Evaluation of resistive index of the prostate and bladder sonomorphologic parameters as replacements for urodynamics to predict bladder outlet obstruction in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

Abstract

Objective: This study investigated whether the resistive index (RI) of prostate and bladder sonomorphologic parameters (total prostate volume [TPV], detrusor wall thickness [DWT], intraprostatic protrusion [IPP]) can be used instead of urodynamic studies (UDS) to predict bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Methods: Men aged ≥50 years with clinical BPH/LUTS were prospectively enrolled included. Basic evaluations, measurement of sonomorphologic parameters, and UDS were performed in accordance with the International Continence Society's Good Urodynamics Practices protocol.Results: Data of 240 patients were divided into two groups based on the BOO index(BOOI).Group 1 consisted of patients negative for BOO (BOOI <40), whereas Group 2 consisted of patients positive for BOO (BOOI > 40). Patient age, International Prostate Symptom Score (IPSS), quality of life score and post-void residual volume were comparable between the two groups, whereas significant differences were evident in peak flow rate, TPV, DWT, RI, and IPP (P < 0.01 for all). Pearson correlation analysis revealed a significant correlation between BOOI and DWT (r = 0.198, P = 0.002), IPP (r = 0.450, P = 0.000), and RI (r = 0.334, P = 0.000). Multiple regression analysis revealed a significant correlation between BOOI and IPP (β = 0.382, P = 0.000) and RI (β = 0.226, P = 0.000). Receiver operating characteristic analysis showed that the area under curve was 0.785 for RI (95% confidence interval [CI] 0.703-0.867, P < 0.001) and 0.905 for IPP (95% CI 0.850-0.961, P < 0.001). At a cut-off value of 7.5 mm for IPP, the sensitivity was 86.9%, specificity was 83.3% and positive predictive value was 92.41%.Conclusion: IPP and RI may be the best non-invasive predictors for BOO in selected patients with LUTS/BPH.

Bladder Sonomorphological Tests in Diagnosing Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis

“…A collective result of low RoB study group including only 3 studies [11, 18, 21] evaluating UEBW indicated that there was slightly increase in SSY to 0.931 (95% CI, 0.885–0.963; I 2 = 25.5%) and SPY to 0.796 (95% CI, 0.718–0.860; I 2 = 89.9%). Combined results from 9 studies [7, 10, 12-14, 17, 19, 20, 22] with low RoB evaluating DWT did not obviously change the accuracy, with combined SSY of 0.655 (95% CI, 0.615–0.693; I 2 = 89.9%) and SPY was 0.907 (95% CI, 0.877–0.931; I 2 = 74.3%). Considering the measure methods, 1 study [15] using the corrected UEBW were excluded.…”

“…SROC curves for SSY and SPY and publication bias plot are exhibited in Figures 4 and 5. Totally 10 studies [7, 10, 12-14, 16, 17, 19, 20, 22] and 1,204 participants were included in our analysis concerning about DWT. Data shown in Table 3 performs that the pooled SSY for DWT for BOO diagnose was 0.68 (95% CI, 0.56–0.78) and SPY was 0.91 (95% CI, 0.82–0.96) with I 2 values of 93%.…”

“…The process of selecting study is exhibited in Figure 1. Totally 16 studies [7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23]…”

Effect of bladder filling volume on detrusor contractility in men with bladder outlet obstruction

“…Prostatic volume was also not correlated with contractility. The correlation between prostatic volume and urodynamic obstruction is still unclear with conflicting results between studies 19–21 . Sullivan and Yalla study in 1996 showed a significant increase in detrusor isometric pressure with the degree of urodynamic obstruction, 22 so contractility seemed to depend more on urodynamic obstruction than on anatomical obstacle.…”

“…The correlation between prostatic volume and urodynamic obstruction is still unclear with conflicting results between studies. [19][20][21] Sullivan and Yalla study in 1996 showed a significant increase in detrusor isometric pressure with the degree of urodynamic obstruction, 22 so contractility seemed to depend more on urodynamic obstruction than on anatomical obstacle. In daily practice, the measurement of contractility by stop-test tends to be replaced by nomograms applied to pressure-flow study data, such as the International Continence Society nomogram and the BCI, which are easier to perform.…”