title: Intravesical Prostatic Protrusion as a Predicting Factor for the Adverse Clinical Outcome in Patients With Symptomatic Benign Prostatic Enlargement Treated With Dutasteride.
abstract: To evaluate the role of intravesical prostatic protrusion (IPP) as a predictive factor for adverse clinical outcomes in patients treated with dutasteride for lower urinary tract symptoms secondary to benign prostatic enlargement (BPE).
  
  
  
  In total, 111 patients treated with dutasteride for symptomatic BPE were analyzed. Stepwise multivariate logistic regression was applied to evaluate predictors for acute urinary retention (AUR) or benign prostatic hyperplasia (BPH)-related surgery. We applied an IPP cutoff value of 10 mm. The clinical variables were assessed using univariate analysis.
  
  
  
  Of 111 patients, 27 (24.3%) developed AUR or required surgical intervention. On multivariate analysis, IPP remained as the independent predictor for AUR and need for BPH-related surgery (odds ratio, 1.27; P < .001). Both international prostate symptom score and maximum urinary flow rate significantly improved in patients with low IPP (P  =  .03 and P  <  .001, respectively), but not in those with high IPP. No significant reduction was found in the degree of IPP despite the significant reduction in prostate volume after dutasteride treatment (P  =  .84 and P  <  .001, respectively). The 3-year cumulative incidence of AUR or BPH-related surgery in the low IPP group vs the high IPP group was 9.9% vs 71.5%, respectively (P  <  .001).
  
  
  
  High IPP is associated with a higher risk of treatment resistance, AUR, or the need for prostatic surgery in patients receiving dutasteride treatment for symptomatic BPE. Dutasteride might not be effective for IPP reduction.
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan. Electronic address: kinoshita@hirakata.kmu.ac.jp.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Mishima
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yanishi
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komai
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Kaneki
authors.initials: K
authors.lastname: Yasuda
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Sugi
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000368:Aged; D000068538:Dutasteride / Q000627:therapeutic use*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D011379:Prognosis; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D017211:Treatment Failure; D001743:Urinary Bladder; D016055:Urinary Retention / Q000209:etiology*
chemical_list: D058891:5-alpha Reductase Inhibitors; D000068538:Dutasteride