Standardized assessment to enhance the diagnostic value of prostate volume; Part I: Morphometry in patients with lower urinary tract symptoms

Aarnink, R.G.; Rosette, J.J.M.H.C. de la; Huynen, A.L.; Giesen, R.J.B.; Debruyne, F.M.J.; Wijkstra, Hessel

doi:10.1002/(sici)1097-0045(199611)29:5<317::aid-pros7>3.0.co;2-6

Cited by 10 publications

(11 citation statements)

References 15 publications

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“…17 The AP diameter is usually the shorter one, as compared with others diameters (CC and LL) (Aarnink et al 18 and present series). We assumed 60 cm 3 and 45 mm as cut-off points for prostate volume and AP diameter, respectively, as previously performed by other authors, 19,20 even if both these arbitrary thresholds have been not internationally recognized.…”

Section: Discussioncontrasting

confidence: 98%

Metabolic syndrome and lower urinary tract symptoms: the role of inflammation

Gacci

Vignozzi

Sebastianelli

et al. 2012

Prostate Cancer Prostatic Dis

140

137

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BACKGROUND: Epidemiological data indicate that lower urinary tract symptoms (LUTS)/BPH can be associated with metabolic syndrome (MetS). Chronic inflammation has been proposed as a candidate mechanism at the crossroad between these two clinical entities. Aim of study is to examine the correlation among pre-operatory LUTS/BPH severity, MetS features and inflammatory infiltrates in prostatectomy specimens. METHODS: A total of 271 consecutive men treated with simple prostatectomy were retrospectively selected for this study in two tertiary referral centers for LUTS/BPH. Prostate diameters and volume were measured by transrectal ultrasound, LUTS scored by International Prostate Symptom Score (IPSS) and obstruction by uroflowmetry. The International Diabetes Federation and American Heart Association and the National Heart, Lung and Blood Institute was used to define MetS. The inflammatory infiltrate was investigated combining anatomic location, grade and extent of flogosis into the overall inflammatory score (IS); the glandular disruption (GD) was used as a further marker. RESULTS: Eighty-six (31.7%) men were affected by MetS. Prostatic volume and anterior-posterior (AP) diameter were positively associated to the number of MetS components. Among MetS determinants, only dyslipidaemia (increased serum triglycerides and reduced serum high-density lipoprotein) was associated with an increased risk of having a prostatic volume 460 cm 3 (hazard ratio (HR) ¼ 3.268, Po0.001). A significant positive correlation between the presence of MetS and the IS was observed. MetS patients presented lower uroflowmetric parameters as compared with those without MetS (Maximum flow rate (Q max ): 8.6 vs 10.1, P ¼ 0.008 and average flow rate (Q ave ): 4.6 vs 5.3, P ¼ 0.033, respectively), and higher obstructive urinary symptoms score (P ¼ 0.064). A positive correlation among both IS-GD and IPSS Score was also observed (adjusted r ¼ 0.172, P ¼ 0.008 and adjusted r ¼ 0.128, P ¼ 0.050). CONCLUSIONS: MetS is associated with prostate volume, prostatic AP diameter and intraprostatic IS. The significantly positive association between MetS and prostatic AP diameter could support the observation that MetS patients presented lower uroflowmetric parameters. In conclusion, MetS can be regarded as a new determinant of prostate inflammation and BPH progression.

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Section: Discussioncontrasting

confidence: 98%

Metabolic syndrome and lower urinary tract symptoms: the role of inflammation

Gacci

Vignozzi

Sebastianelli

et al. 2012

Prostate Cancer Prostatic Dis

140

137

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“…Although BPH mainly develops in TZ and PUGs, it can also develop in the peripheral zone (14). However, TZ enlargement typically compresses and decreases the volume of the peripheral zone in most BPH patients (6).…”

Section: Pathophysiology Of Benign Prostatic Hyperplasiasupporting

confidence: 46%

Magnetic resonance imaging of benign prostatic hyperplasia

Güneyli

Ward²,

Thomas³

et al. 2016

Diagn Interv Radiol

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Benign prostatic hyperplasia (BPH) is a histologic diagnosis showing glandular and stromal hyperplasia in the prostate. Its symptoms usually occur after the age of 40, and its prevalence reaches 50%-60% by the age of 60 (1). About 50% of men who have a histologic diagnosis of BPH have lower urinary tract symptoms including storage and voiding symptoms (2). Imaging plays an important role in evaluation of enlargement locations and nodules, estimation of prostatic volumes, and management of BPH patients. Ultrasonography (US) and magnetic resonance imaging (MRI) are used in evaluation of the prostate. US is the most common imaging modality in BPH patients, because it is relatively inexpensive and provides important information in most patients. Recently, MRI has been more commonly used in management of prostate cancer (3). Wasserman (4) described the US classification of BPH using findings on sagittal and axial images of transrectal US based on the pathologic classification (5). Following this, Wasserman et al. (6) implemented this classification to MRI. The classification for detecting BPH types is important, as patients with different BPH types may have different symptoms and treatment options.In this paper, we retrospectively evaluated MRI scans of BPH patients who were histologically diagnosed as BPH and presented the different types of BPH on T2-weighted MRI, since the prostatic parenchyma is best evaluated on T2-weighted images (6, 7). Additionally, the sagittal and axial images that are important for the classification of BPH were only available on T2-weighted images. In our practice, we perform prostate MRI on a 3.0 T scanner (AchievaTX; Philips) using an endorectal coil (Prostate eCoil, Medrad). Anatomy of the prostateIn previous studies (4,8), the anatomy of the prostate has been reviewed. There are three main glandular zones (central, transition, peripheral) and one stromal zone (anterior fibromuscular stroma). There is also a subsphincteric periurethral gland (PUG) region, which is a fraction of the size of the transition zone (TZ) (9). BPH mostly involves PUGs, TZ, and stromal ABSTRACTBenign prostatic hyperplasia (BPH) is a common condition in middle-aged and older men and negatively affects the quality of life. An ultrasound classification for BPH based on a previous pathologic classification was reported, and the types of BPH were classified according to different enlargement locations in the prostate. Afterwards, this classification was demonstrated using magnetic resonance imaging (MRI). The classification of BPH is important, as patients with different types of BPH can have different symptoms and treatment options. BPH types on MRI are as follows: type 0, an equal to or less than 25 cm 3 prostate showing little or no zonal enlargements; type 1, bilateral transition zone (TZ) enlargement; type 2, retrourethral enlargement; type 3, bilateral TZ and retrourethral enlargement; type 4, pedunculated enlargement; type 5, pedunculated with bilateral TZ and/or retrourethral enlargement; type 6, subtrigon...

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“…Subsequently, 37 studies received a COSMIN score of fair, good or excellent. 21–57 Twenty-four studies 58–81 received ‘poor’ COSMIN scores and were therefore excluded from the best evidence synthesis. Of the 37 included studies, 18 studies evaluated the assessment of BOO and 17 BPO, 2 studied aspects relevant to both BOO and BPO.…”

Section: Resultsmentioning

confidence: 99%

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

et al. 2022

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ObjectivesTo systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS).DesignSystematic review with best evidence synthesis.SettingPrimary care.ParticipantsMen with LUTS due to bladder outlet obstruction or benign prostatic obstruction.Review methodsPubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis.ResultsOf the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence.ConclusionClinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.

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Standardized assessment to enhance the diagnostic value of prostate volume; Part I: Morphometry in patients with lower urinary tract symptoms

Cited by 10 publications

References 15 publications

Metabolic syndrome and lower urinary tract symptoms: the role of inflammation

Metabolic syndrome and lower urinary tract symptoms: the role of inflammation

Magnetic resonance imaging of benign prostatic hyperplasia

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

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