title: Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment.
abstract: OBJECTIVE
  To assess intravesical prostatic protrusion (IPP) as a novel predictor of clinical progression in patients with benign prostatic enlargement (BPE).
  
  
  METHODS
  All patients attending the outpatient clinic at our institution who were being treated for lower urinary tract symptoms (LUTS) secondary to BPE between January 1997 and December 2003 were recruited into the study. International Prostate Symptom Score (IPSS) scores, uroflowmetry parameters, post-void residual urine volume (PVR), IPP and serum prostate-specific antigen (PSA) were collected. IPP was classified into Grade 1, 2 or 3. Patients were stratified to different treatment options including watchful waiting, alpha blockers or 5-alpha reductase inhibitors. Those who developed high post-void residual urine volume (>100 mL), acute urinary retention or a deterioration of at least 4 points in IPSS score were considered to have disease progression. Using the Grade 1 IPP group as a reference, the odds ratio for clinical progression of Grade 2 and Grade 3 IPP were calculated by using multivariate analysis.
  
  
  RESULTS
  A total of 259 patients with a mean age of 63 years (range 50-90 years) and mean follow-up time of 32 months were available for analysis. Fifty-two patients were found to have clinical progression. Odds ratio for progression of a Grade 2 IPP was 5.1 (95% confidence interval [CI] 1.6-16.2) and that of a Grade 3 IPP was 10.4 (95% CI 3.3-33.4).
  
  
  CONCLUSIONS
  A higher IPP grade is associated with a higher risk of clinical progression in BPE. IPP is a useful non-invasive predictor for clinical progression in BPE.
authors.affiliation: Department of Urology, Singapore General Hospital, Singapore.
authors.forename: Lui Shiong
authors.initials: LS
authors.lastname: Lee
authors.forename: Hong Gee
authors.initials: HG
authors.lastname: Sim
authors.forename: Kok Bin
authors.initials: KB
authors.lastname: Lim
authors.forename: Delin
authors.initials: D
authors.lastname: Wang
authors.forename: Keong Tatt
authors.initials: KT
authors.lastname: Foo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011470:Prostatic Hyperplasia / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D001743:Urinary Bladder