shows the reasons given by the surgeons for either recommending or not recommending surgery. As this was based on ITT groups, there are some cases for which BOO was confirmed in the routine care arm, but this was largely because there was crossover between the arms. The most common reason for recommending surgery in the UDS arm was the confirmation of BOO being present (51%). However, for the routine care arm, the most common reason was unimproved symptoms (42%). A common reason in the UDS arm was no evidence of BOO (26%), which was most probably established from the UDS procedure. Other reasons were relatively balanced between the arms.
Considerations of surgical recommendations
When categorising the reasons provided, the team were concerned that some of the recommendations may have been inconsistent with assessment findings and very variable across centres. To assess the benefits of UDS in the pathway, a post hoc analysis looked through each individual’s baseline flow rate, VV, PVR overall IPSS, IPSS QoL, IPSS urgency question (question 4) and IPSS weak stream question (question 5). When men had UDS, the uroflowmetry results were scrutinised alongside the BCI and BOOI. When available, UDS results were used to make an initial treatment decision; when missing, flow rates were used. Criteria for recommending surgery consisted of the following, based on a consultation exercise of urologists not participating in UPSTREAM.
Surgery was recommended if:
Surgery was not recommended if:
Using these criteria, the recommendations would have been those displayed in .
Applying an internal universal surgery recommendation based on the available data
Looking at these figures on an ‘as-treated’ basis gave very similar results.
