A New Classification for Hemorrhoidal Disease: The Creation of the “BPRST” Staging and Its Application in Clinical Practice

Abstract

Purpose: Present an updated classification for symptomatic hemorrhoids, which not only guides the treatment of internal hemorrhoids but also the treatment of external components. In addition, this new classification includes new treatment alternatives created over the last few years.Methods: Throughout the past 7 years, the authors developed a method to classify patients with symptomatic hemorrhoids. This study, besides presenting this classification proposal, also retrospectively analyzed 149 consecutive patients treated between March 2011 and November 2013 and aimed to evaluate the association between the management adopted with Goligher classification and our proposed BPRST classification.Results: Both classifications had a statistically significant association with the adopted management strategies. However, the BPRST classification tended to have fewer management discrepancies when each stage of disease was individually analyzed.Conclusion: Although there is much disagreement about how the classification of hemorrhoidal disease should be updated, it is accepted that some kind of revision is needed. The BPRST method showed a strong association with the management that should be adopted for each stage of the disease. Further studies are needed for its validation, but the current results are encouraging.

The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment

“…Patients with bleeding HD without prolapse or external components, stage I BPRST, the recommended management involved medical therapy (dietary supplementation of fibers, behavioral measures, oral hydration, laxatives, ointments) and office procedures (rubber-band ligation, sclerotherapy or infrared photocoagulation) [ 1 , 6 , [9] , [10] , [11] , [12] ].…”

“…For irreducible prolapse (R2), intolerable external components (S1) or with refractory acute hemorrhoidal thrombosis (T1), stage III BPRST, conventional hemorrhoidectomy with anodermal excision (Milligan-Morgan, Ferguson-Heaton, Obando, among other techniques) was the procedure of choice [ 1 , 6 , [9] , [10] , [11] , [12] ] .…”

“…We have previously published a proposal for a new classification for hemorrhoids named BPRST, an acronym in which each letter that corresponds to an important aspect of HD that interferes with clinical reasoning: bleeding, prolapse, reducibility, skin tags and thrombosis. This classification was compared to Goligher's is a retrospective study at our institution, revealing good correlation with the treatment adopted but fewer discrepancies [ 6 ].…”

Milligan–Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study

“…The need for more descriptive and analytical classification systems is obvious. In this direction, the BPRST classification, which has been recently proposed, takes into account parameters such as bleeding, prolapse, reduction, skin tags, and, thrombosis in order to classify HD [ 22 ]. Therefore, important HD characteristics, not properly acknowledged by the Goligher classification, are increasingly appreciated in the more recent reports [ 22 , 23 ].…”

Treatment of Hemorrhoid in Unusual Condition-Pregnancy

“…In actual clinical practice, classification of hemorrhoids was done based on the extent of internal hemorrhoidal tissue prolapse, and treatment was outlined in accordance with classical classification [3]. According to some findings, classification systems that take into account many symptoms at once are more practical [4,5]. The treatment for hemorrhoid was determined according to the severity of the symptoms, which might range from conservative management to intervention or surgical treatment [6][7][8][9].…”