Voiding dysfunction is a well-documented complication of prostate biopsy [1]. Although this complication is reported as a deterioration in the international prostate symptom score (IPSS) or maximum urine flow rate (Qmax) after prostate biopsy, prediction of change in lower urinary tract symptoms (LUTS)-related quality of life of patients following this procedure is equally important. This study aimed to assess the value of baseline figures and change in both IPSS item sub-scores and Qmax in predicting alteration in LUTS-related quality of life of patients undergoing trans-rectal prostate biopsy.

A cohort of sixty-one patients with indications for trans-rectal prostate biopsy in our teaching hospital were prospectively recruited from February 2017 to July 2018. Patients who had pre-existing adult neurogenic lower urinary tract dysfunction, those on an α-adrenergic blocker or having a urethral or suprapubic catheter and those who had post-biopsy acute urinary retention were excluded from the study. The baseline characteristics of the patients were obtained. Item sub-scores of IPSS including bother scores of each patient were determined using the IPSS questionnaire before and on day seven after trans-rectal prostate biopsy. Qmax of each patient was also determined before and seven days after the biopsy using a uroflowmeter based on a load cell weight transducer. Paired samples t-test, Pearson's correlation and linear regression on SPSS were used for data analysis with p < 0.05 considered significant.

The average age, prostate specific antigen and total IPSS of the patients were 64.9 ± 8.8 years, 16.0 (IQR 7.3 – 29.3) ng/ml and 12.1 ± 7.1 respectively. Except for the daytime frequency sub-score and the maximum urine flow rate, there was an insignificant worsening in other post-biopsy IPSS item sub-scores in comparison to pre-biopsy values as shown in Table 1. There was a significant correlation of change in item sub-scores of daytime frequency (p = 0.008, r = 0.339), urgency (p = 0.001, r = 0.475), nocturia (p = 0.012, r = 0.319), slow stream (p = 0.001, r = 0.581), and straining to void (p = 0.001, r = 0.608) with a change in bother score after prostate biopsy. There was also a significant correlation of baseline intermittency (p = 0.043, r = ‒ 0.259), urgency (p = 0.036, r = ‒ 0.269), and straining to void (p = 0.014, r = ‒ 0.312) with a change in bother score. Baseline Qmax (p = 0.269) or a change in Qmax (p = 0.230) had no significant correlation with a change in bother score. Only item sub-scores related to change in straining to void (p = 0.001, B = 0.423), change in urgency (p = 0.003, B = 0.276), change in urinary stream (p = 0.020, B = 0.245) and change in daytime frequency (p = 0.016, B = 0.230) were independent factors that influenced a change in bother score of these patients.

From this study, it was clear that only change in the severity of some lower urinary tract symptoms, rather than baseline values, had an impact on change in the quality of life of patients following prostate biopsy. Specifically, variation in straining to void, urgency, urinary stream and daytime frequency sub-scores had a significant influence on the alteration in the bother score of these patients with a change in voiding symptoms, especially straining to void, having the greatest contribution. This could be because patients with lower LUTS scores, as in this study, were more concerned about the worsening of voiding symptoms rather than storage symptoms [2]. It could also be because the influence of IPSS items on bother score may vary with study populations [3].

While change in the maximum urine flow rate had no impact on alteration in LUTS-related quality of life of patients following prostate biopsy, variation in some voiding and storage symptoms, especially change in straining to void sub-score, directly affected LUTS-related quality of life of these patients.

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