MP74-17: Penile cuff test shows poor accuracy for diagnosis of bladder outlet obstruction for men: a pragmatic analysis within a high volume urologic clinic
Introduction: There has been a recent shift in the management offerings for treatment of benign prostatic hyperplasia (BPH). Patients desire minimally invasive therapies with lower risks of complications, side effects and discomfort. Penile cuff test (PCT) is a non-invasive bladder pressure manometer use to measure detrusor pressure and urine flow. Recently, PCT has demonstrated noninferiority compared to the gold standard pressure flow studies (PFS), which require placement of catheters within urethra and rectum. We sought to compare the accuracy of PCT to PFS in the real world setting of a high volume academic voiding dysfunction clinic. Methods: Adult men with BPH underwent PCT and PFS from April 2018-October 2021. PFS and PCT were obtained by trained technologists. All patients participated in urodynamic evaluation which included measurement of vesicular and abdominal pressures at time of filling and voiding as well as post-void residual. The diagnosis of bladder outlet obstruction was determined by ICS and PCT nomogram for UDS and PCT, respectively. Results: 74 male patients were included. The PCT nomogram classified 21 patients as obstructed and 53 as un-obstructed. Out of the 53 individuals classified as unobstructed by PCT, 29 were identified as non-obstructive/equivocal on UDS and 24 were identified as unobstructed on UDS. With UDS as gold standard, PCT showed a sensitivity of 0.31 and specificity of 0.75. The positive predictive value (PPV) was 0.62 and negative predictive value (NPV) was 0.45. Detrusor pressure at Qmax for UDS and cuff pressure at interruption during PCT was correlated with AUA symptoms score (AUA SS) (p < 0.05, Table 2). Conclusions: Our single-center experience with penile cuff testing demonstrates poor accuracy in diagnosis of bladder outlet obstruction when compared to pressure flow studies, in contrast to recent meta-analysis comparing similar modalities. PCT is associated with AUA SS, demonstrating possible clinical utility. SOURCE OF Funding: None
