Korean J Urol.  2012 Apr;53(4):253-257.

Transitional Zone Index and Intravesical Prostatic Protrusion in Benign Prostatic Hyperplasia Patients: Correlations according to Treatment Received and Other Clinical Data

• Huang T
• Qi J
• Yu Y
• Xu D
• Jiao Y
• Kang J
• Zhu Y
• Chen Y

Abstract

PURPOSE
The aim of this research was to assess the value of the transitional zone index (TZI) and intravesical prostatic protrusion (IPP) from transrectal ultrasonography in evaluating the severity and progression of disease by analyzing the relationship between the 2 parameters and symptoms, clinical history, and urodynamics in benign prostatic hyperplasia (BPH) patients undergoing different treatment.
MATERIALS AND METHODS
A total of 203 patients receiving medication and 162 patients who underwent transurethral resection of the prostate because of BPH were enrolled in this retrospective analysis. The clinical history and subjective and objective examination results of all patients were recorded and compared after being classified by TZI and IPP level. Linear regression was used to find correlations between IPP, TZI, and urodynamics.
RESULTS
The 2 parameters were found to differ significantly between patients receiving medication and patients undergoing surgical therapy (p<0.05). PSA, maximum flow rate (Qmax), detrusor pressure at Qmax (PdetQmax), and the bladder outlet obstruction index (BOOI) differed according to various TZI levels (p<0.05). In addition, the voiding symptom score, Qmax, and BOOI of subgroups with various IPP levels were also significantly different (p<0.05). Both TZI and IPP had significant effects on Qmax, BOOI, and PdetQmax (p<0.05) and the incidence of acute urinary retention (p=0.000).
CONCLUSIONS
The results demonstrated that both TZI and IPP had favorable value for assessing severity and progression in patients with BPH. Further studies are needed to confirm whether the two parameters have predictive value in the efficacy of BPH treatment and could be considered as factors in the selection of therapy.

Keyword

Benign prostatic hyperplasia; Medication; Transurethral resection of the prostate; Ultrasonography; Urodynamics

MeSH Terms

Humans
Incidence
Indoles
Linear Models
Prostate
Prostatic Hyperplasia
Retrospective Studies
Urinary Bladder Neck Obstruction
Urinary Retention
Urodynamics
Indoles

Reference

1. Harding C, Robson W, Drinnan M, Sajeel M, Ramsden P, Griffiths C, et al. Predicting the outcome of prostatectomy using noninvasive bladder pressure and urine flow measurements. Eur Urol. 2007. 52:186–192.

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

3. Rodrigues P, Lucon AM, Freire GC, Arap S. Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection. J Urol. 2001. 165:499–502.

4. Yalla SV, Sullivan MP, Lecamwasam HS, DuBeau CE, Vickers MA, Cravalho EG. Correlation of American Urological Association symptom index with obstructive and nonobstructive prostatism. J Urol. 1995. 153(3 Pt 1):674–679.

5. Kaplan SA, Bowers DL, Te AE, Olsson CA. Differential diagnosis of prostatism: a 12-year retrospective analysis of symptoms, urodynamics and satisfaction with therapy. J Urol. 1996. 155:1305–1308.

6. Bruskewitz RC, Larsen EH, Madsen PO, Dørflinger T. 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol. 1986. 136:613–615.

7. Neal DE, Ramsden PD, Sharples L, Smith A, Powell PH, Styles RA, et al. Outcome of elective prostatectomy. BMJ. 1989. 299:762–767.

8. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003. 170(2 Pt 1):530–547.

9. van Venrooij GE, van Melick HH, Boon TA. Comparison of outcomes of transurethral prostate resection in urodynamicallyobstructed versus selected urodynamicallyunobstructed or equivocal men. Urology. 2003. 62:672–676.

10. Griffiths D, Höfner K, van Mastrigt R, Rollema HJ, Spångberg A, Gleason D. Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn. 1997. 16:1–18.

11. 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.

12. Seki N, Kai N, Seguchi H, Takei M, Yamaguchi A, Naito S. Predictives regarding outcome after transurethral resection for prostatic adenoma associated with detrusor underactivity. Urology. 2006. 67:306–310.

13. Han DH, Jeong YS, Choo MS, Lee KS. The efficacy of transurethral resection of the prostate in the patients with weak bladder contractility index. Urology. 2008. 71:657–661.

14. Tanaka Y, Masumori N, Itoh N, Furuya S, Ogura H, Tsukamoto T. Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity? Int J Urol. 2006. 13:1398–1404.

15. Nose H, Foo KT, Lim KB, Yokoyama T, Ozawa H, Kumon H. Accuracy of two noninvasive methods of diagnosing bladder outlet obstruction using ultrasonography: intravesical prostatic protrusion and velocity-flow video urodynamics. Urology. 2005. 65:493–497.

16. 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.

17. Ku JH, Ko DW, Cho JY, Oh SJ. Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms. Urology. 2010. 75:1467–1471.

18. Kaplan SA, Te AE, Pressler LB, Olsson CA. Transition zone index as a method of assessing benign prostatic hyperplasia: correlation with symptoms, urine flow and detrusor pressure. J Urol. 1995. 154:1764–1769.

19. Wang Y, Pei F. Clinical significance of the parameters of prostate volume measured by TRUS in evaluating bladder outlet obstruction. Zhonghua Nan Ke Xue. 2003. 9:522–523. 526

20. 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.