Intravesical Prostatic Protrusion: A Potential Marker of Alpha-blocker Treatment Success in Patients With Benign Prostatic Enlargement.

OBJECTIVE: To investigate the value of anatomic and blood-flow measurements of the prostate via ultrasound in identifying medical treatment response of patients with lower urinary tract symptoms due to benign prostatic enlargement. A secondary objective of the study was to compare transabdominal-transrectal measurements.

MATERIALS AND METHODS: Male patients (age range 50-80) with lower urinary tract symptoms who applied to our outpatient clinic to be diagnosed with benign prostatic enlargement that were eligible for medical management were included in the prospective study. Patients (n = 49) were administered with tamsulosin for management. At baseline evaluation, all patients underwent International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), transabdominal and transrectal ultrasound [prostate volume (PV), post-void rezidu and intravesical prostatic protrusion (IPP)], and prostate subcapsular resistive index value measurement. Follow-ups were carried out 1 and 3 months after treatment. At these time-points, patients were assessed with IPSS and uroflowmetry.

RESULTS: IPP were identified to be negatively correlated with baseline Qmax values (P = .001, R = -0.485) and positively correlated with PSA (P = .013, R = 0.353) and PV (P = .003, R = 0.420). PV was related with resistive index (P = .026, R = 0.318) and PSA (P = .001, R = 0.619). Subsequent to medical treatment on the follow-ups, an overall improvement in the IPSS and Qmax was identified (P = .001). However, a negative correlation was identified in the change that occurred between IPSS and IPP (P = .004, R = -0.410). Other parameters were not correlated (P > .05) with the change in IPSS and Qmax. Transabdominal and transrectal measures were similar (P = .001).

CONCLUSION: This study has shown that increased IPP values are associated with lower response to alpha-receptor specific management. Transabdominal measurements are sufficient for the evaluation compared with transrectal measurement.