Intravesical Prostatic Protrusion and Surgical Outcomes in Benign Prostatic Hyperplasia: A Magnetic Resonance Imaging-Based Evaluation

Year 2025, Volume: 20 Issue: 2, 97 - 103, 29.06.2025

Emre Uzun , Kazım Ceviz , Hüseyin Gültekin , Hasan Batuhan Arabacı , Giray Özgirgin

https://doi.org/10.33719/nju1649999

Abstract

Objective: This study aimed to investigate the impact of preoperative intravesical prostatic protrusion (IPP) measurements obtained via magnetic resonance imaging (MRI) on postoperative outcomes in patients undergoing transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).
Material and Methods: A retrospective review was performed on 160 patients who underwent monopolar TURP at our clinic between January 2021 and December 2023. IPP was measured on sagittal MRI images as the vertical distance from the bladder base to the tip of the prostate protruding into the bladder. Patients were divided into three groups according to IPP length: Group A (IPP <5 mm, n=25), Group B (5 mm ≤ IPP <10 mm, n=30), and Group C (IPP ≥10 mm, n=38). Preoperative and postoperative data, including prostate-specific antigen (PSA) levels, International Prostate Symptom Score (IPSS), average urinary flow rate (Qavg), and maximum urinary flow rate (Qmax), were collected and analyzed across the groups.
Results: The mean age of the patients was 65.3 ± 6.7 years. PSA levels were significantly higher in Group C compared to Group A (p=0.014). Prostate volume and the volume of resected tissue were significantly greater in Group C than in Groups A and B (p<0.001). Postoperatively, all groups showed significant decreases in PSA and IPSS values, along with significant increases in Qmax and Qavg. The improvement in Qmax after TURP was significantly greater in Groups B and C compared to Group A (p=0.019). However, the reduction in IPSS scores did not differ significantly among the groups (p=0.727).
Conclusion: IPP correlates positively with prostate volume, PSA levels, and the amount of resected tissue. TURP significantly improves urinary function and symptom scores regardless of IPP length. However, the improvement in Qmax is more pronounced in patients with a higher IPP. IPP measurement may serve as a useful parameter in the surgical decision-making process for BPH patients.

Keywords

intravesical prostatic protrusion , benign prostatic hyperplasia , transurethral resection of the prostate , magnetic resonance imaging , urinary function.

Ethical Statement

The study was approved by the Ethics Committee of Ankara Bilkent City Hospital (Approval No: TABED 2-24-605).

Supporting Institution

None.

Thanks

None.

İntravezikal Prostatik Protrüzyon ve Benign Prostat Hiperplazisinde Cerrahi Sonuçlar: Manyetik Rezonans Görüntüleme Temelli Değerlendirme

Abstract

Amaç
Bu çalışma, benign prostat hiperplazisi (BPH) nedeniyle transüretral prostat rezeksiyonu (TURP) uygulanan hastalarda, manyetik rezonans görüntüleme (MRG) ile elde edilen preoperatif intravezikal prostatik protrüzyon (IPP) ölçümlerinin postoperatif sonuçlar üzerindeki etkisini araştırmayı amaçladı.

Gereç ve Yöntemler
Ocak 2021 ile Aralık 2023 tarihleri arasında kliniğimizde monopolar TURP uygulanan 160 hastanın retrospektif incelemesi yapıldı. IPP, sagittal MRG görüntülerinde mesane tabanından mesaneye protrüde olan prostat ucuna kadar olan dikey mesafe olarak ölçüldü. Hastalar IPP uzunluğuna göre üç gruba ayrıldı: Grup A (IPP <5 mm, n=25), Grup B (5 mm ≤ IPP <10 mm, n=30) ve Grup C (IPP ≥10 mm, n=38). Prostat spesifik antijen (PSA) seviyeleri, Uluslararası Prostat Semptom Skoru (IPSS), ortalama idrar akış hızı (Qavg) ve maksimum idrar akış hızı (Qmax) gibi preoperatif ve postoperatif veriler toplandı ve gruplar arasında analiz edildi.

Bulgular
Hastaların ortalama yaşı 65,3 ± 6,7 yıl idi. PSA seviyeleri Grup C’de Grup A’ya kıyasla anlamlı olarak daha yüksek bulundu (p=0,014). Prostat hacmi ve rezeke edilen doku hacmi, Grup C’de Grup A ve B’ye göre anlamlı derecede daha fazlaydı (p<0,001). Postoperatif dönemde tüm gruplarda PSA ve IPSS değerlerinde anlamlı düşüşler, Qmax ve Qavg değerlerinde ise anlamlı artışlar gözlendi. TURP sonrası Qmax’teki iyileşme, Grup B ve C’de Grup A’ya kıyasla daha belirgin olup, aradaki fark istatistiksel olarak anlamlıydı (p=0,019). Ancak, IPSS skorlarındaki azalma gruplar arasında anlamlı bir fark göstermedi (p=0,727).

Sonuç
IPP, prostat hacmi, PSA seviyeleri ve rezeke edilen doku miktarı ile pozitif korelasyon göstermektedir. TURP, IPP uzunluğundan bağımsız olarak idrar fonksiyonlarını ve semptom skorlarını anlamlı şekilde iyileştirmektedir. Ancak, Qmax’teki iyileşme, yüksek IPP değerine sahip hastalarda daha belirgin görülmüştür. IPP ölçümü, BPH hastalarının cerrahi karar sürecinde faydalı bir parametre olarak değerlendirilebilir.

Keywords

benign prostat hiperplazisi , transüretral prostat rezeksiyonu , manyetik rezonans görüntüleme , üriner fonksiyon , intravezikal prostatik protrüzyon

Ethical Statement

TABED 2-24-605

Supporting Institution

Yoktur.

Thanks

Yoktur.

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