Decision making in the management of benign prostatic enlargement and the role of transabdominal ultrasound

Abstract

Benign prostate enlargement (BPE) is a common disease affecting elderly men. It can present clinically in many ways including, but not exclusively, lower urinary tract symptoms (LUTS) and acute urinary retention (AUR). Therefore, in managing men with BPE, a correct diagnosis in the outpatient setting is important. Diagnosis of BPE in the clinic can be aided by simple, non-invasive, transabdominal ultrasound (TAUS). In our practice, a normal prostate is generally defined as less than 20 mL, and shows no intravesical prostatic protrusion (IPP) to distort the normal funneling bladder neck on TAUS, with a maximum flow rate of more than 15 mL/s. The degree of IPP can be measured non-invasively in the midsagittal plane, and can be graded accordingly. Studies have shown that the grade of IPP correlates well with the degree of bladder outlet obstruction (BOO). In addition, TAUS can also be used to measure prostate volume (PV) and post-void residual urine (PVR). There is a good correlation between IPP and PV, but IPP is a better predictor for BOO. Patients with low-grade IPP, no significant PVR (<100 mL) and no bothersome symptoms (low stage) can generally be watched; whereas those with high-grade IPP, significant PVR (>100 mL) and bothersome symptoms (higher stage) will need more aggressive management. The final decision for management can then be tailored and individualized to achieve cost-effectiveness.