Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?

doi:10.1016/j.ajur.2015.10.002

Asian Journal of Urology, 2016, 3 (1): 39-43 doi: 10.1016/j.ajur.2015.10.002

Original Article

Current Issue | Archive | Adv Search

Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?

Alvin Lee^a, Han Jie Lee^a, Kok Bin Lim^b, Hong Hong Huang^a, Henry Ho^a, Keong Tatt Foo^a

a Department of Urology, Singapore General Hospital, Singapore;
b Urology Centre, Raffles Hospital, Singapore

Abstract
Related Citation (15)

Download:

HTML

PDF (828KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective: Men with benign prostate hyperplasia (BPH) with good urinary flow may still have bladder outlet obstruction (BOO). Intravesical prostatic protrusion (IPP) has been shown to be able to predict BOO. We aim to investigate the use of IPP to predict BOO in men with good urinary flow.
Methods: One hundred and fourteen consecutive men (>50 years old) presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002. They were evaluated with serum prostate specific antigen (PSA), uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume (PV). Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index > 40. Men with Q_max ≥12.0 mL/s were considered to have good flow.
Results: Among the 114 men, 61 patients had good urinary flow. Their median age, PV and Qmax were 66 years, 32.9 mm³ and 14.5 mL/s respectively. 14/61 (23.0%) patients had BOO and their distribution of IPP were as follows: Grade 1 e 0/20 (0%) obstructed, Grade 2-6/22 (27.3%) and Grade 3-8/19 (42.1%). Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%. The area-under-curve (AUC) for IPP was greater than that for PV (0.757 vs. 0.696).
Conclusion: Even in men with good flow, high grades of IPP were more likely to have BOO and hence, may be a useful adjunct to predict BOO.

Key words： Male Prostate hyperplasia Pathology Ultrasonography Urinary bladder Urodynamics

Received: 05 July 2015 Published: 29 January 2016

Corresponding Authors: Henry Ho E-mail: henry.ho.s.s@sgh.com.sg

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Alvin Lee
	Han Jie Lee
	Kok Bin Lim
	Hong Hong Huang
	Henry Ho
	Keong Tatt Foo

TRENDMD:

Cite this article:

Alvin Lee,Han Jie Lee,Kok Bin Lim, et al. Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?[J]. Asian Journal of Urology, 2016, 3(1): 39-43.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2015.10.002 OR http://www.ajurology.com/EN/Y2016/V3/I1/39

[1]	Chute CG, Panser LA, Girman CJ, Oesterling JE, Guess HA, Jacobsen SJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol 1993; 150:85-9.
[2]	Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 1999;84: 14-5.
[3]	Lim KB, Ho H, Foo KT, Wong MY, Fook-Chong S. Comparison of intravesical prostatic protrusion, prostate volume and serum prostatic specific antigen in the evaluation of bladder outlet obstruction. Int J Urol 2006;13:1509-13.
[4]	Chia SJ, Heng CT, Chan SP, Foo KT. Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 2003;91:371-4.
[5]	Porru D, Jalious H, Cvalli V, Sallusto F, Rovereto B. Prognostic value of a combination of IPSS, flow rate and residual urine volume compared to pressure-flow studies in the preoperative evaluation of symptomatic BPH. Eur Urol 2002;41: 246-9.
[6]	Reynard JM, Yang Q, Donovan JL, Peters TJ, Schafer W, de la Rosette JJ, et al. The ICS-‘BPH'Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction. Br J Urol 1998;82:619-23.
[7]	Tan YH, Foo KT. Intravesical prostatic protrusion predicts the outcome of a trial without catheter following acute urinary retention. J Urol 2003;170:2339-41.
[8]	Mariappan P, Brown D, McNeil A. Intravesical prostatic protrusion is better than prostate volume in predicting outcome of trial without catheter in white men presenting with acute urinary retention: a prospective clinical study. J Urol 2007; 178:573-7.
[9]	Park HY, Lee JY, Park SY, Lee SW, Kim YT, Choi HY, et al. Efficacy of alpha blocker treatment according to the degree of intravesical prostatic protrusion detected by transrectal ultrasonography in patients with benign prostatic hyperplasia. Korean J Urol 2012;53:92-7.
[10]	Lee LS, Sim HG, Lim KB, Wang D, Foo KT. Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment. Int J Urol 2010;17:69-74.
[11]	Yuen SJ, Ngiap JT, Cheng CW, Foo KT. Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. Int J Urol 2002; 9:225-8.
[12]	Kuo TL, Teo JS, Foo KT. The role of intravesical prostatic protrusion (IPP) in the evaluation and treatment of bladder outlet obstruction (BOO). Neurourol Urodyn 2015 Mar 1. http://dx.doi.org/10.1002/nau.22741 [Epub ahead of print].
[13]	Randall A. Surgical pathology of prostatic obstructions. Baltimore, MD: Williams & Wilkins; 1931.
[14]	Klingler HC, Madersbacher S, Djavan B, Schatzl G, Marberger M, Schmidbauer CP. Morbidity of the evaluation of the lower urinary tract with transurethral multichannel pressure-flow studies. J Urol 1998;159:191-4.
[15]	Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, Tsukamoto T. Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol 2006;13:1398-404.
[16]	Oelke M, Höfner K, Jonas U, De la rosette JJ, Ubbink DT, Wijkstra H. Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol 2007;52:827-34.
[17]	Manieri C, Carter SS, Romano G, Trucchi A, Valenti M, Tubaro A. The diagnosis of bladder outlet obstruction in men by ultrasound measurement of bladder wall thickness. J Urol 1998;159:761-5.
[18]	Ku JH, Ko DW, Cho JY, Oh SJ. Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms. Urology 2010;75: 1467-71.
[19]	Kojima M, Inui E, Ochiai A, Naya Y, Ukimura O, Watanabe H. Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: a preliminary report. Urology 1996;47:942-7.
[20]	Reynard JM, Peters TJ, Lim C, Abrams P. The value of multiple free-flow studies in men with lower urinary tract symptoms. Br J Urol 1996;77:813-8.
[21]	Vesely S, Kuntson T, Damber JE, Dicuio M, Dahlstrnad C. Relationship between age, prostate volume, prostate specific antigen,symptom score and uroflowmetry in men with lower urinary tract symptoms. Scand J Urol Nephrol 2003;36:322-8.
[22]	Steele GS, Sullivan MP, Sleep DJ, Yalla SV. Combination of symptom score, flow rate and prostate volume for predicting bladder outflow obstruction in men with lower urinary tract symptoms. J Urol 2000;164:344-8.
[23]	Yalla SV, Sullivan MP, Lecamwasam HS, Dubeau CE, Vickers MA, Cravalho EG. Correlation of American Urological Association symptom index with obstructive and nonobstructive prostatism. J Urol 1995;153:674-9.
[24]	Van venrooij GE, Boon TA. The value of symptom score, quality of life score, maximal urinary flow rate, residual volume and prostate size for the diagnosis of obstructive benign prostatic hyperplasia: a urodynamic analysis. J Urol 1996;155: 2014-8.
[25]	Eckhardt MD, Van venrooij GE, Boon TA. Symptoms and quality of life versus age, prostate volume, and urodynamic parameters in 565 strictly selected men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Urology 2001;57:695-700.
[26]	Van venrooij GE, Boon TA, De gier RP. International prostate symptom score and quality of life assessment versus urodynamic parameters in men with benign prostatic hyperplasia symptoms. J Urol 1995;153:1516-9.
[27]	Oh MM, Kim JW, Kim JJ, Moon du G. Is there a correlation between the outcome of transurethral resection of prostate and preoperative degree of bladder outlet obstruction? Asian J Androl 2012;14:556-9.
[28]	Shin SH, Kim JW, Kim JW, Oh MM, Moon du G. Defining the degree of intravesical prostatic protrusion in association with bladder outlet obstruction. Korean J Urol 2013;54:369-72.