Impact Of Transurethral Resection Of Prostate On International Prostate Symptom Score And Peak Urinary Flow Rate

2020 ◽  
Vol 16 (1) ◽  
pp. 11-15
Author(s):  
Md Waliul Islam ◽  
Md Abul Hossain ◽  
Md Nurul Hooda ◽  
Kazi Rafiqul Abedin ◽  
Husne Ara
Keyword(s):  
Flow Rate ◽  
Transurethral Resection ◽  
Urine Volume ◽  
T Test ◽  
Urinary Symptoms ◽  
Urinary Flow Rate ◽  
Transurethral Resection Of Prostate ◽  
Urinary Flow ◽  
Paired Student ◽  
The Impact

Objectives: To evaluate urinary symptoms and quality of life in patient with BPH before and after TURP. To determine the impact of TURP on the urinary symptoms (IPSS) and peak urinary flow rate. Methods: This study is prospective study carried out between 2010 and 2011 in the department of Urology, National Institute of Kidney Diseases & Urology. Total 102 cases were selected purposively according to selection criteria. Each patient was observed and followed up at 8 weeks (1st visit), 16 weeks (2nd visit) 24 weeks (3rd visit) after transurethral resection of prostate (TURP). IPSS score, QOL score also recorded and uroflowmetry was done to see the peak urinary flow rate (Qmax) of urine and voiding time. USG was done to see post voidal residual urine volume and DRE also done in selected cases. Data was complied and statistical analysis were done using computer based software, Statistical Package for Social Science (SPSS), using paired ‘t’ test. A P value <0.05 was taken as significance. Results: Before TURP, IPSS range 17-25 and mean 21.61+2.43, after TURP, range 0-7 and mean 4.27+1.71). Hence a significant improvement of IPSS was found from 2 months to 6 months follow up after TURP. The change was tested using “paired student ‘t’ test”. Before TURP Qmax range 7-12.2 and mean was 9.96+1.69, which became range 18-25 and mean was 22.61+2.28 after TURP and therefore change of mean Qmax was 12.64+2.69. The change was tested using “paired student ‘t’ test”. The change was found significant (P<0.001). Conclusion: Transurethral resection of prostate resolves obstructive symptoms, rapid improvement of urinary flow rate Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2013 p.11-15

scholarly journals Effects of Transurethral Resection of Prostate (TURP) on Quality of Life in Case of Benign Prostatic Hyperplasia

2019 ◽  
Vol 5 (2) ◽  
pp. 143-147
Author(s):  
Md Abul Hossain ◽  
Md Akter Alam ◽  
Md Fazal Naser ◽  
Md Shafiqul Azam
Keyword(s):  
Quality Of Life ◽  
Benign Prostatic Hyperplasia ◽  
Flow Rate ◽  
Transurethral Resection ◽  
Prostatic Hyperplasia ◽  
Urinary Flow Rate ◽  
Transurethral Resection Of Prostate ◽  
Urinary Flow

Background: BPH is one of the most common cause of LUTS which significantly impairs the quality of life. TURP is minimally invasive surgical procedure for Benign Prostatic hyperplasia which has impact on quality of life. Impact on quality of life can be measured by QoL score and effect of TURP can be evaluated. Objective: The purpose of the present study was to evaluate the impact of transurethral resection of prostate (TURP) on Quality of Life (QoL) score. Methodology: This prospective study was carried out in the Department of Urology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, from July 2015 to June 2016. Total fifty patients between 50 to 72 years attending for the treatment of benign prostatic hypertrophy (BPH) with lower urinary tract symptoms (LUTS) were included for the study according to inclusion & exclusion criteria. All of them were evaluated with baseline international prostate symptoms score (IPSS), QoL score, peak urinary flow rate (Qmax), voided volume, voiding time and PVR and were recorded in a predesigned data sheet. Selected patients underwent Transurethral Resection of Prostate. They were followed after 1 month and 3 months with same parameter and compared with the baseline values. Results: The baseline international prostate symptoms score (IPSS) in this study was 25.18±1.45. At one month and three months follow up visits after TURP, the IPSS was decreased to 15.0±1.07 and 8.14±0.76 respectively. There was significant improvement of peak urinary flow rate (Qmax) in the postoperative period, at the 1st follow up visit after one month of TURP (15.78±1.42, p<0.001) and at the 2nd follow visit after three months of TURP (18.78, p <0.001). The mean QoL score was 5.30±0.46 before TURP. After one month of TURP it was 3.20±0.45 and after 3 months of TURP it was 1.86±0.57. Conclusion: There is a significant improvement of quality of after TURP. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 143-147

scholarly journals Success of Handmade Transobturator Slings Prepared From Conventional Polypropylene Mesh in the Treatment of Stress Urinary Incontinence in Women

2020 ◽  
Vol 17 (1) ◽  
pp. 3-8
Author(s):  
Md Waliul Islam ◽  
Parveen Sultana ◽  
Abdul Matin Anamur Rashid Choudhury ◽  
Tasmina Parveen ◽  
Md Nurul Hooda
Keyword(s):  
Quality Of Life ◽  
Flow Rate ◽  
Transurethral Resection ◽  
Digital Rectal Examination ◽  
Urinary Flow Rate ◽  
Transurethral Resection Of Prostate ◽  
Base Line ◽  
Urinary Flow ◽  
Residual Urine

Objective: To determine the improvement of the quality of life in patient of BPH after transurethral resection of prostate. Methods: A total of 102 of patients complaining lower urinary tract symtoms due to Benign prostatic hyperplasia (BPH). Each of the patient was followed up at 8 weeks (1st visit), 16 weeks (2nd visit) and 24 weeks (3rd visit) after transurethral resection of prostate (TURP). Before TURP for base line study of each patient was evaluated by history, physical examination, digital rectal examination (DRE), International Prostate Symptoms Score (IPSS), Quality of Life Score (QOL), Urinalysis, volume of the prostate and post voidal residual urine (PVR) were determined by ultrasonogram. Improvement of lower urinary tract symptoms and quality of life was determined using IPSS. Improvement was based on the changes from base line in symptoms,urinary flow rate, amount of post voidal residual urine and quality of life.Urine flow rate was measured by uroflowmetry as peak urinary flow rate (Qmax), voiding time and voided volume and was considered valid only if the voided volume was >200 ml. Symptoms were assessed using IPSS & consisting of seven symptoms (frequency, nocturia, urge in continence, urgency, hesitancy, terminal dribbling and sense of incomplete evacuation) that were graded from 0-5. An overall symptoms score was calculated. Result: 102 cases were evaluated by history, physical examination, digital rectal examination (DRE), international prostate symptom scoring (IPSS), quality of life (QOL) scoring, uroflowmetry, post voided residual urine (PVR) and volume of prostate by USG and serum prostate specific antigen (PSA). Cases were selected between 60-75 years. In group-A, among 42 cases (41.2%) <65 years and group-B, 60 cases (58.80%) > 65 years. Age of the patients of each group was compared with IPSS, PVR, Qmax and QOL. Before TURP, IPSS range 17-25 and mean 21.61+2.43, after TURP, range 0-7 and mean 4.27+1.71). There was significant correlation between the IPSS obstructive scores and Qmax at base line (P=<0.001), while correlations at the 1st, 2nd and 3rd follow up significant. There was also a significant correlation between IPSS obstructive score and PVR, and quality of life. After TURP, the IPSS Score showed significant improvements in urinary symptoms with the IPSS showing more significant change for obstructive symptoms. A significant improvement of IPSS was found from 2 months to 6 months follow up after TURP. The change was tested using “paired student ‘t’ test”. Mean quality of life was 5.01+0.64 at base line, which became 0.60+0.91 at end point and therefore change of mean QOL was -4.41+0.93 ml. A significant improvement QOL after transurethral resection of the prostate. The change was test using ‘Paired Student‘t’ test’. The change was found significant (P=<0.001). Conclusion: Transurethral resection of prostate resolves obstructive symptoms, rapid improvement of urinary flow rate and quality of life that is why it is considered as gold standard treatment for moderate to severe symptomatic BPH patients. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.3-8

scholarly journals Association of Detrusor Muscular Activity With the Outcome of Transurethral Resection of Prostate in Patients With Severity of Bladder Outflow Obstruction

2020 ◽  
Vol 18 (2) ◽  
pp. 56-61
Author(s):  
Md Naushad Alam ◽  
Md Fazal Naser ◽  
Kamrun Nahar ◽  
Md Waliul Islam ◽  
Md Mamunur Rashid ◽  
...  
Keyword(s):  
Flow Rate ◽  
Urine Volume ◽  
Muscular Activity ◽  
Urinary Flow Rate ◽  
Urinary Flow ◽  
Residual Urine Volume ◽  
Outflow Obstruction ◽  
College Hospital ◽  
Medical College ◽  
Detrusor Contractility

Objective: To evaluate the association of detrusor muscular activity with outcome of TURP in patients with severity of bladder outflow obstruction. Methods: This is a hospital based cross sectional study conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka.Elderly male patients having lower urinary tract symptoms (IPSS=20-35) with no retention (non-catheterized patient), who attended in Dhaka Medical College Hospital, were included in the study. A total of 73 patients meeting the enrollment criteria were included in the study. They were evaluated by history, physical examination including DRE and necessary investigations to identify the potential candidates for TURP. Then the potential participants were counseled for Urodynamic study. All patients underwent TURP by expert surgeon. Three months after TURP, repeat Urodynamic study was done and the results were compared to see the outcome. Afterward the data were plotted for the clarification of detrusor contractility at three levels: normal detrusor contractility (voiding pressure 40-60cm of water), detrusor over activity (voiding pressure >60cm of water) and detrusor under activity (voiding pressure <40 cm of water). According to the provisional ICS nomogram for the analysis of voiding, patients were divided into three classes. In BOO Index(PdetQmax-2Qmax),obstructed(BOOI > 40); equivocal(BOOI=20-40);Unobstructed(BOOId” 20) are taken into consideration. The test statistic used to analyze the data was descriptive statistics and ANOVA test. The level of significance was set at 0.05 and P<O.05 was considered significant. Results: Out of 73 patients 8 didn’t attend follow up session and hence excluded keeping 65 for final analysis. The mean age was 66.3 ± 9.7 years (50- 87 years) .Detrusor over activity was present in 13(20%), normal detrusor contractility was observed in 46(70.8%) and weak contractility in 6(9.2%). Peak urinary flow rate was almost similar among patients of different groups. However, voided volume and residual volume were lowest in overactive group and highest in underactive group, while normal group was in between two (p = 0.007 and p = 0.046 respectively). Maximum urinary flow rate and voided urine between patients of moderate and severe bladder outlet obstruction were almost comparable (p =0.120 and p = 0.270 respectively). However, residual urine volume was much higher in the patients of moderate BOO than that in severe BOO (p = 0.001).The patients of OAB experienced a significant improvement in percentage of reduction of residual urine volume compared to normal and underactive bladder (p = 0.002), However, there were no significant difference among the patients with overactive, normal and underactive bladder with respect to peak urinary flow rate and voided urine volume (p = 0.499 and p = 0.847 respectively). Conclusion: TURP is an effective surgical procedure for treatment of BPH, especially for patients with severe degree of BOO with normal or overactive detrusor contraction. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.56-61

scholarly journals Evaluation of the Short Term Outcome of Unilateral Urethral Mobilization Compared to Circumferential Urethral Mobilization for the Management of Bulbar Urethral Stricture

2020 ◽  
Vol 19 (1) ◽  
pp. 32-37
Author(s):  
Kartik Chandra Ghosh ◽  
Md Mizanur Rahman ◽  
Md Shafiqul Alam Chowdhury ◽  
Produyt Kumar Saha ◽  
Mohammed Mizanur Rahman ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Buccal Mucosa ◽  
Urine Volume ◽  
Urinary Flow Rate ◽  
P Value ◽  
Urinary Flow ◽  
College Hospital ◽  
Group I ◽  
Group Ii

Objective: To evaluate and compare the outcome of buccal mucosal graft urethroplasty of unilateral and circumferential urethral mobilization for the management of bulbar urethral stricture. Methods: Seventy patients having bulbar urethral strictures admitted in the Department of Urology, Dhaka Medical College Hospital, Dhaka between January 2010 to December 2011. Patients were divided into two groups. Group-I, underwent unilateral urethral mobilization, and Group-II, underwent circumferential urethral mobilization for buccal mucosa graft urethroplasty. All patients were followed up at least six months. The statistics used to analyze the data were descriptive statistics, and p value <0.05 was considered as significant. Results: Mean±SD of age in Group-II and Group-I were 41.1±9.2 and 37.4±8.2 years respectively. All the baseline findings were identically distributed between the groups. Comparison of outcome at month 3 showed that peak urinary flow rate increased from their baseline figures, but the increase was significantly more in the unilateral group than that in the circumferential group (21.2±1.2 vs. 18.9±2.0 Qmax, p =< 0.001). After 6 months, evaluation showed that the peak urinary flow rate significantly higher in Group-I, than that in Group-II, (24.2±2.9 vs. 21.9 ± 3.3, p < 0.001). The voided urine volume was also significantly higher in Group-I, than that in Group-II (330.8±50.1 vs. 294.5±46.1 ml, p = 0.004). Consequently, PVR was lower in the former group than that in the latter group (11.6±3.3 vs. 14.1±2.9 ml, p = 0.002). Complications in unilateral urethral mobilization had a significantly lower (20%) than that of circumferential urethral mobilization(45.71%) (p=0.024). Conclusion: Buccal mucosa grafting is a versatile and effective treatment for the anterior urethral stricture, and the outcome is excellent following unilateral urethral mobilization in experienced hands. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.32-37

scholarly journals Evaluation of the short-term outcome of unilateral urethral mobilization for the management of bulbar urethral stricture

2021 ◽  
Vol 9 (12) ◽  
pp. 3506
Author(s):  
Kartik Chandra Ghosh ◽  
Prodyut Kumar Saha ◽  
Masud Ahmed ◽  
Farhad Mahmud ◽  
Uttam Karmaker
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Urine Volume ◽  
Postoperative Outcome ◽  
Urinary Flow Rate ◽  
Urethral Reconstruction ◽  
Urinary Flow ◽  
College Hospital ◽  
Term Outcome ◽  
The Mean

Background: In modern urology, successful male urethral reconstruction poses a continuing challenge.Methods: It was a quasi-experimental study conducted in the department of urology, Dhaka medical college hospital, Dhaka, Bangladesh between January 2010 to December 2011. 35 patients having bulbar urethral strictures admitted in the department were study participants. All the participants underwent unilateral urethral mobilization, for buccal mucosa graft urethroplasty and followed up at least six months. RGU and MCU was done when peak flow was <15 ml /sec in uroflowmetry. Urethroscopy was done at 3rd and 6th month. The statistics used to analyze the data were descriptive statistics, and the tests done were student’s t-test, chi-square test, ANOVA, and Fisher exact test.Results: The length of strictures was observed ≤3 cm among 31% (n=11) and >3 cm among 69% (n=24) patients. As the immediate postoperative outcome among the participants, we found the mean peak urinary flow rate (Qmax), 15.3±1.2 and voided urine volume (ml), 328.8±50. Finally, as the postoperative outcome after 6 months among the participants, we found the mean peak urinary flow rate (Qmax), 24.2±2.9; voided urine volume (ml), 330.8±50.1 and PVR (ml), 11.6±3.3. In this study, some potential complications were bleeding and wound infection which were found among 11.43% and 17.14% patients respectively. Conclusions: Considering the satisfactory outcomes and lower complications unilateral urethral mobilization procedure can be considered as an effective treatment method for the management of bulbar urethral stricture.  

URINARY FLOW RATE RECORDING: THE IMPACT OF A SINGLE DOSE OF A DIURETIC ON CLINIC LOGISTICS AND FLOW RATE PARAMETERS

1999 ◽  
Vol 161 (5) ◽  
pp. 1509-1512 ◽  
Author(s):  
EARL J. GUREVITCH ◽  
NAVEEN KELLA ◽  
TRACY GAPIN ◽  
CLAUS G. ROEHRBORN
Keyword(s):  
Single Dose ◽  
Flow Rate ◽  
Urinary Flow Rate ◽  
Urinary Flow ◽  
The Impact

scholarly journals Electroacupuncture for Postoperative Urinary Retention: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-17
Author(s):  
Yajing Zhong ◽  
Fanzhu Zeng ◽  
Jiaying Li ◽  
Yunhua Yang ◽  
Shuxian Zhong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Retention ◽  
Therapeutic Effect ◽  
Flow Rate ◽  
Urine Volume ◽  
Bladder Capacity ◽  
Urinary Flow Rate ◽  
Urinary Flow ◽  
Residual Urine Volume ◽  
Postoperative Urinary Retention

Background. This systematic review aimed at summarizing and evaluating the evidence from randomized controlled trials (RCTs) which used electroacupuncture (EA) to treat postoperative urinary retention (PUR).Methods. We searched thirteen databases electronically through April 2018 without language restrictions. We included RCTs of women with PUR; other types of urinary retention or not-RCTs were excluded. Two independent reviewers extracted studies’ characteristics, and disagreements were resolved by consensus. Data were pooled and expressed as standard mean difference (SMD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes, with 95% confidence interval (CI).Results. We found very low to moderate level of evidence that effects of less than or equal to a week were statistically significant: therapeutic effect improved (OR=4.21; 95%CI [3.04, 5.83]; P<0.00001), residual urine volume decreased (SMD=-13.24; 95%CI [-15.70, -10.78]; P<0.00001), bladder capacity increased (SMD=0.56; 95%CI [0.30, 0.83]; P<0.0001), and urinary flow rate improved (SMD=0.91; 95%CI [0.64, 1.18]; P<0.00001). Effect over a week was statistically significant as well. Therapeutic effect improved (OR=8.29; 95%CI [2.91, 24.25]; P<0.0001), residual urine volume decreased (SMD=-1.78; 95%CI [-2.66, -0.89]; P<0.0001), bladder capacity (SMD=0.92; 95%CI [0.61, 1.23]; P<0.00001) and urinary flow rate (SMD=1.69; 95%CI [0.59, 2.79]; P=0.003) increased, and first urination after surgery was earlier (SMD=-0.92; 95%CI [-1.37, -0.46]; P<0.0001), compared with physical exercise, medication, or no treatment.Conclusion. The efficacy and safety of EA on key outcomes in women with PUR are statistically significant, but the level of most evidence was very low or low. More large-scale, long-term RCTs with rigorous methodological quality are needed.

scholarly journals Comparison of Outcome of Transurethral Resection of Prostate Between Patients With Preoperative Low or Normal and High Voiding Pressure

2020 ◽  
Vol 21 (2) ◽  
pp. 111-119
Author(s):  
Md Nazrul Islam ◽  
Md Jahangir Alam ◽  
Amirul Islam ◽  
Maruf Ahmed ◽  
Pravath Chandra Biswas
Keyword(s):  
Flow Rate ◽  
Urine Volume ◽  
Urinary Flow Rate ◽  
Urinary Flow ◽  
Pressure Group ◽  
Urodynamic Study ◽  
Detrusor Pressure ◽  
Intravesical Pressure ◽  
Residual Urine ◽  
Maximum Urinary Flow

Objective: T0 compare the outcome of Transurethral Resecton of Prostate between Patients with Preoperative Low or Normal and High Voiding Pressure. Methods: This hospital based prospective observational study was conducted in the Department of Urology of Dhaka Medical college Hospital from July 2008 to June 2010 on male patients aging >59 years having Lower urinary tract symptoms (LUTS) attending to urology OPD& IPD were evaluated by history, physical examination including DRE and necessary investigations like USG of KUB and prostate with MCC & PVR, Q max, IPSS score to identify the potential candidates for TURP. Potential participants were counseled for urodynamic study. Who fulfilled the selection criteria included in this study in outpatient basis or admitted in the urology ward and numbered chronologically and performed urodynamic study and then patients underwent TURP, after 12 weeks of completion of TURP again a follow-up urodynamic study performed in all patients to compare the outcome between two groups. Sample size was 65, high pressure voiding group were 36 in number and Normal or low pressure voiding group were 29 in number. Data were collected on variables of interest using a structural data collection format. Data were processed and analyzed using SPSS (Statistical package for social science) software program. The test of significant employed to analyze the data was descriptive statistics and Student’s t-test, Paired and unpaired t- test, Fisher exact test. Probability value (P value < 0.05) was considered significant. Results: In this study the age ranges were 59 and 88 years and mean age was 70.7 ± 6.7 years. the maximum urinary flow rate, residual urine volume and maximum intravesical pressure 3 months after transurethral prostatic resection were significantly better in patients with high detrusor pressure compared to those with normal/low normal/low detrusor pressure (15.9±0.7 vs. 21.3±2.2ml/sec, p<0.001, 18.1±11.8 vs. 2.9±0.7 ml, p<0.001 and 48.3±6.2 vs. 71.9±15.2 cmH2O, p<0.001 respectively).The maximum urinary flow rate ( Q max ), residual urine volume, maximum intravesical pressure and detrusor pressure at peak urinary flow rate and also IPSS score were significantly improved 3 months after operation in both groups, more improvement was observed in preoperative high voiding pressure group. Post-voiding residual urine is a clear indication of poor outcome, and also the maximum urinary flow rate, maximum intravesical pressure and detrusor pressure at peak urinary flow rate all factors may precipitate decompensation of bladder and in low voiding pressure group decompensation of bladder occurs more than the high voiding pressure group as the preoperative and postoperative residual urine develops more in low voiding pressure group. Conclusion: The high voiding pressures (detrusor pressure) may influence in good postoperative outcome and helps in resolution of a significant outflow obstruction, there are good urodynamic reasons for avoiding unwanted TURP rather it could be justified by using urodynamic study which may predict outcome of TURP. So, we may assess properly the patient for prostatectomy by urodynamic study. As if we do this type of evaluation before TURP it may reduce the unwanted operation. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 111-119

Frequency of Carcinoma Prostate in Patients with Clinically Diagnosed Benign Prostatic Hyperplasia (BPH) and Prostate Specific Antigen d" 4ng/ml

2020 ◽  
Vol 15 (2) ◽  
pp. 44-47
Author(s):  
Md Shafiqur Rahman ◽  
Sudip Das Gupta ◽  
Sajid Hasan ◽  
Prodyut Kumar Saha ◽  
Amanur Rasul ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Benign Prostatic Hyperplasia ◽  
Flow Rate ◽  
Histopathological Examination ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Prostatic Hyperplasia ◽  
Urinary Flow Rate ◽  
Transurethral Resection Of Prostate ◽  
Urinary Flow

Objectives: The present study was carried out in the Department of Urology, Sir Salimullah Medical College Mitford Hospital Dhaka between July 2009 to May 2010. To determine the frequency of prostate cancer in patients with BPH & PSA level d” 4 ngm/ml. Methods: A total of 198 subjects aged above 50 years with serum PSA level of not more than 4.0 ng per milliliter , no suspicious nodule on digital rectal examination , homogenous echogenicity of prostate on ultrasonographic findings, peak urinary flow rate (Qmax) < 10ml/sec in uroflowmetry and no clinically significant coexisting conditions were included in the study. All the patients presented with obstructive urinary symptoms attended at four tertiary hospitals in Dhaka city during the study period were evaluated with clinical history, physical examination and some investigations. All the patients were treated with transurethral resection of prostate (TURP). Chips were collected carefully and sent for histopathology. Results: The mean age was 65.1 ± 7.3 years. About 32% of patients had serum PSA level 2 ng/ml or less and 68.2% more than 2 ng/ml. The peak urinary flow rate was 7.2 ± 2.7 ml/sec. One hundred and ninety three (98%) patients were diagnosed as having benign prostatic hyperplasia (BPH) on histopathological examination and 5(2.5%) as having prostate carcinoma. Conclusion: Prostate cancer is not rare among men with PSA levels of 4.0 ng per milliliter or less Bangladesh Journal of Urology, Vol. 15, No. 2, July 2012 p.44-47

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