Is Intravenous Urography Mandatory in the Management of Benign Prostatic Hyperplasia?

Abstract

Fifty-four consecutive patients with uncomplicated benign prostatic hyperplasia (BPH) underwent intravenous urography (IVU) and ultrasonography (US) to observe the benefits of IVU over US. The parameters used were upper tract abnormalities detected on both modalities and the influence of radiological prostatic impression (RPI) on the route of surgery and its comparison to digitally estimated prostatic size (DEP). Both RPI and DEP were compared to the adenoma weight (AW). Correlation of RPI and DEP was excellent (87.5%) in grade III but poor in grades I and II. RPI and AW correlated well in grade III (100%) and was also significant in grades I and II, whereas DEP correlated well with AW in all grades. Both RPI and DEP could predict the route of prostatectomy accurately in grades I and III, whereas in grade II, RPI was marginally better in predicting the route. There was no upper tract abnormalities that were detected on IVU and missed by US. In conclusion, IVU did not add any additional information beyond that obtained by rectal examination and US to alter the surgical approach and hence the routine use of urography in uncomplicated BPH should be questioned in Saudi Arabia. Benign prostatic hyperplasia (BPH) is the most common urological problem in patients over the age of 60-years. Approximately 20% to 25% of men over the age of 50-years may require prostatic surgery [1]. IVU has been commonly performed prior to surgery; the rationale of which is debatable. In developed countries, the use of IVU as a preoperative investigation in BPH management is dwindling due to the lack of additional information obtained and infrequent upper tract pathology [2][3][4][5][6]. In developing countries around the Middle East, even though the health care is fairly extensive, the elderly male population may not have had adequate medical care throughout their lives and hence there may be undetected upper tract disease. For example, bilharziasis is rampant in the Middle East and could afflict the elderly population and may remain asymptomatic. We have therefore evaluated 54 men undergoing treatment for uncomplicated BPH to see if IVU is mandatory to detect any upper tract abnormality and to see if it