A Review of Intravesical Prostatic Protrusion in the Evaluation and Treatment of Benign Prostatic Enlargement

A Review of Intravesical Prostatic Protrusion in the Evaluation and Treatment of Benign Prostatic Enlargement



Abstract Views
711

Downloads
355

Citations

Share

##plugins.themes.bootstrap3.article.sidebar##

##plugins.themes.bootstrap3.article.main##

The evaluation of severity of symptoms, tracking complications, choosing effective and efficient approach to treatment, and prognosis is important in benign prostatic enlargement (BPE) patients. Measurement of intravesical prostatic protrusion (IPP) is an easy, affordable and non-invasive marker for benign prostatic obstruction with a high diagnostic value. This study aims to undertake a descriptive review of current literature for the role of IPP in the evaluation and treatment of patients with BPE. Relevant articles written in English language were retrieved from PubMed and Google Scholar. Keywords used for searching articles included intravesical prostatic Protrusion and Benign Prostatic Enlargement/ hyperplasia/ Obstruction; evaluation; and treatment. Papers published between January 1990 and October 2020 were extracted and evaluated. The analyzed studies showed that IPP can be assessed by various modalities and is important in the evaluation of symptom severity, tracking progression and complications of disease, choosing treatment option and prognostication. It is important that IPP be always assessed at the point of initial evaluation of BPE patients.

Keywords: Benign Prostatic Enlargement, Evaluation, Intravesical Prostatic Protrusion, and Treatment
  1. P. Abrams, L. Cardozo, M. Fall, D. Griffiths, P. Rosier, U. Ulmsten, and et al, “The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society,” Urology, vol. 61, no. 1, pp. 37-49, Jan. 2003.
    DOI
     Google Scholar 
  2. T. Huang, J. Qi, Y. Yu, D. Xu, Y. Jiao, J. Kang, and et al, “Transitional zone index and intravesical prostatic protrusion in benign prostatic hyperplasia patients: correlations according to treatment received and other clinical data,” Korean J. Urol., vol. 53, no. 4, pp. 253-257, Apr. 2012.
    DOI
     Google Scholar 
  3. G. B. Sigdel, and W. K. Belokar, “Clinical significance of intravesical prostatic protrusion in patients with benign prostatic hyperplasia,” J. Univ. Coll. Med. Sci., vol. 3, no. 1, pp. 6-10, Sept. 2015.
    DOI
     Google Scholar 
  4. K. T. Foo, “Decision making in the management of benign prostatic enlargement and the role of transabdominal ultrasound,” Int. J. Urol., vol. 17, no. 12, pp. 974-979, Dec. 2010.
    DOI
     Google Scholar 
  5. S. H. Shin, J. W. Kim, J. W. Kim, M. M. Oh, and D. G. Moon, “Defining the degree of intravesical prostatic protrusion in association with bladder outlet obstruction,” Korean J. Urol., vol. 54, no. 6, pp. 369-372, Jun. 2013.
    DOI
     Google Scholar 
  6. L. O. Reis, G. C. Barreiro, J. Baracat, A. Prudente, and C. A. D'Ancona, “Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction,” Int. Braz. J. Urol., vol. 34, no. 5, pp. 627-637, Oct. 2008.
    DOI
     Google Scholar 
  7. T. L. Kuo, J. S. Teo, and K. T. Foo, “The role of intravesical prostatic protrusion (IPP) in the evaluation and treatment of bladder outlet obstruction (BOO),” Neurourol. Urodyn., vol. 35, no. 4, pp. 535-537, Apr. 2016.
    DOI
     Google Scholar 
  8. A. K. M. S. Hossain, A. K. M. K. Alam, A. K. M. K. Habib, M. M. Rashid, H. Rahman, A. K. M. A. Islam, and M. U. Jahan, “Comparison between prostate volume and intravesical prostatic protrusion in detecting bladder outlet obstruction due to benign prostatic hyperplasia” Bangladesh Med. Res. Counc. Bull., vol. 38, no. 1, pp. 14-17, Apr. 2012.
    DOI
     Google Scholar 
  9. D. Wang, H. Huang, Y. M. Law, and K. T. Foo, “Relationships between prostatic volume and intravesical prostatic protrusion on transabdominal ultrasound and benign prostatic obstruction in patients with lower urinary tract symptoms,” Ann. Acad. Med. Singap., vol. 44, no. 2, pp. 60-65, Feb. 2015.
    DOI
     Google Scholar 
  10. A. Lee, H. J. Lee, K. B. Lim, H. H. Huang, H. Ho, and K. T. Foo, “Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?,” Asian J. Urol., vol. 3, no. 1, pp. 39-43, Jan. 2016.
    DOI
     Google Scholar 
  11. S. K. Reddy, and A. B. Shaik, “Non-invasive evaluation of bladder outlet obstruction in benign prostatic hyperplasia: a clinical correlation study,” Arab J. Urol., vol. 17, no. 4, pp. 259-264, Oct. 2019.
    DOI
     Google Scholar 
  12. J. Gandhi, S. J. Weissbart, A. N. Kim, G. Joshi, S. A. Kaplan, and S. A. Khan, “Clinical considerations for intravesical prostatic protrusion in the evaluation and management of bladder outlet obstruction secondary to benign prostatic hyperplasia,” Curr. Urol., vol.12, no. 1, pp. 6-12, Oct. 2018.
    DOI
     Google Scholar 
  13. M. S. Kim, K. K. Park, B. H. Chung, and S. H. Lee, “Effect of photoselective vaporization prostatectomy on lower urinary tract symptoms in benign prostatic hyperplasia with or without intravesical prostatic protrusion,” Korean J. Urol., vol. 54, no. 1, pp. 36-41, Jan. 2013.
    DOI
     Google Scholar 
  14. H. Y. Park, J. Y. Lee, S. Y. Park, S. W. Lee, Y. T. Kim, H. Y. Choi, and et al, “Efficacy of alpha blocker treatment according to the degree of intravesical prostatic protrusion detected by transrectal ultrasonography in patients with benign prostatic hyperplasia,” Korean J. Urol. Vol. 53, no. 2, pp. 92-97, Feb. 2012.
    DOI
     Google Scholar 
  15. B. U. Eze, T. U. Mbaeri, C. K. Oranusi, J. A. Abiahu, A. M. Nwofor, J. C. Orakwe, and O. O. Mbonu, “Correlation between intravesical prostatic protrusion and international prostate symptom score among Nigerian men with benign prostatic hyperplasia,” Niger. J. Clin. Pract., vol. 22, no. 4, pp. 454-459, Apr. 2019.
    DOI
     Google Scholar 
  16. S. P. Yuen, J. T. Ngiap, C. W. Cheng, and K. T. Foo, “Effects of bladder volume on transabdominal ultrasound measurement of intravesical prostatic volume,” Int. J. Urol., vol. 9, no. 4, pp. 225-229, Apr. 2002.
    DOI
     Google Scholar 
  17. P. Mariappan, D. J. Brown, and A. S. McNeill, “Intravesical prostatic protrusion is better than prostate volume in predicting the outcome of trial without catheter in white men presenting with acute urinary retention: a prospective clinical study,” J. Urol., vol. 178, no. 2, pp. 573-577, Aug. 2007.
    DOI
     Google Scholar 
  18. S. W. Lee, J. M. Cho, J. Y. Kang, and T. K. Yoo, “Clinical and urodynamic significance of morphological differences in intravesical prostatic protrusion,” Korean J. Urol., vol. 51, no. 10, pp. 694-699, Oct. 2010.
    DOI
     Google Scholar 
  19. H. Nose, K. T. Foo, K. B. Lim, T. Yokoyama, H. Ozawa, and H. Kumon, “Accuracy of two noninvasive methods of diagnosing bladder outlet obstruction using ultrasonography: Intravesical prostatic protrusion and velocity-flow video urodynamics,” Urology, vol. 65, no. 3, Mar. 2005.
    DOI
     Google Scholar 
  20. W. Huang, J. J. Cao, M. Cao, H. S. Wu, Y. Y. Yang, Z. M. Xu, and X.D. Jin, “Risk factors for bladder calculi in patients with benign prostatic hyperplasia,” Medicine,vol. 96, no. 32, pp. e7728, Aug. 2017.
    DOI
     Google Scholar 
  21. L. S. Lee, H. G. Sim, K. B. Lim, D. Wang, and K. T. Foo, “Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment,” Int. J, Urol., vol. 17, no. 1, pp. 69-74, Jan. 2010.
    DOI
     Google Scholar 
  22. C. K. Doo, and H. S. Uh, “Anatomic configuration of prostate obtained by noninvasive ultrasonography can predict clinical voiding parameters for determining BOO in men with LUTS.” Urology, vol. 73, no. 2, pp. 232-236, Feb. 2009.
    DOI
     Google Scholar 
  23. S.Yang, W. S. Hong, J. M. Lee, T. Kim, H. Chung, H. S. Kim, and et al, “Is intravesical prostatic protrusion associated with predominant and intractable storage symptoms in BPH patients with over 30 g of prostate volume?,” Neurourol. Urodyn., vol. 27, no. 7, pp. 580-581, Sept. 2008.
    DOI
     Google Scholar 
  24. P. Abrams, C. Chapple, S. Khoury, C. Roehrborn, and J. De la Rosette, “International consultation on new developments in prostate cancer and prostate diseases. Evaluation and treatment of lower urinary tract symptoms in older men,” J. Urol., vol. 189, pp. S93-S101, 2013.
    DOI
     Google Scholar 
  25. Z. Keqin, X. Zhishun, Z. Jing, W. Haixin, Z. Dongqing, and S. Benkang, “Clinical significance of intravesical prostatic protrusion in patients with benign prostatic enlargement.” Urology, vol. 70, no. 6, pp. 1096-1099, Dec. 2007.
    DOI
     Google Scholar 
  26. M. J. Barry, F. J. Fowler, M. P. O’Leary, R. C. Bruskewitz, H. L. Holtgrewe, W. K. Mebust, and et al, “The American Urological Association symptom index for benign prostatic hyperplasia,” J. Urol., vol. 148, no.5, pp. 1549-1557, Nov. 1992.
    DOI
     Google Scholar 
  27. J. M. Lee, H. Chung, T. W. Kim, H. S. Kim, J. H. Wang, and S. K. Yang, “The correlation of intravesical prostatic protrusion with storage symptoms, as measured by transrectal ultrasound,” Korean J. Urol., vol. 49, no. 2, pp. 145-149, Feb, 2008.
    DOI
     Google Scholar 
  28. C. P. Hou, Y. H. Lin, C. L. Chen, Y. L. Tsai, P. L. Chang, and K. H. Tsui, “Impact of the static prostatic urethral angle on men with lower urinary tract symptoms,” Urol. Sci., vol. 27, no. 1, pp. 47-50, Mar. 2016.
    DOI
     Google Scholar 
  29. J. Tjahjodjati, and J. Santoso, “Relationship between prostate-urethral angle, intravesical prostatic protrusion, international prostatic symptom score, and uroflowmetry in benign prostatic hyperplasia patients,” Int. J. Integr. Health Sci., vol. 3, no. 2, pp. 50-54, 2015.
    DOI
     Google Scholar 
  30. Y. M. Seo, and H. J. Kim, “Impact of intravesical protrusion of the prostate in the treatment of lower urinary tract symptoms/benign prostatic hyperplasia of moderate size by alpha receptor antagonist,” Int. Neurourol. J., vol. 16. no. 4, pp. 187-190, Dec. 2012.
    DOI
     Google Scholar 
  31. S. Guneyli, E. Ward, Y. Peng, A. Nehal Yousuf, I. Trilisky, C. Westin, T. Antic, and A. Oto, “MRI evaluation of benign prostatic hyperplasia: correlation with international prostate symptom score,” J. Magn. Reson. Imaging, vol. 45, no. 3, pp. 917-925, Mar. 2017.
    DOI
     Google Scholar 
  32. H. K. Park, G. Y. Choo, H. Chung, S. H. Paick, H. G. Kim, H. S. Kim, Y. S. Lho, W. S. Hong, and S. K. YANG, “Effect of intravesical prostatic protrusion on the characteristics of lower urinary tract symptom change after 12‐week drug medication: a prospective analysis,” Low. Urin. Tract Symptoms, vol. 5, no. 1, pp. 1-4, Jan. 2013.
    DOI
     Google Scholar 
  33. Y. J. Park, K. H. Bae, B. S. Jin, H. J. Jung, and J. S. Park, “Is increased prostatic urethral angle related to lower urinary tract symptoms in males with benign prostatic hyperplasia/lower urinary tract symptoms?,” Korean J. Urol., vol. 53, no. 6, pp. 410-413. Jun, 2012.
    DOI
     Google Scholar 
  34. C. A. Agbo, V. M. Ramyil, N. K. Dakum, S. I. Shuaibu, V. E. Onowa, L. E. Nabasu, Z. Z. Galam, and B. C. Ukaonu, “The value of intravesical prostatic protrusion in evaluation of bladder outlet obstruction from benign prostatic enlargement in Nigeria,” Afr. J. Urol., vol. 24, no. 4, pp. 342-346, 2018.
    DOI
     Google Scholar 
  35. M. A. Hossain, M. W. Islam, M. F. Naser, and M. S. Azam, “Correlation of international prostate symptom score With intravesical protrusion of prostate in patients with benign enlargement of prostate,” Bangladesh J. Urol., vol. 22, no. 2, pp. 151-154, Nov. 2019.
    DOI
     Google Scholar 
  36. J. Zheng, J. Pan, Y. Qin, J. Huang, Y. Luo, X. Gao, and X. Zhou, “Role for intravesical prostatic protrusion in lower urinary tract symptom: a fluid structural interaction analysis study,” BMC Urol., vol. 15, no. 1, pp. 86-86, Dec. 2015. https://doi.org/10.1186/s12894-015-0081-y
    DOI
     Google Scholar 
  37. T. Yoshida, H. Kinoshita, K. Yoshida, T. Mishima, H. Taniguchi, M. Yanishi, Y. Komai, K. Yasuda, M. Sugi, and T. Matsuda, “Intravesical prostatic protrusion as a predicting factor for the adverse clinical outcome in patients with symptomatic benign prostatic enlargement treated with dutasteride,” Urology, vol.91, pp. 154-157, 2016.
    DOI
     Google Scholar 
  38. C. H. Lu, H. H. Wu, T. P. Lin, Y. H. Huang, H. J. Chung, J. Y. Kuo, W. J. Huang, S. H. Lu, Y. H. Chang, and A. T. Lin, “Is intravesical prostatic protrusion a risk factor for hydronephrosis and renal insufficiency in benign prostate hyperplasia patients?,” J. Chin. Med. Assoc., vol. 82, no. 5, pp. 381-384, May 2019.
    DOI
     Google Scholar 
  39. J. W. Kim, M. M. Oh, H. S. Park, J. Cheon, J. G. Lee, J. J. Kim, and D. G. Moon, “Intravesical prostatic protrusion is a risk factor for bladder stone in patients with benign prostatic hyperplasia,” Urology, vol. 84, no. 5, pp. 1026-1029, Nov. 2014.
    DOI
     Google Scholar 
  40. R. C. Flanigan, D. J. Reda, J. H. Wasson, R. J. Anderson, M. Abdellatif, and R. C. Bruskewitz, “5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study,” J. Uro., vol. 160, no. 1, pp. 12-17, Jul. 1998.
    DOI
     Google Scholar 
  41. A. Ahmed, “Sonographic parameters predicting the outcome of patients with lower urinary tract symptoms/benign prostatic hyperplasia treated with alpha1-adrenoreceptor antagonist,” Urology, vol. 88, pp. 143-148, Nov. 2016.
    DOI
     Google Scholar 
  42. Q. Liu, Y. Zhu, J. Liu, J. Qi, and J. Kang, “Ultrasound image features of intravesical prostatic protrusion indicated failure of medication therapy of finasteride and doxazosin in patients with benign prostatic hyperplasia (LUTS/BPH),” Int. Urol. Nephrol., vol. 49, no. 3, pp. 399-404, Mar. 2017.
    DOI
     Google Scholar 
  43. K. Hirayama, K. Masui, A. Hamada, Y. Shichiri, N. Masuzawa, and S. Hamada, “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,” Urology, vol. 86, no. 3, pp. 565-569, Sep. 2015.
    DOI
     Google Scholar 
  44. R. T. Puthenveetil, D. Baishya, S. Barua, and D. Sarma, “Implication of ultrasound bladder parameters on treatment response in patients with benign prostatic hyperplasia under medical management,” Asian J. Urol., vol. 2, no. 4, pp. 233-237, Oct. 2015.
    DOI
     Google Scholar 
  45. Y. H. Tan, and K. T. Foo, “Intravesical prostatic protrusion predicts the outcome of a trial without catheter following acute urine retention,” J. Urol., vol. 170, no. 6, pp. 2339-2341, Dec. 2003.
    DOI
     Google Scholar 
  46. X. D. Li, Y. P. Wu, Z. B. Ke, T. T. Lin, S. H. Chen, X. Y. Xue, N. Xu, and Y. Wei, “Predictors of postoperative lower urinary tract symptoms improvements in patient with small-volume prostate and bladder outlet obstruction,” Ther. Clin. Risk Manag., vol. 15, pp. 1291-1304, Nov. 2019.
    DOI
     Google Scholar 
  47. X. Chen, Q. Man, X. Wei, X. Ren, G. Li, Z. Lu, X. Zhang, and C. Qin, “Predictive value of preoperative comprehensive evaluation on the efficacy of HoLEP,” Transl. Androl. Urol., vol. 9, no. 4, pp. 1603-1610, Aug. 2020.
    DOI
     Google Scholar 
  48. J. Park, C. H. Park, I. Sun, S. Y. Cho, M. C. Cho, H. Jeong, and H. Son, “Preoperative transrectal ultrasonographic findings can predict the improvement of the peak urinary flow rate after surgical treatment of benign prostatic enlargement in patients with lower urinary tract symptoms,” J. Urol., vol. 197, no. 4S, pp. e513-514, Apr. 2017.
    DOI
     Google Scholar 
  49. J. H. Wee, Y. S. Choi, W. J. Bae, S. J. Kim, H. J. Cho, S. H. Hong, J. Y. Lee, and S. W. Kim, “Influence of intravesical prostatic protrusion on preoperative lower urinary tract symptoms and outcomes after 120 w high performance system laser treatment in men with benign prostatic hyperplasia,” Korean J. Urol., vol. 53, no. 7, pp. 472-477, Jul. 2012.
    DOI
     Google Scholar 
  50. M. Meira, A. M. de Assis, A. M. Moreira, A. A. Antunes, F. C. Carnevale, and M. Srougi, “Intravesical prostatic protrusion does not influence the efficacy of prostatic artery embolization” J. Vasc. Interv. Radiol., vol.32, no. 1, pp. 106-112, Jan. 2021.
    DOI
     Google Scholar 
  51. S. Z. Maron, A. Sher, J. Kim, R. A. Lookstein, A. R. Rastinehad, and A. Fischman, “Effect of median lobe enlargement on early prostatic artery embolization outcomes,” J. Vasc. Interv. Radiol., vol. 31, no. 3, pp. 370-377, Mar. 2020.
    DOI
     Google Scholar 
  52. L. Topazio, C. Perugia, C. De Nunzio, G. Gaziev, V. Iacovelli, D. Bianchi, G. Vespasiani, and E. F. Agrò, “Intravescical prostatic protrusion is a predictor of alpha blockers response: results from an observational study,” BMC urol., vol. 18, no. 1, pp. 1-5, Dec. 2018.
    DOI
     Google Scholar 
  53. O. S. Sharis, M. Z. Zulkifli, and A. H. Hamzaini, “Predicting outcome of trial of voiding without catheter in acute urinary retention with intravesical prostatic protrusion” Malays. J. Med. Sci., vol. 20, no. 1, pp. 56-59, Jan. 2013.
     Google Scholar 
  54. H. Y. Tiong, M. J. Tibung, M. Macalalag, M. K. Li, and D. Consigliere, “Alfuzosin 10 mg once daily increases the chances of successful trial without catheter after acute urinary retention secondary to benign prostate hyperplasia” Urol. Int., vol. 83, no. 1, pp. 44-48, Jul. 2009.
    DOI
     Google Scholar 
  55. Z. Liu, J. Chen, and Q. Lu Q, “Impact of intravesical prostatic protrusion and pathological type on transurethral resection of the prostate for benign prostatic hyperplasia.” Biomed. Res., vol. 28, no. 9, pp. 8367-8371, Sept. 2017.
     Google Scholar 
  56. T. Huang, J. Qi, Y. J. Yu, D. Xu, Y. Jiao, J. Kang, Y. Q. Chen, and Y. K. Zhu, “Predictive value of resistive index, detrusor wall thickness and ultrasound estimated bladder weight regarding the outcome after transurethral prostatectomy for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction,” Int. J. Urol., vol. 19, no. 4, pp. 343-350, Apr. 2012.
    DOI
     Google Scholar 
  57. J. W. Lee, J. H. Ryu, T. K. Yoo, S. S. Byun, Y. J. Jeong, and T. Y. Jung, “Relationship between intravesical prostatic protrusion and postoperative outcomes in patients with benign prostatic hyperplasia,” Korean J. Urol., vol. 53, no. 7, pp. 478-482, Jul. 2012.
    DOI
     Google Scholar 
  58. S. C. H. Yu, C. C. M. Cho, E. H. Y. Hung, J. Zou, B. T. Y. Yuen, L. Shi, and et al, “Thickness-to-height ratio of intravesical prostatic protrusion predicts the clinical outcome and morbidity of prostatic artery embolization for benign prostatic hyperplasia,” J. Vasc. Interv. Radiol., vol. 30, no. 11, pp. 1807-1816, Oct. 2019.
    DOI
     Google Scholar 

Downloads

Download data is not yet available.
Crossref
Scopus
Google Scholar
Europe PMC

How to Cite

Eze, B. U., Amu, O. C., & Edeh, J. A. (2021). A Review of Intravesical Prostatic Protrusion in the Evaluation and Treatment of Benign Prostatic Enlargement. European Journal of Medical and Health Sciences, 3(1), 13–17. https://doi.org/10.24018/ejmed.2021.3.1.648