A high score — above 10 mm — in intravesical prostatic protrusion (IPP) is predictive of adverse clinical outcomes in patients with urinary problems due to benign prostatic hyperplasia (BPH), according to a study titled “Intravesical Prostatic Protrusion as a Predicting Factor for the Adverse Clinical Outcome in Patients with Symptomatic Benign Prostatic Enlargement Treated with Dutasteride” and published in the journal Urology.
BPH leads to lower urinary tract problems in older men. Current treatments include the use of 5α-reductase inhibitors due to their ability to reduce prostate volume and their capacity to decrease the risk of acute urinary retention or surgical intervention in BPH patients. However, patients often fail to respond to this type of treatment.
Researchers investigated if intravesical prostatic protrusion (IPP), a non-invasive method used to determine bladder prostatic obstruction, could really predict clinical outcomes in patients treated with the 5α-reductase inhibitor dutasteride. The team reviewed data from patients with acute urinary retention as a result of BPH, who were treated with dutasteride for approximately four years (from April 2010 to December 2014) at the Kansai Medical University, Osaka, Japan. Researchers analyzed 111 of these patients for symptomatic BPH.
They found that 27 patients developed acute urinary retention or had to be submitted to surgical intervention. Importantly, they observed that IPP is an independent factor capable of predicting patients’ risk of urinary problems and need for BPH-related surgery (9.5 mm in IPP was determined to be the cut-off value in predicting acute urinary retention or surgery). Moreover, patients with low IPP showed a significant improvement in both prostate symptom score and maximum urinary flow rate, a phenotype not observed in those with high IPP.
Researchers also observed that, while dutasteride treatment resulted in a significant reduction in prostate volume, the treatment did not reduce IPP degree, indicating that dutasteride might not be an effective treatment for IPP reduction.
These results suggest that, in clinical settings, measuring the degree of IPP is a potentially effective way to determine whether medication or immediate prostatic surgery is the more suitable treatment for given BPH patients.