Correlation of Intravesical Prostatic Protrusion in Benign Prostate Hyperplasia and Residual Lower Urinary Tract Symptoms After Surgery: A Systematic Review

Context: Intravesical prostatic protrusion (IPP) is a potential candidate for the initial evaluation of patients with lower urinary tract symptoms (LUTS). Intravesical prostatic protrusion is also known to predict the outcome of trials without a catheter and medical treatment outcomes and to determine bladder outlet obstructions. Objectives: This study aimed to determine whether IPP influences the residual LUTS after surgery in patients with benign prostate hyperplasia who have undergone prostate surgery. Evidence Acquisition: An online database search was conducted regarding the prognosis of postoperative benign prostate hyperplasia patients with intravesical prostatic protrusions. The selected databases comprised PubMed, ScienceDirect, EBSCO, and Cochrane Library. Randomized controlled trial, cohort, or case control studies that were written in English or Bahasa and published up until November 2020 were included. We reviewed postoperative outcomes, including subjective symptoms, based on the International Prostate Symptom Score and objective signs, such as Qmax and post voiding residue. Results: Our initial database search yielded 143 papers. After exclusion from abstract screening, seven papers were considered for full-text analysis. Five of these studies showed higher preoperative intravesical prostatic protrusion within successful postoperative outcomes. Some studies showed that patients with significant intravesical prostatic protrusions had more significant International Prostate Symptom Score decrements. However, two studies demonstrated that intravesical prostatic protrusion was not a significant prognostic factor. Conclusions: Most studies suggested that intravesical prostatic protrusion can predict better post-surgery lower urinary tract symptom outcomes. Further research using information about the risk of bias in ultrasound examination and more homogeneous surgical techniques and considering the duration of patients’ illness before they receive surgical management is needed.

Hubungan Intravesical Prostatic Protrusion (IPP) terhadap Perubahan International Prostate Symptoms Score (IPSS) pada Pasien Benign Prostatic Hyperplasia (BPH) yang Diterapi dengan A1-Blocker di Kota Padang

Latar Belakang dan Tujuan. Benign Prostatic Hyperplasia (BPH) merupakan pembesaran jinak kelenjar prostat akibat proliferasi sel epitel dan stroma sehingga menimbulkan gejala Lower Urinary Tract Symptoms (LUTS). Salah satu penanganan BPH adalah terapi medikamentosa dengan alpha-1 blocker. Keberhasilan terapi medikamentosa dipengaruhi banyak faktor salah satunya adalah Intravesical Prostatic Protrusion (IPP). Metode. Penelitian prospektif komparatif yang bertujuan untuk mencari pengaruh IPP terhadap respon terapi alpha-1-blocker pada pasien BPH. IPSS dipakai sebagai alat ukur tersebut. IPP diperiksa dengan menggunakan USG transabdominal. Penelitian dilakukan dari Juli 2020 sampai Desember 2020. Data dianalisis dengan uji perbandingan rata-rata one way anova dan uji korelasi Pearson. Hasil. Dari sampel 30 orang, pasien dibagi menjadi 3 kelompok berdasarkan derajat IPP yaitu, derajat I (<5mm), derajat II (5-10mm) dan derajat III (>10mm). Tidak terdapat perbedaan bermakna skor rata-rata IPSS awal pada masing – masing kelompok, yaitu 19.6, 18.90, dan 21,30 (p=0.216). Terdapat penurunan bermakna rata-rata IPSS setalah 1 bulan terapi dengan alpha-1 blocker. Terdapat korelasi yang bermakna nilai IPP terhadap penurunan IPSS akhir dengan arah korelasi negatif. Kesimpulan. Terdapat hubungan bermakna antara derajat IPP terhadap penurunan IPSS pada pasien BPH setelah mendapatkan terapi aplha-1 blocker, semakin tinggi derajat IPP maka semakin rendah perbaikan IPSS akhir.

RELATION OF TOTAL CHOLESTEROL TO PROSTATE VOLUME AND INTRAVESICAL PROSTATIC PROTRUSION IN BENIGN PROSTATIC HYPERPLASIA PATIENTS

Objective: To determine the relationship between total cholesterol, prostate volume, and intravesical prostatic protrusion in patients with benign prostatic hyperplasia. Material & Methods: This study used a cross-sectional method, carried out at the Paru and Bina Sehat Hospital in Jember. The sample in this study was BPH patients who met the inclusion criteria taken through medical record data from October 2019 to January 2020 Results: Samples on this study amounted to 33 patients. In this study, there was a difference between normal and high cholesterol with prostate volume in BPH patients (p = 0.00) and there was a significant relationship between cholesterol and prostate volume with strong correlation strength (p = 0.00 and r = 0.751) while the difference between high and normal cholesterol with IPP obtained insignificant results (p = 0.211) and the correlation between cholesterol and IPP obtained an insignificant relation with weak correlation strength (p = 0.217 and r = 0.221). Conclusion: There is a significant relationship between total cholesterol and prostate volume and a significant difference in prostate volume between normal and high total cholesterol in BPH patients, while there is no significant result between total cholesterol and intravesical prostatic protrusion in BPH patients.

A CLINICAL STUDY TO CORRELATE LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC HYPERPLASIA WITH THE PROSTATE VOLUME AND THE INTRAVESICAL PROSTATIC PROTRUSION

Introduction: International Prostate Symptom score (IPSS) which is identical to AUA symptom index, is recommended as a symptom scoring instrument to be used for baseline assessment of symptoms severity in men presenting with Lower Urinary Tract Symptoms.The correlation of prostate volume PV, IPP and IPSS has been extensively investigated. It was generally accepted that there was weak correlation of PV with IPSS and strong correlation of IPP with IPSS.We conducted this study to nd out whether this generally accepted correlation holds true for our patients from north east region of india Materials and Methods:This was a prospectively designed study conducted in the department of Urology, Regional institute of medical sciences imphal to To correlate lower urinary tract symptoms due to benign prostatic hyperplasia with prostate volume and intravesical prostatic protrusion. A total of 154 patients of BPH were included in the study. Statistical analysis was done by using IBM SPSS Version 21 for windows.Chi square test/scher exact test was used as a test of signicance of the study for comparing the outcome variables. P-value <0.05 was taken as signicant. Spearman correlation coefcient for categorical data and Pearson's correlation coefcient analysis for continuous variables was carried out Results and Observations:In our study maximum number of patients were in the moderate IPSS grade category 89 patients(58.00%) were having moderate symptoms,55 patients(36.0%) were having severe symptoms and 10 patients(6.0%) were having mild symptoms.There was statistically signicant and strong correlation between intraprostatic protrusion and International Prostate Symptoms Score with ('p' value <0.0001 and r =0.78). There was statistically signicant and strong correlation between Prostate volume (PV) and International Prostate Symptoms Score with ('p' value <0.001 and r =0.56). Conclusion:This study concludes that both IPP and PV have strong correlation with symptoms of BOO measured by IPSS. IPP is easy to acquire and non invasive. IPP can also helps in predicting some times the high IPSS score despite of a small prostate volume

Clinical Significance of Intravesical Prostatic Protrusion Index in Patients with Clinical Diagnosis of Benign Prostatic Hyperplasia.

Purpose: To investigate the clinical significance of the intravesical prostatic protrusion (IPP) index in benign prostatic hyperplasia (BPH) patients to clarify its diagnostic value in predicting the clinical and structural abnormalities of the prostate. Materials and Methods: In this descriptive and analytical cross-sectional study, we include every man older than 50 years old with lower urinary tract symptoms (LUTS), predominantly voiding or obstructive, suggestive of BPH. The patients were evaluated to determine the following indices: IPSS (International Prostate Symptom Score) Index, QoL (quality of life), prostate volume (PV) and postvoid residual urine (PVR), serum PSA level, and the maximum urinary flow rate (Qmax) obtained by uroflowmetry. Subsequently, the assessment of the IPP index was undertaken by transabdominal ultrasonography. The categorization of the IPP index was done into 3 grades: grade one (below 5 mm), grade two (between 5 and 10 mm), and grade three (greater than 10 mm). Results: The significant direct correlation between the intravesical prostatic protrusion and international prostate symptom score, quality of life, prostate volume, postvoid residual urine, and serum PSA as well as inversely with the maximum urinary flow rate was confirmed both before and after the medical treatment. Also, the need for surgical intervention increased significantly with increasing IPP levels. Conclusion: The intravesical prostatic protrusion can be used to evaluate and predict the severity of symptoms and outcomes in patients with clinical BPH.

A Review of Intravesical Prostatic Protrusion in the Evaluation and Treatment of Benign Prostatic Enlargement

The evaluation of severity of symptoms, tracking complications, choosing effective and efficient approach to treatment, and prognosis is important in benign prostatic enlargement (BPE) patients. Measurement of intravesical prostatic protrusion (IPP) is an easy, affordable and non-invasive marker for benign prostatic obstruction with a high diagnostic value. This study aims to undertake a descriptive review of current literature for the role of IPP in the evaluation and treatment of patients with BPE. Relevant articles written in English language were retrieved from PubMed and Google Scholar. Keywords used for searching articles included intravesical prostatic Protrusion and Benign Prostatic Enlargement/ hyperplasia/ Obstruction; evaluation; and treatment. Papers published between January 1990 and October 2020 were extracted and evaluated. The analyzed studies showed that IPP can be assessed by various modalities and is important in the evaluation of symptom severity, tracking progression and complications of disease, choosing treatment option and prognostication. It is important that IPP be always assessed at the point of initial evaluation of BPE patients.

Correlation of intravesical prostatic protrusion with severity of lower urinary symptoms among patients with benign prostatic hyperplasia

Background Benign prostate hyperplasia (BPH) is characterized by an increase in the number of epithelial and stromal cells in the periurethral area of the prostate. Lower urinary tract symptoms (LUTS) often develop as a manifestation of bladder outlet obstruction (BOO) due to benign prostate enlargement. When the prostate enlarges, protrusion into the bladder often occurs as a result of morphological changes of the gland. Prostatic protrusion into the bladder can be measured with ultrasound as intravesical prostatic protrusion (IPP). There are studies that have shown IPP as a reliable predictor of bladder obstruction index (BOOI) as measured by pressure flow studies. IPP is thereby reliable in assessing the severity of BOO in patients with BPH. The severity of symptoms in patients with BPH can be assessed through several scoring systems. The most widely used symptoms scoring system is the International Prostate Symptoms Score (IPSS). The aim of this study is to determine the correlation of IPP with IPSS in men with BPH at our facility. Methods The study was a cross-sectional observational study that was conducted at the Division of Urology, Department of Surgery, in our facility. The study was conducted on patients greater than 50 years LUTS and an enlarged prostate on digital rectal examination and/or ultrasound. All consenting patients were assessed with the International Prostate Symptoms Score (IPSS) questionnaire, following which an abdominal ultrasound was done to measure the intravesical prostatic protrusion (IPP), prostate volume (PV) and post-void residual (PVR) urine. All the patients had uroflowmetry, and the peak flow rate was determined. The data obtained were entered into a proforma. The results were analyzed using Statistical Package for Social Sciences (SPSS) software package version 20. Results A total of 167 patients were seen during the study period. The mean age was 63.7 ± 8.9 years, with a range of 45–90 years. The mean IPSS was 18.24 ± 6.93, with a range of 5–35. There were severe symptoms in 49.1%, while 43.1% had moderate symptoms and 7.8% had mild symptoms. The overall mean IPP was 10.3 ± 8 mm. Sixty-two patients (37.1%) had grade I IPP, 21 patients (12.6%) had grade II IPP and 84 patients (50.3%) had grade III IPP. The mean prostate volume and peak flow rate were 64 g ± 34.7 and 11.6 ml/s ± 5.4, respectively. The median PVR was 45 ml with a range of 0–400 ml. There was a significant positive correlation between the IPP and IPSS (P = 0.001). IPP also had a significant positive correlation with prostate volume and post-void residual and a significant negative correlation with the peak flow rate (P < 0.01). Conclusion Intravesical prostatic protrusion is a reliable predictor of severity of LUTS as measured by IPSS, and it also shows good correlation with other surrogates of bladder outlet obstruction.