Korean J Urol.  2012 Jul;53(7):478-482. 10.4111/kju.2012.53.7.478.

Relationship between Intravesical Prostatic Protrusion and Postoperative Outcomes in Patients with Benign Prostatic Hyperplasia

• Lee JW
• Ryu JH
• Yoo TK
• Byun SS
• Jeong YJ
• Jung TY

• KMID: 1988759
• DOI: http://doi.org/10.4111/kju.2012.53.7.478

Abstract

PURPOSE
To evaluate the significance of intravesical prostatic protrusion (IPP) for predicting postoperative outcomes in patients with benign prostatic hyperplasia.
MATERIALS AND METHODS
A total of 177 patients with a possible follow-up of at least 6 months who were treated with transurethral resection of the prostate (TURP) were analyzed. We divided the patients into two groups on the basis of the degree of IPP: the significant IPP group (IPP> or =5 mm, n=74) and the no significant IPP group (IPP<5 mm, n=103). We analyzed postoperative changes in parameters, such as the International Prostate Symptom Score (IPSS), IPSS quality-of-life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). The IPSS was subdivided into voiding (IPSS-v) and storage (IPSS-s) symptoms. Multivariate logistic regression analysis was performed to identify whether IPP could predict surgical outcomes of TURP.
RESULTS
Preoperative parameters were not significantly different between the two groups except for total prostate volume and transitional zone volume. Postoperative changes in IPSS, IPSS-v, IPSS-s, and QoL score were higher in the significant IPP group than in the group with no significant IPP. Changes in Qmax and PVR were not significantly different between the two groups. Multivariate logistic regression analysis (after adjustment for age, prostate-specific antigen level, total prostate volume, and transitional zone volume) revealed that the odds ratios (95% confidence interval) of decreased IPSS and IPSS-s in the significant IPP group were 3.43 (1.03 to 11.44) and 3.51 (1.43 to 8.63), respectively (p=0.045 and 0.006, respectively).
CONCLUSIONS
Significant IPP is an independent factor for predicting better postoperative outcomes of IPSS and IPSS-s.

Keyword

Intravesical prostatic protrusion; Prostatic hyperplasia; Transurethral resection of prostate; Treatment outcome

MeSH Terms

Follow-Up Studies
Humans
Indoles
Logistic Models
Odds Ratio
Prostate
Prostate-Specific Antigen
Prostatic Hyperplasia
Transurethral Resection of Prostate
Treatment Outcome
Indoles
Prostate-Specific Antigen

Figure

• 

  FIG. 1 Measurement of intravesical prostatic protrusion (IPP). (A) Schematic estimation of IPP: the vertical distance from the tip of the protrusion to the base of the bladder (sagittal views of bladder and prostate by TRUS). (B) IPP of 5 mm or more. (C) IPP of less than 5 mm.

Reference

1. Madersbacher S, Marberger M. Is transurethral resection of the prostate still justified? BJU Int. 1999. 83:227–237.

2. Madersbacher S, Lackner J, Brossner C, Rohlich M, Stancik I, Willinger M, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol. 2005. 47:499–504.

3. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008. 180:246–249.

4. Ameda K, Koyanagi T, Nantani M, Taniguchi K, Matsuno T. The relevance of preoperative cystometrography in patients with benign prostatic hyperplasia: correlating the findings with clinical features and outcome after prostatectomy. J Urol. 1994. 152(2 Pt 1):443–447.

5. Paez Borda A, Lujan Galan M, Martin Oses E, Llanes Gonzalez L, Berenguer Sanchez A. Predictive factors on postoperative quality of life in transurethral resection of prostatic adenoma. Arch Esp Urol. 1998. 51:409–418.

6. Kuo HC, Chang SC, Hsu T. Predictive factors for successful surgical outcome of benign prostatic hypertrophy. Eur Urol. 1993. 24:12–19.

7. Milonas D, Saferis V, Jievaltas M. Transition zone index and bothersomeness of voiding symptoms as predictors of early unfavorable outcomes after transurethral resection of prostate. Urol Int. 2008. 81:421–426.

8. Seki N, Takei M, Yamaguchi A, Naito S. Analysis of prognostic factors regarding the outcome after a transurethral resection for symptomatic benign prostatic enlargement. Neurourol Urodyn. 2006. 25:428–432.

9. Tan YH, Foo KT. Intravesical prostatic protrusion predicts the outcome of a trial without catheter following acute urine retention. J Urol. 2003. 170(6 Pt 1):2339–2341.

10. Mariappan P, Brown DJ, McNeill AS. Intravesical prostatic protrusion is better than prostate volume in predicting the outcome of trial without catheter in white men presenting with acute urinary retention: a prospective clinical study. J Urol. 2007. 178:573–577.

11. Lee LS, Sim HG, Lim KB, Wang D, Foo KT. Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment. Int J Urol. 2010. 17:69–74.

12. Chia SJ, Heng CT, Chan SP, Foo KT. Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int. 2003. 91:371–374.

13. Keqin Z, Zhishun X, Jing Z, Haixin W, Dongqing Z, Benkang S. Clinical significance of intravesical prostatic protrusion in patients with benign prostatic enlargement. Urology. 2007. 70:1096–1099.

14. Lim KB, Ho H, Foo KT, Wong MY, Fook-Chong S. Comparison of intravesical prostatic protrusion, prostate volume and serum prostatic-specific antigen in the evaluation of bladder outlet obstruction. Int J Urol. 2006. 13:1509–1513.

15. Kuo HC. Clinical prostate score for diagnosis of bladder outlet obstruction by prostate measurements and uroflowmetry. Urology. 1999. 54:90–96.

16. Lieber MM, Jacobson DJ, McGree ME, St Sauver JL, Girman CJ, Jacobsen SJ. Intravesical prostatic protrusion in men in Olmsted County, Minnesota. J Urol. 2009. 182:2819–2824.

17. Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR. Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year followup. J Urol. 1999. 162:1640–1644.

18. Tan AH, Gilling PJ, Kennett KM, Frampton C, Westenberg AM, Fraundorfer MR. A randomized trial comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia in large glands (40 to 200 grams). J Urol. 2003. 170(4 Pt 1):1270–1274.

19. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2004. 172(5 Pt 1):1926–1929.

20. Mattiasson A, Wagrell L, Schelin S, Nordling J, Richthoff J, Magnusson B, et al. Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology. 2007. 69:91–96.

21. Horasanli K, Silay MS, Altay B, Tanriverdi O, Sarica K, Miroglu C. Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 ml: a short-term prospective randomized trial. Urology. 2008. 71:247–251.

22. Lee JM, Chung H, Kim TW, Kim HS, Wang JH, Yang SK. The correlation of intravesical prostatic protrusion with storage symptoms, as measured by transrectal ultrasound. Korean J Urol. 2008. 49:145–149.

23. Masumori N, Furuya R, Tanaka Y, Furuya S, Ogura H, Tsukamoto T. The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery. BJU Int. 2010. 105:1429–1433.