Correlation between the International Prostate Symptom Score, Ultrasound Features and Maximum Flow Rate in Cameroonian Patients with Benign Prostatic Hypertrophy
Background: Benign prostatic hypertrophy is the non-malignant stromal and epithelial proliferation of the prostate gland, with or without associated anatomical enlargement of the gland and clinical symptoms. Symptomatic Benign prostatic hypertrophy may cause obstructive symptoms, irritative symptoms or both obstructive symptoms include a sensation of incomplete bladder emptying, straining to void, urinary hesitancy and weak stream while irritative symptoms include dysuria, nocturia, urinary frequency and urinary urgency. A quantitative measure of the severity of lower urinary tract symptoms due to benign prostatic hypertrophy can be obtained using the International Prostate Symptoms Score. Ultrasonography is useful for helping to determine bladder and prostate size in patients with urinary lower urinary tract symptoms. Uroflowmetry is a non-invasive test that assesses voiding function. It provides valuable data on the voided volume, time is taken to reach maximum flow rate and average flow rate. The goal of this study was to improve the follow up of patients with benign prostatic hypertrophy by providing simple, available, affordable and non-invasive that best predict bladder outlet obstruction and the quality of life in these patients. Method: This was a cross-sectional analytic study carried out over a period of five months from May 2020 to September 2020 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, which is a tertiary hospital in Cameroon. Were included in the study, adult males who presented with lower urinary tract symptoms and prostatic enlargement suggestive of benign prostatic hypertrophy taking into account clinical, uroflowmetry and ultrasound findings. Results: A study population of 103 participants was recruited. The mean age of patients was 63.17 ± 10.26 years. Concerning the International Prostate Symptoms Score, the mean total, voiding (obstructive) and storage (irritative) scores were 14.6 ± 6.2, 8.5 ± 4.1 and 6.05 ± 2.7 respectively. The mean maximum flow rate was 13.44 ± 3.88 mL/s. The mean prostate volume was 53.71 ± 16.46 ml. A majority of patients have an enlarged prostate 1.5 to 2 times (46 to 60 mL) the upper limit for normal value. The intravesical prostatic protrusion was present in eighty-three (80.58%) and absent in 20 (19.42%). Above a prostate volume of 60 mL, 91% to 100% of our patients had intravesical prostatic protrusion. There was strong evidence (p < 0.001) that a change from no intravesical prostatic protrusion to intravesical prostatic protrusion
References
[1]
Roehrborn, C. and McConnell, J. (2002) Etiology, Pathophysiology, Epidemiology and Natural History of Benign Prostatic Hyperplasia. In: Walsh, P., Retik, A., Vaughan, E. and Wein, A., Eds., Campbell’s Urology, Saunders, Philadelphia, 1297-1336.
[2]
Lepor, H. (2004) Pathophysiology, Epidemiology, and Natural History of Benign Prostatic Hyperplasia. Reviews in Urology, 6, 3-10.
[3]
Roehrborn, C.G. (2005) Benign Prostatic Hyperplasia: An Overview. Reviews in Urology, 7, S3-S14.
[4]
Wadie, B.S., Ibrahim, E.H.I., de la Rosette, J.J., Gomha, M.A. and Ghoneim, M.A. (2001) The Relationship of the International Prostate Symptom Score and Objective Parameters for Diagnosing Bladder Outlet Obstruction. Part I: When Statistics Fail. Journal of Urology, 165, 32-34. https://doi.org/10.1097/00005392-200101000-00008
[5]
Park, H.Y., Lee, J.Y., Park, S.Y., Lee, S.W., Kim, Y.T., Choi, H.Y., et al. (2012) Efficacy of Alpha Blocker Treatment According to the Degree of Intravesical Prostatic Protrusion Detected by Transrectal Ultrasonography in Patients with Benign Prostatic Hyperplasia. Korean Journal of Urology, 53, 92-97.
[6]
Eze, B.U. (2016) Correlation between Intravesical Prostatic Protrusion and International Prostate Symptom Score (IPSS) in Men with Benign Prostatic Hyperplasia at Nnamdi Azikiwe University Teaching Hospital, Nnewi. Faculty of SURGERY. http://www.dissertation.npmcn.edu.ng/index.php/FMCS/article/view/1445
[7]
Panicker, A.B.J.N. (2014) Lower Urinary Tract Dysfunction and the Nervous System. In: Aminoff, M.J. and Josephson, S.A., Eds., Aminoff’s Neurology and General Medicine, Academic Press, Boston, 613-631. http://www.sciencedirect.com/science/article/pii/B9780124077102000291 https://doi.org/10.1016/B978-0-12-407710-2.00029-1
[8]
Collins, C.W. and Winters, J.C. (2014) AUA/SUFU Adult Urodynamics Guideline: A Clinical Review. Urologic Clinics of North America, 41, 353-362. https://doi.org/10.1016/j.ucl.2014.04.011
[9]
Lim, K.B., Ho, H., Foo, K.T., Wong, M.Y.C. and Fook-Chong, S. (2006) Comparison of Intravesical Prostatic Protrusion, Prostate Volume and Serum Prostatic-Specific Antigen in the Evaluation of Bladder Outlet Obstruction. International Journal of Urology, 13, 1509-1513. https://doi.org/10.1111/j.1442-2042.2006.01611.x
[10]
Reis, L.O., Barreiro, G.C., Baracat, J., Prudente, A. and D’Ancona, C.A. (2008) Intravesical Protrusion of the Prostate as a Predictive Method of Bladder Outlet Obstruction. International Brazilian Journal of Urology, 34, 627-637. https://doi.org/10.1590/S1677-55382008000500012
[11]
Tan, Y.H. and Foo, K.T. (2003) Intravesical Prostatic Protrusion Predicts the Outcome of a Trial without Catheter Following Acute Urine Retention. Journal of Urology, 170, 2339-2341. https://doi.org/10.1097/01.ju.0000095474.86981.00
[12]
Lee, H.J., Lee, A., Huang, H.H., Sundaram, P. and Foo, K.T. (2017) Patients with Small Prostates and Low-Grade Intravesical Prostatic Protrusion—An Urodynamic Evaluation. Asian Journal of Urology, 4, 247-252. https://doi.org/10.1016/j.ajur.2017.03.003
[13]
Agbo, C.A., Ramyil, V.M., Dakum, N.K., Shuaibu, S.I., Onowa, V.E., Nabasu, L.E., et al. (2018) The Value of Intravesical Prostatic Protrusion in Evaluation of Bladder Outlet Obstruction from Benign Prostatic Enlargement in Nigeria. African Journal of Urology, 24, 342-346. https://doi.org/10.1016/j.afju.2018.11.007
[14]
Vuichoud, C. and Loughlin, K.R. (2015) Benign Prostatic Hyperplasia: Epidemiology, Economics and Evaluation. Canadian Journal of Urology, 22, 1-6.
[15]
Berry, S.J., Coffey, D.S., Walsh, P.C. and Ewing, L.L. (1984) The Development of Human Benign Prostatic Hyperplasia with Age. Journal of Urology, 132, 474-479. https://doi.org/10.1016/S0022-5347(17)49698-4
[16]
McNeill, S.A., Hargreave, T.B., Geffriaud-Ricouard, C., Santoni, J.P. and Roehrborn, C.G. (2001) Postvoid Residual Urine in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Pooled Analysis of Eleven Controlled Studies with Alfuzosin. Urology, 57, 459-465. https://doi.org/10.1016/S0090-4295(00)01021-9
[17]
Hunter, D.J.W., Berra-Unamuno, A. and Martin-Gordo, A. (1996) Prevalence of Urinary Symptoms and Other Urological Conditions in Spanish Men 50 Years Old or Older. Journal of Urology, 155, 1965-1970. https://doi.org/10.1016/S0022-5347(01)66063-4
[18]
Sigdel, G. and Belokar, W.K. (2015) Clinical Significance of Intravesical Prostatic Protrusion in Patients with Benign Prostatic Hyperplasia. Journal of Universal College of Medical Sciences, 3, 6-10.
[19]
Lu, S.Y., Yang, C.M., Fan, Y.H., Lin, A.T.L. and Chen, K.K. (2016) Intravesical Prostatic Protrusion Correlates Well with Storage Symptoms in Elderly Male Patients with Non-Neurogenic Overactive Bladder. Urological Science, 27, 17-20. https://doi.org/10.1016/j.urols.2015.05.006
[20]
Aganovic, D., Prcic, A., Hadziosmanovic, O. and Hasanbegovic, M. (2012) Does the Combination of Intravesical Prostatic Protrusion and Bladder Outlet Obstruction Number Increase Test Accuracy According to Benign Prostatic Obstruction at the Individual Level? Acta Informatica Medica, 20, 160-166. https://doi.org/10.5455/aim.2012.20.160-166
[21]
Lee, L.S., Sim, H.G., Lim, K.B., Wang, D. and Foo, K.T. (2010) Intravesical Prostatic Protrusion Predicts Clinical Progression of Benign Prostatic Enlargement in Patients Receiving Medical Treatment. International Journal of Urology, 17, 69-74. https://doi.org/10.1111/j.1442-2042.2009.02409.x
[22]
Tjahjodjati, T. and Santoso, J. (2015) Relationship of Prostate-Urethral Angle and Intravesical Prostatic Prtusion with International Prostatic Symptoms Score and Uroflowmetry in Benign Prostatic Hyperplasia Patients. International Journal of Integrated Health Sciences, 3, 50-54. https://doi.org/10.15850/ijihs.v3n2.583
[23]
Hou, C.P., Lin, Y.H., Chen, C.L., Tsai, Y.L., Chang, P.L. and Tsui, K.H. (2016) Impact of the Static Prostatic Urethral Angle on Men with Lower Urinary Tract Symptoms. Urological Science, 27, 47-50. https://doi.org/10.1016/j.urols.2014.07.009
[24]
Lieber, M.M., Jacobson, D.J., McGree, M.E., St. Sauver, J.L., Girman, C.J. and Jacobsen, S.J. (2009) Intravesical Prostatic Protrusion in Men in Olmsted County, Minnesota. The Journal of Urology, 182, 2819-2824. https://doi.org/10.1016/j.juro.2009.08.086
[25]
Shin, S.H., Kim,J.W., Kim, J.W., Oh, M.M. and Moon, D.G. (2013) Defining the Degree of Intravesical Prostatic Protrusion in Association with Bladder Outlet Obstruction. Korean Journal of Urology, 54, 369-372.
