Is Increased Prostatic Urethral Angle Related to Lower Urinary Tract Symptoms in Males with Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms?

Abstract

PurposeThe prostatic urethra is a bent tube, and the clinical significance of the prostatic urethral angle (PUA) was recently reported. We investigated the statistical significance of an increased PUA on the International Prostate Symptom Score (IPSS) in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptom (LUTS).Materials and MethodsA retrospective analysis was done of 270 men with BPH/LUTS from July 2009 to June 2011. Prostate volume, PUA, and intravesical prostatic protrusion (IPP) were measured by transrectal ultrasonography (TRUS). The IPSS was analyzed separately as storage and voiding symptom score. In order to minimize the effect of prostate size on voiding, patients with prostate size over 40 ml were excluded.ResultsThe mean age was 62.0±9.3 years. The mean prostate volume was 29.0±5.5 ml (range, 20 to 40 ml), and median PUA and IPP were 34° (range, 12 to 52°) and 1.7 mm (range, 0 to 5.3 mm), respectively. The mean IPSS, mean IPSS-ss, and mean IPSS-vs were 19.0±8.2, 7.3±4.0, and 11.6±5.5, respectively. The prostate volume had no statistically significant correlation with IPSS, IPSS-ss, or IPSS-vs. IPP had a statistically significant correlation with IPSS (p<0.001), IPSS-ss (p<0.001), and IPSS-vs (p<0.001). PUA had no statistically significant correlation with IPSS or IPSS-ss. However, PUA had a significant correlation with IPSS-vs (p=0.047). Comparing a higher PUA (≥34°) with a lower PUA (<34°), patients with a higher PUA had a higher IPSS (p=0.001) and a higher IPSS-vs (p=0.001). There was no significant difference in IPSS-ss, prostate volume, or PSA between the two groups.ConclusionsIPP showed significantly correlated with the IPSS and voiding symptom score was affected by the PUA but not by the prostate volume. As the PUA increased, the patients' voiding symptoms worsened. Further study may be needed.

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

“…At baseline evaluation (pre-treatment), no difference in the IPSS/QoL score was found between both groups (P-value = 0.68 and 0.09 respectively) ( Table 1). These findings are similar and agree with previous reports (12)(13). At 2 months of follow-up our study showed a statistically significant improvement in the IPSS/QoL scores in group A compared to group B (P-value = 0.0005 and < 0.000 respectively) ( Table 2).…”

“…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 LUTS (13)(14). In terms of medical therapy for BPH several drugs are widely distributed in the market and selective α1-blocker is the recommended treatment (15).…”

MRI evaluation of benign prostatic hyperplasia: Correlation with international prostate symptom score

“…Benign prostatic hyperplasia (BPH) is a common condition in middle‐aged and older men. Its symptoms usually start after the age of 40, and its prevalence is found to be more than 50% by the age of 60 . Although it is a common condition and incurs a substantial burden on healthcare systems, its etiology and pathophysiology are not well understood.…”

Imaging in benign prostatic hyperplasia

“…Park et al [18] studied 270 LUTS and BPH patients retrospectively, and for minimizing the effect of prostate size on voiding they excluded patients with prostate weight more than 40 cc. Patients with tumor, infection, neurogenic bladder, and stone were also excluded.…”