Correlation between the International Prostate Symptom Score, Ultrasound Features and Maximum Flow Rate in Cameroonian Patients with Benign Prostatic Hypertrophy

Background: Benign prostatic hypertrophy is the non-malignant stromal and epithelial proliferation of the prostate gland, with or without associated anatomical enlargement of the gland and clinical symptoms. Symptomatic Benign prostatic hypertrophy may cause obstructive symptoms, irritative symptoms or both obstructive symptoms include a sensation of incomplete bladder emptying, straining to void, urinary hesitancy and weak stream while irritative symptoms include dysuria, nocturia, urinary frequency and urinary urgency. A quantitative measure of the severity of lower urinary tract symptoms due to benign prostatic hypertrophy can be obtained using the International Prostate Symptoms Score. Ultrasonography is useful for helping to determine bladder and prostate size in patients with urinary lower urinary tract symptoms. Uroflowmetry is a non-invasive test that assesses voiding function. It provides valuable data on the voided volume, time is taken to reach maximum flow rate and average flow rate. The goal of this study was to improve the follow up of patients with benign prostatic hypertrophy by providing simple, available, affordable and non-invasive that best predict bladder outlet obstruction and the quality of life in these patients. Method: This was a cross-sectional analytic study carried out over a period of five months from May 2020 to September 2020 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, which is a tertiary hospital in Cameroon. Were included in the study, adult males who presented with lower urinary tract symptoms and prostatic enlargement suggestive of benign prostatic hypertrophy taking into account clinical, uroflowmetry and ultrasound findings. Results: A study population of 103 participants was recruited. The mean age of patients was 63.17 ± 10.26 years. Concerning the International Prostate Symptoms Score, the mean total, voiding (obstructive) and storage (irritative) scores were 14.6 ± 6.2, 8.5 ± 4.1 and 6.05 ± 2.7 respectively. The mean maximum flow rate was 13.44 ± 3.88 mL/s. The mean prostate volume was 53.71 ± 16.46 ml. A majority of patients have an enlarged prostate 1.5 to 2 times (46 to 60 mL) the upper limit for normal value. The intravesical prostatic protrusion was present in eighty-three (80.58%) and absent in 20 (19.42%). Above a prostate volume of 60 mL, 91% to 100% of our patients had intravesical prostatic protrusion. There was strong evidence (p < 0.001) that a change from no intravesical prostatic protrusion to intravesical prostatic protrusion grade 1 increased the chances of having a low maximum flow rate with a crude odds ratio of 7.98. The adjusted odds ratio after multivariate analysis was 5.26 and this remained statistically significant (p = 0.03). Conclusion: the measure of intravesical prostatic protrusion is superior to the prostate volume in the assessment of maximum flow rate and thus the follow up of patients with benign prostatic hypertrophy. This measure which is non-invasive, easy to measure, easily accessible, and cost effective may be a useful tool in predicting voiding dysfunction and acute urinary retention.

Prostatic Adenomectomy by High Approach versus Millin: Our Results on a Series of 15 Cases

Background: In 2023, conventional surgery for benign prostatic hyperplasia (BPH) is still used despite the introduction of minimally invasive techniques in the therapeutic arsenal. Objective: To present our results of Millin prostatic adenomectomy in a preliminary series of 15 cases. Patients and Methods: Cross-sectional study conducted at the Urology Department of the Bouaké University Hospital from January 2022 to January 2023. It involved 15 patients with benign prostatic hyperplasia (BPH) who had undergone high adenomectomy using the Millin technique. Results: During the study period, 15 cases of benign prostatic hyperplasia were treated surgically by high adenomectomy using the Millin technique. The mean age of the patients was 63.6 years, ranging from 53 to 78 years. Nine (9) patients were consulted for progressive complications of benign prostatic hyperplasia (BPH), i.e. 60% (n = 9). The mean IPSS score was 28 (20 to 35), and seven (7) patients had a comorbidity (46.44%). The digital rectal examination (DRE) was in favour of benign prostatic hypertrophy in all patients, and the mean weight of the prostate at DRE was 75 g, ranging from 55 g to 100 g. From a paraclinical point of view, prostatic ultrasound revealed a mean BPH weight of 82.7 g with extremes of 55 to 100 g. Post-micturition residue was greater than 150 ml in 60% (n = 9). The mean prostate-specific antigen (PSA) level was 3.8 ng/ml, ranging from 1.4 to 15 ng/ml. There was one case of severe anaemia with a haemoglobin level of 6 g/dl on haemogram, treated by blood transfusion. The cytobacteriological examination of the urine (ECBU) revealed five cases of E. coli infection, i.e. 33.33% (n = 5). Millin prostatic adenomectomy was performed under antibiotic prophylaxis at induction. All patients underwent locoregional anaesthesia. The mean weight of the adenoma was 80 g with extremes of 55 to 155 g. Blood loss was minimal at less than 100 ml, i.e. 86.6% (n = 13). The average operating time was 56.9 minutes, ranging from 45 to 75 minutes. The Retzius space was drained in an average of 2.75 days, with extremes of 2 to 4 days. The average duration of postoperative bladder catheterisation was 8.7 days, with extremes of 7 to 10 days. The average duration of bladder irrigation-washing was 3.6 days. The average hospital stay was 8.55 days, with extremes of 8 to 10 days. Morbidity was represented by Orchi-epididymitis (66%, n = 1) and mortality was 6.66% (n = 1). 6 months later, the 14 patients had good micturition comfort with an RPM of less than 10 ml. Anatomo-pathological examination of the adenomectomy specimen was in favour of an adenomyofibroma of the prostate with no stigma of malignancy. Conclusion: Prostatic adenomectomy using the Millin technique is rarely performed, but a look at the results shows that it is still the least morbid and fatal technique.

Associations among benign prostate hypertrophy, atypical adenomatous hyperplasia and latent carcinoma of the prostate

Aim： To investigate the frequency of atypical adenomatous hyperplasia （AAH） and its associations with benign prostate hypertrophy （BPH） and latent histological carcinoma of the prostate （LPC） in autopsy material. Methods： Two hundred and twelve prostate specimens obtained from autopsy material were subjected to whole mount analysis in an attempt to investigate the associations among BPH, AAH and LPC. Results： Most histological carcinomas and AAH lesions were found in enlarged prostates with intense hypertrophy. No statistically significant relation was found between BPH and the main characteristics of LPC, such as tumor volume, histological differentiation and biological behavior. Our data regarding multi-focal tumors showed a tendency for multi-focal carcinomas to develop in larger prostates, and a tendency of AAH lesions to develop in larger prostates. No statistically significant relation was found between AAH and LPC. Conclusion： There seems not any causative aetiopathogenetical or topographical relation between AAH lesions and prostate adenocarcinoma. AAH lesion seems to be a well-defined mimicker of prostatic adenocarcinoma, and the reported association of AAH with prostatic carcinoma could probably be an epiphenomenon.

Clinical value of intravesical prostatic protrusion in the evaluation and management of prostatic and other lower urinary tract diseases

Intravesical prostatic protrusion(IPP)has emerged as a new prostatic morphometric parameter of significance to aid the clinicians in various aspects of managing the patients with some diseases of the lower urinary tract and the prostate.These include but may not be limited to its role in such conditions as:bladder outlet obstruction,trial without catheter,medical treatment effect,progression of lower urinary tract symptoms related to benign prostatic hypertrophy(LUTS/BPH),risk factor for bladder stone in BPH,overactive bladder,prostate carcinoma,and early urinary continence recovery after laparoscopic radical prostatectomy.In this review,I will try to summarize the different researchers’efforts on the potential practical application of this clinical tool.Technology is ever evolving to help us in the diagnosis and management of our patients.However,we as clinicians should contemplate their cost and possible suffering for the patient by wise and judicious utilization based on our clinical experience and tools.IPP seems to be one such promising clinical tool.

Isolated Gross Hematuria or Associated to Acute Retention of Urine as a Sign of Urologic Malignant Pathology

The causes oflGH （Isolated gross hematuria）, as the only symptom or associated with ARU （acute retention of urine） caused by clots in the urinary tract in patients who do not have a previous diagnosis of urological malignant pathology and to study the immediate mortality in patients with that sign are described. A descriptive observational study of the etiologies of patients shows the above mentioned symptomatology from the 1 st of January to the 30th of June of 2008 in the Emergency Department which received follow-up treatment up to December 2010. It also describes the mortality before the definitive diagnosis and the days between receiving attention in the Emergencies Department and the diagnostic tests. One hundred and four cases with the criteria described above were evaluated. Of these, 20.0% turned out to have bladder, prostate or kidney cancer; the bladder being the most affected organ. Of all the pathology, benign and malignant, the most frequent one is the benign hypertrophy of the prostate （49.8% of the total）. Of the total, 4.8% of the patients died in the following weeks before finishing the diagnostic study. Isolated gross hematuria is a clinical symptom closely related to urological malignant pathology and it does not have an insignificant mortality rate in a short period of time. For these reasons it is necessary to accelerate the diagnostic tests as soon as the patient presents the symptom.