Predicting the Outcome of Patients with Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia Treated with Alpha Blocker Monotherapy by Measurement of Bladder and Prostate Parameters Using Ultrasound

Abstract
Background: Benign Prostatic Hyperplasia (BPH) is a condition intimately related to ageing. Although it is not life threatening, its clinical manifestation as Lower Urinary Tract Symptoms (LUTS) reduces the patient's quality of life.
Aim of the Study: To determine prostate and bladder sonographic parameters that can predict the outcome of patients with LUTS/BPH treated by alpha 1a adrenoreceptor blocker monotherapy.
Patients and Methods: Fifty patients complaining of LUTS/BPH were prospectively enrolled. Transrectal Ultra-sonography (TRUS) was done to all patients. Tamsulosin 0.4mg oral tablet was given to all patients once daily for 3 months then the response to treatment on the basis of Inter-national Prostatic Symptom Score (IPSS), Quality of Life (QoL) score and maximum urine flow rate (Qmax) was eval-uated. The impacts of baseline parameters on treatment out-come were statistically analyzed.
Results: 45 patients completed the study. From them 15 patients (33.3%) had ineffective treatment. Pre treatment IPSS storage subscore, Qmax and TRUS measured parameters [Bladder Wall Thickness (BWT), Intravesical Prostatic Pro-trusion (IPP) and ultrasound estimated bladder weight (UEBW)] were the independent predictors of treatment failure. Receiver Operator characteristic (ROC) curves for parameters (BWT, UEBW and IPP) showed that Areas Under Curve (AUC) were (0.870, 0.908 and 0.836 respectively) at cut-off values of 9mm, 36g and 8.2mm. Using these cut-off values, the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 75.0% and 97.6%; 72.4% and 96.0%; 67.5% and 95.0% for BWT, UEBW and IPP, respectively. Combination of these sono-morphologic parameters increased their positive predictive value to 76.39%.
Conclusion: Combined use of sonographic parameters BWT, UEBW and IPP can predict alpha blocker monotherapy failure in BPH patients which aid in determining therapeutic plan and the need for further medical therapy or surgical intervention.