Department of Urology, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 135-720, South Korea.
Department of Mechanical Engineering, Yonsei University College of Engineering, Seoul, South Korea.
World J Urol. 2020 May;38(5):1275-1282. doi: 10.1007/s00345-019-02925-1. Epub 2019 Aug 27.
Lower urinary tract symptoms in men have previously been attributed to obstruction from an enlarged prostate. However, several factors in addition to prostate volume have been identified as impacting urine flow. Prostatic apex shape is one factor that has not been evaluated. This study evaluates the relationship between prostatic apex shape and voiding symptoms and urine flow.
A retrospective, exploratory data review was conducted for 806 healthy men who underwent routine transrectal ultrasonography at our hospital, and data for 329 patients with uroflowmetric measurements were reviewed for the confirmatory study. Patients were categorized into four groups according to the prostatic apex shape on midsagittal ultrasonography. The association between prostatic apex shape and voiding symptoms was investigated. International Prostate Symptom Score (IPSS) and uroflowmetry were measured, and the associations between IPSS, uroflowmetry, and prostatic apex shape were analyzed.
Patients in group 4 (356/806, 44.2%), whose prostatic apex did not overlap the membranous urethra anteriorly or posteriorly, had a significantly lower incidence of moderate and severe lower urinary tract symptoms compared to other groups. There was a significant relationship between prostatic apex shape and total International Prostate Symptom Score. Patients in group 3, whose prostatic apex overlapped posteriorly with the membranous urethra, had lower maximum flow rates on uroflowmetry. There were significant correlations between the maximum flow rate and independent factors including age, intravesicle prostatic protrusion, and prostatic apex shape.
Prostatic apex shape is an independent risk factor for voiding symptom severity and low maximum flow rate.
男性下尿路症状以前归因于前列腺增大引起的梗阻。然而，除了前列腺体积之外，还有几个因素已被确定会影响尿流。前列腺尖部形状就是尚未评估的因素之一。本研究评估前列腺尖部形状与排尿症状和尿流之间的关系。
对在我院接受常规经直肠超声检查的 806 名健康男性进行回顾性探索性数据分析，并对 329 名接受尿流率测量的患者进行了确认性研究的数据回顾。根据正中矢状面超声前列腺尖部形状将患者分为 4 组。研究了前列腺尖部形状与排尿症状之间的关系。测量国际前列腺症状评分（IPSS）和尿流率，并分析 IPSS、尿流率与前列腺尖部形状之间的相关性。
4 组（356/806，44.2%）患者的前列腺尖部不向前或向后覆盖膜部尿道，其中、重度下尿路症状的发生率明显低于其他组。前列腺尖部形状与总国际前列腺症状评分之间存在显著关系。3 组患者（356/806，44.2%）的前列腺尖部向后与膜部尿道重叠，尿流率的最大流量较低。最大流量与包括年龄、膀胱内前列腺突出、前列腺尖部形状等独立因素之间存在显著相关性。
前列腺尖部形状是排尿症状严重程度和最大流量低的独立危险因素。
