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Does Intravesical Prostatic Protrusion Predict Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia?


Aim: To prospectively detect clinically significant bladder outlet obstruction (BOO) in all symptomatic patients presenting with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) by studying select parameters like prostate volume, bladder wall thickness (BWT), intravesical prostatic protrusion (IPP), post-void residue (PVR), and uroflowmetry. Our aim is also to determine the effectiveness of using IPP in correctly predicting BOO in symptomatic patients with BPH, and to compare IPP with other parameters of BOO like prostate volume, bladder wall thickness, PVR, and uroflowmetry in patients with symptomatic BPH.

Methods: After obtaining institutional ethical clearance for this study and administering an informed consent, history, focused urological examination, and International Prostate Symptom Score (IPSS), select ultrasonographic and uroflowmetry parameters were recorded and analyzed in 48 selected patients, as per our protocol.

Results: The mean BWT, PVR, and IPP were 6.26 mm, 91.27 cc, and 8.2 mm, respectively, and their mean maximal flow rate (MFR), average flow rate (AVR), voiding duration, acceleration, and hesitancy time in 44/48 evaluable patients (4 patients had AUR) were 13.68 (3 to 49) mL/min, 7.17 (2 to 25) mL/min, 49.12 (15 to 115) secs, 3.82 (0 to 70) secs, and 13.9 (1 to 242) secs, respectively. The paired sample test (2-tailed) analysis demonstrated that the relationship between BWT vs MFR, IPP (mm) vs MFR, PVR vs MFR, and AFR was highly significant (P < 0.001).

Conclusion: With increasing life expectancy, more men are destined to develop bothersome symptoms due to BPH. Bladder wall thickness and post-void residue in conjunction with intravesical prostatic protrusion are good predictors of clinically significant bladder outlet obstruction due to BPH. A search for more reliable, accurate, and non-invasive methods could substitute present methods of evaluating symptomatic BOO due to BPH.

Iqbal Singh, Shankar Kumar

Submitted February 27, 2013 - Accepted for Publication May 10, 2013

KEYWORDS: BPH, bladder outlet obstruction, bladder wall thickness, post-void residue, intravesical prostatic protrusion

CORRESPONDENCE: Dr. Iqbal Singh, MCh (Urology), DNB (GU Surgery), MS, DNB (Surgery), Professor & Senior Consultant Urologist, Department of Surgery (Urology), University College of Medical Sciences, New Delhi, India ([email protected])

CITATION: UroToday Int J. 2013 June;6(3):art 40.


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