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Lee, Chung, Kim, Kim, Wang, and Yang: The Correlation of Intravesical Prostatic Protrusion with Storage Symptoms, as Measured by Transrectal Ultrasound
Original Article
Korean Journal of Urology

Korean Journal of Urology 2008; 49(2): 145-149.

Published online: 29 February 2008

DOI: https://doi.org/10.4111/kju.2008.49.2.145

The Correlation of Intravesical Prostatic Protrusion with Storage Symptoms, as Measured by Transrectal Ultrasound

Jun Min Lee, Hong Chung, Tong-Wook Kim, Hong Sup Kim, Joon Ho Wang1, Sang-Kuk Yang

Department of Urology, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea.

1Department of Internal Medicine, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Korea.

yskurol@kku.ac.kr

Received 5 October 2007       Accepted 7 December 2007

Copyright © 2008 The Korean Urological Association

Abstract

Purpose

Intravesical prostatic protrusion (IPP) is a morphological change that's due to excessive growth of the median and lateral lobes of the prostate into the bladder. Few studies have been performed regarding the correlation between IPP and the voiding/storage symptoms. The aim of this study is to identify the clinical significance of IPP by defining its relationship with the prostate volume (PV), the International Prostate Symptom Score (IPSS), the uroflowmetry results and the medication response.

Materials and Methods

We performed a retrospective study of 95 male patients who were examined between August 2006 and July 2007. The patients were evaluated with the IPSS/quality of life (QoL) test, uroflowmetry (Urodyn-1000™; Medtronic), the post void residual urine (PVR), and IPP and PV by transrectal ultrasound (TRUS) (PROSOUND SSD-3500™; ALOKA). The IPP was compared with the total IPSS, the voiding and storage symptom score, uroflowmetry parameters and the flow patterns (normal, obstructive, detrusor impairment, Valsalva). The patients were classified into two groups (the IPP and non-IPP groups) based on the presence of IPP as identified by TRUS.

Results

The PV and IPP showed a significant correlation (r=0.627, p< 0.001). There was no correlation between IPP and total IPSS (p=0.444); however, the storage symptom score was significantly increased in proportion to IPP (p=0.030). With an IPP increase, the Qmax was decreased (r=-0.319, p<0.001) and the PVR was increased (r=0.388, p=0.002). The IPP group showed a lower decrease of the QoL score after 8 weeks of medication, as compared to the non-IPP group (p=0.034).

Conclusions

The IPP showed significant correlation with the storage symptoms, but not with the total IPSS. Theoretically, IPP is a unique anatomical configuration of the prostate, and it may worsen the prominent storage symptoms that are the result of irritation of the bladder neck and trigone. IPP should be checked carefully during TRUS as IPP could potentially be a useful marker for the assessment and management of lower urinary tract symptoms.

Keywords: Benign prostatic hyperplasia, Bladder outlet obstruction, Ultrasound

Figures and Tables

Fig. 1
Comparison of the International Prostate Symptom Score (IPSS) and the quality of life (QoL) according to the presence of intravesical prostatic protrusion at the initial visit (A), Comparison of the change of IPSS and the QoL according to the presence of intravesical prostatic protrusion after 8 weeks of medication (B), *p<0.05.
kju-49-145-g001
Table 1
Correlation analysis between intravesical prostatic protrusion and the prostate volume/International Prostate Symptom Score/uroflowmetry parameters
kju-49-145-i001

Statistical significance was evaluated by correlation analysis, *p<0.05. IPP: intravesical prostatic protrusion, TRUS: transrectal ultrasound, TPV: total prostate volume, TZV: transitional zone volume, IPSS: International Prostate Symptom Score, QoL: quality of life, Qmax: maximal flow rate, Qavg: average flow rate, PVR: post voided residual urine

Table 2
Comparison of occurrence of transurethral resection of the prostate and acute urinary retention during 8 weeks of medication, according to the presence of intravesical prostatic protrusion
kju-49-145-i002

Statistical significance was evaluated by paired Mann Whitney U-test, *p<0.05. IPP: intravesical prostatic protrusion, TURP: transurethral resection of prostate, AUR: acute urinary retention

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