Role for intravesical prostatic protrusion in lower urinary tract symptom: a fluid structural interaction analysis study

Abstract

BackgroundNumerous studies indicated that Intravesical prostatic protrusion is relevant to prognosis of LUTS, however, the confounding effect that is brought about by prostate volume, urethra anterior curvature angle and other factors makes it hard to evaluate the role of intravesical prostatic protrusion in clinical observation.MethodsWe proposed a fluid structural interaction analysis approach. 3D models were constructed based on MRI images, and prostatic urethra diameters were calibrated with urodynamic data. Comparisons of urine flow dynamics were made between models with various degree of intravesical prostatic protrusion, while the intravesical pressure, anterior urethra curvature angle and diameter of prostatic urethra were same among all models to rule out their confounding effects.ResultsSimulation result showed that the decrement of diameter and increment of variation in cross-sectional area for prostatic urethra were related to the degree of intravesical prostatic protrusion. Such deformation would lead to deterioration of flow efficiency and could compromise the effect of bladder outlet obstruction alleviation treatment.ConclusionsThese results provided further evidence for intravesical prostatic protrusion being an independent risk factor for bladder outlet obstruction severity and demonstrated that intravesical prostatic protrusion would be a promising marker in clinical decision making.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0081-y) contains supplementary material, which is available to authorized users.

Intravesical prostatic protrusion is not always the same shape: Evaluation by preoperative cystoscopy and outcome in HoLEP

“…However, these reports did not consider the difference in IPP regarding whether it was the middle lobe, the lateral lobe, or both. A computational fluid dynamic study has shown that IPP predisposed to prostate deformation causes constriction of the prostatic urethra . IPP has been considered to cause a “ball‐valve” effect during voiding .…”

Clinical Considerations for Intravesical Prostatic Protrusion in the Evaluation and Management of Bladder Outlet Obstruction Secondary to Benign Prostatic Hyperplasia

“…Superior to these connections, there is merging with other fascia that leaves the IPP susceptible to the radial component of intravesical pressure, thus leading to prostatic deformation. This study provided further evidence suggesting that IPP influences BOO independently, and that flow deterioration is more resistant to alleviation of obstruction during treatment as the IPP grade increases [7]. …”

“…A 2015 fluid structural interaction analysis study demonstrated that IPP predisposed the prostate to deformation caused by intravesical pressure. The authors found that the compression of the prostatic urethra and increased variation of cross-sectional area around bladder neck would diminish urine flow efficiency, as well as compromise the effect of obstruction alleviation treatment [7]. Bladder neck and urethral constraint may be due to the nature of the fascia “capsule” surrounding the prostate.…”

“…Urethral resistance ensues due to IPP and impedes the hydraulic energy that normally drives micturition [7]. A 2015 fluid structural interaction analysis study demonstrated that IPP predisposed the prostate to deformation caused by intravesical pressure.…”

Morphologic features of benign prostatic hyperplasia depending on the size of intravesical prostatic protrusion

“…Так, считается, что при больших показателях ИПП вну-трипузырный отдел предстательной железы во вре-мя мочеиспускания может поддаваться радиаль-ному сдавливанию внутрипузырным давлением. Это приводит к сужению простатического отдела уретры и возникновению эффекта «шарового кла-пана», лежащего в основе развития ИВО [17].…”