Prostatic Urethral Angle Research Articles

Current State of the Art in Non-Invasive Urodynamics

Lower urinary tract symptoms (LUTS) are highly prevalent and bothersome. The pressure flow or voiding part of urodynamics gives information regarding detrusor contractility and whether bladder outlet obstruction (BOO) is present. However, urodynamics are invasive and can be associated with infection and take time to perform. Moreover it is not clear whether urodynamics are beneficial in assessing LUTS routinely or whether they are able to predict outcomes following surgery for obstruction. As a result several non-invasive techniques and investigations have been developed to try to aid in the work up and management of patients with LUTS / BPE. A PubMed search was performed to review the literature on non-invasive urodynamic tests for voiding dysfunction. Techniques include transition zone index, intravesical prostatic protrusion, prostate circle area ratio, prostatic urethral angle, resistive index, bladder wall and detrusor wall thickness, ultrasound estimated bladder weight, near infrared spectroscopy, condom catheter and penile cuff compression techniques and are summarized in this review.

Imaging in benign prostatic hyperplasia

This article discusses the new imaging techniques in diagnosis and treatment of benign prostatic hyperplasia by reviewing the most recent publications. Imaging study for the evaluation of patients with lower urinary tract symptoms is not suggested by American Urology Association guidelines; however, European Association of Urology recommends the assessment of the upper urinary tract by modalities like ultrasound. Several new imaging indices like resistive index of capsular artery, presumed circle area ratio, prostatic urethral angle, intraprostatic protrusion, and detrusor wall thickness are used to find a noninvasive way for bladder outlet obstruction diagnosis. In addition to them, 3D transrectal ultrasound, near infrared spectroscopy, and MRI are used to add more practical findings in patient management. Urologists have requested more imaging studies than expected for benign prostatic hyperplasia patients in recent years, and several studies have been done to find a noninvasive way to diagnose bladder outlet obstruction. However, none of them could play the urodynamic studies role in bladder outlet obstruction diagnosis.

CORRELATION BETWEEN PROSTATIC URETHRAL ANGLE WITH CLINICAL PARAMETERS AND BOO IN LUTS ASSOCIATED WITH BPH

Objective: We investigated the correlation of the PUA on clinical parameters and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Material & Method: This study was performed between January to April 2011. A cross sectional analysis of 24 men with LUTS associated BPH aged > 50 years was performed. Patients underwent evaluation including International Prostatic Symptom Score (IPSS), transrectal ultrasonography, uroflowmetry, and pressure-flow study. Statistical analysis was performed to evaluate correlation of the PUA on clinical parameters and bladder outlet obstruction (BOO). Results: A total of 24 patients, aged 51 to 78 years were enrolled in this study. The mean value of total IPSS, prostate volume, PUA, and Qmax was 22 (range 7-35), 34,4 cm3 (range 21–70 cm3), 37,3° (range 25°–55°), and 10,5 mL/s (range 4,2–17,9 mL/s), respectively. Pearson’s correlation analysis showed that PUA was not significantly correlated with IPSS (p = 0,117), Qmax (p = 0,434), total prostate volume (p = 0,213). Patients with increased PUA (PUA > 35°) had higher incidence and degree of BOO (p < 0,05). Conclusion: PUA may be one method to assess the presence of BOO in men with LUTS associated BPH. Our investigation suggest that PUA may help in the treatment of individuals by better predicting their likely classification from a pressure-flow study.Keywords: Prostatic urethral angle, benign prostatic hyperplasia, lower urinary tract symptoms, bladder outlet obstruction.

Prostatic Urethral Angulation Associated With Urinary Flow Rate and Urinary Symptom Scores in Men With Lower Urinary Tract Symptoms

To evaluate the effect of the prostatic urethral angle (PUA) on the peak flow rate (Qmax) and urinary symptoms in the clinical setting. The records were obtained from a prospectively maintained database for first-visit men with lower urinary tract symptoms. Uroflowmetric measurements, postvoid residual urine volume, and International Prostate Symptom Score were assessed. The prostate-related parameters, including prostate volume, PUA, and intravesical prostatic protrusion, were measured using transrectal ultrasonography. Patients with comorbidities that can affect voiding function or in whom the PUA could not be measured were excluded. A total of 316 patients were included. On multivariate linear regression analysis, the PUA (P = .002) was independently associated with the International Prostate Symptom Score. However, the International Prostate Symptom Score was not influenced by patient age, prostate volume, or intravesical prostatic protrusion. The mean PUA was significantly different according to symptom severity. The mean PUA was 42.2° ± 7.0°, 45.5° ± 9.1°, and 47.3° ± 8.6° in patients with mild, moderate, and severe symptoms, respectively (P = .004, analysis of variance). Although the PUA (P <.001) and patient age (P <.001) were independent predictors of Qmax, the prostate volume and intravesical prostatic protrusion did not affect the Qmax. The mean PUA was 52.2° ± 7.3° in patients with a Qmax <10 mL/s, 45.0° ± 7.9° in those with a Qmax ≥10 mL/s but <20 mL/s, and 39.8° ± 7.9° in those with a Qmax of ≥20 mL/s (P <.001, analysis of variance). The results of our study has shown that the PUA is significantly associated with the Qmax and symptom scores in men with lower urinary tract symptoms. Our findings suggest that the PUA should be considered in the treatment of male patients with lower urinary tract symptoms.

229 Is increased prostatic urethral angle a cause of lower urinary tract symptoms in benign prostatic hyperplasia/lower urinary tract symptom in male?

229 Is increased prostatic urethral angle a cause of lower urinary tract symptoms in benign prostatic hyperplasia/lower urinary tract symptom in male?

Is Increased Prostatic Urethral Angle Related to Lower Urinary Tract Symptoms in Males with Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms?

PurposeThe prostatic urethra is a bent tube, and the clinical significance of the prostatic urethral angle (PUA) was recently reported. We investigated the statistical significance of an increased PUA on the International Prostate Symptom Score (IPSS) in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptom (LUTS).Materials and MethodsA retrospective analysis was done of 270 men with BPH/LUTS from July 2009 to June 2011. Prostate volume, PUA, and intravesical prostatic protrusion (IPP) were measured by transrectal ultrasonography (TRUS). The IPSS was analyzed separately as storage and voiding symptom score. In order to minimize the effect of prostate size on voiding, patients with prostate size over 40 ml were excluded.ResultsThe mean age was 62.0±9.3 years. The mean prostate volume was 29.0±5.5 ml (range, 20 to 40 ml), and median PUA and IPP were 34° (range, 12 to 52°) and 1.7 mm (range, 0 to 5.3 mm), respectively. The mean IPSS, mean IPSS-ss, and mean IPSS-vs were 19.0±8.2, 7.3±4.0, and 11.6±5.5, respectively. The prostate volume had no statistically significant correlation with IPSS, IPSS-ss, or IPSS-vs. IPP had a statistically significant correlation with IPSS (p<0.001), IPSS-ss (p<0.001), and IPSS-vs (p<0.001). PUA had no statistically significant correlation with IPSS or IPSS-ss. However, PUA had a significant correlation with IPSS-vs (p=0.047). Comparing a higher PUA (≥34°) with a lower PUA (<34°), patients with a higher PUA had a higher IPSS (p=0.001) and a higher IPSS-vs (p=0.001). There was no significant difference in IPSS-ss, prostate volume, or PSA between the two groups.ConclusionsIPP showed significantly correlated with the IPSS and voiding symptom score was affected by the PUA but not by the prostate volume. As the PUA increased, the patients' voiding symptoms worsened. Further study may be needed.

Can noninvasive evaluation of benign prostatic obstruction be optimized?

Lower urinary tract symptoms caused by benign prostatic obstruction is a common disorder and the incidence is increasing with higher life expectancy. The present article focuses on recently published methods to diagnose bladder outlet obstruction and differ between benign obstruction and prostate cancer in lower urinary tract symptoms patients. Several new ultrasound imaging techniques have been reported. Resistive index in the prostatic artery, detrusor wall thickness and prostatic urethral angle all may correlate with obstruction, but more studies are needed to establish their place in clinical practice. Intravesical prostatic protrusion can predict obstruction and may be considered for clinical use. Near infrared spectroscopy has to be studied more to clarify its usefulness in clinical practice. There has been a rapid development of novel serum and urine-based biomarkers for prostate cancer in the last decade to differentiate between benign prostatic hyperplasia and prostate cancer. The recent studies with the use of prostate-specific antigen and urine prostate cancer gene 3 look promising. Among promising new techniques in the investigation of prostatic obstruction, intravesical prostatic protrusion may be considered for clinical use. None of the methods described in recent studies can fully replace urodynamic investigation. Novel biomarkers in the future may help the clinicians to differentiate benign prostatic hyperplasia from prostate cancer.

Correlation Between Prostatic Urethral Angle and Bladder Outlet Obstruction Index in Patients With Lower Urinary Tract Symptoms

To evaluate the association of prostatic urethral angle (PUA) with bladder outlet obstruction (BOO) index in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). A retrospective analysis was made of 260 men with LUTS and/or BPH aged>50 years (median: 65.9, range: 50-87). Patients underwent an evaluation including the International Prostatic Symptom Score, serum prostate-specific antigen levels, transrectal ultrasonography, frequency-volume chart, uroflowmetry, and measurement of postvoid residual, and multichannel video urodynamic study with a pressure-flow study. Patients with higher PUA (PUA>or=35 degrees) had higher prostate-specific antigen levels (P=.043), larger prostate volume (P<.001), higher maximal urethral closure pressure (P=.004), higher detrusor pressure at maximum flow rate (P=.008), and higher BOO index (P=.032), in comparison with those who had lower PUA (PUA<35 degrees). There was no significant difference of PUA values according to the degree of intravesical prostatic protrusion. When we compared BOO index according to PUA, patients with higher PUA had higher BOO index than those with lower PUA (30.6+/-1.8 vs 23.6+/-1.8, P=.006). The area under the curve of PUA was significant for BOO (area, 63.0%; 95% confidence interval, 55.1%-70.9%; P=.002). PUA may be one method to asses the presence of BOO in men with LUTS and/or BPH. Our findings suggest that PUA may help in the treatment of individuals by better predicting their likely classification from a pressure-flow study.

Relationship Between Prostatic Urethral Angle and Urinary Flow Rate: Its Implication in Benign Prostatic Hyperplasia Pathogenesis

The prostatic urethra is a bent tube, and the clinical significance of the prostatic urethral angle (PUA) is poorly understood. We investigated the effect of the PUA on the urinary flow rate in men without benign prostatic obstruction. In a theoretical model, the urinary flow rate at the end of the prostatic urethra was formulated according to some principles of fluid dynamics, including the Navier-Storkes equation, Bernoulli's equation, and the loss of coefficient at bends. The change in the urinary flow rate according to the PUA was also calculated through mathematical simulations. In addition, the relationship between the PUA and the peak flow rate was evaluated in 65 healthy men without benign prostatic obstruction (age 50 to 59 years, prostate volume less than 30 cm(3), peak flow rate greater than 15 mL/s). The prostate volume and PUA were determined by transrectal ultrasonography. Using the fluid dynamic model, the urinary flow rate increased in proportion to the urethral diameter and was inversely associated with the PUA. The mathematical simulations showed that the urinary flow rate decreased by more than 27% as the PUA increased from 35 degrees to 90 degrees. In the clinical setting, the peak flow rate was significantly associated with the PUA by linear regression analysis (R = 0.34, beta = -0.342, P = 0.005), but it was not associated with the total prostate volume (R = 0.18, beta = -0.181, P = 0.150). The PUA was inversely associated with the urinary flow rate in this theoretical model and preliminary clinical study. This relationship could be an important factor in the pathogenesis of benign prostatic hyperplasia/lower urinary tract symptoms.