Relationship between Acute Urinary Retention and Intraprostatic Inflammation in Benign Prostatic Hyperplasia

Ji Yong Ha; Dong Yun Kwak; Hyuk Soo Chang; Choal Hee Park; Sun Young Kwon; Chun Il Kim

doi:10.4111/kju.2008.49.12.1081

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Ha, Kwak, Chang, Park, Kwon, and Kim: Relationship between Acute Urinary Retention and Intraprostatic Inflammation in Benign Prostatic Hyperplasia

Original Article

Korean J Urol 2008;49(12):1081-1086.

Published online: 20 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.12.1081

Relationship between Acute Urinary Retention and Intraprostatic Inflammation in Benign Prostatic Hyperplasia

Ji Yong Ha, Dong Yun Kwak, Hyuk Soo Chang, Choal Hee Park, Sun Young Kwon¹, Chun Il Kim

From the Department of Urology, Keimyung University School of Medicine, Daegu, Korea

¹Department of Pathology, Keimyung University School of Medicine, Daegu, Korea

Received 10 July 2008 Revised 25 September 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Acute or chronic prostatic inflammation exists to varying degrees in surgical specimens of prostates, extirpated for the treatment of benign prostatic hyperplasia (BPH). We investigated the relationship between acute urinary retention (AUR) and intraprostatic inflammation.

Materials and Methods

Between January 1997 and December 2006, 221 patients underwent transurethral resection of the prostate (TURP) for the treatment of BPH. The patients were divided into 2 groups based on the indication for surgery; an AUR group and a lower urinary tract symptoms (LUTS) group. The area of acute inflammation, the extent, and the aggressiveness of chronic inflammation were classified into four grades. The grades of inflammation, prostate volume, age, serum prostate-specific antigen (PSA), and prior medical treatment were compared between the two groups. All specimens were reviewed by one pathologist.

Results

The AUR group consisted of 106 (47.9%) patients, and the LUTS group consisted of 115 (52.1%) patients. There were no statistical differences between the two groups with respect to the mean values of the age, prostate size, and severity of chronic inflammation. There was a significant relationship between AUR and the areas of acute inflammation, and the extent of chronic inflammation (p=0.014 and p=0.003, respectively). The aggressiveness of chronic inflammation had no relationship with AUR (p=0.062). The serum PSA level was higher in the AUR group than the LUTS group (11.5 vs. 5.3ng/ml, respectively).

Conclusions

The association for AUR with acute and chronic inflammation was stronger than that which existed with prostate size. Thus intraprostatic inflammation is an important risk factor in AUR. (Korean J Urol 2008;49:1081–1086)

Keywords: Urinary retention, Prostatic hyperplasia, Prostatitis

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Fig. 1.

Extent of chronic inflammation was graded on a 4-point scale. (A) Grade 1: scattered inflammatory cell infiltrate within the stroma without lymphoid nodules (H&E, x200). (B) Grade 2: nonconfluent lymphoid nodules (H&E, x200). (C) Grade 3: large inflammatory areas with confluence of infiltrate (H&E, x200).

Fig. 2.

Aggressiveness of chronic inflammation was graded on a 4-point scale. (A) Grade 1: contact between inflammatory cell infiltrate and glandular epithelium (however, minimal epithelium dissociation can be observed without disruption) (H&E, x400). (B) Grade 2: interstitial inflammatory infiltrate associated with a clear but limited (＜25% of the examined material) glandular epithelium disruption (H&E, x400). (C) Grade 3: glandular epithelium disruption on ＞25% of the examined material (H&E, x400).

Fig. 3.

Bar chart shows extent of chronic inflammation based on chief complaint.

Fig. 4.

Bar chart shows aggressiveness of chronic inflammation based on chief complaint.

Table 1.

Characteristics of the patients in the AUR and LUTS groups

Patients characteristics	AUR	LUTS	p-value
No. of patients (n=221) (%)	106 (47.9)	115 (52.1)
Age (years)	71.0±7.3 (55–85)	67.8±6.5 (55–83)	0.249
Prostate volume (ml)	68.6 (26–115)	60.0 (25–131)	0.063
PSA (ng/ml)	11.5 (0.6–135.9)	5.3 (0.2–42.1)	0.002
Pre-medication No.
of patients (%)	66 (62.3)	98 (85.2)	＜0.001
(α-blocker±5ARI)

AUR: acute urinary retention, LUTS: lower urinary tract symptoms, PSA: prostate-specific antigen, 5ARI: 5 alpha reductase inhibitor

Table 2.

Analysis for histologic inflammation in the AUR and LUTS groups

Grade 0		Grade 1	Grade 2	Grade 3	p-value
Acute inflammation
AUR (n=106) (%)	24 (20.9)	19 (16.5)	23 (20.0)	40 (34.8)	0.014
LUTS (n=115) (%)	32 (30.2)	29 (27.4)	33 (31.1)	21 (19.8)	0.014
Extent of chronic inflammation
AUR (%)	1 (0.9)	35 (30.4)	53 (46.1)	17 (14.8)	0.003
LUTS (%)	6 (5.7)	60 (56.6)	39 (36.8)	10 (9.4)	0.003
Aggressiveness of chronic inflammation
AUR (%)	1 (0.9)	12 (10.4)	37 (32.2)	56 (48.7)	0.062
LUTS (%)	6 (5.7)	22 (20.8)	41 (38.7)	46 (43.4)	0.062

AUR: acute urinary retention, LUTS: lower urinary tract symptoms

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