Guy's and St Thomas' NHS Foundation Trust, London, UK.
Nat Rev Urol. 2023 Nov;20(11):645-653. doi: 10.1038/s41585-023-00774-7. Epub 2023 May 15.
The role of the prostatic middle lobe in the presentation and management of benign prostatic hyperplasia (BPH) is under-appreciated. Middle lobe enlargement is associated with intravesical prostatic protrusion (IPP), which causes a unique type of bladder outlet obstruction (BOO) via a 'ball-valve' mechanism. IPP is a reliable predictor of BOO and the strongest independent factor for failure of medical therapy necessitating conversion to surgical intervention. Men with middle lobe enlargement tend to exhibit mixed symptoms of both the storage and the voiding types, but symptomatology will vary depending on the degree of IPP present. Initial assessments such as uroflowmetry and post-void residual volumes are inadequate to detect IPP and could confound the clinical picture. Radiological evaluation of prostate morphology is key to assessment as it provides important prognostic information and can help with operative planning. Treatment strategies employed for BPH should consider the shape and morphology of prostate adenomata, specifically the presence of middle lobe enlargement and the degree of associated IPP.
前列腺中叶在良性前列腺增生（BPH）的表现和管理中的作用未被充分认识。中叶增大与膀胱内前列腺突入（IPP）有关，通过“球阀”机制引起一种独特类型的膀胱出口梗阻（BOO）。IPP 是 BOO 的可靠预测因子，也是需要转为手术干预的药物治疗失败的最强独立因素。中叶增大的男性往往表现出两种类型的储尿和排尿症状，但症状会因存在的 IPP 程度而异。尿流率和残余尿量等初始评估不足以检测 IPP，并且可能使临床情况复杂化。前列腺形态的影像学评估是评估的关键，因为它提供了重要的预后信息，并有助于手术规划。用于 BPH 的治疗策略应考虑前列腺腺瘤的形状和形态，特别是中叶增大的存在和相关 IPP 的程度。
