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Intravesical prostatic protrusion is not the same in its shape: evaluation by preoperative cystoscopy and outcome in HoLEP

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Sources of Funding: none

Introduction

Intravesical prostatic protrusion (IPP) has been known as a predictor of efficacy not only for medical treatment such as alpha 1 blocker and dutasteride, but also for holmium laser enucleation of the prostate (HoLEP). However, the IPP is considered not the same in its shape because middle lobe and/or lateral lobes can protrude into bladder. Here, we evaluated the shape of IPP by cystoscopy and analyzed the outcome.

Methods

We reviewed charts of patients who had undergone HoLEP in Kyoto University Hospital from January 2006 to June 2016. Among 222 cases, 157 cases were evaluable for IPSS, uroflowmetry, IPP and its shape by preoperative flexible cystoscopy in outpatient clinic. IPP was classified into 5 groups: A, no protrusion; B, middle lobe only; C, lateral lobe only; D, bilateral lobe; E, B+C or B+D. Paired match analysis with similar IPP and other parameters was performed between the group with middle lobe protrusion (B+E, n=33) and the one without it (C+D, n=33).

Results

Table 1 shows the number of patients, age, score of total IPSS, QOL score, Qmax and IPP in the five groups. The group A (no protrusion) had a significantly higher Qmax than other groups. Groups with middle lobe protrusion (B or E) had a better tendency in changes in total IPSS score and Qmax. Paired match analysis shown in Table 2 demonstrated that the group with middle lobe protrusion had a significantly greater improvement of total IPSS score than the one without it (-16.6 vs. -10.8. p<0.01). Among them with less than 16 mm of IPP, all of patients with middle lobe protrusion improved IPSS, while only 76.5% (13/ 16) of patients without it were improved.

Conclusions

Patients with middle lobe protrusion had a greater improvement of IPSS in HoLEP than those having similar length of IPP without middle lobe protrusion. IPP should be clinically divided into two groups at least.

Funding

none

Authors
Hiromitsu Negoro
Ktsuhiro Ito
Atsuro Sawada
Shusuke Akamatsu
Ryoichi Saito
Takashi Kobayashi
Naoki Terada
Toshinari Yamasaki
Takahiro Inoue
Tomomi Kamba
Osamu Ogawa
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