Role of Doppler ultrasound and resistive index in benign prostatic hypertrophy
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The aim of the present study was to assess the resistive index in patients with benign prostatic hypertrophy (BPH) and the role of power Doppler ultrasonography.From April 1996 to December 1997, a total of 214 men aged 48-86 years with symptoms of BPH were prospectively enrolled to participate in our study. All patients presented to our clinic with lower urinary tract symptoms. Transrectal ultrasonography was used to calculate the total prostate volume (TPV), transition zone (TZ) volume, transition zone index (TZI = TZ volume/TPV) and presumed circle area ratio (PCAR). Power Doppler imaging was used to identify the capsular and urethral arteries of the prostate and measure its resistive index (RI) value.The RI of capsular arteries significantly correlated with theTPV, TZ volume, TZI (r = 0.470; P < 0.0001) and PCAR (r = 0.334; P < 0.0001). Correlations were found between the RI of capsular arteries and the International Prostatic Symptom Score (IPSS) (r = 0.389; P < 0.0001), peak flow rate of uroflowmetry (r = -0.393; P < 0.0001).We demonstrated that an increase of the RI of capsular arteries correlated with increases in the TZI and PCAR in BPH. The lower IPSS and peak flow rate correlated with the high RI of capsular arteries; however, no correlation between the RI of urethral arteries and prostatic parameters was found. The findings suggested that the RI of capsular arteries may become the index for measuring lower urinary obstruction in the future.Keywords:
Resistive index
Doppler ultrasound
Individual anatomical structural variations, including intravesical prostatic protrusion (IPP), prostatic urethral angle (PUA), prostatic urethral length, or prostatic apex shape, were correlated with micturition symptoms. We aimed to investigate the effects of these variables on micturition symptoms in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS).This observational study was based on data from 263 men with the first visit to health promotion center and without BPH/LUTS treatment between March 2020 and September 2022. A multivariate analysis was performed to determine the variables affecting total international prostate symptom score, maximum flow rate (Qmax), and voiding efficacy (postvoid residual volume to total bladder volume ratio).Of 263 patients, decreasing PUA increases the severity of international prostate symptoms score (mild, 141.9°; moderate, 136.0°; severe, 131.2°; P<0.015). A multivariate analysis reported that the total international prostate symptom score was correlated with age (P=0.002), PUA (P=0.007), and Qmax (P=0.008). Qmax was negatively associated with IPP (P=0.002). In subanalysis for large prostate volume (≥30 mL, n=81), international prostate symptom score was correlated with PUA (P=0.013), Qmax was correlated with prostatic apex shape (P=0.017), and length of proximal prostatic urethra (P=0.007). IPP was not identified as a significant factor. For small prostate volume (<30 mL, n=182), age (P=0.011) and prostate volume (P=0.004) are correlated with increasing Qmax.This study presented that individual anatomical structure variations influenced the micturition symptoms according to prostate volume. To identify the major resistant factors in men with BPH/LUTS, further studies are required to investigate which components played a role in major resistant factors for micturition symptoms.
Urination
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To evaluate whether intravesical protrusion of the prostate (IPP) is related to the treatment effect of alpha-1 receptor antagonist in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) with a prostate size of less than 40 g.A total of 77 BPH patients over 50 years of age treated with alfuzosin (alpha blocker) were enrolled prospectively. The study included only patients with BPH of 40 g or less. The patients were classified into two groups depending on the presence of IPP at baseline: the IPP group (41 patients) and the non-IPP group (36 patients). Prostate volume, prostate-specific antigen (PSA), International Prostate Symptom Score and quality of life (IPSS/QoL), maximum flow rate (Qmax), and postvoid residual (PVR) volume were compared between the groups. The clinical significance of IPP was evaluated after the patients had been taking alfuzosin for 8 weeks.PSA and IPSS (total and voiding subscore) showed significant correlations with IPP (P<0.05). Comparison of parameters before and after 8 weeks showed that alfuzosin improved the total IPSS and all subscores (P<0.001), QoL (P<0.001), Qmax (P<0.001), and PVR (P=0.030) in the non-IPP group.Alfuzosin may be less effective in improving symptom scores, PVR, and Qmax in the treatment of LUTS/BPH in the presence of IPP.
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Abstract Background The aim of the study is to find the correlation between the prostate volume and severity of lower urinary tract symptoms (LUTS) as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia (BPH). Methods The study was a prospective correlational study conducted between June 2016 and November 2017. A total of 290 patients who presented with LUTS suggestive of BPH and satisfied the inclusion criteria were consecutively recruited. Clinical evaluation including digital rectal examination of the prostate was done. Symptoms severity was assessed using the self-administered international prostate symptoms score (IPSS) questionnaire. Prostate volume was determined by transrectal ultrasound scan, and the urine flow rate was measured using uroflowmeter. Data were analyzed using SPSS version 20.0, and p value < 0.05 was taken to be statistically significant. Results The mean age of the patients was 64.22 ± 9.04 years with a range of 40 to 95 years. Most of the patients had moderate symptoms (55%) on IPSS with the mean IPSS value of 16.41 ± 7.43. The mean Qmax value was 16.55 ± 7.41 ml/s, and the median prostate volume (IQR) was 45.05 (35, 59). There was a positive significant correlation between prostate volume and IPSS ( r = 0.179, p = 0.002) and a negative significant correlation between prostate volume and Qmax ( r = − 0.176, p = 0.003). Conclusion This study showed a significant correlation between the prostate volume and IPSS, and also between prostate volume and maximum flow rate (Qmax).
Rectal examination
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Nephrology
Transrectal ultrasonography
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Resistive index
Urinary tract obstruction
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The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH).The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist.The 110 patients were categorized according to IPSS (mild symptoms, 0-7; moderate symptoms, 8-19; and severe symptoms, 20-35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP.RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.
Transrectal ultrasonography
Resistive index
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Objectives: Although there are several studies addressing the efficacy of phosphodiesterase type 5 inhibitors for the management of benign prostatic hyperplasia-lower urinary tract symptoms (BPH-LUTS), unfortunately, there is a lack of high evidence data to support their effect at the prostate level. The existing studies suggested that resistive index (RI) could be used as a hemodynamic parameter to measure the severity of benign prostatic hyperplasia and intraprostatic pressure or bladder outlet obstruction. The aim of this study was to evaluate the effect of a single dose 20 mg tadalafil on resistive index value in prostate zones to evaluate the mechanism of action of phosphodiesterase type 5-inhibitors at the prostate level. Methods: Twenty consecutive patients aged between 54-67 years with BPH-LUTS [International Prostate Symptom Score ≥ 12] and erectile dysfunction [five-item International Index of Erectile Function (IIEF) questionnaire < 22] underwent RI measurement in prostate transitional zone (TZ) and peripheral zone (PZ) using transrectal power Doppler ultrasonography baseline and within 16 hours after the administration of 20 mg tadalafil. The primary study end point is the change in prostate TZ RI values. Results: The mean baseline total prostate scores and peak urinary flow were 16.2 ± 4.34 (range: 12-26) and 10.45 ml/s (range: 7-13 ml/s), respectively. The mean baseline total IIEF was 12.8 ± 4.22 (range: 6-20). The mean TZ RI at baseline and after tadalafil administration were 0.4985 and 0.5497, respectively (p = 0.232). No statistically significant differences for RI changes between baseline and after the administration of a single dose 20 mg tadalafil were observed in the prostatic zones. Conclusion: A single dose 20 mg tadalafil showed no impact on prostate TZ RI.
Resistive index
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The prostatic urethra is a bent tube, and the clinical significance of the prostatic urethral angle (PUA) was recently reported. We investigated the statistical significance of an increased PUA on the International Prostate Symptom Score (IPSS) in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptom (LUTS).A retrospective analysis was done of 270 men with BPH/LUTS from July 2009 to June 2011. Prostate volume, PUA, and intravesical prostatic protrusion (IPP) were measured by transrectal ultrasonography (TRUS). The IPSS was analyzed separately as storage and voiding symptom score. In order to minimize the effect of prostate size on voiding, patients with prostate size over 40 ml were excluded.The mean age was 62.0±9.3 years. The mean prostate volume was 29.0±5.5 ml (range, 20 to 40 ml), and median PUA and IPP were 34° (range, 12 to 52°) and 1.7 mm (range, 0 to 5.3 mm), respectively. The mean IPSS, mean IPSS-ss, and mean IPSS-vs were 19.0±8.2, 7.3±4.0, and 11.6±5.5, respectively. The prostate volume had no statistically significant correlation with IPSS, IPSS-ss, or IPSS-vs. IPP had a statistically significant correlation with IPSS (p<0.001), IPSS-ss (p<0.001), and IPSS-vs (p<0.001). PUA had no statistically significant correlation with IPSS or IPSS-ss. However, PUA had a significant correlation with IPSS-vs (p=0.047). Comparing a higher PUA (≥34°) with a lower PUA (<34°), patients with a higher PUA had a higher IPSS (p=0.001) and a higher IPSS-vs (p=0.001). There was no significant difference in IPSS-ss, prostate volume, or PSA between the two groups.IPP showed significantly correlated with the IPSS and voiding symptom score was affected by the PUA but not by the prostate volume. As the PUA increased, the patients' voiding symptoms worsened. Further study may be needed.
Transrectal ultrasonography
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IntroductIon: To study the relationship between intravesical prostatic protrusion (IPP) and prostate volume (PV) and to determine which one of them is the better in assessment of symptoms in benign prostatic hyperplasia (BPH).
Method: In this prospective study, 60 men with lower urinary tract symptoms (LUTS) were included. They were evaluated with digital rectal examination, International Prostate Symptoms Score (IPSS), Quality Of Life (QOL), Uroflowmetry, Residual Urine Volume (RUV) measurement, IPP and PV using transabdominal ultrasound scan. IPP and PV were correlated with IPSS using
Pearson’s correlation coefficient. One-way ANOVA was used to measure association between ordinal variables.
Results: Of 60 men with LUTS due to BPH, the mean IPSS was 18.33 ± 6.736 with quality of life (QOL) score of 4.07 ± 1.148. IPP correlated well and positively with IPSS (r=0.354, p=0.006) and QOL (0.429, p=0.001). PV correlated weakly with IPSS (r=0.270, p=0.0370) however there was no correlation with IPP, QOL.
ConclusIon: The IPP assessed by transabdominal ultrasound is more accurate than PV in evaluating bothersome symptoms in men with BPH.
Key words: Intravesical protrusion of prostate, International prostate symptom score, Lower urinary tract symptoms
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To evaluate the impact of intravesical prostatic protrusion (IPP) and prostatic calcification on medical treatment for male lower urinary tract symptoms (LUTS). Men over the age of 40 years with total International Prostate Symptom Score (IPSS) ≥ 8 were recruited from January to August 2013. The maximal flow rate, postvoiding residual (PVR) urine volume, total prostate volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), and grades of IPP and prostate calcification were recorded. All patients received α-blocker monotherapy, and Global Response Assessment (GRA) was used to determine treatment response 1 month after the treatment. The primary end point was to compare the treatment results in patients with and without significant IPP or prostate calcification. Univariate and multivariate logistic regression analyses were performed to determine whether IPP and prostatic calcification are predictors of improved outcome (GRA ≥ 1). We enrolled 112 men with a mean age of 65.5 (range, 42–89) years. IPP was significantly positively correlated with TPV, TZV, TZI, and PVR. Prostatic calcification was significantly negatively correlated with total IPSS, IPSS Voiding, and IPSS Storage. After 1-month treatment with α-blockers, the average total IPSS decreased from 18.2 ± 7.4 to 13.1 ± 4.5. Sixty-nine patients (61.6%) reported improved outcomes. Patients with large prostate volumes (TPV ≥ 40 mL) and small prostate volumes (TPV < 40 mL) had similar improved outcome rates (56.5% and 65.1%, respectively). Patients with significant IPP (Grades II and III) had significantly lower improved outcome rates (36.8%) than those without significant IPP (74.3%). Patients with prostatic calcification also had a significantly lower rate of improved outcome (47.9%) than those who did not (71.9%). Multivariate logistic regression analyses showed that IPP and prostatic calcification are predictors of unfavorable outcome (GRA < 1) after adjusting for age, TPV, and total IPSS. Significant IPP and prostatic calcification are unfavorable predictors of successful α-blocker treatment for benign prostatic hyperplasia-induced male LUTS.
Univariate analysis
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