with IPSS (p<0.05), highly significant correlation with peak flow time and average flow time (p<0.001). No correlation was found with residual urine volume (p>0.05). When the patients were allocated in to 3 groups; Group 1 with 2-4 hesitancy scores (n=15); Group 2 with 5-10 scores (n=25) and Group 3 with >10 scores (n=15), similar medical or surgical therapeutic options were observed. No treatment was needed to relieve obstruction in patients with 4 and lower hesitancy scores. Nine of the patients with 10 or more scores were operated, and 6 patients were treated medically.

Given that replies for IPSS are not reliable in our country and especially in our region, we believe that the hesitancy scoring may be used to determine the severity of infravesical obstruction and to decide for the treatment options. We recommend categorizing it in 3 groups (2-4, 5-10, >10).