Ultrasound predicts need for, and outcome of, RP

Montreal-Among men with BPH, an estimate of bladder weight using ultrasound can help predict both which patients will eventually require a prostatectomy and which ones will have favorable outcomes, according to researchers from the University of Fukui in Japan. Ultrasound-estimated bladder weight (USEBW) may provide a less-invasive alternative to current techniques.

"The gold standard for evaluating bladder outlet obstruction [BOO] is still pressure-flow study, which requires catheterization and is embarrassing and uncomfortable for patients," lead author Hironobu Akino, MD, told Urology Times.

Dr. Akino, an associate professor at the University of Fukui, presented the results of a study on USEBW at the International Continence Society annual meeting here.

Overall, 37 of the 97 patients eventually underwent prostatectomy. Patients were more likely to undergo prostatectomy if they had a USEBW of 35 grams or more and if they had severe LUTS, defined as an International Prostate Symptom Score (IPSS) of 20 or more. The incidence of prostatectomy 5 years after initiating alpha-blocker therapy in patients with a USEBW of 35 grams or greater was 78%, compared with only 36% for those with a USEBW under 35 grams. Both high USEBW and severe LUTS were identified using multivariate analysis as significant risk factors for prostatectomy.

"Univariate analysis showed high USEBW, high IPSS, poor uroflow, and decreased voided volume were associated with prostatectomy," Dr. Akino said. "Multivariate analysis showed that high USEBW and high IPSS were unique risk factors for prostatectomy."

Among the 37 patients who underwent a prostatectomy, seven were taking a cholinergic drug to improve their LUTS 3 months post-surgery, which indicates a poor surgical outcome. Both USEBW and prostate volume, but not severity of LUTS, predicted a poor surgical outcome following prostatectomy. Only one in 25 patients with a USEBW of 35 grams or more had a poor outcome following prostatectomy, compared with six out of the 12 patients with a lower USEBW.

"USEBW can be regarded as a useful parameter for identifying the patient with LUTS at risk of prostatectomy and also predicting the outcome of prostatectomy [based on these findings]," Dr. Akino concluded.