Correlation of Prostate Gland Size and Uroflowmetry in Patients with Lower Urinary Tract Symptoms

Abstract

INTRODUCTIONProstate is one of the accessory glands of the male reproductive system that secretes fluid to form bulk of the semen along with the seminal vesicles and bulbo urethral glands. In post pubescent male, the prostate gland has a volume of upto 20 to 30 ml. The prostate gland comprises of apex, base with an anterior, median, posterior and two lateral lobes. Zones of the prostate gland according to McNeal, are divided into: a) Peripheral zone (70%) of the gland, which are more prone for prostatic cancer; b) Central zone (20%) of the gland, is posterior to the lumen, and above the ejaculatory ducts; c) Peri urethral transition zone (10%), most common for BPH. Structural zone of prostate is composed of concentric zones separated by an ill-defined irregular capsule. The inner zone of prostate gland near the urethra is composed of submucosal glands that open directly into prostatic sinuses which are more prone for BPH. The outer zone has large branched glands and is more prone for prostatic cancer [1]. In men above 40 years of age, BPH is a common entity with significant disability. It is a condition that occurs when the enlarged prostate gland compresses the urethra leading to BOO. BPH can be a histological diagnosis that refers to proliferation of smooth muscle, fibrous tissue and glandular tissue within the prostatic transition zone. The clinical assessment of prostatic size by trans abdominal sonogram has proven to be a more accurate predictor of actual prostatic size, as studies show that trans-abdominal sonogram estimate of prostate size and surgical size shows good correlation [2]. The enlarged gland contributes to the lower urinary tract symptoms through two routes by direct BOO from enlarged tissue (static component) and by increased smooth muscle tone and resistance (dynamic component). The over activity of detrusor is thought to be a contributor to the storage symptoms seen in lower urinary tract symptoms. The symptoms of lower urinary tract caused secondary to BPH are usually not life threatening but can impact the quality of life and should not be underestimated [3]. Urine flowmetry is the electronic recording of urine flow rate throughout the micturation. Abnormal urine flow may be caused by BOO and bladder dysfunction resulting in significant PVR volume. Increasing PVR urine volume denotes significant bladder dysfunction and risk of developing urinary tract infection. Thus, this concept favours inclusion of PVR urine volume measurement in the evaluation of men with BPH [4]. Thus men with lower urinary tract symptoms based on International prostatic symptoms scale, suggestive of BPH should undergo clinical evaluation for prostatic size by trans-abdominal sonogram. They should further be evaluated by urine flowmetry for PVR urine to assess the severity of BOO. Complication of BPH includes bladder calculi, renal failure, infection, incontinence, retention, haematuria [5]. So the purpose of this study was to assess the size of the prostate gland in patients with lower urinary tract symptoms and to ...

A study on association between inguinal hernia and benign prostatic hyperplasia

“…Keeping the cut-off value at 15 ml/sec, 21% of cases and 17% of controls had Q max value <15 ml/sec. 13 Even though in this study, the difference between cases and controls was not statistically significant, both mean Q max values and percentage of patients having Q max <15 ml/sec were higher among patients with Inguinal hernia than the patients without hernia. Q max being the best parameter to analyse the obstructive nature of BPH, a reasonable explanation for these values can be that the patients with obstructive voiding dysfunction due to BPH may need to strain for voiding, and this effort over time may have a direct impact on the abdominal wall, which in turn contributes to the development of IH.…”

“…3 Many symptom severity scores are being used in the evaluation of lower urinary tract symptoms that occur due to BPH. The most frequently used is the International Prostate Symptom Score (IPSS) by which the symptoms are classified as mild (score: 0-7), moderate (score: [8][9][10][11][12][13][14][15][16][17][18][19], or severe (score: 20-35). 3,4 The occurrence of both inguinal hernia and benign prostatic hyperplasia with lower urinary tract symptoms increases with age.…”

The Prognostic Value of Post-Void Residual Urine Volume, Abdominal Prostate and Transrectal Prostate Ultrasound for Complication of Benign Prostate Hyperplasia: A Case Report Sonographic Analysis

“…The prostate gland is part of the male reproductive system. By zonal anatomic convention described by McNeal [9], the prostate gland is divided into three glandular zones: TZ represents about 10% of the glandular tissues [10]. Various studies show that the TZ volume is directly associated with urodynamic obstruction of the bladder and it is a signifi cant predictor of surgical outcome [11].…”

“…Various studies show that the TZ volume is directly associated with urodynamic obstruction of the bladder and it is a signifi cant predictor of surgical outcome [11]. It is the site of Benign Prostatic Hypertrophy [10].…”

“…In another study, [10] In another study, Kelly [15], stated that urofl owmetry could serve as a noninvasive screening test for selecting patients who should undergo more sophisticated urodynamic studies This case study remains limited by potential shortcoming.…”