الفهرس 
Anatomy of prostateOnly 14 pages are availabe for public view
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Abstract
B
enign prostatic hyperplasia (BPH) is an increasingly common condition in aged males. By the age of 60 years, more than 50% of men will have microscopic evidence of the disease, and more than 40% of men beyond this age will have lower urinary tract symptoms (LUTS).
LUTS are the most common problem that affects BPH patients, and include urinary frequency, urgency, weak stream, straining and nocturia. Although urologists normally attribute LUTS that are concomitant with BPH to urinary obstruction caused by enlarged prostate, some controversies still exist.
The International Prostate Symptom Score (I-PSS), became the gold standard outcome measurement for most clinical trials that assessed responses to interventions for the management of BPH. I-PSS symptom scores range from 0 to 8 for “mild” symptoms, 9 to 20 for “moderate” symptoms, and 21 to 35 for “severe” symptoms. Responses to the quality-of-life question range from 0 (delighted) to 6 (terrible).
In most instances, the enlarged prostate leads to obstruction and lower urinary tract symptoms (LUTS), which comprise frequency, urgency, weak stream, straining and nocturia. In order to evaluate the severity of the symptoms, several scoring systems have been created, among which the International Prostate Symptom Score (I-PSS) is accepted most extensively by urologists worldwide.
Besides these subjective symptoms, some objective parameters, which include prostate volume, uroflowmetry, prostate-specific antigen (PSA) and residual urine volume, are also used to assess the state of illness and the effect of treatment. Although LUTS are traditionally thought to be the sequelae of enlarged prostate and bladder outlet obstruction, the correlation between the severity of subjective symptoms and objective parameters remains unclear, especially in Oriental populations.
In our study, we evaluated the relationship between LUTS - as stipulated in I-PSS - and some other parameters regarding DRE, PSA, ultrasound criteria involving prostatic size, intravesical protrution of the prostate, bladder wall thickness, full bladder capacity, post void residual urine, uroflometry and urodynamic study then between these parameters and each other in a group of patients enrolled from the Ain Shams University outpatient clinincs (Demerdash).
Upon dividing the I-PSS into its 2 components of voiding and storage aspects, we concluded that there is a bivariate indirect significant Pearson correlation between the voiding score of I-PSS and the maximum peak flow in which the more the voiding score the less peak maximum flow.
We also concluded that the maximum peak flow (Q-max) can be predicted from the other studied variables independently regarding (I-PSS, the estimated weights of the prostatic gland with pelvic and transrectal ultrasound, estimated weight of the prostatic gland adenoma via transrectal ultrasound, intravesical protrusion of the prostate, bladder wall thickness and bladder voiding efficiency) giving us a clue about the patient’s uroflometry study.
However , There was not any significant relationship between the I-PSS and all of the other studied parameters regarding (prostatic volume, bladder wall thickness, intravesical protrusion and bladder voiding efficiency) neither on univariate nor on multivariate analysis going with other studies which concluded that the (I-PSS) validated by the AUA should not be used to diagnose infravesical obstruction.
We also go along with other studies that have found that prostate volume is not associated with LUTS, and objective parameters cannot predict the severity of symptoms in BPH patients.
There is a direct significant relation concerning Urinary bladder wall thickness on one hand and the estimated weight of the prostatic gland on the other hand, in which the more the estimated weight of the gland or its adenoma, the more the thickness of the bladder wall is, which was agreed by other studies.
There was a significant direct relationship relating the bladder voiding efficiency and the estimated weight of the prostatic gland via pelvic ultrasound. Although the bladder voiding efficiency is an index that provides an easy to use and precise way of defining an individual’s voiding function, yet there were not sufficient studies discussing it.
There is a direct significant relation between intravesical protrusion of the prostate and estimated weight of the prostatic adenoma via transrectal ultrasound.