Sonographic correlations between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic hyperplasia in Ibadan, Nigeria

Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p =0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP

Impact of the degrees of intravesical prostatic protrusion on the recovery of urinary continence after radical prostatectomy / 中华男科学杂志

Objective@#To investigate the influence of the degrees of intravesical prostatic protrusion (IPP) on the recovery of urinary continence after radical prostatectomy.@*METHODS@#We retrospectively analyzed the clinical data on 212 patients diagnosed with prostate cancer by biopsy and treated by laparoscopic radical prostatectomy by the same surgeon. Based on the degrees of IPP measured by MRI, we divided the patients into an IPP ≤ 10 mm group (n = 146) and an IPP > 10 mm group (n = 66) and determined the factors influencing the recovery of urinary continence by univariate and multivariate logistic regression analyses.@*RESULTS@#At 1, 3, 6 and 12 months after surgery, the urinary continence rates of the patients were 32.5%, 50.5%, 82.1% and 91%, respectively. Univariate analysis indicated that the factors influencing the recovery of urinary continence included IPP, body mass index (BMI), bladder neck preservation (BNP), neurovascular bundle preservation (NVBP) and clinical tumor (T) stage at 3 months (P 10 mm (P 10 mm and BMI ≥ 25 kg/m2 are independent factors influencing the long-term recovery of urinary continence after radical prostatectomy.

Urinary Continence after Robot-Assisted Laparoscopic Radical Prostatectomy: The Impact of Intravesical Prostatic Protrusion

PURPOSE: To assess the impact of intravesical prostatic protrusion (IPP) on the outcomes of robot-assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS: The medical records of 1094 men who underwent RALP from January 2007 to March 2013 were analyzed using our database to identify 641 additional men without IPP (non-IPP group). We excluded 259 patients who presented insufficient data and 14 patients who did not have an MRI image. We compared the following parameters: preoperative transrectal ultrasound, prostate specific antigen (PSA), clinicopathologic characteristics, intraoperative characteristics, postoperative oncologic characteristics, minor and major postoperative complications, and continence until postoperative 1 year. IPP grade was stratified by grade into three groups: Grade 1 (IPP≤5 mm), Grade 2 (5 mm10 mm). RESULTS: Of the 821 patients who underwent RALP, 557 (67.8%) experienced continence at postoperative 3 months, 681 (82.9%) at 6 months, and 757 (92.2%) at 12 months. According to IPP grade, there were significant differences in recovering full continence at postoperative 3 months, 6 months, and 12 months (p<0.001). On multivariate analysis, IPP was the most powerful predictor of postoperative continence in patients who underwent RALP (p<0.001). Using a generalized estimating equation model, IPP also was shown to be the most powerful independent variable for postoperative continence in patients who underwent RALP (p<0.001). CONCLUSION: Patients with low-grade IPP have significantly higher chances of recovering full continence. Therefore, the known IPP grade will be helpful during consultations with patients before RALP.

Defining the Degree of Intravesical Prostatic Protrusion in Association With Bladder Outlet Obstruction

PURPOSE: The present study was done to define the degree of intravesical prostatic protrusion (IPP) causing bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms. MATERIALS AND METHODS: We retrospectively evaluated 239 patients with BPH, analyzing age, IPP, prostate volume, International Prostate Symptom Score (IPSS), and the results from a pressure-flow study. Urethral resistance was quantified by using the BOO index (BOOI), according to the formula BOOI=PdetQmax-2xQmax (where Pdet is detrusor pressure at the peak flow rate and Qmax is peak flow rate). BOO was defined by a BOOI above 40. Patients with a BOOI below 20 were excluded. Patients were classified into two groups (obstructed and unobstructed groups) by the BOOI. Correlations were determined by logistic regression analysis, and receiver operating characteristic curves were plotted to estimate the optimal cutoff for IPP. RESULTS: There were significant differences in total prostate volume, postvoiding residual urine (PVR), IPP, and Qmax (p<0.001, p<0.001, p<0.001, and p=0.026, respectively) between the obstructed and unobstructed groups, but there were no significant differences in age (p=0.653), IPSS total score (p=0.624), or quality of life score (p=0.138). IPP had a significant prognosis (p<0.001) but was weakly correlated with prostate volume (p=0.026). The correlation coefficients between IPP and Qmax, PVR, prostate volume, and BOO were 0.551, -0.159, 0.225, and 0.391, respectively. For IPP, the area under the curve was 0.759 (95% confidence interval, 0.657 to 0.861) and the cutoff to indicate BOO was 5.5 mm with 66.7% sensitivity and 80.5% specificity. CONCLUSIONS: An IPP exceeding 5.5 mm was significantly associated with BOO.

Predicting Outcome of Trial of Voiding Without Catheter in Acute Urinary Retention with Intravesical Prostatic Protrusion

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.

Relationship between Intravesical Prostatic Protrusion and Postoperative Outcomes in Patients with Benign Prostatic Hyperplasia

PURPOSE: To evaluate the significance of intravesical prostatic protrusion (IPP) for predicting postoperative outcomes in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 177 patients with a possible follow-up of at least 6 months who were treated with transurethral resection of the prostate (TURP) were analyzed. We divided the patients into two groups on the basis of the degree of IPP: the significant IPP group (IPP> or =5 mm, n=74) and the no significant IPP group (IPP<5 mm, n=103). We analyzed postoperative changes in parameters, such as the International Prostate Symptom Score (IPSS), IPSS quality-of-life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). The IPSS was subdivided into voiding (IPSS-v) and storage (IPSS-s) symptoms. Multivariate logistic regression analysis was performed to identify whether IPP could predict surgical outcomes of TURP. RESULTS: Preoperative parameters were not significantly different between the two groups except for total prostate volume and transitional zone volume. Postoperative changes in IPSS, IPSS-v, IPSS-s, and QoL score were higher in the significant IPP group than in the group with no significant IPP. Changes in Qmax and PVR were not significantly different between the two groups. Multivariate logistic regression analysis (after adjustment for age, prostate-specific antigen level, total prostate volume, and transitional zone volume) revealed that the odds ratios (95% confidence interval) of decreased IPSS and IPSS-s in the significant IPP group were 3.43 (1.03 to 11.44) and 3.51 (1.43 to 8.63), respectively (p=0.045 and 0.006, respectively). CONCLUSIONS: Significant IPP is an independent factor for predicting better postoperative outcomes of IPSS and IPSS-s.

The Clinical Implication of Intravesical Prostatic Protrusion to Lower Urinary Tract Symptoms in Patients of Prostatic Volume 30~50gm / 대한남성과학회지

PURPOSE: Intravesical prostatic protrusion (IPP) is a morphological change of prostate protruded into bladder and might be related to bladder outlet obstruction (BOO) depending on the extent of protrusion. There is a high possibility that lower urinary tract symptoms (LUTS) tends to get worse as IPP grows. Therefore, it is necessary to examine the effect of IPP on LUTS after revision of prostate volume in order to identify the direct effect of IPP on BOO and LUTS. MATERIALS AND METHODS: A retrospective study of 296 male patients diagnosed with benign prostate hyperplasia (BPH) between August 2006 and December 2008 were performed. The patients were evaluated with international prostate symptoms score (IPSS) and quality of life (QoL), uroflowmetry (UFR), post-void residual urine volume (PVR), prostate volume and IPP as measured by transurectal ultrasound (TRUS). The changes of IPSS after 8 weeks of medication treatment and the occurrence rates of transurethral resection of prostate (TURP) and acute urinary retention (AUR) were compared. By checking IPSS and UFR, the improvement of voiding symptom was evaluated. RESULTS: The population of patients with moderate enlargement (30-50gm) of prostate extent was 147 (49.6%) out of 296, the whole examined population. There were correlation between IPP and IPSS (p=0.002) and the storage symptoms score was significantly increased (p=0.014). After 8 weeks of medication treatment, both moderate BPH patients with IPP showed similar improvement in storage symptom compared to non-IPP groups. But, the TURP was significantly performed more with IPP (p=0.040) than non-IPP groups and more AUR has occurred (p=0.013). After TURP, IPP group resulted in improvement of IPSS, storage symptoms score and voiding symptoms score statistically compared to non-IPP group. As the change of UFR and IPSS after TURP had shown, the improvements of voiding volume, maximal flow rate (Qmax), and average flow rate (Qavg) in IPP groups were smaller however, it is no correlation in statistical view. CONCLUSIONS: Moderate BPH group with IPP has a higher possibility of having AUR and surgical treatment while showing significant correlation with storage symptoms. A further prospective study is necessary for identification of improvement of IPSS and UFR after TURP and IPP should be checked carefully during TRUS.

Ultrasonic measurement of intravesical prostatic protrusion in benign prostatic hyperplasia patients / 中华泌尿外科杂志

Objective To study a noninvasive method in evaluating the bladder outlet obstruc-tion (BOO) and bladder function in patients with benign prostatic hyperplasia (BPH) based on the transabdominal ultrasonic measurement of intravesical prostatic protrusion (IPP). Methods The da-ta of 206 first visit BPH patients with lower urinary tract symptoms (LUTS) were retrospectively re-viewed. Patients were divided into 2 groups based on the degree of IPP: the research group with IPP greater than 10 mm(n=78) and control group with IPP 10 mm or less(n=128). Clinical data and uro-dynamic findings of the 2 groups were analyzed to find the clinical significance of IPP. Resells In-creased prostate volume(73.7±35.9 ml vs 62.8±36.5 ml), serum prostate specific antigen(1.81± 0.67 ng/ml vs 1. 64±0.36 ng/ml), post-voiding residual urine volume (PVR)(290.2±217.2 ml vs 228.2±167.9 ml), incidence of acute urine retention(33.3% vs 18.0%)and bladder trabeculation (23.1% vs 11.7%)had signicant differences between the 2 groups (P<0.05). Positive correlation was found between IPP and prostate volume as well as PVR (r=0.401 and 0.342, respectively). In the urodynamic study, significantly lower peak flow rate (Qmax) (7.6±4.1 ml/s vs 9.1±3.6 ml/s), higher incidence of detrusor overactivity (82.1% vs 17.2%) and low bladder compliance (35.9% vs 12.5%)were found in research group (P<0.01). In addition, maximum detrusor pressure(109.8± 84.9 cm H2O vs 84.9±44.1 cm H2O) and BOO index (BOOI) (75.2±27.1 vs 65.9±34.6) were significantly higher in the research group (p<0.05). The correlation study showed that r between IPP and Qmax, Pdet. max and BOOI was-0.284, 0.252 and 0.456, respectively. The incidence of acute urinary intention recurrence was higher in research group than in control group (64.3% vs 23.5%) (P<0.05). Conclusions IPP is a useful predictor in evaluating BOO and detrusor function. BOO and impaired detrusor function in obvious IPP patients are more severe. The obvious IPP pa-tients, especially those presenting with acute urine retention, may benefit more from early surgical in-tervention.