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Intravesical prostatic protrusion is not always the same shape: Evaluation by preoperative cystoscopy and outcome in HoLEP
Author(s) -
Ito Katsuhiro,
Takashima Yasushi,
Akamatsu Shusuke,
Terada Naoki,
Kobayashi Takashi,
Yamasaki Toshinari,
Inoue Takahiro,
Kamba Tomomi,
Ogawa Osamu,
Negoro Hiromitsu
Publication year - 2018
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23428
Subject(s) - medicine , enucleation , cystoscopy , international prostate symptom score , urology , lobe , prostate , surgery , lower urinary tract symptoms , anatomy , urinary system , cancer
Aims To examine how morphological differences in intravesical prostatic protrusion (IPP) predict outcome of Holmium laser enucleation of prostate (HoLEP) treatment. Methods We analyzed 173 patients who had undergone HoLEP in our hospital. The protrusion shape was evaluated by outpatient preoperative flexible cystoscopy and classified into five groups: A, no protrusion; B, middle lobe only; C, unilateral lobe only; D, bilateral lobes; and E, B + C or B + D. Paired‐match analysis that adjusted for preoperative International Prostate Symptom Score (IPSS) voiding/storage subscores and IPP was performed between the group with middle lobe protrusion (B + E) and the group without it (C + D). Results Type A prostate shape was found in 23 patients, type B in 14, type C in 31, type D in 71, and type E in 34. Groups with middle lobe protrusion (B and E) had better changes in the total IPSS ( P < 0.05) and the IPSS storage subscore ( P < 0.01). Pair matching identified 37 patients each with or without middle lobe protrusion. The group with middle lobe protrusion had significantly more improved total IPSS (−17.5 ± 7.5 vs −13.5 ± 8.3, P < 0.05) and IPSS storage subscore (−6.9 ± 3.4 vs −4.8 ± 3.3, P < 0.05) than did those without middle lobe protrusion. Conclusions Patients with middle lobe protrusion had greater IPSS improvement after HoLEP than those having comparable‐length IPP but without middle lobe protrusion. IPP is not always the same shape and should be clinically divided into at least two groups.