ABSTRACT
Introduction: The objective of this study is to determine the relationships between prostatic volume (PV) and intravesical prostatic protrusion (IPP) with benign prostatic obstruction (BPO).
Materials and Methods: A total of 408 males (aged 50 years and above) who presented with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) were recruited. All had International Prostate Symptoms Score (IPSS), quality of life (QOL) index, uroflowmetry (Qmax) and postvoid residual urine (PVR) measured by transabdominal ultrasonography (TAUS). The PV and the degree of IPP were also measured by TAUS in the transverse and sagittal planes respectively. The PV is classified as Grade a, (20 ml or less), Grade b, (more than 20 ml to 40 ml) and Grade c, (more than 40 ml), while the IPP is graded as Grade 1 (5 mm or less), Grade 2 (more than 5 mm to 10 mm) and Grade 3 (more than 10 mm). Results: :There was a fair positive correlation between the PV and IPP (Spearman, rs = 0.62, P <0.001) with important clinical exceptions. There was negative correlation between the PV and Qmax (rs = -0.20, P = 0.022), IPP and Qmax (rs = -0.30, P <0.001). PV and IPP were good predictors of BPO. However, IPP was slightly better (rs of -0.30 vs -0.20) than PV. Conclusion: PV is related to IPP with important clinical exceptions. IPP is a better predictor of BPO than PV.Benign prostatic hyperplasia (BPH) is one of the commonest diseases of ageing men. It can be associated with bothersome lower urinary tract symptoms (LUTS) that affect quality of life and it causes structural and functional changes in the bladder. Previous clinical guidelines had emphasised on managing symptoms; however current thinking is that the prevention of progression of BPH is also important. Progression depends not only on the size but also the shape of the prostate adenoma which causes obstruction, hence, the importance of studying the relationship between prostate volume (PV) and the intravesical prostatic protrusion (IPP). IPP which distorts the funneling effect of the bladder neck can be considered to represent the shape of the prostate. The severity of LUTS suggestive of BPH correlates poorly with benign prostatic obstruction (BPO). Differences in the mean symptom index score in men with and without BPO were not statistically significant. Although pressure flow studies and voiding urethral pressure profilometry are reliable means of identifying BPO, they are not routinely performed for ageing men with LUTS suggestive of BPH. This is because urodynamic studies are acknowledged to be relatively complex, invasive and not cost-effective. The other non-invasive methods have not been effective for predicting BPO.
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