Clinical Significance of Intravesical Prostatic Protrusion in Patients with Benign Prostatic Enlargement

Zhang, Ke‐Qin; Zhang, Xu; Zhang, Jing; Wang, Haixin; Zhang, Dongqing; Shi, Benkang

doi:10.1016/j.urology.2007.08.008

Cited by 127 publications

(86 citation statements)

References 17 publications

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“…Looking at measurement of the prostatic parameters in our patients, the TPV and TZV were higher in patients with PUA > 35˚ and the IPP was similar with no significant difference between both groups. In fact several studies reported that the prostate volume does not correlate with the clinical LUTS and/or the degree of BOO (2, 3); in addition the mean IPP of our patients was small 3.6 ± 1.1 mm, while Keqin et al used an IPP cutoff value of 10 mm for better classification of BOO in patients and correlation with clinical symptoms (21). Therefore, it is clearly evident that the PUA is an important prostatic measurement and it might be a predictor of treatment efficacy of α-blockers in men with LUTS/BPH.…”

Section: Discussioncontrasting

confidence: 63%

“…Some studies reported that the prostate volume does not correlate with the clinical LUTS and/or the degree of bladder outlet obstruction (BOO) (2,3), and other studies discussed several anatomical factors that may explain the clinical effect of BPH such as intravesical prostatic protrusion (IPP), transition zone volume (TZV), transition zone index (TZI) and presumed circle area ratio (4)(5)(6)(7)(8)(9). Recently, Cho et al introduced the term prostatic-urethral angulation (PUA) as a new measurement that could be a causal factor for BPH (10), and in their subsequent preliminary clinical study using the fluid dynamic model, they reported that the urinary flow rate decreased by more than 27% as the PUA increased from 35° to 90° (11).…”

mentioning

confidence: 99%

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Clinical significance of prostatic-urethral angulation on the treatment outcome of patients with symptomatic benign prostatic hyperplasia treated with tamsulosin hydrochloride

El-Tatawy

Gameel

El-enen

et al. 2015

Arch Ital Urol Androl

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SummaryNo conflict of interest declared.Up till now the exact pathophysiology of BPH is still poorly understood and different theories have emerged and changed over the past years. Some studies reported that the prostate volume does not correlate with the clinical LUTS and/or the degree of bladder outlet obstruction (BOO) (2, 3), and other studies discussed several anatomical factors that may explain the clinical effect of BPH such as intravesical prostatic protrusion (IPP), transition zone volume (TZV), transition zone index (TZI) and presumed circle area ratio (4-9). Recently, Cho et al. introduced the term prostatic-urethral angulation (PUA) as a new measurement that could be a causal factor for BPH (10), and in their subsequent preliminary clinical study using the fluid dynamic model, they reported that the urinary flow rate decreased by more than 27% as the PUA increased from 35° to 90° (11). Patients with PUA ≥ 35° had larger prostate volume and higher BOO index, in comparison with those who had PUA < 35° (12). Further studies showed that the PUA is significantly associated with maximum flow rate (Qmax) and voiding symptom scores in men with . In terms of medical therapy for BPH several drugs are widely distributed in the market and selective α1-blocker is the recommended treatment (15). Tamsulosin hydrochloride is a highly selective α1A-blocker that is currently used and proved to be effective and safe in treatment of symptomatic BPH alone or in combination with other drugs (16). The effect of PUA on the treatment outcome of tamsulosin hydrochloride on men with LUTS was first evaluated and PUA was inversely correlated with changes in Qmax and symptoms score after treatment (17). The aim of the present study is to evaluate the clinical outcome of medical treatment (by selective α1A-blocker) on male patients presented with LUTS/BPH and its correlation to the degree of PUA.

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Section: Discussioncontrasting

confidence: 63%

mentioning

confidence: 99%

Clinical significance of prostatic-urethral angulation on the treatment outcome of patients with symptomatic benign prostatic hyperplasia treated with tamsulosin hydrochloride

El-Tatawy

Gameel

El-enen

et al. 2015

Arch Ital Urol Androl

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“…IPP. IPP was studied in a total of 1013 patients across ten studies [6,8,9,13,15,17,23,28,36,39]. Five studies used a cutoff of 10 mm to define BOO, and overall reported similar diagnostic accuracy to uroflowmetry alone, with median sensitivity of 67.8% and specificity of 74.8%, a PPV of 73.8% and NPV of 69.3%.…”

Section: Diagnostic Accuracy Resultsmentioning

confidence: 99%

Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

et al. 2017

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Keywords:Bladder outlet obstruction (BOO) Men Lower urinary tract symptoms Diagnosis Urodynamics Noninvasive Systematic review Please visit www.eu-acme.org/ europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically. AbstractContext: Several noninvasive tests have been developed for diagnosing bladder outlet obstruction (BOO) in men to avoid the burden and morbidity associated with invasive urodynamics. The diagnostic accuracy of these tests, however, remains uncertain. Objective: To systematically review available evidence regarding the diagnostic accuracy of noninvasive tests in diagnosing BOO in men with lower urinary tract symptoms (LUTS) using a pressure-flow study as the reference standard. Evidence acquisition: The EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central, Google Scholar, and WHO International Clinical Trials Registry Platform Search Portal databases were searched up to May 18, 2016. All studies reporting diagnostic accuracy for noninvasive tests for BOO or detrusor underactivity in men with LUTS compared to pressure-flow studies were included. Two reviewers independently screened all articles, searched the reference lists of retrieved articles, and performed the data extraction. The quality of evidence and risk of bias were assessed using the QUADAS-2 tool. Evidence synthesis: The search yielded 2774 potentially relevant reports. After screening titles and abstracts, 53 reports were retrieved for full-text screening, of which 42 (recruiting a total of 4444 patients) were eligible. Overall, the results were predominantly based on findings from nonrandomised experimental studies and, within the limits of such study designs, the quality of evidence was typically moderate across the literature. Differences in noninvasive test threshold values and variations in the urodynamic definition of BOO between studies limited the comparability of the data.

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“…The increasing grades of IVPP are significantly directly correlated with IPSS score (r 0.163, p <0.037), Q-max (r 0.231 p<0.027) and Post-void residual (r 0.331 p<0.031). 11 Among the three Q-max is the best correlated one. The Prostatic volume (p<0.131) and QOL index (p<0.053) do not correlate well with IVPP.…”

Section: Discussionmentioning

confidence: 97%

Effect of Intravesical Prostatic Protrusion (Ivpp) on Lower Urinary Tract Function and Management

T¹,

Balaji²,

Vetrichandar³

et al. 2016

jemds

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AIMS AND OBJECTIVESTo correlate Intravesical Prostatic Protrusion (IVPP) with International Prostate Symptoms Score (IPSS), Quality of Life Index (QOL), Uroflowmetry, Post Void Urine (PVR) and Pressure Flow Study (PFS) and to assess whether the presence and increasing grades of Intravesical prostatic protrusion are directly correlated with the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy. MATERIALS AND METHODSNon-randomized prospective cohort study, conducted in Department of Urology, Govt. Stanley Hospital, from June 2012 to June 2015, on a sample of 100 patients with IVPP. IVPP was correlated with IPSS, Quality of life index, Uroflowmetry, Effects of drug therapy, Response to surgical therapy. Response of patients with Intravesical prostatic protrusion of same grade to surgical therapy and drug therapy are compared to decide which modality of management is best. RESULTSThe incidence of IVPP in patients presenting with LUTS due to BPH is 1 in 5. Majority present with grade 2 IVPP. The increasing grades of IVPP are significantly directly correlated with IPSS score, Q-max and Post void residual. Statistical analysis showed IVPP to correlate significantly with BOO. TURP showed a very good and significant mean decrease of IPSS and Q-max, whereas those who had medical treatment showed only a mean decrease of 2 in IPSS score and 1 in Q-max. CONCLUSIONThe increasing grades of IVPP are significantly directly correlated with IPSS score max and Post void residual. IVPP have a very good positive and negative predictive value and also a good accuracy rate in comparison with all other parameters in predicting the BOO. The surgical intervention statistically proved to be superior to medical treatment in IVPP patients. KEYWORDSIVPP, Prostate, Urology. HOW TO CITE THIS ARTICLE:Rajaraman T, Balaji AR, Vetrichandar S, et al. Effect of intravesical prostatic protrusion (IVPP) on lower urinary tract function and management.

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Clinical Significance of Intravesical Prostatic Protrusion in Patients with Benign Prostatic Enlargement

Cited by 127 publications

References 17 publications

Clinical significance of prostatic-urethral angulation on the treatment outcome of patients with symptomatic benign prostatic hyperplasia treated with tamsulosin hydrochloride

Clinical significance of prostatic-urethral angulation on the treatment outcome of patients with symptomatic benign prostatic hyperplasia treated with tamsulosin hydrochloride

Systematic Review of the Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

Effect of Intravesical Prostatic Protrusion (Ivpp) on Lower Urinary Tract Function and Management

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