Abstract
PurposeTo evaluate the effects of prostatic anatomical factors on male lower urinary tract symptoms (LUTS) and the peak flow rate (Qmax) in patients with small prostate volume (PV).Materials and MethodsRecords were obtained from a prospectively maintained database of first-visit men with LUTS. Patients whose total PV (TPV) was greater than 30 mL were excluded; 444 patients were enrolled in the study. The TPV, transitional zone volume (TZV), transitional zone index (TZI), intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA) were measured by transrectal ultrasonography. LUTS were evaluated using the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) questionnaires. Uroflowmetric measurements were also made.ResultsPUA (r = 0.269, P<0.001), TZV (r = 0.160, P<0.001), and TZI (r = 0.109, P = 0.022) significantly correlated with the IPSS. Qmax (r = −0.334, P<0.001) and OABSS (r = 0.211, P<0.001) correlated only with PUA. In a multivariate regression analysis, PUA and age were independently associated with IPSS, OABSS, and Qmax. For IPSS of 20 or greater, the area under the ROC curve (AUC) of PUA was 0.667 and the cut-off value was 43.7°. When Qmax was 10 mL/s or less, the AUC of PUA was 0.664 and the cut-off value was 43.5°.ConclusionsPUA has a significant association with symptom severity and Qmax among prostatic anatomical factors analyzed in men with LUTS and small PV. PUA should be considered as an important clinical factor in male LUTS management. Furthermore, the impact of PUA on response to medical treatment and disease progression needs to be investigated.
Highlights
Benign prostatic hyperplasia (BPH) that includes benign prostatic enlargement (BPE) and benign prostatic obstruction (BPO) has conventionally been considered a major factor in male lower urinary tract symptoms (LUTS) [1]
prostatic urethral angulation (PUA) has a significant association with symptom severity and Qmax among prostatic anatomical factors analyzed in men with LUTS and small prostate volume (PV)
PUA should be considered as an important clinical factor in male LUTS management
Summary
Benign prostatic hyperplasia (BPH) that includes benign prostatic enlargement (BPE) and benign prostatic obstruction (BPO) has conventionally been considered a major factor in male lower urinary tract symptoms (LUTS) [1]. The pathophysiology of male LUTS is highly complex and multifactorial, and recently the importance of other causal factors including changes in the bladder and prostate as well as in related structures such as the pelvic vasculature and innervation has been highlighted [2]. To reflect this viewpoint, the European Association of Urology (EAU) replaced ‘LUTS suggestive of BPH (LUTS/BPH)’ with ‘Non-neurogenic male LUTS including BPO’ in the latest version of the EAU guidelines for male LUTS [3]. Physicians frequently encounter men with LUTS and a PV less than 25 mL; the significance of the PV has been neglected or regarded as uncertain in the consultation and management of these patients
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