Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment

Abstract

Objectives: To assess intravesical prostatic protrusion (IPP) as a novel predictor of clinical progression in patients with benign prostatic enlargement (BPE). Methods: All patients attending the outpatient clinic at our institution who were being treated for lower urinary tract symptoms (LUTS) secondary to BPE between January 1997 and December 2003 were recruited into the study. International Prostate Symptom Score (IPSS) scores, uroflowmetry parameters, post-void residual urine volume (PVR), IPP and serum prostate-specific antigen (PSA) were collected. IPP was classified into Grade 1, 2 or 3. Patients were stratified to different treatment options including watchful waiting, alpha blockers or 5-alpha reductase inhibitors. Those who developed high post-void residual urine volume (>100 mL), acute urinary retention or a deterioration of at least 4 points in IPSS score were considered to have disease progression. Using the Grade 1 IPP group as a reference, the odds ratio for clinical progression of Grade 2 and Grade 3 IPP were calculated by using multivariate analysis. Results: A total of 259 patients with a mean age of 63 years (range 50-90 years) and mean follow-up time of 32 months were available for analysis. Fifty-two patients were found to have clinical progression. Odds ratio for progression of a Grade 2 IPP was 5.1 (95% confidence interval [CI] 1.6-16.2) and that of a Grade 3 IPP was 10.4 (95% CI 3.3-33.4). Conclusion: A higher IPP grade is associated with a higher risk of clinical progression in BPE. IPP is a useful non-invasive predictor for clinical progression in BPE.

Evaluation of Intravesical Prostatic Protrusion as a Predictor of Dutasteride-Resistant Lower Urinary Tract Symptoms/Benign Prostatic Enlargement With a High Likelihood of Surgical Intervention

“…Although there are other studies 22,23 suggesting that IPP might predict clinical progression in LUTS and/or BPE, there is no specific study of patients under combination therapy with histological examinations. Thus, the present study has apparently revealed that the treatment protocol in cases with severe IPP tends to be converted to surgical intervention and has also suggested that administration of dutasteride from the early stage of LUTS and/ or BPE might be preferable.…”

Singapore Urological Association Clinical Guidelines for Male Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia

“…Patients with Grade 3 IPP were more likely to have clinical deterioration compared to those with Grade 1 IPP (44% vs. 6%) at a mean follow-up period of 32 months. (14) Not all patients with Grade 3 IPP progress, so further management of BPH should be based on the severity of the disease, which can be classified according to the staging system (Table I). (15) Disease severity is based on the presence or absence of significant prostatic obstruction (that impairs either the emptying or storage functions of the bladder) and the presence or absence of bothersome symptoms (quality of life [QOL] score ≥ 3).…”

Application of Prostate Ultrasound for Benign Prostatic Hyperplasia and Male Urinary Stress Incontinence

“…Lee et al showed that men with Grade 3 IPP who are on medical management are sevenfold more likely to progress over a mean follow-up period of 32 months [ 12 ].…”