Abdominal or Transrectal Ultrasonographic Prostate Volume and Cystoscopic Prostatic Urethral Length Measurements to Determine the Surgical Technique for Prostatectomy in Patients with Benign Prostate Hyperplasia

Abstract

What's known on the subject? and What does the study add? ÖZ AmaçBiz bu çalışmada, prostatektomi açısından en uygun cerrahi yaklaşıma -endoskopik veya açık-karar vermek için, görüntüleme teknikleri ve rezeke edilen doku ağırlığı arasındaki ilişkiyi kullanarak, prostat hacim ölçümleri için en uygun tekniği belirlemeyi amaçladık. Gereç ve YöntemTransüretral rezeksiyon planlanan, alt üriner sistem yakınmaları bulunan, 49-95 yaşlarında 60 hasta çalışmamıza dahil edildi. Rezeke edilen doku ağırlığı, abdomimal ve cerrahi öncesi masada ölçülen transrektal ultrasonografi (TRUS) prostat boyutları ve sistoskopi esnasında ölçülen prostatik üretral uzunluk arasındaki ilişki incelendi. Prostat hacimleri açısından, 75 cc'den küçük eşit ve büyük ve de prostatik uzunluk ölçümlerine gore de 2,5 cm'den kısa ve uzun olmak üzere 2 grup oluşturuldu. Bu iki grup arasında, rezeke edilen doku ağırlığı ve cerrahi öncesi hacim ölçüm yöntemleri arasında en iyi ilişki belirlemek için istatistiksel analiz yapıldı. BulgularRezeke edilen doku ağırlığı ile prostatik hacim ölçümleri arasındaki en güçlü ilişki TRUS ölçümleri ile olanla saptandı (r=0,79; p<0,001). Abdominal ve TRUS prostat hacimleri ve prostatik üretra uzunluk katsayıları, sırasıyla, 0,127, 0,287 ve 0,219 idi. ObjectiveWe aimed to determine the most suitable technique for prostate volume (PV) measurement to decide for the most appropriate surgical approach -endoscopic or open -by establishing the relationship between imaging techniques and the resected tissue weight (RTW). Materials and MethodsSixty men aged 49-95 years with lower urinary tract symptoms, who were scheduled for transurethral resection, were enrolled. The relationship of RTW with PV determined by preoperative abdominal ultrasonography as well as transrectal ultrasonography (TRUS) performed at the table just before surgery, and prostatic urethral length (PUL) measured at the time of cystoscopy was analyzed. Two groups were established with respect to PV, (less than or equal to 75 cc and greater than 75 cc, respectively), and according to PUL (less than or equal to 2.5 cm and longer than 2.5 cm, respectively). Statistical analyses were performed between the groups to identify the best correlation between resected tissue weight and presurgical volume determination methods. ResultsThe strongest correlation between RTW and prostatic volume measurements was established for the TRUS measurements (r=0.79; p<0.001). The coefficients of the abdominal and transrectal ultrasonographic volume and PUL were 0.127, 0.287 and 0.219, respectively.The prostate volume (PV) is the most important parameter while taking a decision about surgical technique in case of needed. The aim of this work is to determine the most accurate technique about PV between 3 techniques that we used. If succeded this, it can be gave more information about surgical technique and hospitalization process to the patients, and also the preparation of the operation room to the operation team.

Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review

“…Then, full-text screening was performed for 152 studies, of which 61 studies met all selection criteria and were scored using the COSMIN checklist. Subsequently, 37 studies received a COSMIN score of fair, good or excellent 21–57. Twenty-four studies58–81 received ‘poor’ COSMIN scores and were therefore excluded from the best evidence synthesis.…”

“…Nineteen studies evaluated assessment methods related to prostate size or intravesical prostatic protrusion, peripheral zone volume and transitional zone volume or transitional zone index to evaluate BPO due to benign prostatic enlargement, unless specified otherwise 21 26 27 30–33 36 39 40 42 43 45 46 49 52–55. An overview of the COSMIN scores per study on BPO is provided in table 4.…”

“…Another study investigated a cut-off prostate volume of <80 cc compared with a specimen weight of <80 with fair sensitivity (56%) and specificity (100%) 52. Transabdominal ultrasound measured prostate size correlated good with transrectal ultrasound measured prostate size (r=0.8253 to r=0.9840 45) and good with enucleated tissue weight (r=0.7333 to r=0.8231 52). Correlations with transitional zone volume measured by transrectal ultrasound were good (r=0.95) 45.…”

“…Correlations with transitional zone volume measured by transrectal ultrasound were good (r=0.95) 45. The COSMIN scores for criterion validity were fair31 33 45 52 to good 40 53. Due to the inconsistency of findings, number of studies (n=6) and total sample size (n=395), the level of evidence was graded as moderate for the validity of measuring prostate size using transabdominal ultrasound (see table 5, online supplemental table 2C).…”

“…Prostate size measured by transrectal ultrasound correlated poor to good with enucleated tissue weight (r=0.6742 to r=0.9526 30 31 33 52) One study found a mean difference of −12.5 g underestimation of prostate volume measured by transrectal ultrasound, with levels of agreement between −38 and 13 g 42. Other studies assessed the criterion validity of various transrectal ultrasound formulas or outline methods to calculate and measure prostate size.…”