Abstract
Purpose
To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery.
Methods
The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3 months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression.
Results
Among patients with prostate volume < 50 mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3 months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50 mL.
Conclusion
Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.
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References
Kuntz RM, Lehrich K, Ahyai S (2004) Does perioperative outcome of transurethral holmium laser enucleation of the prostate depend on prostate size? J Endourol 18(2):183–188. https://doi.org/10.1089/089277904322959842
Girman CJ, Jacobsen SJ, Guess HA, Oesterling JE, Chute CG, Panser LA, Lieber MM (1995) Natural history of prostatism: relationship among symptoms, prostate volume and peak urinary flow rate. J Urol 153(5):1510–1515. https://doi.org/10.1016/s0022-5347(01)67448-2
Ku JH, Ko DW, Cho JY, Oh SJ (2010) Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms. Urology 75(6):1467–1471. https://doi.org/10.1016/j.urology.2009.08.049
Bang WJ, Kim HW, Lee JY, Lee DH, Hah YS, Lee HH, Koo KC, Yu HS, Ham WS, Cho KS (2012) Prostatic urethral angulation associated with urinary flow rate and urinary symptom scores in men with lower urinary tract symptoms. Urology 80(6):1333–1337. https://doi.org/10.1016/j.urology.2012.08.058
Keqin Z, Zhishun X, Jing Z, Haixin W, Dongqing Z, Benkang S (2007) Clinical significance of intravesical prostatic protrusion in patients with benign prostatic enlargement. Urology 70(6):1096–1099. https://doi.org/10.1016/j.urology.2007.08.008
Kaplan SA, Te AE, Pressler LB, Olsson CA (1995) Transition zone index as a method of assessing benign prostatic hyperplasia: correlation with symptoms, urine flow and detrusor pressure. J Urol 154(5):1764–1769
Bushman W (2009) Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin N Am 36(4):403–415. https://doi.org/10.1016/j.ucl.2009.07.003
Giannarini G (2007) Editorial comment on: Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol 52(5):1463. https://doi.org/10.1016/j.eururo.2007.04.054
Mayer EK, Kroeze SG, Chopra S, Bottle A, Patel A (2012) Examining the 'gold standard': a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int 110(11):1595–1601. https://doi.org/10.1111/j.1464-410X.2012.11119.x
Park YJ, Bae KH, Jin BS, Jung HJ, Park JS (2012) Is increased prostatic urethral angle related to lower urinary tract symptoms in males with benign prostatic hyperplasia/lower urinary tract symptoms? Korean J Urol 53(6):410–413. https://doi.org/10.4111/kju.2012.53.6.410
Cho KS, Kim JH, Kim DJ, Choi YD, Kim JH, Hong SJ (2008) Relationship between prostatic urethral angle and urinary flow rate: its implication in benign prostatic hyperplasia pathogenesis. Urology 71(5):858–862. https://doi.org/10.1016/j.urology.2008.01.019
Yuen JS, Ngiap JS, Cheng CW, Foo KT (2002) Effects of bladder volume on transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. Int J Urol 9(4):225–229. https://doi.org/10.1046/j.1442-2042.2002.00453.x
Hirayama K, Masui K, Hamada A, Shichiri Y, Masuzawa N, Hamada S (2015) Evaluation of intravesical prostatic protrusion as a predictor of dutasteride-resistant lower urinary tract symptoms/benign prostatic enlargement with a high likelihood of surgical intervention. Urology 86(3):565–569. https://doi.org/10.1016/j.urology.2015.05.021
Logie J, Clifford GM, Farmer RD (2005) Incidence, prevalence and management of lower urinary tract symptoms in men in the UK. BJU Int 95(4):557–562. https://doi.org/10.1111/j.1464-410X.2005.05339.x
Izard J, Nickel JC (2011) Impact of medical therapy on transurethral resection of the prostate: two decades of change. BJU Int 108(1):89–93. https://doi.org/10.1111/j.1464-410X.2010.09737.x
Sciarra A, D'Eramo G, Casale P, Loreto A, Buscarini M, Di Nicola S, Seccareccia F, Di Silverio F (1998) Relationship among symptom score, prostate volume, and urinary flow rates in 543 patients with and without benign prostatic hyperplasia. Prostate 34(2):121–128 (discussion 129)
Kang DH, Lee JY, Hah YS, Chung DY, Lee DH, Cho KS (2014) Correlation of prostatic urethral angle with the severity of urinary symptom and peak flow rate in men with small prostate volume. PLoS ONE ONE 9(8):e104395. https://doi.org/10.1371/journal.pone.0104395
Rodriguez-Nieves JA, Macoska JA (2013) Prostatic fibrosis, lower urinary tract symptoms, and BPH. Nat Rev Urol 10(9):546–550. https://doi.org/10.1038/nrurol.2013.149
Hocaoglu Y, Roosen A, Herrmann K, Tritschler S, Stief C, Bauer RM (2012) Real-time magnetic resonance imaging (MRI): anatomical changes during physiological voiding in men. BJU Int 109(2):234–239. https://doi.org/10.1111/j.1464-410X.2011.10255.x
Chia SJ, Heng CT, Chan SP, Foo KT (2003) Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 91(4):371–374
Tan YH, Foo KT (2003) Intravesical prostatic protrusion predicts the outcome of a trial without catheter following acute urine retention. J Urol 170(6 Pt 1):2339–2341. https://doi.org/10.1097/01.ju.0000095474.86981.00
Acknowledgements
This research was supported by Hanmi Healthcare Inc. (H20180764).
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MS: project development, data collection, manuscript writing. WJB: data collection. CYO: project development, manuscript writing. YSL: data collection. JSC: data collection.
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The Institutional Review Board of Hallym University Sacred Heart Hospital, Republic of Korea, approved this study (No. 2018-07-023).
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Shim, M., Bang, W.J., Oh, C.Y. et al. Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size. World J Urol 38, 1997–2003 (2020). https://doi.org/10.1007/s00345-019-02990-6
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DOI: https://doi.org/10.1007/s00345-019-02990-6