Benjamin P. Saylor is associate editor of Urology Times, an Advanstar Communications publication.
The test can help clinician determine whether a second procedure would be of benefit to a patient.
In an era of ever-increasing treatment options for benign prostatic hyperplasia (BPH), the UroCuff test is useful for assessing bladder function in patients.
Tobias S. Köhler, MD, MPH, discussed the UroCuff test in a presentation at the 2021 Society of Benign Prostate Disease Annual Meeting, which was held virtually in March. Köhler, professor of urology and chair of Mayo Men’s Health at Mayo Clinic in Rochester, Minnesota, began his talk by discussing challenges in BPH care and the importance of assessing bladder function.
“Men often will be lost to follow-up, especially if their symptoms are mild,” Köhler said. Other patients may choose to delay surgical intervention and instead take medications. Then, by the time patients seek management of BPH, permanent bladder damage often has occurred.In addition, patients with severe symptoms frequently have unrealistic expectations for symptom relief, he said.
The UroCuff test, he explained, is a noninvasive pressure-flow study that is easy to use and is similar to a uroflow test. It does not require catheters and can be ordered the same day.
This “is a huge advantage in the day where brick-and-mortar visits are decreasing and video visits are increasing,” Köhler said. “Imagine getting all the information you need in 1 visit instead of having to reschedule the patient come back on a different day for their urodynamics, etc.”
Patients taking the UroCuff test should have an urge of 8, 9, or 10 on a scale of 1 to 10 in order to obtain good data, according to Köhler. Neurogenic bladder and failed prior intervention are factors he considers when ordering the test, and he also pointed out the 2019 amendment to the American Urological Association (AUA) clinical guidelines for surgical management of lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia, which states, “Clinicians should consider pressure flow studies prior to surgical intervention for LUTS attributed to BPH when diagnostic certainty exists (Expert Opinion).”1
Köhler also highlighted the recently added AUA guideline statement that states, “Clinicians should inform patients of the possibility of treatment failure and the need for additional or secondary treatments when considering surgical and minimally invasive treatments for LUTS secondary to BPH (Clinical Principle).” With the UroCuff test, Köhler said, clinicians can assess whether a second procedure would benefit patients.
UroCuff has been extensively reviewed in the literature, with 92 peer-reviewed papers on the subject. One key finding from the literature, Köhler said, is that “the UroCuff test is highly correlated with catheterized [urodynamic] studies, so you can be fairly confident that the UroCuff readings that you get will mimic those that you would get with standard urodynamics.”
How it works
The UroCuff system works on Pascal’s principle, which states that—per Encyclopedia Britannica definition—“in a fluid at rest in a closed container, a pressure change in 1 part is transmitted without loss to every portion of the fluid and to the walls of the container.”
“So, if you can measure the pressure in the urine at the tip of the urethra, you can get a better idea of the pressure inside the bladder,” Köhler said.
UroCuff is available in 2 patient connection types: the Classic and DC (direct compression). With the Classic connection, an adapter is wrapped around the penis and acts as a blood pressure cuff. With the DC connection, the adapter gently seals to the glans, creating an extended urethra, according to Köhler. The newer DC connection offers the advantages of maintaining a natural voiding pattern and recording pressure throughout the void, Köhler said. Patients who have to sit to void or who have hypospadias, however, cannot use the DC type. The report generated by the test is similar to that from catheterized flow studies, Köhler said.
Köhler discussed results of a study he coauthored that was recently published in Journal of Urology.2 The study evaluated data from more than 50,000 patients across 103 urology practices who had undergone UroCuff testing. Patients were categorized by Newcastle Noninvasive Nomogram quadrants. The results showed that 24% of patients had unobstructed flow, 32% had high pressure/high flow, 29% had obstructed flow, and 15% had low pressure/low flow. Köhler also discussed data from his experience with the first 50 patients on whom he performed the UroCuff test. In this group, 44% of patients had unobstructed flow, 9% had high pressure/high flow, 41% had obstructed flow, and 6% had low pressure/low flow. In addition, 15 of the patients had undergone a previous procedure, and of these patients, 9 had unobstructed flow and 6 had obstructed flow.
“I think, all in all, UroCuff…can really help with stratifying our patients and making informed decisions with them to help them pick…the best option for them,” Köhler concluded.
Disclosures: Köhler has no BPH-related disclosures. He is a member of the AUA BPH guidelines committee but does not serve as a spokesperson for the group.
1. Foster HE, Dahm P, Köhler TS, et al. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2019. J Urol. 2019;202(3):592-598. doi:10.1097/JU.0000000000000319
2. Kaplan SA, Köhler TS, Kausik SJ. Noninvasive pressure flow studies in the evaluation of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: a review of 50,000 patients. J Urol. 2020;204(6):1296-1304. doi:10.1097/JU.0000000000001195