Intravesical Prostatic Protrusion Research Articles

Clinical characteristics and useful signs to differentiate detrusor underactivity from bladder outlet obstruction in men with non-neurogenic lower urinary tract symptoms.

To investigate the clinical characteristics and useful signs to differentiate detrusor underactivity from bladder outlet obstruction in men with non-neurogenic lower urinary tract symptoms. A total of 638 treatment-naive men with non-neurogenic lower urinary tract symptoms who underwent subjective and objective evaluations were reviewed retrospectively. We divided the patients into detrusor underactivity and bladder outlet obstruction groups based on urodynamic findings, and compared parameters obtained from questionnaires and non-invasive tests. Detrusor underactivity was defined as bladder contractility index≤100 and bladder outlet obstruction index≤40, whereas bladder outlet obstruction was defined as bladder contractility index>100 and bladder outlet obstruction index>40. Of 638 patients, 145 (22.7%) had detrusor underactivity and 273 (42.8%) had bladder outlet obstruction. Total international prostate symptom score and international prostate symptom score-voiding subscore were significantly higher in the detrusor underactivity group. There were significant differences in prostate volume, intravesical prostatic protrusion, and all uroflowmetry parameters between the two groups. In multivariate logistic regression analysis, lower intravesical prostatic protrusion (cut-off value 8.2mm), lower bladder voiding efficiency (cut-off value 70%), and the presence of sawtooth and interrupted waveform on uroflowmetry were significant predictive factors for detrusor underactivity. In particular, the incidence of sawtooth and interrupted waveform was significantly higher in the detrusor underactivity group (80%) than in the bladder outlet obstruction group (12.8%), which showed both high sensitivity (80%) and specificity (87.2%) in differentiating detrusor underactivity from bladder outlet obstruction. Sawtooth and interrupted waveform on uroflowmetry can be a useful predictive factor for detrusor underactivity. In addition, lower intravesical prostatic protrusion and bladder voiding efficiency can be of supplementary use.

Association between the neutrophil-to-lymphocyte ratio and intravesical prostatic protrusion in men with benign prostatic hyperplasia.

ObjectiveTo analyze the association between neutrophil‐to‐lymphocyte ratio (NLR) and intravesical prostatic protrusion (IPP) in men with benign prostatic hyperplasia.MethodsTwo hundred and fifty men aged >50 years who presented with lower urinary tract symptoms at our institution between 2014 and 2018 were analyzed. Pearson's method was used for analysis of the correlation between NLR and IPP. Multivariate logistic regression analysis was used to identify predictors of IPP. Further analysis according to total prostate volume (TPV) was performed.ResultsThe NLR correlated positively with IPP (Pearson's r = 0.459, P < 0.001) and was an independent predictor of IPP ≥10 mm (odds ratio, 2.95; 95% confidence interval, 1.59–5.47; P = 0.0006). Among the 142 men with prostates <40 cm3, mean NLR was 2.50 ± 0.71 in those with IPP ≥10 mm and 1.71 ± 0.57 in those with IPP < 10 mm (P < 0.001). The NLR differed significantly between those with a prostate <40 cm3 and IPP ≥10 mm and those with a larger prostate and IPP < 10 mm (2.50 ± 0.71 vs 2.07 ± 0.77, respectively; P = 0.020).ConclusionsNLR can be used as a surrogate marker for presence of IPP. Its clinical value would be especially important in men with a small prostate gland but high IPP. The NLR seemed to be more strongly correlated with IPP than with TPV.

Non-invasive evaluation of bladder outlet obstruction in benign prostatic hyperplasia: a clinical correlation study

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

Evaluation of different MRI parameters in benign prostatic hyperplasia-induced bladder outlet obstruction

BackgroundBenign prostatic hyperplasia (BPH) is a common health problem faced by aging men and can be associated with bladder outlet obstruction (BOO). BPH patients usually suffer from lower urinary tract symptoms (LUTS) including obstructive and irritative urinary symptoms. The purpose of the current study was to clarify the correlation between MRI-derived prostate measurements and BPH-induced symptoms and findings including International Prostate Symptom Score (IPSS), uroflowmetry, and Postvoid residual urine (PVR).MethodsIn all, 34 patients (mean age was 58 ± 8 years, range 43 to 73 years) were examined by prostate MRI, uroflowmetry, postvoid residual urine, and fulfilled International Prostate Symptom Score questionnaire in this prospective study. The MRI-derived measurements including total prostate volume, transition zone volume, transition zone index, prostatic urethral angle, intravesical prostatic protrusion, and anterior fibromuscular stroma distance were correlated with International Prostate Symptom Score, uroflowmetry including maximum flow rate (Qmax) and Qmax grades, and postvoid residual urine using Pearson correlation coefficients (r) and multiple linear regression. Relationship between BPH types was correlated with the same parameters using one-way analysis of variance.ResultsWe found a strong significant correlation between total prostate volume, transition zone volume, and transition zone index with International Prostate Symptom Score, Qmax, Qmax grades, and postvoid residual urine; however, in multiple linear regression analysis, all of them were found to be significant parameters for International Prostate Symptom Score. Also, our study showed a strong significant correlation between anterior fibromuscular stroma distance and intravesical prostatic protrusion with International Prostate Symptom Score and postvoid residual urine; however, in multiple linear regression analysis, only intravesical prostatic protrusion was found to be a significant parameter for postvoid residual urine. Our results also revealed a significant correlation between BPH types with Qmax, Qmax grades, International Prostate Symptom Score, and postvoid residual urine.ConclusionSeveral MRI-derived prostate parameters (total prostatic volume, transition zone volume, transition zone index, prostatic urethral angle, intravesical prostatic protrusion, anterior fibromuscular stroma distance, and BPH types) correlating significantly with the International Prostate Symptom Score, uroflowmetry parameters (Qmax and Qmax grades), and postvoid residual urine.

Association of metabolic syndrome with intravesical prostatic protrusion and international prostatic severity symptoms score in patients with benign prostatic enlargement

Background: Intravesical prostatic protrusion (IPP), a morphological change resulting from enlarged lateral and median lobe of prostate. It could be for assessment of BOO (Bladder outlet obstruction). MetS is one of the causative factors for the development of Benign Prostatic Enlargement (BPE) and associated LUTS. The aim of this study is to assess the association of components of MetS and MetS with IPP, TPV and International Prostatic Severity Symptoms Score (IPSS).Methods: This is a single centre cross-sectional study in Department of Urology, GMCH, Guwahati, Assam, India between March 2016 and May 2018, 114 consecutive men aged &gt;50 years presenting with LUTS suggestive of BPE (PSA 0-4ng/ml). MetS was defined according to International Diabetes Federation criteria. We have analysed IPSS and IPP of these patients. Patients were classified into 3 groups each for IPSS and IPP (IPSS: group I - 0-7, II -8-19, III -&gt;20 and IPP: Group I- &lt;5 mm, II- 5-10 mm, III- &gt;10 mm).Results: We have correlated these groups with each component of MetS and MetS. IPSS group III had significant correlation with hyperglycaemia (HG), hypertriglyceridemia (HTG), hypertension (HTN) and HDL cholesterol (HDL), group II had significant correlation with HG, HTN and HDL and group I had significant correlation with HTN (p&lt;0.001). Similarly, IPP group III had significant correlation with HG, HTG, HTN, obesity and HDL, group II had significant correlation with HG, HTN and obesity and group I had significant correlation with HTN only (p&lt;0.001).Conclusions: We found that patients with higher IPSS and IPP had significant correlation with MetS components.

Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms.

ABSTRACTPurpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other.Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry.Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed.Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

New Diagnostics for Male Lower Urinary Tract Symptoms.

Lower urinary tract symptoms (LUTS) is a common constellation of symptoms that affect the aging male population with an astonishing prevalence. New technology and new uses of established technology are being used to help further evaluate LUTS in the male population and help guide treatment options. This review focuses on the developments and future directions in diagnostic modalities for evaluation of male LUTS, focusing on evaluation of both the filling and voiding phases of micturition. New techniques in evaluating the voiding phase include penile cuff test, external pressure sensing condom catheter, ultrasound measurement of detrusor wall thickness, ultrasound measurement of intravesical prostatic protrusion, doppler ultrasound and NIRS technology. Evaluation of the filling phase is still undergoing much development and requires additional validation studies. The techniques undergoing evaluation include sensation meters during UDS, assessing bladder micromotion and wall rhythm, assessing detrusor wall biomechanics, ultrasound measurement of detrusor wall thickness, pelvic doppler ultrasound, as well as functional brain imaging including fNIRS and fMRI. The development of novel, non-invasive, diagnostic tools have the potential for better evaluation of LUTS with earlier and enhanced treatments. This will likely improve the quality of life for men with LUTS.

Is intravesical prostatic protrusion a risk factor for hydronephrosis and renal insufficiency in benign prostate hyperplasia patients?

Some patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms hesitate to undergo surgical treatment until acute urinary retention (AUR) occurs. Some of these patients have been found to have hydronephrosis or even renal insufficiency. This study aimed to analyze the risk factors for hydronephrosis in patients with AUR who needed to receive transurethral resection of the prostate (TURP). We retrospectively analyzed 91 patients from January 2014 to June 2015, who had BPH and received TURP for AUR. Patients with urolithiasis, prostate cancer, bladder cancer, gross hematuria, previous bladder radiation therapy, or urinary tract surgery were excluded. Parameters of intravesical prostatic protrusion (IPP), serum prostatic specific antigen (PSA), total prostate volume (PV), age, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and serum creatinine (Cr) were compared between the hydronephrosis and non-hydronephrosis groups. There were significant differences in IPP (p < 0.001) and Serum Cr (p < 0.001) between the hydronephrosis and non-hydronephrosis groups. For IPP, the cut-off values of the highest risk of hydronephrosis was 1.95 cm. There were no significant differences in age, BMI, DM, HTN, CAD, total PV, and PSA between the two groups. IPP was not correlated with total PV (p = 0.423). Most of the patients with hydronephrosis had renal function improvement after TURP. IPP was a significant risk factor for hydronephrosis in BPH patients. If the patients' IPP exceeded 1.95 cm, they had a higher risk of having hydronephrosis when AUR occurred. Hydronephrosis is a risk factor for renal insufficiency, and Serum Cr levels decreased significantly in the patients of our study.

The Effect of Intravesical Prostatic Protrusion in Patients with Benign Prostatic Hyperplasia: Controlled, Clinical Study

Background: Although prostate cancer releases more prostate-specific antigen (PSA) per unit of prostate volume (PV), data are limited regarding the association between intravesical prostatic protrusion (IPP) and the PSA level. Objectives: The study aim was to evaluate the IPP effect in patients with benign prostatic hyperplasia. Method: This study included patients with (n = 119) and without (n = 121) IPP. The age, International Prostate Symptom Score (IPSS), PSA level, maximum and average flow rates, PV, hematuria, urinary retention, and post-void residual (PVR) volume were compared between the 2 groups. Results: The mean ages were similar between the 2 groups (66.56 ± 8.67 and 66.92 ± 8.7 years, respectively, p = 0.747), and there were no statistically significant differences in the IPSS, maximum and average flow rates, hematuria, PVR volume, and urinary retention means (p > 0.05). However, the IPP patients had lower total PSA (tPSA) and free PSA (fPSA) levels than those without IPP (3.55 [4.18] vs. 5.26 [5.24] ng/mL, p = 0.013 and 0.7 [1.09] vs. 1.05 [1.23] ng/mL, p = 0.029, respectively). Moreover, there were strong positive correlations between the IPP grade and the tPSA and fPSA levels (r = 0.262, p = 0.001 and r = 0.254, p = 0.002 respectively). Conclusions: This study demonstrated that IPP results in a decreased PSA level, even with a higher PV.

Value of intravesical prostatic protrusion estimated by ultrasound in the diagnosis of bladder outlet obstruction and acute urinary retention in benign prostatic hyperplasia

Objective This prospective study compared the sensitivity, specificity, and accuracy of intravesical protrusion of prostate (IPP), prostate volume (PV), detrusor wall thickness (DWT), and post-voiding residual urine (PVR) for diagnosis of bladder outlet obstruction (BOO) and predicted acute urinary retention (AUR) in patients with benign prostatic hyperplasia. Patients and methods Eighty patients of 50 years or older with obstructed lower urinary symptoms owing to prostate enlargement were included in this study. Of them, 20 patients presented with acute retention of urine. All patients underwent the following: international prostatic symptoms score, quality-of-life question, digital rectal examination, free uroflowmetry (Qmax), and transabdominal ultrasound, which measured DWT, PV, IPP, and PVR. Pressure flow study (PFS) was done to differentiate obstructed from the nonobstructed bladder. IPP, PV, DWT, Qmax, and PVR were used as index tests. To differentiate the effectiveness of these index tests, the area under the curve was calculated for each index. Results Eighty patients were classified into four groups according to their presentation and PFS finding: group I included 30 patients with no BOO [bladder outlet obstruction index (BOOI) 40), group III included 20 patients who presented with AUR, and group IV included 20 normal men as a control group. There were significant differences in PV, IPP, DWT, Qmax, and PVR between obstructed and nonobstructed patients, with a significant correlation with the BOOI. There was no significant difference regarding age and international prostatic symptoms score. There was a significant correlation between IPP and DWT with PFS in the diagnosis of BOO in patients complaining from benign prostatic hyperplasia. IPP more than 7.5 mm had the best accuracy (90.5%) in the diagnosis of BOO. IPP more than 7.5 mm and DWT more than 2 mm diagnosed acute retention of urine in 90% of patients. Conclusion IPP measurement is the best noninvasive test in detecting BOO in comparison with other index tests. Combined IPP and DWT were more accurate in predicted BOO and AUR than other index tests.

Predicts the Successfulness of a Trial Voiding Without Catheter (TWOC) Through Urine Retention Volume, Detrusor Wall Thickness (DWT) and Intravesical Protrusion of Prostate (IPP) on Acute Urinary Retention (AUR) Patients Due to Benign Prostatic Hyperplasia (BPH)

This study aimedwas to identify the successfulness of Trial Voiding without Catheter (TWOC) on acute urinary retention (AUR) patients due to Benign Prostatic Hyperplasia (BPH), based on urine retention volume, Detrusor Wall Thickness (DWT) and Intravesical Protrusion of Prostate (IPP). The 24 patients over 50 years old underwent catheter per urethra and recorded urine volume at retention. Transabdominal ultrasound was performed several days later to evaluate the thickness of the Detrusor Wall Thickness (DWT) and intravesical protrusion (IPP), and detrusor IPP is classified as free de 1 (0- 10 mm). Trial voiding without catheter (TWOC) was carried out on day 5 and was considered successful if the patient was able to spontaneously micturition during first 6 hours, post voided residual volume (PVR) 10 ml/second. Data will be analyzed by simple and multiple logistic regression test with significance level (α = 0.05). The result demonstrate the detrusor muscle thickness examination and IPP degree can be used to predict TWOC success, while urine retention volume does not affect the success of TWOC.

Correlation between intravesical prostatic protrusion and international prostate symptom score among Nigerian men with benign prostatic hyperplasia.

Intravesical prostatic protrusion (IPP) is a noninvasive test that can predict bladder outlet obstruction in patients with benign prostatic hyperplasia (BPH). The objective of this study was to determinethe correlation between IPP and International Prostate Symptom Score (IPSS) in patients with BPH. A cross-sectional prospective study of new patients with symptomatic BPH who presented to the urology clinics of NAUTH, Nnewi. Ethical approval and informed consent were obtained. Participants had abdominal ultrasonography measurements of IPP from midline sagittal image of the prostate (at bladder volume ≥100 mL) using Prosound SSD3500 with abdominal probe frequency of 3.5 MHz. IPP was divided into three grades (grade I: 0-4.9mm, grade II: 5.0-9.9 mm, and grade III: ≥10.0 mm). Data were analyzed using SPSS version 20. The data were subjected to analysis of variance, and Pearson's correlation was used to assess correlation where necessary. P value < 0.05 was considered significant. In all, 101 men with a mean age of 67.09 ± 10.93 years were included in the study. The average IPSS, storage symptoms IPSS (IPSS-S), voiding symptoms IPSS (IPSS-V), Quality of Life (QoL) index, and IPP were 17.05 ± 7.62, 7.81 ± 5.17, 9.24 ± 3.16, 4.75 ± 1.59, and 13.50 ± 7.47 mm, respectively. There were significant differences between the mean IPSS (P = 0.000), mean IPSS-S (P = 0.000), and mean IPSS-V (P = 0.002) among the three grades of IPP. There were significant positive correlations between IPP and IPSS (P = 0.000), IPSS-S (P = 0.000), IPSS-V (P = 0.000), and IPSS QoL index (P = 0.000). There were significant positive correlations between IPP and IPSS, IPSS-S, IPSS-V, and IPSS QoL index.

Penile Compression Release Index Revisited: Evaluation and Comparison with Other Noninvasive Tools in the Prediction of Bladder Outlet Obstruction in Men with Benign Prostatic Enlargement.

Aim:To determine the discriminatory power of penile urethral compression-release index (PCRI), clinical prostate score (CLIPS) and bladder outlet obstruction index 2 (BOON2) for the detection of bladder outlet obstruction (BOO), and the associated bladder abnormality in patients with benign prostatic enlargement (BPE).Material and methods:In study was included of 135 patients with proven BPE underwent urodynamic measurement (UDM) and PCR maneuver. PCR Index was calculated following the formula: (Qs-Qss)/Qss x 100(%). CLIPS score was calculated based on non-invasive variables (prostate volume, maximal urinary flow, residual urine and voided volume), while BOON2 was calculated using the formula intravesical prostate protrusion (IPP)-3 x Qmax-0.2 x mean voided volume. UDM results were plotted on Schaefer and URA nomograms.Results:A comparative analysis was made using ROC curves. The area under the curve (AUC) for PCRI is 0.85 (PTP 91.3%), while AUC for CLIPS and BOON2 is 0.8 (PTP 77.6%) and 0.82 (PTP 74.5%), respectively. PCRI with the cut-off point of 96% clearly distinguishes obstructed patients with normocontractile detrusor and the presence of detrusor overactivity (DO), versus those unobstructed. CLIPS (>10) shows good BOO prediction, but without the possibility of distinguishing between detrusor contractility grade and the occurrence of DO. BOON2 has shown that impaired contractility has influence on this number in obstructed patients.Conclusion:PCRI is a very good noninvasive urodynamic test for a group-wise detection of BOO in patients with BPE and associated bladder co-morbidities; it is therefore superior in comparison with to CLIPS or BOON2.

The value of intravesical prostatic protrusion in evaluation of bladder outlet obstruction from benign prostatic enlargement in Nigeria

Objective : To determine the significance of intravesical prostatic protrusion in evaluation of bladder outlet obstruction from benign prostatic enlargement in Jos, Nigeria. Patients and Method : A hospital based cross-sectional prospective study that included patients who presented to the Urology clinic of Jos University Teaching Hospital, Jos, Nigeria with clinical features of BPE. Each had IPSS, Qmax, IPP, PV, PVR and PSA measured. IPP was measured through transabdominal ultrasound scan along mid sagittal view in millimetre using a curvilinear probe 3.5 MHz. IPP was divided into three grades (grade I: 10 mm). Statistical analysis was done using SPSS® version 20 (SPSS, IBM, Chicago, IL, USA). Appropriate test statistics were used with p-value < 0.05 considered as significant. Results : Eighty-seven patients aged 40–86 years were enrolled in the study. The means of age, IPSS, IPSS-v, IPSS-s, Qmax, IPP, PV, PVR and PSA – were 64.6 ± 10.2 years, 16.7 ± 7.6, 9.8 ± 3.5, 6.9 ± 3.3, 8.2 ± 3.8 ml/s, 12.9 ± 7.0 mm, 70.1 ± 50.3 mls, 78.3 ± 69.3 mls and 7.2 ± 1.9 ng/ml respectively. IPP correlated positively with IPSS (r = 0.808, p = 0.000), IPSS-S (r = 0.799, p = 0.000), IPSS-V (r = 0.717, p = 0.000), and PVR (r = 0.306, p = 0.004) but negatively with Qmax (r =−0.519, p = 0.000). Conclusion : The IPP correlates significantly with IPSS, Qmax and PVR. Therefore, it is a valuable parameter – for evaluation of patients with BOO due to BPE.

The Rezūm system in the treatment of male lower urinary tract symptoms (LUTSs) due to benign prostatic obstruction (BPO)

The classical algorithm of the management of male lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH) includes a surgical approach in case pharmacological therapy has failed. Emerging minimally-invasive treatments (MITs) offer potential for rapid symptomatic relief, reducing the morbidity of invasive BPH surgery. Convective interstitial radiofrequency water vapour thermal ablation of the prostate with the Rezūm® system is a novel MIT for the treatment of bothersome moderate-to-severe lower urinary tract symptoms associated with BPH. It provides early effective and durable relief of storage and voiding LUTSs, preserving both erectile and ejaculatory function and improving quality of life. The procedure allows the treatment of a wide spectrum of prostate gland morphologies including intravesical prostatic protrusion, median lobe protrusion or elevated bladder neck. In selected patients, this procedure can also be offered for first-line treatment to prevent symptom progression and may thus be used as an alternative to long-term pharmaceutical treatment in order to avoid potential side-effects of drugs. This review describes this new technology and its clinical application and presents the current clinical evidence that supports the efficacy, safety and prospects of the Rezūm procedure to date.

81] Correlation between intravesical prostatic protrusion and the failure of medical treatment

ObjectiveTo study the correlation between the index of intravesical protrusion of the prostate (IPP) and the failure of medical treatment in the treatment of urinary disorders for patients with prostatic adenoma.

Predicting the Outcome of Patients with Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia Treated with Alpha Blocker Monotherapy by Measurement of Bladder and Prostate Parameters Using Ultrasound

AbstractBackground: Benign Prostatic Hyperplasia (BPH) is a condition intimately related to ageing. Although it is not life threatening, its clinical manifestation as Lower Urinary Tract Symptoms (LUTS) reduces the patient's quality of life.Aim of the Study: To determine prostate and bladder sonographic parameters that can predict the outcome of patients with LUTS/BPH treated by alpha 1a adrenoreceptor blocker monotherapy.Patients and Methods: Fifty patients complaining of LUTS/BPH were prospectively enrolled. Transrectal Ultra-sonography (TRUS) was done to all patients. Tamsulosin 0.4mg oral tablet was given to all patients once daily for 3 months then the response to treatment on the basis of Inter-national Prostatic Symptom Score (IPSS), Quality of Life (QoL) score and maximum urine flow rate (Qmax) was eval-uated. The impacts of baseline parameters on treatment out-come were statistically analyzed.Results: 45 patients completed the study. From them 15 patients (33.3%) had ineffective treatment. Pre treatment IPSS storage subscore, Qmax and TRUS measured parameters [Bladder Wall Thickness (BWT), Intravesical Prostatic Pro-trusion (IPP) and ultrasound estimated bladder weight (UEBW)] were the independent predictors of treatment failure. Receiver Operator characteristic (ROC) curves for parameters (BWT, UEBW and IPP) showed that Areas Under Curve (AUC) were (0.870, 0.908 and 0.836 respectively) at cut-off values of 9mm, 36g and 8.2mm. Using these cut-off values, the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 75.0% and 97.6%; 72.4% and 96.0%; 67.5% and 95.0% for BWT, UEBW and IPP, respectively. Combination of these sono-morphologic parameters increased their positive predictive value to 76.39%.Conclusion: Combined use of sonographic parameters BWT, UEBW and IPP can predict alpha blocker monotherapy failure in BPH patients which aid in determining therapeutic plan and the need for further medical therapy or surgical intervention.

Intravesical prostatic protrusion is not always the same shape: Evaluation by preoperative cystoscopy and outcome in HoLEP.

To examine how morphological differences in intravesical prostatic protrusion (IPP) predict outcome of Holmium laser enucleation of prostate (HoLEP) treatment. We analyzed 173 patients who had undergone HoLEP in our hospital. The protrusion shape was evaluated by outpatient preoperative flexible cystoscopy and classified into five groups: A, no protrusion; B, middle lobe only; C, unilateral lobe only; D, bilateral lobes; and E, B + C or B + D. Paired-match analysis that adjusted for preoperative International Prostate Symptom Score (IPSS) voiding/storage subscores and IPP was performed between the group with middle lobe protrusion (B + E) and the group without it (C + D). Type A prostate shape was found in 23 patients, type B in 14, type C in 31, type D in 71, and type E in 34. Groups with middle lobe protrusion (B and E) had better changes in the total IPSS (P < 0.05) and the IPSS storage subscore (P < 0.01). Pair matching identified 37 patients each with or without middle lobe protrusion. The group with middle lobe protrusion had significantly more improved total IPSS (-17.5 ± 7.5 vs -13.5 ± 8.3, P < 0.05) and IPSS storage subscore (-6.9 ± 3.4 vs -4.8 ± 3.3, P < 0.05) than did those without middle lobe protrusion. Patients with middle lobe protrusion had greater IPSS improvement after HoLEP than those having comparable-length IPP but without middle lobe protrusion. IPP is not always the same shape and should be clinically divided into at least two groups.

Correlation Between Intravesical Prostatic Protrusion with Prostate Volume, Uroflowmetry and International Prostate Symptom Score in Men Over 50 Years Old

To evaluate the relationship between IPP, age, prostate volume, uroflowmetry result, PSA, and IPSS. We retrospectively studied 162 patients presenting with LUTS suggestive of BPH between January 2012 and December 2014, analyzing age, IPP, pressure flow study, prostate volume, PSA, and International Prostate Symptom Score. IPP was classified into three stages: grade 1 (≤5 mm), grade 2 (5 mm &lt; IPP ≤ 10 mm), and grade 3 (&gt;10 mm). Statistical analysis included Kruskall-Wallis with Mann-Whitney as post hoc analysis and Spearman’s correlation coefficients were performed. The mean age was 67±7.7 years old. Achieved IPP values were the following: grade 1–40 (24.7%), grade 2–60 (37%), and grade 3–62 (38.3%). Results show statistically significant difference between IPP grades Qmax, PVR, and PV (p ≤ 0.05). Mean difference between IPP groups were significant using Mann-Whitney post hoc test for Qmax, PVR, and PV between IPP group 1 and 2, PV between IPP group 1 and 3, and Qmax, PVR, and PV between IPP group 2 and 3. Spearman’s correlations coefficient show positive correlation between IPP and PV (r = 0.506, p ≤ 0.05), PVR (r = 0.341, p ≤ 0.05), and PSA (r = 0.253, p ≤ 0.05). Intravesical prostate protrusion measured through abdominal ultrasound are a non-invasive and accessible method that significantly correlates with peak flow rate (Qmax), prostate volume, post void residue, and prostate specific antigen.

Features of the composition of hospitalized patients with benign prostatic hyperplasia in the aspect of the outpatient stage of medical care

The objective: analysis of data on the current composition of patients with benign prostatic hyperplasia (BPH) hospitalized for surgical care.Materials and methods. The study involved 266 patients with BPH, who underwent transurethral resection of the prostate in the profile department of the Aleksandrovsky Clinical Hospital in 2015–2016 in order to assess the general condition of the patients at the time of hospitalization and to identify the problematic issues of providing medical care in ambulatory-polyclinic conditions.Results. It was found out that the significant majority was hospitalized urgently (53,0%), more often in the winter-autumn period of the year (60,4%), the age of which differs be a large percentage of patients under 60 years (12,8% versus 10,4% with a planned one). Among them, men were about 70 years old, 10% were newly diagnosed cases, half of them had symptoms of lower urinary tract (LUT) during 5 years at the time of going to the doctor. With rare exceptions, patients were treated conservatively, took α -adrenoblockers (2/3 to 5 years, 1/3 – 5 to 10 and more years). In 27,8% of patients, there were repeated cases of acute urinary retention (AUR), twice as often among urgently hospitalized ones. Practically all the course of the diseases was complicated by concomitant pathology (1227 nosological units of diseases of different organs and systems). There number increases with age: one patient at 44 to 59 years old had in average 3.0; 60–69 – 4.4; 70–79 – 5.2; ≥80 years – 5.6. Cardiovascular diseases prevail, in every forth there is chronic inflammatory, metabolic syndrome (DM, obesity).Conclusion.The findings confirmed a clear relationship between the volume of the prostate and intravesical prostatic protrusion (IPP) – r=0.33, which was more pronounced with a maximum urination rate (r=0.59) with the residual volume. It was revealed that with the increase of IPP the volume of residual urine decreases with a simultaneous deterioration of the quality of life and an increase in the LUT symptomatology. However, they do not depend on the volume of the prostate.