TRUS versus transabdominal ultrasound as a predictor of enucleated adenoma weight in patients with BPH: a tool for standard preoperative work-up?
BACKGROUND
Despite being formally included in the assessment of patients presenting with lower urinary tract symptoms (LUTS), transrectal ultrasonography (TRUS) is not routinely offered to these patients. This tactic however might not be optimum since data exist on the superiority of TRUS over transabdominal ultrasound in accurately predicting prostate volumes. We aimed to evaluate TRUS as a standard tool in the evaluation of patients with benign prostate hyperplasia (BPH) with a special focus on the potential impact it might have on the decision of open versus transurethral surgery.


METHODS
Seventy-one patients presenting with LUTS due to BPH and eventually managed with open surgery based on their preference and prostate volume were included in the protocol. TRUS was performed in all patients preoperatively and calculations of the transition zone were made. These were compared with respective transabdominal calculations of the prostate volume as well as the enucleated specimen weight (W).


RESULTS
TRUS slightly underestimated W by 4.4% (95% CI 10.5, 1.7) while transabdominal ultrasound overestimated it by 55.7% (95% CI 31.8, 79.6). Regression analysis indicated TRUS as a better predictor of W (R (2) = 0.817, P < 0.0005) followed by transabdominal ultrasound (R (2) = 0.669, P < 0.0005). Strictly based on European Association of Urology (EAU) criteria, transabdominal measurements miscategorized 25 cases by falsely assigning them to the open surgery (>80 cc) group while TRUS did so for four cases.


CONCLUSIONS
TRUS is more accurate than transabdominal ultrasound in predicting adenoma volume in patients with BPH and its standard use might lead to fewer open approaches, with consequent less morbidity and hospitalization.
First Urology Department, University of Athens Medical School, Laiko General Hospital, 17 Ag Thoma St., 11527, Athens, Greece.
Konstantinos G
KG
Stravodimos
Andreas
A
Petrolekas
Theodoros
T
Kapetanakis
Stavros
S
Vourekas
Georgios
G
Koritsiadis
Ioannis
I
Adamakis
Dionysios
D
Mitropoulos
Constantinos
C
Constantinides
D000005:Abdomen / Q000000981:diagnostic imaging; D000236:Adenoma / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011336:Probability; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging; D012044:Regression Analysis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
D017430:Prostate-Specific Antigen