Abstract
ABSTRACTObjectives: To determine the utility of ultrasonography (US)-derived parameters (e.g. prostate volume [PV], bladder wall thickness [BWT], post-void residual urine volume [PVR], and intravesical prostatic protrusion [IPP]) and uroflowmetry for identifying bladder outlet obstruction (BOO) by correlating them with the results of pressure–flow urodynamic studies (UDS).Patients and methods: In all, 164 patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), from May 2016 to December 2018, were included in this study. All had International Prostate Symptoms Score (IPSS), Quality-of-Life (QOL) index, uroflowmetry (including maximum urinary flow rate [Qmax]) and PVR measured by transabdominal US. Pressure–flow UDS were performed on all men and BOO was defined by a BOO Index (BOOI) >40. Men with a Qmax of ≥12.0 mL/s were considered to have ‘good’ flow.Results: Amongst the 164 men, the mean (SD) age, PV, BWT and Qmax were 66.72 (9.88) years, 51.91 (13.24) mm, 5.07 (0.91) mm, and 8.46 (3.59) mL/s, respectively. In all, 91 (55.49%) patients had BOO with a BOOI >40 and nine (5.49%) had equivocal BOO with a BOOI of 20–40. The IPP was a statistically significant predictor (P < 0.001) of BOO compared with other variables in the initial evaluation. In patients with BOO confirmed by the pressure–flow UDS, IPP Grade III was associated with a higher BOOI than was Grade I and II (P < 0.001).Conclusion: BWT, PV and PVR in conjunction with IPP are good predictors of clinically significant BOO due to BPH.Abbreviations: AUC: area under the curve; BOOI: BOO Index; BPO, benign prostatic obstruction; BWT, bladder wall thickness; IPP: intravesical prostatic protrusion; Pdet: detrusor pressure; PV: prostate volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QOL: quality of life; ROC: receiver operating characteristic; (TA)US: (transabdominal) ultrasonography; UDS: urodynamic studies
Highlights
benign prostatic hyperplasia (BPH) is a common benign disease of the prostate in ageing men
post-void residual urine volume (PVR), bladder wall thickness (BWT), prostate volume (PV), and intravesical prostatic protrusion (IPP) Grade, were good predictors of bladder outlet obstruction (BOO). When both the maximum urinary flow rate (Qmax) and PVR were combined as the primary evaluation for LUTS, the predictive power was less than when the IPP Grade was included in the assessment
The mean Qmax was significantly higher in IPP Grade I and Grade II than in Grade III patients (Table 4)
Summary
BPH is a common benign disease of the prostate in ageing men. Prevalence of histological BPH increases with age, rising from ~40% in men aged 51–60 years to 90% by 81–90 years [1]. Significant BOO is urodynamically characterised by increased detrusor pressure (Pdet) and a decreased urinary flow rate [2]. Non-invasive methods to diagnose BOO include: symptom evaluation (IPSS), PSA measurement, ultrasonography (US)-derived parameters such as prostate volume (PV), bladder wall thickness (BWT), intravesical prostatic protrusion (IPP), and post-void residual urine volume (PVR) [3,4]. US estimation of the prostate size and PVR with uroflowmetry have been routinely used by most urologists the world over to determine the presence of BOO. IPP can be measured accurately and non-invasively by TRUS and can predict voiding parameters for determining BOO in men who present with LUTS. Ultrastructural changes in the bladder wall have been studied by Elbadawi et al [7] from specimens obtained from patients with BOO and they found that there was an increased smooth muscle bulk, with or without interstitial collagen deposition.
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