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Luo GC, Foo KT, Kuo T, Tan G
Correspondence: Prof Keong Tatt Foo, email@example.com
INTRODUCTION The objective of this study was to evaluate the accuracy of using intravesical prostatic protrusion (IPP) as a parameter for the diagnosis of prostate adenoma (PA), as well as to determine the relationship between the site of PA and bladder outlet obstruction. IPP was determined with the use of transabdominal ultrasonography (TAUS).
METHODS A total of 77 consecutive adult men aged 30–85 years with haematuria or undergoing checkup for bladder tumour were enrolled. International Prostate Symptom Score (IPSS), and the results of uroflowmetry, TAUS and cystourethroscopy were assessed. All cases of IPP were classified into grades 0 (no IPP), 1 (1–5 mm), 2 (6–10 mm) or 3 (> 10 mm). PA diagnosis was confirmed using flexible cystourethroscopy. The sites of PA were classified as U0 (no adenoma), U1 (lateral lobes), U2 (middle lobe) or U3 (lateral and middle lobes).
RESULTS Of the 77 patients, 11 (14.3%) had no IPP. PA was confirmed using cystourethroscopy for all patients with IPP and for 7 of the 11 patients without IPP. Of the 37 patients with prostate volume < 20 g, 29 (78.4%) had IPP. Sensitivity, specificity, as well as positive and negative predictive values for diagnosing PA using only IPP were 90.4%, 100.0%, 100.0% and 36.4%, respectively. Higher sensitivity (95.9%) and negative predictive value (50.0%) were obtained when PA was used together with peak urinary flow rate (Qmax) < 20.0 mL/s. The mean Qmax of patients classified as U1 (n = 39) was 16.0 mL/s, while the mean Qmax in those classified as U2 (n = 12) and U3 (n = 22) was 11.9 mL/s and 8.9 mL/s, respectively.
CONCLUSION All patients with IPP had PA, and PA in the middle lobe was more obstructive than those in lateral lobes. Patients without IPP may still have PA.
Keywords: benign prostate hyperplasia, intravesical prostatic protrusion, prostate adenoma, transabdominal ultrasonography
Singapore Med J 2013; 54(9): 482-486; http://dx.doi.org/10.11622/smedj.2013168
|1. Hirayama A, Samma S, Fujimoto K, et al. Comparison of parameters to determine the cause of urinary disturbance in men with prostate volume less than 20 milliliters. Int J Urol 2002; 9:554-9; discussion 560.
|2. Foo KT, Lim KB, Ho H, Fook S. Co-relationship between the size of the prostate, the intravesical prostatic protrusion and benign prostatic obstruction. European Urology 2005; Suppl 4:71.|
|3. McNeal JE. Normal histology of the prostate. Am J Surg Pathol 1988; 12:619-33.
|4. Abrams P, Chapple C, Khoury S, et al. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol 2009; 181:1779-87.
|5. Bosch JL, Bangma CH, Groeneveld FP, Bohnen AM. The long-term relationship between a real change in prostate volume and a significant change in lower urinary tract symptom severity in population-based men: the Krimpen study. Eur Urol 2008; 53:819-25.
|6. Edwards JL. Diagnosis and management of benign prostatic hyperplasia. Am Fam Physician 2008; 77:1403-10.|
|7. Girman CJ, Jacobsen SJ, Guess HA, et al. Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol 1995; 153:1510-5.
|8. Eckhardt MD, van Venrooij GE, Boon TA. Symptoms, prostate volume, and urodynamic findings in elderly male volunteers without and with LUTS and in patients with LUTS suggestive of benign prostatic hyperplasia. Urology 2001; 58:966-71.
|9. Randalls A. Surgical Pathology of Prostatic Obstruction. Baltimore: Williams & Wilkins, 1931.|
|10. Yuen JS, Ngiap JT, Cheng CW, Foo KT. Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. Int J Urol 2002; 9:225-9.
|11. Chia SJ, Heng CT, Chan SP, Foo KT. Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 2003; 91:371-4.
|12. 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.
|13. Tan YH, Foo KT. Intravesical prostatic protrusion predicts the outcome of a trial without catheter following acute urine retention. J Urol 2003; 170:2339-41.
|14. 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; 178:573-7.
|15.Anderson JT, Nordling J. Prostatism II. The correlation between cysto-urethroscopic, cystometric and urodynamic findings. Scand J Urol Nephrol 1980; 14:23-7.|
|16. Reis LO, Barreiro GC, Baracat J, Prudente A, D'Ancona CA. Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction. Int Braz J Urol 2008; 34:627-33.
|17. 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; 13:1509-13.
|18. Abrams PH. Prostatism and prostatectomy: the value of urine flow rate measurement in the preoperative assessment for operation. J Urol 1977; 117:70-1.|
|19. Pernkopf D, Plas E, Lang T, et al. Uroflow nomogram for male adolescents. J Urol 2005; 174:1436-9.
|20. Eryildirim B, Tarhan F, Kuyumcuo?lu U, Erbay E, Pembegül N. Positionrelated changes in uroflowmetric parameters in healthy young men. Neurourol Urodyn 2006; 25:249-51.
|21. Foo KT. Decision making in the management of benign prostatic enlargement and the role of transabdominal ultrasound. Int J Urol 2010; 17:974-9.
|22. Wang DL, Foo KT. Staging of benign prostate hyperplasia is helpful in patients with lower urinary tract symptoms suggestive of benign prostate hyperplasia. Ann Acad Med Singapore 2010; 39:798-802.|