MP45-07 ROLES OF PROSTATE ENLARGEMENT, INFLAMMATION AND FIBROSIS IN BLADDER OUTLET OBSTRUCTION

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research & Pathophysiology1 Apr 2018MP45-07 ROLES OF PROSTATE ENLARGEMENT, INFLAMMATION AND FIBROSIS IN BLADDER OUTLET OBSTRUCTION Matthew D Grimes, Andrew Schneider, Sijian Wang, and Wade Bushman Matthew D GrimesMatthew D Grimes More articles by this author , Andrew SchneiderAndrew Schneider More articles by this author , Sijian WangSijian Wang More articles by this author , and Wade BushmanWade Bushman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1446AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate enlargement, inflammation and fibrosis have all been implicated in the genesis of LUTS in aging men. Recent studies in our laboratory demonstrated that prostate inflammation induced an increase in prostate collagen (fibrosis) and this finding suggested that inflammation-induced fibrosis in the human prostate contributes to development of bladder outlet obstruction (BOO). Using surgical specimens from a cohort of patients with BPH/LUTS, we performed quantitative analysis of inflammation and collagen content to test the hypothesis that histologic inflammation is positively correlated with prostate collagen content and to evaluate the role of fibrosis in BOO. METHODS We identified 44 men who underwent either TURP or open simple prostatectomy (OSP) for BPH/LUTS for whom preoperative urodynamic data were available. Prostate volume was calculated from CT or TRUS using the ellipsoid formula. Inflammation was quantitated using a consensus scoring system for prostate inflammation (Nickel, et al., 2001) and the total inflammation score represented the sum of stromal, epithelial and glandular inflammation. Collagen was quantitated using a previously validated quantitative method of picrosirius red staining for collagen and image J analysis (Wong et al., 2014). Bladder outlet obstruction index (BOOI) was calculated from the formula BOOI = PdetQmax - 2Qmax. RESULTS The surgical cohort included 35 men (77%) who underwent TURP and 11 (23%) who underwent OSP. Median age was 63 (IQR 55.8-73.3) and median prostate volume 48cc (IQR 37-82.4). We observed a significant correlation between BOOI and prostate volume (p-value=0.04) and linear regression analysis suggested the contribution of prostate enlargement to BOOI is greater for larger glands (>45g). We observed no significant correlation between inflammation and collagen content and no significant contribution of fibrosis to BOOI. CONCLUSIONS These data affirm a positive correlation of prostate volume with BOOI but do support the hypothesis that inflammation-induced fibrosis contributes to obstruction in most men. The suggestion that prostate volume makes a greater contribution to obstruction in larger glands suggests differing drivers of BOO in patients with smaller prostates. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e599 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Matthew D Grimes More articles by this author Andrew Schneider More articles by this author Sijian Wang More articles by this author Wade Bushman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...