Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study
Introduction: Benign Prostatic Hyperplasia (BPH) is mainly managed with alpha-blocker and 5 alpha reductase inhibitors. Non responders are offered surgery. To wait for the drug response is sometimes cumbersome for the patients with bothersome symptoms and may also lead to complications. On the...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-07-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/18184/58882_CE[Ra1]_F(IS)_PF1(HB_KM)_PFA(HB_KM)_PN(KM).pdf |
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| author | Mohit Mittal Raghav Talwar Ananya Dutta Abhishek Kumar Shukla |
| author_facet | Mohit Mittal Raghav Talwar Ananya Dutta Abhishek Kumar Shukla |
| author_sort | Mohit Mittal |
| collection | DOAJ |
| description | Introduction: Benign Prostatic Hyperplasia (BPH) is mainly
managed with alpha-blocker and 5 alpha reductase inhibitors.
Non responders are offered surgery. To wait for the drug
response is sometimes cumbersome for the patients with
bothersome symptoms and may also lead to complications. On
the other hand, some have minimal symptoms on drugs but
silently develop obstructive complications.
Aim: To understand the role of sonographic parameters of
prostate and bladder of BPH patients in predicting and assessing
response to medical treatment.
Materials and Methods: This prospective cohort study was
conducted in the Department of Urology at Army Hospital
Research and Referral, New Delhi, India. The duration of the study
was 15 months, from October 2017 to January 2019. A total of
100 consecutive patients of BPH with Prostate-specific Antigen
(PSA) <4 ng/mL and prostate of >35 cc were given three months
of alpha-blocker and dutasteride. Based on there subjective
response, they were grouped into Symptomatic Improved (SI)
and Not Improved (NI) group. Values of sonographic parameters
including Prostate Volume (PV), prostatic capsular artery
Resistance Index (RI), Intravesical Protrusion of Prostate (IPP),
Detrusor Wall Thickness (DWT) and Post-void Residual volume
(PVR), as well as, International Prostate Symptom Score (IPSS)
and Uroflowmetry (UFM) at baseline and after three months of
treatment were analysed and compared in both the groups. The
significance of change in parameters was analysed using paired
t-test and two sample Student’s t-test.
Results: The mean age of the study participants was 64.8±5.86
years. There was an association between IPSS and flow with
initial reading of PV, PVR, DWT, RI and IPP. Post-treatment both,
SI (n=74) and NI (n=26) group showed valuable difference in DWT,
PV and PVR but it was significantly more in improved group.
Significant change in RI was observed only in SI group and IPP
did not change in either group. Area Under Curve (AUC) under
Receiver Operating Characteristic (ROC) was suggestive of higher
sensitivity for IPP in predicting drug outcome.
Conclusion: Combined use of Ultrasonography (USG) and
Kidney, Ureter, and Bladder (KUB) parameters as described
above like RI, DWT, PV and IPP can be used to predict and
assess the objective response to drug in BPH. This helps in
determining therapeutic plan and the need for further medical
therapy or surgical intervention. |
| first_indexed | 2024-03-12T20:59:27Z |
| format | Article |
| id | doaj.art-df536a751d1e417aab524341cc49d91c |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-12T20:59:27Z |
| publishDate | 2023-07-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-df536a751d1e417aab524341cc49d91c2023-07-31T10:30:31ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-07-01177061110.7860/JCDR/2023/58882.18184Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort StudyMohit Mittal0Raghav Talwar1Ananya Dutta2Abhishek Kumar Shukla3Assistant Professor, Department of Surgery, MH Gurdaspur, Panjab, India.Professor, Department of Surgery, AFMC, Pune, Maharashtra, India.Associate Professor, Department of Urology, CHEC, Kolkata, West Bengal, IndiaAssociate Professor, Department of Urology, CHSC, Pune, Maharashtra, India.Introduction: Benign Prostatic Hyperplasia (BPH) is mainly managed with alpha-blocker and 5 alpha reductase inhibitors. Non responders are offered surgery. To wait for the drug response is sometimes cumbersome for the patients with bothersome symptoms and may also lead to complications. On the other hand, some have minimal symptoms on drugs but silently develop obstructive complications. Aim: To understand the role of sonographic parameters of prostate and bladder of BPH patients in predicting and assessing response to medical treatment. Materials and Methods: This prospective cohort study was conducted in the Department of Urology at Army Hospital Research and Referral, New Delhi, India. The duration of the study was 15 months, from October 2017 to January 2019. A total of 100 consecutive patients of BPH with Prostate-specific Antigen (PSA) <4 ng/mL and prostate of >35 cc were given three months of alpha-blocker and dutasteride. Based on there subjective response, they were grouped into Symptomatic Improved (SI) and Not Improved (NI) group. Values of sonographic parameters including Prostate Volume (PV), prostatic capsular artery Resistance Index (RI), Intravesical Protrusion of Prostate (IPP), Detrusor Wall Thickness (DWT) and Post-void Residual volume (PVR), as well as, International Prostate Symptom Score (IPSS) and Uroflowmetry (UFM) at baseline and after three months of treatment were analysed and compared in both the groups. The significance of change in parameters was analysed using paired t-test and two sample Student’s t-test. Results: The mean age of the study participants was 64.8±5.86 years. There was an association between IPSS and flow with initial reading of PV, PVR, DWT, RI and IPP. Post-treatment both, SI (n=74) and NI (n=26) group showed valuable difference in DWT, PV and PVR but it was significantly more in improved group. Significant change in RI was observed only in SI group and IPP did not change in either group. Area Under Curve (AUC) under Receiver Operating Characteristic (ROC) was suggestive of higher sensitivity for IPP in predicting drug outcome. Conclusion: Combined use of Ultrasonography (USG) and Kidney, Ureter, and Bladder (KUB) parameters as described above like RI, DWT, PV and IPP can be used to predict and assess the objective response to drug in BPH. This helps in determining therapeutic plan and the need for further medical therapy or surgical intervention.https://www.jcdr.net/articles/PDF/18184/58882_CE[Ra1]_F(IS)_PF1(HB_KM)_PFA(HB_KM)_PN(KM).pdfintravesicalprostateresistive indexultrasounduroflowmetry |
| spellingShingle | Mohit Mittal Raghav Talwar Ananya Dutta Abhishek Kumar Shukla Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study Journal of Clinical and Diagnostic Research intravesical prostate resistive index ultrasound uroflowmetry |
| title | Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study |
| title_full | Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study |
| title_fullStr | Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study |
| title_full_unstemmed | Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study |
| title_short | Sonographic Association and Prediction of Treatment Response to Medical Therapy in Patients with Benign Prostatic Hyperplasia: A Prospective Cohort Study |
| title_sort | sonographic association and prediction of treatment response to medical therapy in patients with benign prostatic hyperplasia a prospective cohort study |
| topic | intravesical prostate resistive index ultrasound uroflowmetry |
| url | https://www.jcdr.net/articles/PDF/18184/58882_CE[Ra1]_F(IS)_PF1(HB_KM)_PFA(HB_KM)_PN(KM).pdf |
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