Effectiveness of Prostatic Capsular Artery Resistive İndex in the Evaluation of Benign Prostatic Hyperplasia Treatment

Yıl 2019, Cilt: 4 Sayı: 2, 200 - 209, 30.06.2019

Bekir Turgut , Mustafa Bilal Hamarat

https://doi.org/10.26453/otjhs.465637

Öz

We aimed to evaluate whether the
prostatic capsular artery resistive index can be a parametric criterion in
evaluating the efficacy of α-blocker treatment and the severity of the disease
in patients with benign prostatic hyperplasia. The clinical and diagnostic
investigation findings and the radiographic images were recorded during the
treatment and during the application of procedures in the patients who
presented to our hospital with lower urinary system symptoms. Then, these data
and the information of the respective patients recorded in the hospital
database were examined retrospectively. A total of 66 patients were included in
the study. Of the patients, 36 with higher IPSS were recommended to be treated
and had a mean resistive index of 0.68±0.09, and the patients with lower IPSS
had a mean resistive index of 0.65±0.05. The difference between these two
values was found to be statistically significant (p<0.05).  In 36 patients who were treated for lower
urinary system symptoms, the mean resistive index before the treatment was
0.68±0.09. After the treatment, the mean resistive index decreased to
0.64±0.07. This decrease was statistically significant (p<0.05). The mean
IPSS was 20.38±4.03 before the treatment and it decreased to 14.38±3.69  after the treatment, showing a statistically
significant difference, similarly (p<0.05). We are of the opinion that the
resistive index of the posterior capsular artery of the prostate gland is a
parametric indicator to determine the severity of the benign prostatic
hyperplasia and to assess the efficacy of the treatment with alpha-blocker
medications.

Anahtar Kelimeler

Benign prostatic hyperplasia, transrectal colour doppler ultrasound, international prostate symptom score, prostatıc capsular artery resistive index

Benign Prostat Hiperplazisi Tedavisinin Değerlendirmesinde Prostat Kapsüler Arter Rezistif İndeks Değerinin Etkinliği

Öz

Benign prostat hipertrofisi olan hastalarda  prostat kapsüler arter rezistif indeksin
hastalığın şiddetini belirleme ve uygulanan α-bloker tedavi etkinliğini
değerlendirmede parametrik bir ölçüt olup olamayacağını değerlendirmeyi
amaçladık. Hastanemize başvuran ve tedavi olan 
alt üriner sistem semptomları olan 
hastaların tedavi, işlem, tetkik aşamasında hasta bulguları ve
görüntüleri kayıt altına alındı. Daha sonra retrospektif olarak bu kayıtlar ve
hastanemiz verileri incelendi. Çalışmaya 
66 hasta dahil edildi.  IPSS skoru
yüksek olup tedavi önerilen 36 hastanın rezistif indeks ortalama değeri
0,68±0,09  ,  IPSS skoru düşük olan hastaların rezistif
indeks ortalama değeri 0,65±0,05  dır. Bu
iki değer arasındaki fark istatiksel olarak anlamlı bulunmuştur(p<0,05).   Alt 
üriner  sistem  semptomları 
olan  ve  tedavi 
verilen  36  tedavi öncesi rezistif indeks değeri ortalama
0,68±0,09 ’dir. Tedavi sonrasında ortalama 0,64±0,07 değere gerilemiştir. Bu
gerileme istatistiksel olarak anlamlı bulunmuştur (p<0,05). Aynı
şekilde  tedavi  öncesi ortalama  20,38±4,03 olan  IPSS  değeri  tedavi sonrasında  ortalama 
14,38±3,69  ’e  gerilemiş 
ve  istatistiksel  olarak anlamlı bulunmuştur (p<0,05).
Prostat kapsüler arter rezistif indeks değeri benign prostat hipertrofisinin
şiddetini saptama ve uygulanan alfa bloker tedavi etkinliğinin
değerlendirilmesinde  parametrik bir
belirteç olduğunu düşünüyoruz.

Anahtar Kelimeler

Benign prostat hiperplazisi, transrektal renkli doppler ultrason, uluslararası prostat semptom skoru, prostatik kapsüler arter rezistif indeksi

Kaynakça

• Ikonen S, Kivisaari L, Tervahartiala P, et al. Prostatic MR imaging. Accuracy in differentiating cancer from other prostatic disorders. Acta Radiol. 2001;42(4):348-354.
• Syed M Danish Q, Nitin P. G, Bharat A, Sanjeev S. Prospective evaluation of prostate with transrectal spectral Doppler with biopsy correlation: a clinicopathologic study. Br J Radiol. 2016; 89(1060):20150830. Doi: 10.1259/bjr.20150830
• Kojima M, Ochiai A, Naya Y, Okihara K, Ukimura O, Miki T. Doppler resistive index in benign prostatic hyperplasia: Correlation with ultrasonic appearance of the prostate and infravesical obstruction. Eur Urol. 2000;37:436-442.
• Kwon SY, Ryu JW, Choi DH, Lee KS. Clinical Significance of the Resistive Index of Prostatic Blood Flow According to Prostate Size in Benign Prostatic Hyperplasia. Int Neurourol J. 2016;20(1):75–80.
• Xiaohang L, Bingni Z, Liangping Z et al. Differentiation of prostate cancer and stromal hyperplasia in the transition zone with histogram analysis of the apparent diffusion coefficient. Acta Radiol. 2017;58(12):1528-1534. Doi: 10.1177 / 0284185117698861
• Li C, Chen M, Wan BA, et al. Comparative study of Gaussian and non-Gaussian diffusion models for differential diagnosis of prostate cancer with in-bore transrectal MR-guided biopsy as a pathological reference. Acta Radiol. 2018;1: 284185118760961. Doi: 10.1177 / 0284185118760961
• Ozdemir H, Onur R, Bozgeyik Z, Orhan I, Ogras MS, Ogur E. Measuring Resistance Index in Patients with BPH and Lower Urinary Tract Symptoms. J Clin. Ultrasound. 2005; 33(4): 176-180.
• Andreas P, Wolfgang h, Jasmın B, et al. Vascular resistance in the prostate evaluated by colour Doppler ultrasonography: Is benign prostatic hyperplasia a vascular disease?. BJU. 2006; 98: 587-590. Doi:10.1111/j.1464-410X.2006.06306.x
• Osama A, Ehab E, Mostafa M. K, Ahmad K. Evaluation of the resistive index of prostatic blood flow in benign prostatic hyperplasia. Int Braz J Urol. 2012; 38(2): 225-257 Doi:10.1590/S1677-55382012000200014
• Tsuru N, Kurita Y,Masuda H, Suzuki K, Fujita K. Role of Doppler ultrasound and resistive index in benign prostatic hyperplasia. Int J Urol. 2002; 9(8): 427–430.
• Ozden C, Gunay I, Deren T, et al. Effect of transurethral resection of prostate on prostatic resistive index. Urol Int. 2010; 84: 191–193.
• Zhang X, Li G, Wei X, et al. Resistive index of prostate capsular arteries: a newly identified parameter to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia. J Urol. 2012; 188(3): 881–887 Doi:10.1016/j.juro.2012.04.114