Relationship between Lower Urinary Tract Symptoms and Prostatic Urethral Stiffness Using Strain Elastography: Initial Experiences.

Jong Kyou Kwon,Kang Su Cho,Do Kyung Kim,Jong Won Kim,Joo Yong Lee

doi:10.3390/jcm8111929

Abstract

We attempted to visualize the periurethral stiffness of prostatic urethras using strain elastography in the midsagittal plane of transrectal ultrasonography (TRUS) and to evaluate periurethral stiffness patterns in relation to lower urinary tract symptoms (LUTS). A total of 250 men were enrolled. The stiffness patterns of the entire prostate and individual zones were evaluated using strain elastography during a TRUS examination. After excluding 69 men with inappropriate elastography images, subjects were divided according to periurethral stiffness into either group A (low periurethral stiffness, N = 80) or group B (high periurethral stiffness, N = 101). There were significant differences in patient age (p = 0.022), transitional zone volume (p = 0.001), transitional zone index (p = 0.33), total international prostate symptom score (IPSS) (p < 0.001), IPSS-voiding subscore (p < 0.001), IPSS-storage subscore (p < 0.001), and quality of life (QoL) score (p = 0.002) between groups A and B. After adjusting for relevant variables, significant differences in total IPSS, IPSS-voiding subscore, and QoL score were maintained. Men with high periurethral stiffness were associated with worse urinary symptoms than those with low periurethral stiffness, suggesting that periurethral stiffness might play an important role in the development of LUTS.

Highlights

Benign prostatic hyperplasia (BPH) is known to induce bladder outlet obstruction (BOO) and cause lower urinary tract symptoms (LUTS) [1]
Han et al suggested that calcification and fibrotic changes result from inflammatory processes around the prostatic urethra and are independently associated with urinary flow rate and urinary symptoms [18]
All previous studies were performed in transverse images only, which do not thoroughly reflect changes in elasticity stemming from prostatic fibrosis in the periurethral course, which has been suggested to be a novel cause of LUTS in patients with BPH [14,16,24,25]

Summary

Introduction

Benign prostatic hyperplasia (BPH) is known to induce bladder outlet obstruction (BOO) and cause lower urinary tract symptoms (LUTS) [1]. Han et al suggested that calcification and fibrotic changes result from inflammatory processes around the prostatic urethra and are independently associated with urinary flow rate and urinary symptoms [18]. In this respect, the evaluation of periurethral elasticity can be a promising approach to elucidate the pathophysiology of male LUTS. All previous studies were performed in transverse images only, which do not thoroughly reflect changes in elasticity stemming from prostatic fibrosis in the periurethral course, which has been suggested to be a novel cause of LUTS in patients with BPH [14,16,24,25]. We attempted to visualize the periurethral stiffness of the prostatic urethra using strain elastography and to evaluate relationships between periurethral stiffness patterns and LUTS, using both transverse and midsagittal plane images

Methods

Findings

Discussion

Conclusion