The role of intravesical prostatic protrusion (IPP) in the evaluation and treatment of bladder outlet obstruction (BOO)

Kuo, Tricia Li Chuen; Teo, Jonathan Shunming; Foo, Keong Tatt

doi:10.1002/nau.22741

Cited by 27 publications

(29 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…32 1.6 | Developments in LUTS assessment 1.6.1 | Imaging techniques Multiple imaging techniques with or without flow parameters have been developed over recent decades to potentially diagnose BOO ( Table 1). [33][34][35][36] The best described techniques are Detrusor (or Bladder) Wall Thickness (DWT/BWT), estimated bladder weight, prostate transitional zone volume, and intravesical prostate protrusion (PP). All techniques are generally compared to the current gold standard to define BOO, namely pressure-flow studies and their diagnostic performance is detailed in Table 1.…”

Section: Prostate Size Measurementmentioning

confidence: 99%

See 1 more Smart Citation

Male bladder outlet obstruction: Time to re‐evaluate the definition and reconsider our diagnostic pathway? ICI‐RS 2015

Rademakers

Drake

Gammie

et al. 2017

Neurourology and Urodynamics

View full text Add to dashboard Cite

The diagnosis of bladder outlet obstruction (BOO) in the male is dependent on measurements of pressure and flow made during urodynamic studies. The procedure of urodynamics and the indices used to delineate BOO are well standardized largely as a result of the work of the International Continence Society. The clinical utility of the diagnosis of BOO is however, less well defined and there are several shortcomings and gaps in the currently available medical literature. Consequently the International Consultation on Incontinence Research Society (ICI-RS) held a think tank session in 2015 entitled "Male bladder outlet obstruction: Time to re-evaluate the definition and reconsider our diagnostic pathway?" This manuscript details the discussions that took place within that think tank setting out the pros and cons of the current definition of BOO and exploring alternative clinical tests (alone or in combination) which may be useful in the future investigation of male patients with lower urinary tract symptoms. The think tank panel concluded that pressure-flow studies remain the diagnostic gold-standard for BOO although there is still a lack of high quality evidence. Newer, less invasive, investigations have shown promise in terms of diagnostic accuracy for BOO but similar criticisms can be levelled against these tests. Therefore, the think tank suggests further research with regard to these alternative indicators to determine their clinical utility.

show abstract

Section: Prostate Size Measurementmentioning

confidence: 99%

“…Multiple imaging techniques with or without flow parameters have been developed over recent decades to potentially diagnose BOO (Table ) . The best described techniques are Detrusor (or Bladder) Wall Thickness (DWT/BWT), estimated bladder weight, prostate transitional zone volume, and intravesical prostate protrusion (PP).…”

Section: Introductionmentioning

confidence: 99%

Male bladder outlet obstruction: Time to re‐evaluate the definition and reconsider our diagnostic pathway? ICI‐RS 2015

Rademakers

Drake

Gammie

et al. 2017

Neurourology and Urodynamics

View full text Add to dashboard Cite

show abstract

“…However, it is invasive, time-consuming, and costly. Therefore, it is generally indicated for patients who are not responsive to initial conservative treatment or pharmacotherapy, patients with previous intervention, and those of extreme age range and equivocal cases [11]. That being said, we find it imperative that diagnosis of IPP be confirmed by transabdominal ultrasonography (TAUS) or TRUS of the prostate before proceeding with any sort of medical or surgical management.…”

Section: Clinical Evaluation and Managementmentioning

confidence: 99%

“…Clinical studies have demonstrated that IPP can identify BOO. IPP has shown a positive predictive value of 72% for BOO [11]. In fact, the positive predictive value of the combined parameters IPP and resistive index of the prostatic capsular artery increases to 83.8% [12].…”

Section: Pathophysiology and Clinical Manifestationsmentioning

confidence: 99%

“…Because of this, misdiagnosing IPP as traditional BPH will generally allow the physician to consider α-adrenoceptor antagonist therapy for an indeterminate length of time. α-adrenoceptor antagonists (e.g., tamsulosin) are generally ineffective for treating IPP because the target receptors, which are absent inferior to the bladder neck, are distal to the area of protrusion [11]. A 2013 study showed that men with IPP ≥ 10 mm had poor response to tamsulosin treatment among patients with LUTS due to benign prostatic obstruction, prostatic volume < 40 ml, and PSA < 1.5 ng/ml [14,31].…”

Section: Clinical Evaluation and Managementmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Considerations for Intravesical Prostatic Protrusion in the Evaluation and Management of Bladder Outlet Obstruction Secondary to Benign Prostatic Hyperplasia

et al. 2018

View full text Add to dashboard Cite

Background: Intravesical prostatic protrusion (IPP) is a manifestation of benign prostatic hyperplasia marked by overgrowth of the prostatic median lobe into the bladder, producing bladder outlet obstruction and related storage and voiding symptoms. Methods: A MEDLINE® database search of the current literature was guided using combination of “prostate” with the following terms: intravesical prostatic protrusion, bladder trabeculation, bladder outlet obstruction, lower urinary tract symptoms, alpha blockers, transrectal ultrasonography, and prostatectomy. Results: Although IPP can be identified via a variety of imaging modalities, it is easily detected via transrectal ultrasonography (TRUS). Failing to detect IPP promptly by TRUS may result in refractory symptoms of benign prostatic hyperplasia, as the condition may not respond to typical α₁-adrenoceptor antagonist therapy. In addition, depending on grade, IPP can influence outcomes and complications of prostatectomies. Conclusion: Upon report of lower urinary tract symptoms, initial performance of TRUS along with digital rectal examination prevents delay in the appropriate evaluation and management of prostatic diseases.

show abstract

Deformable phantoms of the prostatic urinary tract for urodynamic investigations

Ishii

Nahas

et al. 2019

Medical Physics

View full text Add to dashboard Cite

Purpose: Assessment of urethral dynamics is clinically regarded to be important in analyzing the functional impact of pathological features like urethral obstruction, albeit it is difficult to perform directly in vivo. To facilitate such an assessment, urethra phantoms may serve well as investigative tools by reconstructing urethral dynamics based on anthropomorphic factors. Here, our aim is to design a new class of anatomically realistic, deformable urethra phantoms that can simulate the geometric, mechanical, and hydrodynamic characteristics of the male prostatic urethra. Methods: A new lost-core tube casting protocol was devised. It first involved the drafting of urethra geometry in computer-aided design software. Next, 3D printing was used to fabricate the urethra geometry and an outer mold. These parts were then used to cast a urinary tract using a polyvinyl alcohol (PVA)-based material (with 26.6 AE 4.0 kPa Young's elastic modulus). After forming a surrounding tissue-mimicking slab using an agar-gelatin mixture (with 17.4 AE 3.4 kPa Young's modulus), the completed urethra phantom was connected to a flow circuit that simulates voiding. To assess the fabricated phantoms' morphology, ultrasound imaging was performed over different planes. Also, color Doppler imaging was performed to visualize the flow profile within the urinary tract. Results: Deformable phantoms were devised for the normal urethra and a diseased urethra with obstruction due to benign prostatic hyperplasia (BPH). During voiding, the short-axis lumen diameter at the verumontanum of the BPH-featured phantom (0.91 AE 0.08 mm) was significantly smaller than that for the normal phantom (2.49 AE 0.20 mm). Also, the maximum flow velocity of the BPHfeatured phantom (59.3 AE 5.8 cm/s; without Doppler angle correction) was found to be higher than that of the normal phantom (22.7 AE 9.0 cm/s). Conclusion: The fabricated phantoms were effective in simulating urethra deformation resulting from urine passage during voiding. They can be used for mechanistic studies of urethral dynamics and for the testing of urodynamic diagnostic techniques in urology.

show abstract

The role of intravesical prostatic protrusion (IPP) in the evaluation and treatment of bladder outlet obstruction (BOO)

Cited by 27 publications

References 17 publications

Male bladder outlet obstruction: Time to re‐evaluate the definition and reconsider our diagnostic pathway? ICI‐RS 2015

Male bladder outlet obstruction: Time to re‐evaluate the definition and reconsider our diagnostic pathway? ICI‐RS 2015

Clinical Considerations for Intravesical Prostatic Protrusion in the Evaluation and Management of Bladder Outlet Obstruction Secondary to Benign Prostatic Hyperplasia

Deformable phantoms of the prostatic urinary tract for urodynamic investigations

Contact Info

Product

Resources

About