A60-year-old man presented with a complaint of a hard mass in the subnavicular fossa for the past 10 years. He had had minimal discomfort in micturition for the past 2 years but was able to manage with it. He had a history of passing a calculus of 1 cm diameter 15 years ago. On examination, a hard mass of 7×5×4 cm was palpable in the subnavicular fossa (Figure 1). Rectal examination was normal. Urine culture and sensitivity showed no growth, the renal parameters, metabolic work-up, plain X-ray and ultrasound scans of the kidney, ureter and bladder area were all normal. X-ray of the penis showed a large calculus in the subnavicular fossa Meatotomy was done and a calculus of 6×4×3.5 cm was extracted (Figure 2), which weighed 40 g. The meatus was reconstructed with Blandy's flap. The postoperative period was uneventful.

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The number of patients living with end-stage renal disease (ESRD) is increasing in our country and demand for renal grafts is ever increasing. Cadaver renal transplantation is being established as a viable supplement to live transplantation. We present a case where a mass lesion was encountered in the donor kidney from a cadaver. Enucleation of the lesion was done and we proceeded with the grafting. Histopathological examination showed a ‘Renomedullary interstitial cell tumour’, a rare benign lesion. Post transplant, the renal function recovered well and the patient is asymptomatic. Such incidental renal masses present an ethical dilemma to the operating surgeon.

AIMS AND OBJECTIVESTo correlate Intravesical Prostatic Protrusion (IVPP) with International Prostate Symptoms Score (IPSS), Quality of Life Index (QOL), Uroflowmetry, Post Void Urine (PVR) and Pressure Flow Study (PFS) and to assess whether the presence and increasing grades of Intravesical prostatic protrusion are directly correlated with the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy. MATERIALS AND METHODSNon-randomized prospective cohort study, conducted in Department of Urology, Govt. Stanley Hospital, from June 2012 to June 2015, on a sample of 100 patients with IVPP. IVPP was correlated with IPSS, Quality of life index, Uroflowmetry, Effects of drug therapy, Response to surgical therapy. Response of patients with Intravesical prostatic protrusion of same grade to surgical therapy and drug therapy are compared to decide which modality of management is best. RESULTSThe incidence of IVPP in patients presenting with LUTS due to BPH is 1 in 5. Majority present with grade 2 IVPP. The increasing grades of IVPP are significantly directly correlated with IPSS score, Q-max and Post void residual. Statistical analysis showed IVPP to correlate significantly with BOO. TURP showed a very good and significant mean decrease of IPSS and Q-max, whereas those who had medical treatment showed only a mean decrease of 2 in IPSS score and 1 in Q-max. CONCLUSIONThe increasing grades of IVPP are significantly directly correlated with IPSS score max and Post void residual. IVPP have a very good positive and negative predictive value and also a good accuracy rate in comparison with all other parameters in predicting the BOO. The surgical intervention statistically proved to be superior to medical treatment in IVPP patients. KEYWORDSIVPP, Prostate, Urology. HOW TO CITE THIS ARTICLE:Rajaraman T, Balaji AR, Vetrichandar S, et al. Effect of intravesical prostatic protrusion (IVPP) on lower urinary tract function and management.