Patients with bladder outlet obstruction who refuse treatment show no clinical and urodynamic change after long-term follow-up

Objective: To evaluate in patients with mild bladder outlet obstruction (BOO) who refused the proposed treatment and were on watchful waiting (WW), the symptomatic and urodynamic changes after 1-5 years of follow-up. Methods: 102 patients with lower urinary tract symptoms (LUTS) and BOO (Schafer class: 2-6, median 3) were clinically and urodinamically re-evaluated after 1-5 years of follow-up. Of these, 82 were submitted to medical (alfuzosin or finasteride) or surgical treatment (prostatectomy or TUIP) and 20, who refused the proposed treatment, were on WW. A retrospective study was made on these 20 patients who underwent a second International Prostatic Symptom Score and pressure-low evaluation after 1-5 years (median: 22 months) of watchful waiting. Wilcoxon matched-pairs signed-ranks test and Kruskal Wallis as appropriate were used for statistical analysis. Results: In the group of patients who refused the proposed treatment, no statistically significant differences between the two evaluations were observed for any of the parameters investigated: International Prostatic Symptom Score (15.1±6.8; 14.7±7.5); maximum flow (11.5±4.2; 12.1±4.3); residual urine (90.2±154.5; 113.3±158.4); Schäfer class (2.9±0.9; 2.8±1.2); Urethral Resistance Algorithm (37.1±14.4; 37.3±16.3); Projected Isometric Pressure (113.7±26.5; 112.7±21.8). Conclusions: Patients with mild BOO may remain clinically and urodynamically stable for a long time.