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The role of prostatic apex shape in voiding symptoms and urine flow: an exploratory and confirmatory study

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Abstract

Purpose

Lower urinary tract symptoms in men have previously been attributed to obstruction from an enlarged prostate. However, several factors in addition to prostate volume have been identified as impacting urine flow. Prostatic apex shape is one factor that has not been evaluated. This study evaluates the relationship between prostatic apex shape and voiding symptoms and urine flow.

Methods

A retrospective, exploratory data review was conducted for 806 healthy men who underwent routine transrectal ultrasonography at our hospital, and data for 329 patients with uroflowmetric measurements were reviewed for the confirmatory study. Patients were categorized into four groups according to the prostatic apex shape on midsagittal ultrasonography. The association between prostatic apex shape and voiding symptoms was investigated. International Prostate Symptom Score (IPSS) and uroflowmetry were measured, and the associations between IPSS, uroflowmetry, and prostatic apex shape were analyzed.

Results

Patients in group 4 (356/806, 44.2%), whose prostatic apex did not overlap the membranous urethra anteriorly or posteriorly, had a significantly lower incidence of moderate and severe lower urinary tract symptoms compared to other groups. There was a significant relationship between prostatic apex shape and total International Prostate Symptom Score. Patients in group 3, whose prostatic apex overlapped posteriorly with the membranous urethra, had lower maximum flow rates on uroflowmetry. There were significant correlations between the maximum flow rate and independent factors including age, intravesicle prostatic protrusion, and prostatic apex shape.

Conclusions

Prostatic apex shape is an independent risk factor for voiding symptom severity and low maximum flow rate.

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Acknowledgements

The authors would like to thank Dong-Su Jang, MFA (Medical Illustrator), for his help with the illustrations.

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Authors and Affiliations

Authors

Contributions

JSP: project development, data analysis, manuscript writing/editing. DL: data collection. KCK: project development, data analysis. BHC: project development, data analysis. KSL: project development, data collection, data analysis, manuscript editing.

Corresponding author

Correspondence to Kwang Suk Lee.

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Conflict of interest

All of the authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not required for the purposes of this study, as it was based upon retrospective anonymous patient data and did not involve patient intervention or the use of human tissue samples.

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Park, J.S., Lee, D., Koo, K.C. et al. The role of prostatic apex shape in voiding symptoms and urine flow: an exploratory and confirmatory study. World J Urol 38, 1275–1282 (2020). https://doi.org/10.1007/s00345-019-02925-1

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  • DOI: https://doi.org/10.1007/s00345-019-02925-1

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