The evaluation of a new measurable clinical parameter to assess lower urinary tract symptoms in men with ultrasonic measurements of bladder parameters is very interesting and promising. By using a commercially developed tool that is seeking a clinical role in assessing lower urinary tract symptoms, the authors correctly indicate the need to examine these parameters in various dynamic states of filling, and to see whether it correlates to actual pathological samples and invasive urodynamic findings, that is, EBW of a fuller bladder may be different from one that is half full despite being at "functional capacity" in both states. This is because "noninvasive" functional capacity is not a set number at any one time point and can vary in the same day in the same patient much less on other days. As a result, it is more a reflection of a dynamic measurement of bladder function than an anatomic static value of "prostate volume." Because surface area is very dependent on filling volume at time of measurement, EBW and BWT are also are dependent on these urodynamic changes. Because functional capacity can change even with a cup of coffee and a change of weather, these parameters may change within the same patient in the same day. As such, it is not surprising that the study results only suggest a moderate association between bladder surface and EBW with AUA score and maximum flow rate. Thus, the authors correctly state that this parameter is a useful investigative tool and its clinical utility has yet to be determined.
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