Correlation of Different Grades of Intravesical Prostatic Protrusion with Uroflowmetry Parameters in Patients with Symptomatic Benign Enlargement of Prostate

Author(s): Dr. Md. Abed Billah, Prof. Dr. Mohammed Monowar-UL-Haque, Dr. Tahmina Akter, Dr. Md. Motiur Rahman, Dr. Mohammad Mamunur Rashid, Dr. Md. Mazedur Rahman, Dr. Md. Mostofa Kamal

Background: Enlargement of the prostate is a common healthcare problem in aging men around the world. The enlargement occurs due to the proliferation of smooth muscles and epithelial cells within the prostatic tissue. Intravesical prostatic protrusion is a phenomenon in which the prostate adenoma enlarges into the bladder along the plane of least resistance. Uroflowmetry is simple and non-invasive investigation of various lower urinary tract diseases by calculating the rate of urine expulsion against the time unit in second.

Aim: To determine the Correlation of different grades of Intravesical Prostatic Protrusion with Uroflowmetry parameters in patients with Symptomatic Benign Enlargement of Prostate.

Methods: This cross-sectional study was carried out in the Department of Urology of Chittagong Medical College Hospital. Study period was November, 2020-October 2021. A total of 42 patients attending with intravesical prostatic protrusion in symptomatic benign enlargement of prostate on abdominal Ultrasonography and age belonged to 45-75 years were enrolled in this study. They were divided into three groups according to grade of Intravesical Prostatic Protrusion. Patients having Intravesical Prostatic Protrusion less than 5mm were considered as Grade I, those with 5-10 mm were considered as grade II and more than 10 mm were considered as Grade III. Uroflowmetry parameters are recorded. Statistical analyses of the results were done by SPSS version 22.0.

Results: The mean age was 62 ± 7.94 years in grade I, 66.9 ± 7.02 years in grade II and 66.48 ± 6.23 years in grade III. The mean prostate volume was 48.86 ± 29.75 (grams) in grade I, 49.9 ± 19.41 (grams) in grade II and 66.84 ± 40.51 (grams) in grade III. The difference was statistically not significant (p>0.05) among three groups. The mean IPP was 3.56 ± 0.55 (mm) in grade I, 7.63 ± 1.28 (mm) in grade II and 16.57 ± 3.18 (mm) in grade III. The difference was statistically significant (p<0.05) among three groups. The mean Qmax was 11.21 ± 6.05 (mL/s) in grade I, 11.71 ± 3.36 (mL/s) in grade II and 8 ± 2.67 (mL/s) in grade III. The difference was statistically significant (p<0.05) among three groups. The mean Qmean was 5.16 ± 2.61 (mL/s) in grade I, 4.3 ± 2.28 (mL/s) in grade II and 3.75 ± 1.26 (mL/s) in grade III. The difference was statistically not significant (p>0.05) among three groups. The mean voided time was 60.57 ± 14.63 (sec) in grade I, 64 ± 19.32 (sec) in grade II and 81.52 ± 30.02 (sec) in grade III. The difference was statistically not significant (p>0.05) among three groups. The mean flow time was 50.43 ± 13.7 (sec) in grade I, 50.6 ± 19.43 (sec) in grade II and 67.64 ± 25.94 (sec) in grade III. The difference was statistically not significant (p>0.05) among three groups. There were a negative significant Pearson’s correlations (r=-0.450, p=0.003) between IPP and Qmax. Positive significant Pearson’s correlation between IPP with voided time (r=0.362, p=0.019) and flow time (r=0.374, p=0.015). Prostate volume was not significantly correlated with IPP.

Conclusion: Most of the patients were in 7th decade in all three groups. The mean flow time and voided time were significantly higher in grade III, however Qmax was significantly less in grade iii. There was a significant negative correlation between IPP with Qmax, significant positive correlations with voided time and flow time. This study concludes that uroflowmetry is a very useful tool to detect severity of bladder outlet obstruction (BOO) in symptomatic BEP patients.