1791 CAN INTRAVESICAL PROSTATIC PROTRUSION PREDICT EARLY RESPONSE TO MEDICAL MANAGEMENT OF BLADDER OUTLET OBSTRUCTION?

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Medical and Hormonal Therapy1 Apr 20101791 CAN INTRAVESICAL PROSTATIC PROTRUSION PREDICT EARLY RESPONSE TO MEDICAL MANAGEMENT OF BLADDER OUTLET OBSTRUCTION? Hemendra Shah, Shabbir Kharodawala, Asmita Shewale, and Manish Bansal Hemendra ShahHemendra Shah More articles by this author , Shabbir KharodawalaShabbir Kharodawala More articles by this author , Asmita ShewaleAsmita Shewale More articles by this author , and Manish BansalManish Bansal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1702AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical prostatic protrusion (IPP) on transabdominal sonography is a potential marker for assessment of bladder outlet obstruction. We assessed the impact of IPP on early response to medical management of bladder outlet obstruction (BOO). METHODS This prospective study included 237 patients aged > 50 years presenting with lower urinary tract symptoms from February 2004 to June 2006. Patients with prostate cancer, urethral stricture, and neurological deficit or on medications for BOO were excluded from study. Patients presenting with urinary retention or requiring surgery for prostate were excluded from study. IPP was measured in mm from the base in the mid sagittal line using transabdominal ultrasound when the bladder volume is between 100 - 200 ml. Its severity was graded as follows, grade I- less than 5 mm, grade II- 5 to 10 mm and grade III- more than 10 mm. All patients were given tamsulosin (0.4 mg). A 5-alpha reductase inhibitor was added if the prostatic weight exceeds 40 gm. The outcome was assessed at 1 and 3 months by AUA symptom score, maximum urinary flow rate and post void residual urine measurement. The outcome amongst patients with different grade of IPP was compared using the unpaired t -test. RESULTS Patients with IPP Grade III were associated with significantly larger prostate and higher PSA levels. They were also associated with larger post void residual urine as compared to patients with grade I IPP (118.63 ml Vs 62.28 ml). After 1 month of medical management the difference between AUA symptom score and post void residual urine measurement amongst patients with grade I and II IPP was found to be statistically significant. However the difference in mean decrease in AUA symptom score and increase in peak urinary flow rates amongst all the 3 groups was not found to be statistically significant. The difference noted in the decrease in post void residual urine between patients with grade I and III IPP was statistically significant. CONCLUSIONS Increasing IPP is associated with larger size of prostate and increasing amount of post-void residual urine. Patients with grade 1 IPP have better improvement in AUA symptom and residual urine estimation as compared to patients with high grade IPP. Table. Follow-up parameters Parameters Grade I P Value I vs. II Grade II P Value II vs. III Grade III P Value III vs. I N Mean±SD N Mean ±SD N Mean ±SD AUA improvement at 1 month 81 3.79±3.89 .336 47 4.51±4.26 .187 27 3.14±4.18 .464 Q max improvement at 1 month (ml/sec) 80 1.39±6.58 .530 35 2.21±4.83 .869 19 2.01±3.32 .698 PVR decrease at 1 month (ml) 79 16.82±51.73 .459 46 7.28±92.15 .040 27 71.85±171.92 .012 AUA improvement at 3 month 81 7.41±5.62 .925 46 7.52±6.29 .277 27 5.81±6.64 .223 Q max improvement at 3 month (ml/sec) 82 3.01±6.26 .752 46 2.65±5.89 .811 27 2.97±4.64 .976 PVR decrease at 3 month (ml) 79 24.06±53.24 .320 46 9.71±107.12 .073 27 74.18±196.40 .041 Mumbai, India© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e695 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hemendra Shah More articles by this author Shabbir Kharodawala More articles by this author Asmita Shewale More articles by this author Manish Bansal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...