Study of Association of Transrectal Ultrasonogram Derived Parameters with Acute Urinary Retention in Symptomatic Patients with Benign Prostatic Hypertrophy

Abstract

INTROUCTION: Benign prostatic hyperplasia (BPH)

for decades has been a significant major problem for

elderly men. BPH is associated with bothersome lower

urinary tract symptoms (mild to severe) namely urinary

frequency, urgency, feeling of incomplete bladder

emptying, nocturia, and decreased force of their urinary

stream. Many of the patients suffering from BPH undergo

surgery for having one of the absolute indications for

surgery (refractory urine retention despite adequate and

effective medical treatment, presence of urinary tract

infections, repeated episodes of infections, gross

hematuria with multiple episodes, pathological and/or

physiological changes of the organs directly or indirectly

involved namely secondary to obstruction). However a

large portion of patients undergo surgery for having

a relative indication, namely sever LUTs not responding to

efficient medical therapy. This relative indication is purely

subjective, and although many diagnostic tools are present

to aid in the assessment of such patients (uroflowmetry,

post voiding residual urine and pressure flow studies),

none of them were totally reliable, either for their weak

correlation or their invasiveness. In this study, we tried to

test the transition zone index and other derived parameters

to determine if calculating such a figure would help in the

assessment of prostatic patients. AIM OF THE STUDY:

The aim of this study is to derive and confirm the

association between the transrectal ultra sonogram

derived prostate measures and the development of acute

urinary retention in symptomatic prostatic patients and

trying to evaluate the clinical usefulness of calculating this

index. MATERIALS AND METHODS: Cross sectional

clinical study of Patients attending Urology OPD and in

patients at Kilpauk Medical College Hospital and Govt.

Royapettah Hospital in the age group between 45 and 85

with lower urinary tract symptoms of benign prostatic

hyperplasia. The study period is from June 2016 to March

2017. TRUS based calculation the transition zone (TZ)

volume, the transition zone index (TZ index = TZ volume/total

prostate volume), the total prostate volume, and presumed

circle area ratio (PCAR). The study of association between

these parameters and acute urinary retention was done using

statistical analysis software. RESULTS: The maximum

number of patients with urinary retention is found in the group

with duration of symptoms of 4-6 yrs (32.10%), followed by

the group with duration between 6-8 yrs. In the frequency

distribution for total prostate volume, acute retention of urine

was found to be maximum (43%) in the prostate volume group

of 50 to 60 g. The largest group (59%) of acute retention of

urine falls in the group with transition zone volume between

30 and 45g. On analysis of the distribution with PCAR, AUR

was present in the maximum percentage (91%) in the group

with ratio ≥0.8.In this study the TZI of ≥0.6 consists of the

maximum patients falling under the Acute Urinary Retention

group. CONCLUSION: In this study it was found that age

of the patient had a good association with the occurrence of

AUR. The association between, total prostate volume,

transition zone volume, transition zone index, PCAR and AUR

was found to be statistically significant. Duration of symptoms

was not significantly associated with the occurrence of AUR.

As the values of TZI and PCAR increased, the association

with acute retention of urine was inferred to be more

significant, there by suggesting that these indices can be used

as strong predictors of AUR. Larger studies are warranted to

detect if these parameters can be useful in deciding the mode

of management.