Journal List > Korean J Urol > v.49(3) > 1005070

Cha, Kim, and Seo: The Effect of Periurethral Prostatic Calculi on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia

Abstract

Purpose

The aim of this study was to evaluate the effect of periurethral prostatic calculi on lower urinary tract symptoms (LUTS) at the initial visit and after treatment with an alpha-blocker in benign prostatic hyperplasia (BPH).

Materials and Methods

A total of 223 male patients with LUTS were studied. Group 1 consisted of 81 patients with periurethral prostatic calculi within 5mm from the prostatic urethra of the transitional zone, as determined by transrectal ultrasound. Group 2 consisted of 142 patients without periurethral prostatic calculi within 5mm from the prostatic urethra. The International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax) and post voided residual urine (PVR) were measured in patients of both groups at the beginning of the study and at eight weeks after the treatment with 4mg doxazosin gastrointestinal therapeutic system (GITS).

Results

Voiding, storage and the total IPSS for Group 1 patients were higher than for Group 2 patients (p<0.05). Quality of life (QoL), Qmax, and PVR were not significantly different at the initial visit. After treatment with 4mg doxazosin GITS, an improvement of voiding, storage and the total IPSS for Group 2 patients was seen as compared to Group 1 patients (p<0.05). The mean improvement of QoL was 0.44±0.73 for group 1 patients and 1.13±0.82 for group 2 patients (p<0.001). The mean change of Qmax was 1.02±1.40ml/sec for Group 1 patients and 1.52±1.84ml/sec for Group 2 patients (p=0.035). Changes of PVR were not significant between the two groups.

Conclusions

This study suggests that the periurethral prostatic calculi may aggravate lower urinary tract symptoms and decrease the effect of alpha-blockers.

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Fig. 1.
Periurethral prostatic calculi within 5mm from the prostatic urethra of the transitional zone were detected on transrectal ultrasonography (TRUS) findings, including more echogenic foci that caused acoustic shadowing as seen on a transverse view (A) and sagittal view (B) in Group 1 patients.
kju-49-237f1.tif
Table 1.
Baseline patient characteristics
Group 1 (n=81) Group 2 (n=142) p-value
Age (years) 63.30±7.72 61.46±7.83 0.093
Prostate vol (ml) 32.79±4.80 32.76±4.70 0.964
Serum total PSA (ng/ml) 2.58±1.62 2.84±1.62 0.251
IPSS
   Voiding symptom 13.86±3.39 12.87±2.85 0.020
   Storage symptom 7.80±1.90 7.08±2.41 0.022
   Total score 21.67±4.98 19.95±4.56 0.010
QoL 4.40±0.90 4.20±0.74 0.089
Qmax (ml/sec) 11.07±2.58 11.88±3.29 0.060
PVR (ml) 78.91±29.48 74.23±18.00 0.142
Prostatic calculi Vol (ml) 1.62±1.01 0

PSA: prostate-specific antigen, IPSS: International Prostate Symptom Score, QoL: quality of life, Qmax: maximal urinary flow rate, PVR: post voided residual urine. ∗Statistical significance was done by student's t-test.

Table 2.
Changes of IPSS, QoL, Qmax, PVR after 8 weeks of treatment with doxazosin GITS
Group 1 Group 2 p-value
IPSS
   Voiding symptom -2.67±1.67 -3.33±1.99 0.012
   Storage symptom -1.31±0.88 -1.73±1.38 0.015
   Total score -3.98±2.03 -5.06±2.49 0.001
IPSS improvement 0.023
   ≥4 59.3% 73.9%
   <4 40.7% 22.1%
QoL 0.44±0.73 1.13±0.82 <0.001
Qmax (ml/sec) 1.02±1.40 1.52±1.84 0.035
PVR (ml) 19.36±20.30 21.06±17.57 0.511

IPSS: International Prostate Symptom Score, QoL: quality of life, Qmax: maximal urinary flow rate, PVR: post voided residual urine, GITS: gastrointestinal therapeutic system.

Statistical significance was done by student's t-test,

Statistical significance was done by chi-square test.

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