Implication of ultrasound bladder parameters on treatment response in patients with benign prostatic hyperplasia under medical management

Objective:The prevalence of benign prostatic hyperplasia(BPH)rapidly increases after the 4th decade of life.The combination of tamsulosin and dutasteride is a well established therapy for BPH of
40 g.Non-invasive urodynamic parameters can predict the outcome of medical therapy in patients with BPH.We aimed to correlate these parameters with treatment responses in BPH patients under medical management.Methods:A prospective study was conducted in the Department of Urology in our hospital from May 2014 to April 2015.A total of 100 patients with BPH
40 g who fulfilled our inclusion criteria were included.Treatment responses were determined by the International Prostate Symptom Score(IPSS)and uroflowmetry.Transabdominal ultrasonography with Doppler was performed to measure prostate volume,intravesical prostatic protrusion(IPP),detrusor wall thickness(DWT),the prostatic capsular artery resistive index(RI)and prostatic urethral angle(PUA)before and 3 months after combination therapy of tamsulosin and dutasteride.Treatment responses were correlated with non-invasive urodynamic parameters.Results:The IPSS,uroflow,age,prostate volume,RI,IPP,DWT and PUA were correlated before and after treatment.Of the 100 patients,70(70%)showed significant improvement and 30(30%)showed no improvement with therapy.Conclusion:Ultrasound bladder parameters are useful tools for measuring the treatment response in BPH patients.Our study shows that RI and DWT significantly correlate with the treatment response in BPH patients.More importantly,pretreatment values of increased IPP and PUA determines the non-improvement of symptoms in BPH patients.Our study suggests the importance of transabdominal ultrasonography(KUBeP)with Doppler for evaluating treatment responses to medical management.

Unusual case of nephrocutaneous fistula--Our experience

A rare case of nephrococutaneous fistula due to spontaneous expulsion of renal calculi is described.A 45-year-old man presented with urinary leakage from an ulcer over the left lumbar region for the last 3 months after a history of spontaneous expulsion of stones from this area.Ultrasonography abdomen revealed a small contracted kidney with multiple calculi in the kidney and renal pelvis,sinus tract from the lower pole of the left kidney with a ruptured calyceal calculus in the sinus tract.CT urography revealed a non excreting left kidney with multiple renal calculi,with hyperdense collection in the renal parenchyma extending to the subcutaneous tissue and left lung suggesting a xenthogranulomatous pyelonephritis(XGP).We performed a left-sided simple nephrectomy with excision of the fistulous tract.Histopathological examination revealed XGP.There have been a few case reports of XGP forming nephrocutaneous fistula in the back.