Can bladder neck thickness on magnetic resonance imaging (MRI) predict early outcomes after anatomic enucleation of the prostate (AEEP) in benign prostatic hyperplasia patients with small-volume prostate?

AIM

We aimed to evaluate whether preoperative bladder neck thickness (BNT) measured by magnetic resonance imaging (MRI) can guide surgical decisions in benign prostatic hyperplasia (BPH) and primary bladder neck obstruction (PBNO) patients with a small volume (≤30 mL).

MATERIALS AND METHODS

The clinical data of 403 patients were retrospectively collected. The Kappa consistency test was used to compare subjective (IPSS-voiding) and objective (Qmax) postoperative outcomes. Multivariable logistic regression identified predictors of the consistency between postoperative objective and subjective evaluations. The receiver operating characteristic (ROC) curve was utilised to identify the optimal preoperative BNT (preop-BNT) cut-off value for predicting residual obstruction.

RESULTS

The Kappa consistency test revealed a significant difference between IPSS-voiding and Qmax improvements (P < 0.001). Multivariable logistic regression identified intravesical prostatic protrusion (IPP), prostate urethral angle (PUA), and preop-BNT as independent factors influencing postoperative outcome consistency. Among 51 PBNO patients confirmed by prostate MRI and urodynamic examination to have residual postoperative obstruction, multivariable logistic regression analysis showed that preop-BNT was an independent risk factor and PUA was an independent protective factor. ROC analysis determined the optimal preop-BNT cut-off value to be 7.50 mm for predicting residual obstruction.

CONCLUSION

PBNO results in a significant difference between postoperative objective evaluation and subjective evaluation improvement in many of these BPH patients with small-volume prostate. Preop-BNT is a valuable indicator for guiding surgical decisions in these patients. Measuring BNT can help determine whether to preserve or incise the bladder neck during anatomic enucleation of the prostate (AEEP), leading to better postoperative outcomes.