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Lights and shadows" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "542" "paginaFinal" => "543" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Alcántara Montero, A. López de Alda González" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Alcántara Montero" "email" => array:1 [ 0 => "a.alcantara.montero@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "López de Alda González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Centro de Salud José María Álvarez, Don Benito, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urología, Hospital Comarcal Don Benito-Villanueva de la Serena, Don Benito, Badajoz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Puede predecir la medición de la protrusión prostática intravesical la respuesta al tratamiento médico en pacientes con hiperplasia benigna de próstata? Luces y sombras" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Benign prostatic hyperplasia (BPH) is the most common cause of bladder outlet obstruction (BOO) in men over 50 who consult for lower urinary tract symptoms (LUTS). In this case, the term benign prostatic obstruction (BPO) is currently the most commonly used. We know that in patients with BPO, medical treatment is the most used, provides relief of symptoms, and can modify the progression of the disease. However, many patients abandon long-term treatments and not all benefit from them. Therefore, it may be beneficial to identify patients who will not respond to medical treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The assessment of BPO is an important factor that can reflect the severity of the disease and can help measure the outcome of the treatment. Nowadays, the assessment in clinical practice of patients with BPO is based on uroflowmetry and ultrasound with the measurement of postvoid residue (PVR). Unfortunately, such evaluations are less likely to clearly identify the degree of BOO in males affected by benign prostatic enlargement (BPE) with respect to the flow-pressure study during the invasive urodynamic study. However, these tests are not always indicated before the surgical treatment of BPO in international clinical guidelines due to the invasiveness and the high costs that they generate.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the last decade, several authors have tried to identify novel and less invasive parameters that could help us evaluate the degree of BPO and predict a response to treatment. Among the most promising are the thickness of the bladder/detrusor wall, the weight of the bladder estimated by ultrasound, the non-invasive flow-pressure studies, the prostatic urethral angle, and the measurement of the intravesical prostatic protrusion (IPP) by ultrasound.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The IPP is the ultrasound measurement of the prostatic middle lobe that projects into the bladder, and it has been proposed that this particular growth of the prostate causes ‘valve effect’ type obstruction, altering the funnel mechanism that the bladder neck physiologically performs during the dynamics of urination. This particular anatomic condition would cause a greater infravesical obstruction than if there was growth exclusively of the lateral prostatic lobes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recent studies have shown that the IPP can be correlated with prostatic volume, detrusor overactivity, bladder compliance, detrusor pressure to the peak urinary flow, BOO index, and PVR, and negatively with <span class="elsevierStyleItalic">Q</span><span class="elsevierStyleInf">max</span>. However, few studies have reported the relationship between IPP and clinical outcomes in patients undergoing medical treatment, and most invstigations were performed with alpha-blockers. Thus, according to the literature consulted, the IPP seems to correlate significantly and inversely with the success of treatment with alpha blockers in patients with LUTS and BPE, and it can be considered a useful tool to discriminate patients to whom medical treatment has a higher probability (low-grade IPP or <5<span class="elsevierStyleHsp" style=""></span>mL) or lower (high-grade IPP or> 10<span class="elsevierStyleHsp" style=""></span>mL) of success.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore, to date, we can conclude that the measurement of the IPP could help us predict the obstruction and, therefore, the progression of the BPH, as well as the response rate to the treatment with alpha-blockers. In addition, the measurement of the IPP would be useful to stratify patients with BPH and LUTS in the initial assessment, helping the urologist to decide which patients could benefit from medical treatment, and thus avoid many unnecessary prescriptions. On the other hand, there are data that seem to show that the degree of IPP could be correlated with the degree of BPO, but the lack of an invasive urodynamic evaluation (flow/pressure study) does not allow us to draw conclusions about it. However, most of the studies performed are observations, in men with prostate volume <40<span class="elsevierStyleHsp" style=""></span>mL, so better designed randomized clinical trials would be required to confirm these findings.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alcántara Montero A, López de Alda González A. ¿Puede predecir la medición de la protrusión prostática intravesical la respuesta al tratamiento médico en pacientes con hiperplasia benigna de próstata? Luces y sombras. Actas Urol Esp. 2018;42:542–543.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[accessed 3 Mar 2018]. Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="http://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/">http://uroweb.org/guideline/treatment-of-non-neurogenic-male-luts/</a>" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benign Prostatic Obstruction (BPO)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Gravas" 1 => "T. Bach" 2 => "M. Drake" 3 => "M. Gacci" 4 => "C. Gratzke" 5 => "T.R.W. Herrmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "EAU Guidelines. 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Wijkstra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2006.12.023" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2007" "volumen" => "52" "paginaInicial" => "827" "paginaFinal" => "834" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17207910" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravesical prostatic protrusion is a predictor of alpha blockers response: results from an observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Topazio" 1 => "C. Perugia" 2 => "C. de Nunzio" 3 => "G. Gaziev" 4 => "V. Iacovelli" 5 => "D. Bianchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12894-018-0320-0" "Revista" => array:5 [ "tituloSerie" => "BMC Urol" "fecha" => "2018" "volumen" => "18" "paginaInicial" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29394926" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004200000008/v1_201810020634/S2173578618301148/v1_201810020634/en/main.assets" "Apartado" => array:4 [ "identificador" => "6296" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004200000008/v1_201810020634/S2173578618301148/v1_201810020634/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578618301148?idApp=UINPBA00004N" ]
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Letter to the Editor
Can the measurement of intravesical prostatic protrusion predict the response to medical treatment in patients with benign prostatic hyperplasia? Lights and shadows
¿Puede predecir la medición de la protrusión prostática intravesical la respuesta al tratamiento médico en pacientes con hiperplasia benigna de próstata? Luces y sombras
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