Role of transrectal ultrasound derived parameters in benign prostatic hyperplasia

Introuction: Benign prostatic hyperplasia (BPH) for decades has been a significant major problem for elderly men. BPH is associated with bothersome lower urinary tract symptoms (mild to severe) namely urinary frequency, urgency, feeling of incomplete bladder emptying, nocturia, and decreased force of their urinary stream. Many of the patients suffering from BPH undergo surgery for having one of the absolute indications for surgery (refractory urine retention despite adequate and effective medical treatment, presence of urinary tract infections, repeated episodes of infections, gross hematuria with multiple episodes, pathological and/or physiological changes of the organs directly or indirectly involved namely secondary to obstruction). However a large portion of patients undergo surgery for having a relative indication, namely sever LUTs not responding to efficient medical therapy. This relative indication is purely subjective, and although many diagnostic tools are present to aid in the assessment of such patients (uroflowmetry, postvoiding residual urine and pressure flow studies), none of them were totally reliable, either for their weak correlation or their invasiveness. . In this study, we tried to test the transition zone index and other derived parameters to determine if calculating such a figure would help in the assessment of prostatic patients.
Aim of the Study: The aim of this study is to derive and confirm the association between the transrectal ultrasonogram derived prostate measures and the development of acute urinary retention in symptomatic prostatic patients and trying to evaluate the clinical usefulness of calculating this index.
Materials and Methods: Cross sectional clinical study of Patients attending Urology OPD and in patients at Kilpauk Medical College Hospital and Govt. Royapettah Hospital in the age group between 45and 85 with lower urinary tract symptoms of benign prostatic hyperplasia. The study period is from June 2016 to March 2017. TRUS based calculation are the transition zone (TZ) volume, the transition zone index
(TZ index = TZ volume/total prostate volume), the total prostate volume, and presumed circle area ratio (PCAR). The study of association between these parameters and acute urinary retention was done using statistical analysis software.
Results: The maximum number of patients with urinary retention is found in the group with duration of symptoms of 4-6 yrs (32.10%), followed by the group with duration between 6-8 yrs. In the frequency distribution for total prostate volume, acute retention of urine was found to be maximum (43%) in the prostate volume group of 50 to 60 g. The largest group (59%) of acute retention of urine falls in the group with transition zone volume between 30 and 45g. On analysis of the distribution with PCAR, AUR was present in the maximum percentage (91%) in the group with ratio ≥0.8.In this study the TZI of ≥0.6 consists of the maximum patients falling under the Acute Urinary Retention group.
Conclusion: In this study it was found that age of the patient had a good association with the occurrence of AUR. The association between, total prostate volume, transition zone volume, transition zone index, PCAR and AUR was found to be statistically significant.