Correlation of Intravesical Prostatic Protrusion with Severity of Lower Urinary Tract Symptoms in Men With Symptomatic Benign Prostatic Hyperplasia at University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu

Abstract

Abstract Background: Benign prostatic hyperplasia (BPH) is one of the causes of lower urinary tract symptoms (LUTS) in men above 50 years of age. It is known that the severity of LUTS (degree of bladder outlet obstruction) does not correlate with the size of the prostate gland in BPH. Severity of LUTS due to BPH can be assessed using the internationally validated international prostate symptom score (IPSS). There are some concerns that the IPSS is subjective and may pose some challenges to the poorly educated patients in our environment during administration. Intravesical prostatic protrusion may be an objective index of degree of bladder outlet obstruction in men with BPH measured using abdominopelvic ultrasound. So the objective of this study is to evaluate for any correlation between IPP and IPSS in men with symptomatic BPH. Objective: The objective of the study is to assess the correlation between IPP and IPSS. Patients and Methods: A hospital based cross-sectional study of new patients with symptomatic LUTS of BPH, who presented to the Urology clinics of University of Nigeria Teaching Hospital Ituku-Ozalla Enugu. Ethical approval was obtained from the ethical committee of the hospital and informed consent from patients. After evaluation (including IPSS, PSA, and FBC, S/E/Ur/Cr, Urinalysis and M/C/S), participants had abdominopelvic ultrasonography measurement of IPP and midline sagittal image of the prostate (at bladder Volume of > 100mls) using Prosound model SSD 3500 with an abdominal probe frequency of 3.5MHz (Versana Essentials) IPP was divided into three grades (Grade I: 0-4.9mm; Grade II: 5.0-9.9mm; Grade III: 10.0mm and above). Data was analyzed using SPSS Version 20 (IBM, SPSS, Chicago, IL, USA). The Pearson correlation was used to assess correlation where necessary. P- value <0.005 was considered significant. Results: Two hundred and seventy four men with a mean age of 64.76+/- 9.04 years were included in the study. Most of the participants had highest educational level of primary education 145 (52.9 %). The average IPSS, IPP, PSA Total were 15.90+/- 4.74 SD, 9.49+/- 2.98 SD, 6.13+/- 1.83 respectively. There is significant positive correlation between IPP and IPSS (r = 0.451; P < 0.001), and a statistically significant negative correlation between IPP, IPSS (r = - 0.742; P < 0.001), (r = - 0.500; P < 0.001) respectively and Qmax. Conclusion: There was a significant positive correlation between IPP and IPSS. Intravesical prostatic protrusion may be used to help assess severity of lower urinary tract symptoms in men with BPH.