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Basic Research Journal of Medicine and Clinical Sciences ISSN 2315-6864 Vol. 4(4) pp. 121-124 April 2015
Available online http//www.basicresearchjournals.org
Copyright ©2015 Basic Research Journal
Short Communication
Correlation between prostate volume and lower urinary
tract symptoms in Sudanese patients with benign
prostatic hyperplasia
Awad Ali M. Alawad, Shihab Mohamed Elamin, Faisal H. Younis
Department of Surgery, Faculty of Medicine, University of Medical Sciences and Technology, Sudan
*Corresponding author email: [email protected]; Tel: 00249912802545
Accepted 29 April, 2015
Abstract
Background: Benign prostatic hyperplasia (BPH) is now recognized as one of the principal medical
problems facing the male population in Sudan. Assessment of patients with prostatic enlargement still
remains a challenge for doctors. Objective: The aim of this study was to correlate the prostate volume
with international prostate symptom score (IPSS) and age in patients with benign prostatic hyperplasia
(BPH). Materials and Methods: This is retrospective observational case-detection hospital based study.
Eighty eight consecutive patients presented with lower urinary tract symptoms attending the urology
clinic at University Teaching Hospital were enrolled. All patients were interviewed using standardized
questionnaires for International Prostate Symptom Score. Trans-abdominal ultrasonogram was used to
assess the prostatic volume. Results: The mean age was 63.36 years with minimum of 27 and a
maximum of 90. The mean volume of prostate was 42.38 cm3. Most of the patients had severe
symptoms with a mean IPSS of 10.52. The correlation between the prostate volume and age was
statistically significant in contrast to the correlation between prostate volume and IPSS which was not
significant. Similarly, correlation between IPSS score and age was not significant. Conclusion: We
concluded that prostate volume had a correlation with age, and no correlation with symptoms score,
and there was no correlation between age and the symptoms score.
Keywords: Serum prostate specific antigen; prostate volume; benign prostatic hyperplasia
INTRODUCTION
Benign prostatic hyperplasia (BPH), diagnosed by the
presence of benign prostate enlargement and lower
urinary tract symptoms (LUTS), has been considered to
be a chronic and progressive disease (Alawad et al.,
2014). Because baseline prostate volume (PV) has been
linked to the progression of BPH (e.g., acute urinary
retention and surgery for BPH), PV has been included as
a useful tool in treatment guidelines. Therefore, it is clear
that knowledge of individual PV would be beneficial for
everyday management of patients presenting to
physicians. This undertaking has some problems, most
notably fact that digital rectal examination is relatively
inaccurate in measuring the correct prostate size when
measured by either transrectal ultrasound (TRUS) or
other imaging modalities, such as computerized
tomography or magnetic resonance imaging (Kwon et al.,
2012). Because imaging modalities accompany financial
burden and limited reproducibility, it is reasonable to
Published by Basic Research Journal of Medicine and Clinical Science
Omer et al. 122
Table 1. Showing descriptive statistics of age, PV and IPSS
Age
IPSS
Prostate volume
N
88
88
88
Range
63
29
79
Minimum
27
1
21
Maximum
90
30
100
Mean
63.36
10.52
42.38
Std. Deviation
12.379
7.311
15.497
Age
1.000
.
88
*
.254
.017
88
Prostate volume
*
.254
.017
88
1.000
.
88
Table 2. Showing correlation between Age and Prostate Volume
Correlation Coefficient
Age
Sig. (2-tailed)
N
Spearman's rho
Correlation Coefficient
Prostate volume Sig. (2-tailed)
N
*. Correlation is significant at the 0.05 level (2-tailed).
search for alternative parameters that could be used
instead of PV.
Lower urinary tract symptoms (LUTS) are the most
common presentation of patients with prostate disease
(Yeh et al., 2012). Early detection is a still a problem
worldwide. For a long time international prostate
symptoms score (IPSS) is thought to be a good measure
of the extent of prostatic disease however many studies
opposed this direction in contrast to others supported this
theory (Franciosi et al., 2007; Hassanzadeh et al., 2010;
Hedelin et al., 2005; Isikay et al., 2007; Vesely et al.,
2003). However, most studies of the relationship between
lower urinary tract symptoms (LUTS) and PV have
originated from developed countries, and few studies
have been conducted in Africa. Thus, we performed a
study to determine the predictive power of LUTS for
prostate volume in Sudanese patients with biopsy proven
benign prostatic hyperplasia.
MATERIALS AND METHODS
This is retrospective observational case-detection
hospital based study. Eighty eight medical records of
patients with an enlarged prostate attending the urology
clinic at University Teaching Hospital were enrolled from
September 2012 through September 2013.
This
research was conducted in University Charity Teaching
Hospital, Khartoum, Sudan.
Demographic details, clinical presentation, international
prostate symptoms score (IPSS) and assessment of
prostate volume (PV) of all patients were entered into our
study proforma. PV was measured with transabdominal
ultrasound and PV was defined by measuring the height
(H), width (W), and length (L) of the prostate from two
selected orthogonal views and calculating the volume (V)
as that of the corresponding ellipsoid formula:
V=0.52×W×H×L (Choi et al., 2013).
Exclusion criteria were patients with a history of
receiving 5-alpha reductase inhibitor therapy and those
with a history of invasive surgical treatment of benign
prostatic hyperplasia (BPH), such as transurethral
resection or laser prostatectomy. Patients with a history
of acute prostatitis, with a history of urinary retention
within the past month, or lacking data on any of the
aforementioned parameters were excluded. Prostate
cancer patients with results confirmed by subsequent
TRUS-guided prostate biopsy were excluded. Only
patients proven to have benign results by the prostate
biopsy were included in this study. Patients with PSA
above 20 ng/ mL were also omitted to decrease the
possibility of occult prostate cancer. After all exclusions,
80 men were enrolled in this study.
All summary statistics are stated with 95% confidence
limits. A method appropriate for small samples was
applied to the percentages and odds ratios were derived
using logistic regression methods (SPSS version 17). Pvalue of less than 0.05 was considered statistically
significant.
RESULTS
The mean age of patients was 63.36 years and the age
ranged from 27 to 90 years. Sixty three (78.7%) patients
were married and 25 (21.2%) were unmarried.
Geographically, 24 (25%) patients were from the rural
area and 64 (75%) from urban area. Descriptive
characteristics of age, IPSS and prostate volume are
shown in Table 1.
When the patients were classified according to the
volume of the prostate it was found that 33 (41.2%) of
them were found to have a prostate size (20-40g).
Whereas, 30 (37.5%) were found to have a prostate size
of (41-61 g).
Table 2 represents, graphically, the relationship between
Published by Basic Research Journal of Medicine and Clinical Science
123. Basic Res. J. Med. Clin. Sci.
Table 3. Showing correlation between IPSS and Prostate Volume
Prostate volume
Spearman's rho
IPSS
Correlation Coefficient
Sig. (2-tailed)
N
Correlation Coefficient
Sig. (2-tailed)
N
Age and prostate volume. Looking into the chart one
could notice there is linear relationship between the two
variables (P =0.001). A positive weak correlation was
also found between PV and age of the patient.
Table 3 represents, graphically, the relationship
between IPSS and prostate volume. P value is more than
0.05 which means that there is no significant correlation
between Prostate Volume and IPSS.
DISCUSSION
Prostate volume (PV) is perhaps the most extensively
studied risk factor for BPH progression. Men with a PV of
≥30 mL are more likely to have moderate-to-severe
symptoms (3.5-fold increase), decreased flow rates (2.5fold increase), and urine retention (three- to four-fold
increase) than are men with a PV < 30 mL. So, PV
information has become more and more important
because the PV strongly predicts BPH-related morbidity
such as acute urinary retention and the need for surgery
(Overland et al., 2001).
Generally, the typical method of measuring PV is
transrectal ultrasound (TRUS). But, TRUS is relatively
painful. Moreover, TRUS is also not cost-effective and
routine evaluation of patients with BPH (Ahmed et al.,
2015). In our setting, TRUS is not available. Additionally,
DRE is simple to perform and practical for estimating the
PV, but it has been revealed that DRE underestimates
the real prostate size.
In Sudan there is a heavy burden of prostatic disease
(Khalid et al., 2011). Doctors use IPSS as a main
indicator of the severity of BPH. A study was conducted
in Gezira, Sudan concerning the relationship between
prostate volume and age of patients. It was a triggering
publication for further studies in Sudan (Abdrabo et al.,
2011). This study showed that Knowledge of prostate
volume is a useful tool to aid physicians and decision
makers in predicting the risk of BPH-related outcomes.
In our study there was a correlation between age and
prostate volume. This agrees with the local study done
here in Sudan by Mohamed Nasr El Din Mohamed et al.
showing that (Abdrabo et al., 2011). The incidence rate of
LUTS/BPH increases linearly with age and reaches its
Prostate volume
1.000
.
88
.073
.500
88
IPSS
.073
.500
88
1.000
.
88
maximum at the age of 79 years and the study done
inchina by Shi-Jun Zhang, indicating a positive correlation
between prostate size and age.
Correlation between prostate volume and lower urinary
tract symptoms and there was no correlation. This agrees
with the studies that were done in Netherlands by
Eckhardt et al. that showed that there is no relationship
between prostate size and lower urinary tract symptoms
and the study that was done in Japan by Tsukamoto et
al. (2001) that also showed no relationship between
prostate size and IPSS score (Tanaka et al., 2001). Also,
a study done by Veseley et al. (2003) in Norway showed
that no relationship between symptoms and objective
measures of BPE and the study done by Agrawal et al. in
showing no correlation with age, symptom score (Tatar et
al., 2014). Ezz el Din et al. stated that the correlation
between objective non-invasive parameters of lower
urinary tract dysfunction and LUTS is weak (Kwon et al.,
2012).
In contrast to the studies that were done in USA by
Griman et al. (1995) referred to a relationship between
prostate size and symptoms caused by the prostate
pathology, 2003 by Curtis et al. showed that there is
direct relationship between development of acute urinary
retention and prostate size (Bosch et al., 1995). Overland
Bet al. stated that there is positive modest correlation (r =
0.176) between IPSS and prostate volume. And the study
in Japan by Tsukamoto et al (2001). in 2007 Apr in Japan
showed that a change in IPSS was associated with a
change in PV (Tanaka et al., 2001). Lastly in our there
was no correlation between age and lower urinary tract
symptoms. This agrees with the study done by Agrawl et
al. showing the same result that there is no correlation
between age and symptoms score (Fowke et al., 2013).
CONCLUSION
There is association between age and prostate volume
with a linear regression value which is an R square value
of 0.70 meaning that with every increase in age of 1 year
there will be a 70 mg increase in the prostate volume and
there is no association between prostate volume and
LUTS and between age and LUTS.
Published by Basic Research Journal of Medicine and Clinical Science
Omer et al. 124
REFERENCES
Abdrabo AA, Fadlalla AI, Fadl-Elmula IM (2011). Age-specific reference
range for serum prostate-specific antigen in Sudanese men. Saudi
Med. J. 32(9): 930-932.
Ahmed FO, Hamdan HZ, Abdelgalil HB, Sharfi AA (2015). A
comparison between transabdominal ultrasonographic and
cystourethroscopy findings in adult Sudanese patients presenting
with haematuria. Int Urol Nephrol, 47(2): 223-228.
Alawad A, Younis F, Eltoum AM, Abdelgani SA (2014). Serum prostatespecific antigen as a predictor of prostate volume in Sudanese
patients with benign prostatic hyperplasia. Intern. J. Med. 2(1): 40-42.
Bosch JL, Hop WC, Kirkels WJ, Schroder FH (1995). The International
Prostate Symptom Score in a community-based sample of men
between 55 and 74 years of age: prevalence and correlation of
symptoms with age, prostate volume, flow rate and residual urine
volume. Br. J. Urol. 75(5): 622-630.
Choi H, Park JY, Shim JS, Kim JH, Bae JH (2013). Free prostatespecific antigen provides more precise data on benign prostate
volume than total prostate-specific antigen in korean population. Int.
Neurourol. J. 17(2): 73-77.
Fowke JH, Phillips S, Koyama T, Byerly S, Concepcion R, Motley SS
(2013). Association between physical activity, lower urinary tract
symptoms (LUTS) and prostate volume. BJU Int, 111(1): 122-128.
Franciosi M, Koff WJ, Rhoden EL (2007). Correlation between the total
volume, transitional zone volume of the prostate, transitional prostate
zone index and lower urinary tract symptoms (LUTS). Int. Urol.
Nephrol. 39(3): 871-877.
Hassanzadeh K, Yavari-kia P, Ahmadi-Asrbadr Y, Nader-Abbasi F
(2010). Non-obstructive lower urinary tract symptoms versus prostate
volume in benign prostatic hyperplasia. Pak. J. Biol. Sci. 13(23):
1129-1134.
Hedelin H, Johansson N, Stroberg P (2005). Relationship between
benign prostatic hyperplasia and lower urinary tract symptoms and
correlation between prostate volume and serum prostate-specific
antigen in clinical routine. Scand. J. Urol. Nephrol. 39(2): 154-159.
Isikay L, Turgay AK, Nuhoglu B, Ozdemir G, Ayyildiz A, Cavumirza T
(2007). Lower urinary tract symptoms, prostate volume, uroflowmetry,
residual urine volume and bladder wall thickness in Turkish men: a
comparative analysis. Int. Urol. Nephrol. 39(4): 1131-1135.
Khalid KE, Brair AI, Elhaj AM, Ali KE (2011). Prostate-specific antigen
level and risk of bone metastasis in Sudanese patients with prostate
cancer. Saudi J. Kidney Dis. Transpl. 22(5): 1041-1043.
Kwon YM, Cho B, Son KY, Choi HC, Park SG, Park JH (2012). Lower
urinary tract symptoms have negative associations with glomerular
filtration rate irrespective of prostate volume in Korean men. Urology,
79(1), 182-187.
Overland GB, Vatten L, Rhodes T, DeMuro C, Jacobsen G, Vada K
(2001). Lower urinary tract symptoms, prostate volume and uroflow in
norwegian community men. Eur. Urol. 39(1): 36-41.
Tanaka Y, Masumori N, Itoh N, Tsukamoto T, Furuya S, Ogura H
(2001). [The prediction of bladder outlet obstruction with prostate
volume, maximum flow rate, residual urine and the international
prostate symptom score in patients with lower urinary tract
symptoms]. Hinyokika Kiyo, 47(12): 843-847.
Tatar IG, Ergun O, Celtikci P, Birgi E, Hekimoglu B (2014). Value of
prostate gland volume measurement by transrectal US in prediction
of the severity of lower urinary tract symptoms. Med Ultrason, 16(4):
315-318.
Veseley S, Knutson T, Damber JE, Dicuio M, Dahlstrand C (2003).
Relationship between age, prostate volume, prostate-specific
antigen, symptom score and uroflowmetry in men with lower urinary
tract symptoms. Scand. J. Urol. Nephrol. 37(4): 322-328.
Yeh HC, Liu CC, Lee YC, Wu WJ, Li WM, Li CC (2012). Associations of
the lower urinary tract symptoms with the lifestyle, prostate volume,
and metabolic syndrome in the elderly males. Aging Male, 15(3): 166172.
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