Reis Leonardo O, Barreiro Guilherme C, Baracat Jamal, Prudente Alessandro, D'Ancona Carlos A
Division of Urology, School of Medicine, University of Campinas, Campinas, Sao Paulo, Brazil.
Int Braz J Urol. 2008 Sep-Oct;34(5):627-33; discussion 634-7. doi: 10.1590/s1677-55382008000500012.
Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO.
Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm.
Forty-two patients, mean age 64.8 +/- 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 +/- 3.2 mL. Achieved IPP's values were the following: grade I - 12 (28.5%), grade II - 5 - (12%) and grade III - 25 (59.5%). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95% confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 % sensitivity (75.1 - 99.2) and 50 % specificity (28.2 - 71.8).
IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.
压力-流率研究是诊断膀胱出口梗阻（BOO）的金标准。本前瞻性研究旨在比较尿动力学评估和前列腺膀胱内突出度测量在诊断BOO中的作用。
对出现与良性前列腺增生相关的下尿路症状（LUTS）且疑似BOO的患者进行前瞻性常规尿动力学评估，并根据膀胱出口梗阻指数（BOOI）进行分类。他们还接受了经腹部超声测量前列腺膀胱内突出度（IPP）和前列腺体积。IPP分为三个阶段：I级小于5mm；II级，5至10mm之间；III级大于10mm。
纳入42例患者，平均年龄64.8±8.5岁。经腹部超声测定平均前列腺体积为45±3.2mL。IPP的分级结果如下：I级-12例（28.5%），II级-5例（12%），III级-25例（59.5%）。梗阻组和非梗阻组男性的前列腺体积结果差异有统计学意义（p = 0.033），梗阻组、不确定组和非梗阻组男性的IPP差异有统计学意义（p = 0.016）。对于IPP，ROC曲线下面积为0.758（95%置信区间-0.601至0.876），提示BOO的截断点为5mm，敏感性为95%（75.1 - 99.2），特异性为50%（28.2 - 71.8）。
经腹部超声测量的IPP和前列腺体积是无创且可及的方法，与尿路BOO显著相关，对男性尿路梗阻性问题的诊断有帮助。
