Transrectal ultrasound parameters: presumed circle area ratio and transitional zone area in the evaluation of patients with lower urinary tract symptoms.
OBJECTIVE
Benign prostatic hyperplasia (BPH) is not the only cause of lower urinary tract symptoms (LUTS) in elderly men. Thus, routine use of invasive measures to debulk the prostate will produce suboptimal treatment outcomes in many patients. We attempted to determine whether two parameters based on transrectal ultrasonography could accurately determine the presence of obstruction and predict the response to therapy.


METHODS
In the first part of the study, the presumed circle area ratio (PCAR) and transitional zone area ratio (TZAR) were determined in 86 men aged 50 years or greater and correlated with the patient's age, International Prostate Symptom Score (IPSS), and peak flow rate Qmax. The ability of cut-off values of PCAR = 0.75 and TZAR = 0.5 to stratify patients for the presence of obstruction was determined. In the second part of the study, PCAR and TZAR were determined in 25 men in urinary retention, who were further classified as having high voiding pressure (Group A) or an underactive detrusor muscle (Group B). Obstruction was reassessed immediately and 1 month after transurethral resection (TURP), and the ability of PCAR and TZAR to predict treatment outcome was assessed.


RESULTS
Both PCAR and TZAR showed weak correlations with IPSS and a moderate inverse correlation with Qmax. The cut-off values were able to separate patients according to Qmax and overall obstructive states. A PCAR of > or = 0.75 or a TZAR of > or = 0.5 would have predicted obstruction in 34 of 36 obstructed patients, and lower values would have correctly predicted the absence of obstruction in 33 of 37 patients. In patients with high voiding pressure, all those with PCAR and TZAR values above the cut-off showed good to average improvement after TURP. In patients with an underactive detrusor, both PCAR and TZAR were extremely useful in predicting the response to TURP.


CONCLUSIONS
In view of the morbidity and mortality of invasive treatments for BPH, subjecting patients with LUTS to these treatments in the absence of obstruction is irrational. We recommend the use of transrectal ultrasonography measures in the routine evaluation of BPH and reserve the more invasive urodynamic studies for patients with discrepant findings. Further studies in a larger group of patients are needed.
Muljibhai Patel Urological Hospital, Nadiad, India.
M M
MM
Desai
D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011470:Prostatic Hyperplasia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D012007:Rectum / Q000000981:diagnostic imaging; D011795:Surveys and Questionnaires; D014524:Urethral Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D016055:Urinary Retention / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics