The relationship between intravesical prostatic protrusion and pressure flow study findings in patients with benign prostate obstruction/lower urinary tract symptoms | Actas Urológicas Españolas (English Edition)

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Park, J.W. Lee, J.S. Rim" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S.C." "apellidos" => "Park" "email" => array:1 [ 0 => "sc.park@wonkwang.ac.kr" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.W." "apellidos" => "Lee" ] 2 => array:2 [ "nombre" => "J.S." "apellidos" => "Rim" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Urología, Facultad de Medicina, Hospital de Wonkwang, Iksan, Republic of Korea" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Relación entre la protrusión prostática intravesical y los hallazgos del estudio de presión-flujo en pacientes con obstrucción prostática benigna/síntomas del tracto urinario inferior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1392 "Ancho" => 1837 "Tamanyo" => 202926 ] ] "descripcion" => array:1 [ "en" => "Relation between intravesical prostate protrusion transverse and other parameters. The intravesical prostate protrusion transverse is correlated with bladder outlet obstruction index." ] ] ] "textoCompleto" => "IntroductionBenign prostatic enlargement is a common cause of BOO in men older than 50 years. There is a significant positive correlation between the LUTS and the presence of BOO.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The LUTS can be caused by various pathologies, such as benign prostatic hyperplasia (BPH), detrusor overactivity, and detrusor underactivity. Because of the complex etiological aspect, the identification of BOO is important in treating patients with LUTS. Validated symptom scores and quality of life questionnaire are used in patient's assessment, but they are of limited diagnostic and prognostic use. The multichannel PFS remains the gold standard diagnostic method for identifying BOO.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> However, the PFS is an invasive and uncomfortable procedure for the patients, and it is time consuming and expensive. The PFS also caused hematuria, urinary tract infection, and difficulty in urination.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Thus, variable non-invasive diagnostic methods included PVR, prostate volume, ultrasound-estimated detrusor thickness and bladder weight, and uroflowmetry attempted to define BOO.<a class="elsevierStyleCrossRefs" href="#bib0020">4–8</a> Though the uroflowmetry and PVR measurement are simple first-line investigations which can raise or lower the suspicion of BOO, they cannot make a definitive diagnosis either.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>IPP is a morphological change due to excessive growth of the median and lateral lobe of the prostate into the bladder. The strongest correlation was observed between the IPP measured by trans-abdominal ultrasonography (TAUS) and the prostate volume.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> The IPP and the TAUS may be useful, noninvasive predictors of urodynamically ascertained BOO, as well as predictors of a trial without catheter success for men with acute urinary retention.<a class="elsevierStyleCrossRefs" href="#bib0045">9–13</a> The objective of this study was to define the predictive value of the IPP measured by TRUS for diagnosing BOO in patients with benign prostate hyperplasia.Materials and methodsFrom March 2006 to August 2009, we conducted a single center study of relationship between the IPP measured by TRUS and PFS in first-visit patients with BPO/LUTS. After our institutional review board approval, 87 patients who underwent PFS for the evaluation of their LUTS were enrolled in this study. All the patients did not receive alpha-blocker for their LUTS. Routine initial evaluation for male LUTS in our Department included past history, digital rectal examination with neurological examination, urinalysis, serum creatinine and prostate specific antigen, IPSS and quality of life, uroflowmetry, PVR and TRUS. Patients with acute urinary retention, bladder stone, upper tract complications, malignancy including prostate cancer, and neurological conditions such as cerebrovascular dysfunction and Parkinson disease were excluded from this study.We assessed the IPP and prostate volume by transrectal ultrasound (Sonoace 9900®, Medison, Korea Republic) when the bladder volume was 150–200ml. The prostate volume was measured using the prostate ellipse formula with 7.5Hz endorectal probe. After measuring the prostate volume, the IPP was checked on the midsagittal plane. The IPP vertical was measured by vertical distance from the tip of the protrusion to the circumference of the bladder at the base of the prostate gland, and the IPP transverse was measured by transverse distance of the circumference of the bladder at the base of the prostate gland (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The grades of the IPP vertical were divided into three groups: group A <5mm, group B 5–10mm, group C >10mm.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> All the TRUS were performed by experienced urologists.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The multichannel urodynamic studies, with a PFS (Duet Logic G2 manometer, Medtronic-Dantec, Denmark) were performed according to the recommendation of the International Continence Society Good Urodynamic Practices protocol.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> The extent of the BOO was calculated as the BOOI: BOOI=detrusor pressure at Qmax−2Qmax. A BOOI of >40 indicates definite obstruction, 20–40 is equivocal and <20 indicates no obstruction.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>All statistical analyses were performed using the SPSS version 13.0 for Windows (SPSS Inc., Chicago, USA). Data distribution was not normal, and nonparametric tests were used. Differences in clinical and urodynamic characteristics among groups were evaluated by the Kruskal–Wallis test and Mann–Whitney U-test. The correlations were quantified by Spearman rank correlation coefficient. A 5% level of significance was used for all statistical testing.ResultsIn all, 87 patients with LUTS were assessed and entered into the study. The mean age was 71.7 years, and the mean prostate specific antigen was 3.1ng/ml. The mean prostate volume was 38.9ml and the mean IPSS was 23.5. The mean maximal flow rate was 8.5ml/s and the mean PVR was 84.2ml. The mean IPP vertical was 8.2mm and the mean IPP transverse was 27.6mm.The distribution of the various clinical parameters according to the BOOI is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Fifty patients (57.5%) had BOO defined as a BOOI>40 in PFS. Prostate volumes were 27.6ml, 32.6ml, and 42.8ml in patients with non-obstruction, equivocal, and obstruction in PFS, respectively (P=0.011). The TZVs were 12.3ml, 14.9ml, and 22.2ml in patients with non-obstruction, equivocal, and obstruction in PFS, respectively (P=0.009). The IPP transverse were 22.9mm, 25.5mm, and 29.5mm in patients with non-obstruction, equivocal, and obstruction in PFS, respectively (P=0.160). The IPP verticals were 5.9mm, 7.8mm, and 8.7mm in patients with non-obstruction, equivocal, and obstruction in PFS, respectively (P=0.317) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The prostate volume and TZV were significantly increased according to the IPP vertical. The prostate volumes were 28.4ml, 35.5ml, and 52.1ml in each group. The TZVs were 12.0ml, 18.2ml, and 27.5ml in each group. The BOOI also increased in group C, but it did not reach statistical significance: 42.9 in group A, 50.1 in group B, and 51.8 in group C (P=0.081). Other clinical parameters were not different between the groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>There was a significant correlation between the IPP vertical and the prostate volume (Spearman's Rho=0.688, P<0.001). The IPP vertical was also significantly correlated with the TZV (Spearman's Rho=0.645, P<0.001). However, no significant correlations were noted between the IPP vertical and the IPSS (Spearman's Rho=0.45, P=0.715), or the BOOI (Spearman's Rho=0.188, P=0.081) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). There was a significant correlation between the IPP transverse and the prostate volume (Spearman's Rho=0.610, P<0.001), or the TZV (Spearman's Rho=0.585, P<0.001). And the IPP transverse was significantly correlated with the BOOI (Spearman's Rho=0.213, P=0.048). However, no significant correlation was noted between the IPP transverse and the IPSS (Spearman's Rho=0.240, P=0.825) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThe BOO is a common cause of LUTS in elderly men over 50 years. LUTS can be caused by various etiologies. The identification of BOO from other pathologies, such as detrusor overactivity or detrusor underactivity, is an important step to accurately treat men with LUTS. The multichannel PFS is the gold standard for diagnosing BOO and underlying mechanisms of LUTS. Even though the PFS is essential for the evaluation of the BOO before invasive treatment is considered, many clinicians skip the PFS as they consider it is invasive, time-consuming and expensive.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Thus, several attempts have been made to date to diagnose BOO by non-invasive methods.The uroflowmetry and PVR by ultrasonography are simple first-line methods for identifying BOO. Men with BOO have a lower maximal flow rate than those with no obstruction, demonstrating a negative correlation of maximal flow rate with Schafer grade of obstruction.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> However, uroflowmetry cannot distinguish obstruction from impaired detrusor contractility as a cause of reduced flow.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The PVR measured by ultrasound is a non-invasive method to indicate how completely a patient empties his bladder. Although the PVR occurs in some patients with BOO, the PVR is often a consequence of detrusor underactivity.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> On the other hand, Kang et al. showed that maximal flow rate and poor compliance were significant factors for predicting BOO in Korean men with LUTS.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Bosch et al. demonstrated that the prostate volume was not useful for the prediction of BOO.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> However, the results of this study showed that male LUTS patients with BOO had a larger prostate volume and TZV. Our results suggest that the BOO was associated with prostate size, especially TZV. These results are consistent with the other Korean study.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> The TAUS is a non-invasive method for identifying the BOO by measuring the IPP, detrusor wall thickness, and estimated bladder weight. Franco et al. suggested that suprapubic ultrasound of detrusor wall thickness and IPP are simple, noninvasive, accurate systems to assess bladder prostatic obstruction in patients with LUTS due to BPH.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>The TAUS measured the vertical distance from the tip of the prostatic protrusion to the circumference of the bladder at the base of the prostate gland in the midsagittal line. Lim et al. demonstrated that the prostate specific antigen, prostate volume and IPP correlate well with one another. And they suggested that the IPP, as a non-invasive clinical parameter, predicts BOO better than the prostate specific antigen and prostate volume.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> The TRUS measured the IPP vertical and transverse, also correlated with the prostate volume and TZV in this study. Chia et al. showed that a higher IPP grade was associated with a higher BOO index than lower grade IPP. Thus, they suggested that the IPP assessed by TAUS is a better and more reliable predictor of BOO than the prostate volume, symptom severity, maximal flow rate, and PVR.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Nose et al. also suggested that IPP grading correlated well the BOO index and the combination of the IPP grading, and Doppler urodynamic study may be a novel standard in the diagnosis of BOO in male patients.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Keqin et al. showed that the BOO index was significantly higher and the incidence of acute urinary retention appeared more often in the significant IPP group. Thus, they suggested that the IPP is a useful predictor for evaluating the BOO and detrusor function. They also suggested that the significant IPP patients, especially those presenting with AUR, may benefit from early surgical intervention.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Lieber et al. showed that, overall, 10% of men had an IPP of 10mm or greater in their community-based study. They also showed that men with an IPP of 10mm or greater were more likely to use medications for BPO/LUTS compared with those with an IPP lower than 10mm.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Lee et al. showed that a higher IPP grade is associated with a higher risk of clinical progression in benign prostate enlargement. Thus, they suggested that the IPP is a useful non-invasive predictor for clinical progression in benign prostate enlargement.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> In this study, the IPP vertical was not associated with the BOO index. However, the IPP transverse was correlated with the BOO index. It showed the IPP transverse is more important than the IPP vertical for evaluating the BOO in TRUS setting.The IPP was measured by TRUS in this study, whereas the TAUS was used in other studies. The TAUS for evaluating the prostate is easily performed in patients with rectal pathologies that underwent rectal surgery. And it is a non-invasive method for the upper urinary tract. On the other hand, for TAUS of the prostate, a filled bladder is essential. The loss of acoustic window (an empty bladder) makes measurement of the IPP difficult and unreliable. Yuen et al. showed that the mean IPP decreases with increasing bladder volume.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> We measured the IPP by TRUS in this study. Although the TRUS is more invasive than the TAUS, the TRUS is more accurate for the measurement of the IPP and a filled bladder is not essential. And the TRUS is very popular for the evaluation of the LUTS in Korea, even at private clinics.This study has several limitations. First, in spite of the prospective study, the number of patients is small. The recruitment of patients was very difficult because the PFS is very uncomfortable and invasive. Although the BOOI was not statistically significantly correlated with the IPP vertical and transverse, the IPP vertical and transverse were increased in patients with BOO. It is possible that a statistically significant correlation between the IPP and the BOO would have been found if the number of patients in each group had been larger. Secondly, the TRUS is more invasive than the TAUS. However, the TRUS gives more accurate information, and it is a popular tool for the evaluation of LUTS in Korea.In conclusion, The IPP vertical measured by TRUS showed significant correlation with the prostate volume and TZV, but not with the severity of symptoms, quality of life, or BOOI. Nevertheless, the IPP transverse on TRUS was correlated with the BOOI. These conclusions might have implications for decision-making in patients with BPO/LUTS, especially invasive treatment. Further clinical research with a larger cohort is mandatory to confirm the relation between the BOOI and the IPP.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres100621" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec87786" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres100620" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec87785" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-06-08" "fechaAceptado" => "2011-06-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec87786" "palabras" => array:3 [ 0 => "Benign prostate hyperplasia" 1 => "Ultrasound" 2 => "Urodynamic study" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec87785" "palabras" => array:3 [ 0 => "Hiperplasia benigna de próstata" 1 => "Ecografía" 2 => "Estudio urodinámico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectivesTo evaluate the relationship between intravesical prostatic protrusion (IPP) on transrectal ultrasonography (TRUS) and pressure-flow study (PFS) findings in patients with benign prostatic obstruction/lower urinary tract symptoms (BPO/LUTS). Materials and methodsBetween March 2006 and August 2009, we reviewed medical records of 87 patients who underwent TRUS and PFS for the evaluation of their LUTS. The patients were classified by the IPP vertical degree: less than 5mm (group A), 5–10mm (group B), over than 10mm (group C). The extent of bladder outlet obstruction (BOO) was calculated as the bladder outlet obstruction index (BOOI) by the PFS. The obstruction was defined as the BOOI over 40. ResultsMean age was 71.1 years, and mean IPP vertical was 8.23mm. The IPP vertical showed significant correlation with prostate volume (r=0.688, P<0.001) and transitional zone volume (TZV) (r=0.645, P<0.001), but there was no correlation between IPP and International Prostate Symptom Score (IPSS), maximal flow rate, post-voided residual urine (PVR) and BOOI. The IPP transverse was significantly correlated with BOOI (r=0.213, P=0.048). ConclusionsThe IPP vertical showed significant correlation with prostate volume and transitional volume, but not with severity of symptom, quality of life, and parameters of PFS. However, the IPP transverse on TRUS was correlated with BOOI." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivosEvaluar la relación entre el grado de protrusión prostática intravesical (PPI) vertical en la ecografía transrectal (ETR) y los hallazgos del estudio de presión-flujo (EPF) en pacientes con obstrucción prostática benigna/síntomas del tracto urinario inferior (OPB/STUI). Material y métodosEntre marzo de 2006 y agosto de 2009, se revisaron los registros médicos de 87 pacientes a los que se les realizó ETR y EPF para la evaluación de los STUI. Se clasificó a los pacientes por el grado de PPI vertical: menos de 5mm (grupo A), 5-10mm (grupo B), y más de 10mm (grupo C). El grado de obstrucción de la salida vesical se calculó como el índice de obstrucción de la salida vesical (IOSV) en el EPF. La obstrucción se definió como el IOSV por encima de 40. ResultadosLa media de edad fue de 71,1 a¿nos y la PPI vertical media fue de 8,23mm. La PPI vertical mostró una correlación importante con el volumen prostático (r=0,688, p<0,001) y el volumen de la zona transicional (VZT) (r=0,645, p<0,001), pero no hubo correlación entre la PPI y la Puntuación Internacional de los Síntomas Prostáticos, la tasa máxima de flujo, la orina residual tras la micción y el IOSV. La PPI transversal estaba considerablemente correlacionada con el IOSV (r=0,213, p=0,048). ConclusionesLa PPI vertical mostró una correlación importante con el volumen de la próstata y el volumen de transición, pero no con la gravedad de los síntomas, la calidad de vida y los parámetros del EPF. Sin embargo, la PPI transversal en ETR guardaba correlación con el IOSV." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Park SC, et al. Relación entre la protrusión prostática intravesical y los hallazgos del estudio de presión-flujo en pacientes con obstrucción prostática benigna/síntomas del tracto urinario inferior. Actas Urol Esp. 2012;36:165–70." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 749 "Ancho" => 1000 "Tamanyo" => 138715 ] ] "descripcion" => array:1 [ "en" => "The measurements of intravesical prostate protrusion vertical and transverse by transrectal ultrasound." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1457 "Ancho" => 1825 "Tamanyo" => 195874 ] ] "descripcion" => array:1 [ "en" => "Relation between intravesical prostate protrusion vertical and other parameters. The prostate volume and transitional zone volume are correlated with intravesical prostate protrusion vertical." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1392 "Ancho" => 1837 "Tamanyo" => 202926 ] ] "descripcion" => array:1 [ "en" => "Relation between intravesical prostate protrusion transverse and other parameters. The intravesical prostate protrusion transverse is correlated with bladder outlet obstruction index." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "PSA: prostate specific antigen; T-zone: transitional zone; MFR: maximal flow rate; QoL: quality of life; IPSS: International Prostate Symptom Score; IPP: intravesical prostatic protrusions." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Characteristics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total (n=87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pressure flow study</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Non-obstruction (n=10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Equivocal (n=18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Obstruction (n=59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.1±8.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.0±10.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.1±7.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.9±8.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.385 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PSA (ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.28±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.98±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.46±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.213 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prostate volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.9±18.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.6±13.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.6±16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.8±18.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.011 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T-zone volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.5±12.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.3±7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.9±7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2±12.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MFR (ml/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.7±9.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5±6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.778 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-voided residual urine volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.2±95.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5±80.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.0±92.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.1±74.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.814 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">QoL score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2±0.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.40±0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.11±0.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.14±0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.695 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.5±7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.4±6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.1±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.2±7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPP transverse (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.6±10.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.9±7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5±10.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.5±11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.160 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPP vertical (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.2±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9±3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.8±6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.7±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.317 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab184056.png" ] ] ] ] "descripcion" => array:1 [ "en" => "The distribution of clinical parameters according to bladder outlet obstruction index." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "PSA: prostate specific antigen; T-zone: transitional zone; MFR: maximal flow rate; QoL: quality of life; IPSS: International Prostate Symptom Score; IPP: intravesical prostatic protrusions; BOOI: bladder outlet obstruction index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group A (n=23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group B (n=36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Group C (n=28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.8±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.9±8.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.6±8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.924 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PSA (ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.870 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prostate volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.4±13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.5±14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.1±18.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T-zone volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.2±10.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5±12.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MFR (ml/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8±8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5±4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.309 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-voided residual urine volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.3±102.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.3±89.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.1±98.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.846 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">QoL score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3±0.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.2±1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1±0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.776 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IPSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.7±6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2±7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.4±7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.216 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BOOI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.9±21.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.1±20.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.8±19.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.081 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab184055.png" ] ] ] ] "descripcion" => array:1 [ "en" => "The distribution of clinical parameters according to IPP vertical." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation between the International Prostate Symptom Score and a pressure-flow study in the evaluation of symptomatic benign prostatic hyperplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.R. 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The relationship between intravesical prostatic protrusion and pressure flow study findings in patients with benign prostate obstruction/lower urinary tract symptoms

Relación entre la protrusión prostática intravesical y los hallazgos del estudio de presión-flujo en pacientes con obstrucción prostática benigna/síntomas del tracto urinario inferior

S.C. Park

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sc.park@wonkwang.ac.kr

Corresponding author.

, J.W. Lee, J.S. Rim

Departamento de Urología, Facultad de Medicina, Hospital de Wonkwang, Iksan, Republic of Korea

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Benign prostatic enlargement is a common cause of BOO in men older than 50 years&#46; There is a significant positive correlation between the LUTS and the presence of BOO&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The LUTS can be caused by various pathologies&#44; such as benign prostatic hyperplasia &#40;BPH&#41;&#44; detrusor overactivity&#44; and detrusor underactivity&#46; Because of the complex etiological aspect&#44; the identification of BOO is important in treating patients with LUTS&#46; Validated symptom scores and quality of life questionnaire are used in patient&#39;s assessment&#44; but they are of limited diagnostic and prognostic use&#46; The multichannel PFS remains the gold standard diagnostic method for identifying BOO&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; the PFS is an invasive and uncomfortable procedure for the patients&#44; and it is time consuming and expensive&#46; The PFS also caused hematuria&#44; urinary tract infection&#44; and difficulty in urination&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Thus&#44; variable non-invasive diagnostic methods included PVR&#44; prostate volume&#44; ultrasound-estimated detrusor thickness and bladder weight&#44; and uroflowmetry attempted to define BOO&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;8</span></a> Though the uroflowmetry and PVR measurement are simple first-line investigations which can raise or lower the suspicion of BOO&#44; they cannot make a definitive diagnosis either&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">IPP is a morphological change due to excessive growth of the median and lateral lobe of the prostate into the bladder&#46; The strongest correlation was observed between the IPP measured by trans-abdominal ultrasonography &#40;TAUS&#41; and the prostate volume&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The IPP and the TAUS may be useful&#44; noninvasive predictors of urodynamically ascertained BOO&#44; as well as predictors of a trial without catheter success for men with acute urinary retention&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;13</span></a> The objective of this study was to define the predictive value of the IPP measured by TRUS for diagnosing BOO in patients with benign prostate hyperplasia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">From March 2006 to August 2009&#44; we conducted a single center study of relationship between the IPP measured by TRUS and PFS in first-visit patients with BPO&#47;LUTS&#46; After our institutional review board approval&#44; 87 patients who underwent PFS for the evaluation of their LUTS were enrolled in this study&#46; All the patients did not receive alpha-blocker for their LUTS&#46; Routine initial evaluation for male LUTS in our Department included past history&#44; digital rectal examination with neurological examination&#44; urinalysis&#44; serum creatinine and prostate specific antigen&#44; IPSS and quality of life&#44; uroflowmetry&#44; PVR and TRUS&#46; Patients with acute urinary retention&#44; bladder stone&#44; upper tract complications&#44; malignancy including prostate cancer&#44; and neurological conditions such as cerebrovascular dysfunction and Parkinson disease were excluded from this study&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We assessed the IPP and prostate volume by transrectal ultrasound &#40;Sonoace 9900<span class="elsevierStyleSup">&#174;</span>&#44; Medison&#44; Korea Republic&#41; when the bladder volume was 150&#8211;200<span class="elsevierStyleHsp" style=""></span>ml&#46; The prostate volume was measured using the prostate ellipse formula with 7&#46;5<span class="elsevierStyleHsp" style=""></span>Hz endorectal probe&#46; After measuring the prostate volume&#44; the IPP was checked on the midsagittal plane&#46; The IPP vertical was measured by vertical distance from the tip of the protrusion to the circumference of the bladder at the base of the prostate gland&#44; and the IPP transverse was measured by transverse distance of the circumference of the bladder at the base of the prostate gland &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The grades of the IPP vertical were divided into three groups&#58; group A &#60;5<span class="elsevierStyleHsp" style=""></span>mm&#44; group B 5&#8211;10<span class="elsevierStyleHsp" style=""></span>mm&#44; group C &#62;10<span class="elsevierStyleHsp" style=""></span>mm&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> All the TRUS were performed by experienced urologists&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The multichannel urodynamic studies&#44; with a PFS &#40;Duet Logic G2 manometer&#44; Medtronic-Dantec&#44; Denmark&#41; were performed according to the recommendation of the International Continence Society Good Urodynamic Practices protocol&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The extent of the BOO was calculated as the BOOI&#58; BOOI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>detrusor pressure at <span class="elsevierStyleItalic">Q</span><span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleItalic">Q</span><span class="elsevierStyleInf">max</span>&#46; A BOOI of &#62;40 indicates definite obstruction&#44; 20&#8211;40 is equivocal and &#60;20 indicates no obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">All statistical analyses were performed using the SPSS version 13&#46;0 for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; USA&#41;&#46; Data distribution was not normal&#44; and nonparametric tests were used&#46; Differences in clinical and urodynamic characteristics among groups were evaluated by the Kruskal&#8211;Wallis test and Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>-test&#46; The correlations were quantified by Spearman rank correlation coefficient&#46; A 5&#37; level of significance was used for all statistical testing&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">In all&#44; 87 patients with LUTS were assessed and entered into the study&#46; The mean age was 71&#46;7 years&#44; and the mean prostate specific antigen was 3&#46;1<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; The mean prostate volume was 38&#46;9<span class="elsevierStyleHsp" style=""></span>ml and the mean IPSS was 23&#46;5&#46; The mean maximal flow rate was 8&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#47;s and the mean PVR was 84&#46;2<span class="elsevierStyleHsp" style=""></span>ml&#46; The mean IPP vertical was 8&#46;2<span class="elsevierStyleHsp" style=""></span>mm and the mean IPP transverse was 27&#46;6<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The distribution of the various clinical parameters according to the BOOI is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Fifty patients &#40;57&#46;5&#37;&#41; had BOO defined as a BOOI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40 in PFS&#46; Prostate volumes were 27&#46;6<span class="elsevierStyleHsp" style=""></span>ml&#44; 32&#46;6<span class="elsevierStyleHsp" style=""></span>ml&#44; and 42&#46;8<span class="elsevierStyleHsp" style=""></span>ml in patients with non-obstruction&#44; equivocal&#44; and obstruction in PFS&#44; respectively &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41;&#46; The TZVs were 12&#46;3<span class="elsevierStyleHsp" style=""></span>ml&#44; 14&#46;9<span class="elsevierStyleHsp" style=""></span>ml&#44; and 22&#46;2<span class="elsevierStyleHsp" style=""></span>ml in patients with non-obstruction&#44; equivocal&#44; and obstruction in PFS&#44; respectively &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; The IPP transverse were 22&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#44; 25&#46;5<span class="elsevierStyleHsp" style=""></span>mm&#44; and 29&#46;5<span class="elsevierStyleHsp" style=""></span>mm in patients with non-obstruction&#44; equivocal&#44; and obstruction in PFS&#44; respectively &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;160&#41;&#46; The IPP verticals were 5&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#44; 7&#46;8<span class="elsevierStyleHsp" style=""></span>mm&#44; and 8&#46;7<span class="elsevierStyleHsp" style=""></span>mm in patients with non-obstruction&#44; equivocal&#44; and obstruction in PFS&#44; respectively &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;317&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The prostate volume and TZV were significantly increased according to the IPP vertical&#46; The prostate volumes were 28&#46;4<span class="elsevierStyleHsp" style=""></span>ml&#44; 35&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#44; and 52&#46;1<span class="elsevierStyleHsp" style=""></span>ml in each group&#46; The TZVs were 12&#46;0<span class="elsevierStyleHsp" style=""></span>ml&#44; 18&#46;2<span class="elsevierStyleHsp" style=""></span>ml&#44; and 27&#46;5<span class="elsevierStyleHsp" style=""></span>ml in each group&#46; The BOOI also increased in group C&#44; but it did not reach statistical significance&#58; 42&#46;9 in group A&#44; 50&#46;1 in group B&#44; and 51&#46;8 in group C &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;081&#41;&#46; Other clinical parameters were not different between the groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">There was a significant correlation between the IPP vertical and the prostate volume &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;688&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The IPP vertical was also significantly correlated with the TZV &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;645&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; However&#44; no significant correlations were noted between the IPP vertical and the IPSS &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;45&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;715&#41;&#44; or the BOOI &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;188&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;081&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; There was a significant correlation between the IPP transverse and the prostate volume &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;610&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; or the TZV &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;585&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; And the IPP transverse was significantly correlated with the BOOI &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;213&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41;&#46; However&#44; no significant correlation was noted between the IPP transverse and the IPSS &#40;Spearman&#39;s Rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;240&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;825&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The BOO is a common cause of LUTS in elderly men over 50 years&#46; LUTS can be caused by various etiologies&#46; The identification of BOO from other pathologies&#44; such as detrusor overactivity or detrusor underactivity&#44; is an important step to accurately treat men with LUTS&#46; The multichannel PFS is the gold standard for diagnosing BOO and underlying mechanisms of LUTS&#46; Even though the PFS is essential for the evaluation of the BOO before invasive treatment is considered&#44; many clinicians skip the PFS as they consider it is invasive&#44; time-consuming and expensive&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Thus&#44; several attempts have been made to date to diagnose BOO by non-invasive methods&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The uroflowmetry and PVR by ultrasonography are simple first-line methods for identifying BOO&#46; Men with BOO have a lower maximal flow rate than those with no obstruction&#44; demonstrating a negative correlation of maximal flow rate with Schafer grade of obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However&#44; uroflowmetry cannot distinguish obstruction from impaired detrusor contractility as a cause of reduced flow&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The PVR measured by ultrasound is a non-invasive method to indicate how completely a patient empties his bladder&#46; Although the PVR occurs in some patients with BOO&#44; the PVR is often a consequence of detrusor underactivity&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> On the other hand&#44; Kang et al&#46; showed that maximal flow rate and poor compliance were significant factors for predicting BOO in Korean men with LUTS&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Bosch et al&#46; demonstrated that the prostate volume was not useful for the prediction of BOO&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; the results of this study showed that male LUTS patients with BOO had a larger prostate volume and TZV&#46; Our results suggest that the BOO was associated with prostate size&#44; especially TZV&#46; These results are consistent with the other Korean study&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The TAUS is a non-invasive method for identifying the BOO by measuring the IPP&#44; detrusor wall thickness&#44; and estimated bladder weight&#46; Franco et al&#46; suggested that suprapubic ultrasound of detrusor wall thickness and IPP are simple&#44; noninvasive&#44; accurate systems to assess bladder prostatic obstruction in patients with LUTS due to BPH&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The TAUS measured the vertical distance from the tip of the prostatic protrusion to the circumference of the bladder at the base of the prostate gland in the midsagittal line&#46; Lim et al&#46; demonstrated that the prostate specific antigen&#44; prostate volume and IPP correlate well with one another&#46; And they suggested that the IPP&#44; as a non-invasive clinical parameter&#44; predicts BOO better than the prostate specific antigen and prostate volume&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The TRUS measured the IPP vertical and transverse&#44; also correlated with the prostate volume and TZV in this study&#46; Chia et al&#46; showed that a higher IPP grade was associated with a higher BOO index than lower grade IPP&#46; Thus&#44; they suggested that the IPP assessed by TAUS is a better and more reliable predictor of BOO than the prostate volume&#44; symptom severity&#44; maximal flow rate&#44; and PVR&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Nose et al&#46; also suggested that IPP grading correlated well the BOO index and the combination of the IPP grading&#44; and Doppler urodynamic study may be a novel standard in the diagnosis of BOO in male patients&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Keqin et al&#46; showed that the BOO index was significantly higher and the incidence of acute urinary retention appeared more often in the significant IPP group&#46; Thus&#44; they suggested that the IPP is a useful predictor for evaluating the BOO and detrusor function&#46; They also suggested that the significant IPP patients&#44; especially those presenting with AUR&#44; may benefit from early surgical intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Lieber et al&#46; showed that&#44; overall&#44; 10&#37; of men had an IPP of 10<span class="elsevierStyleHsp" style=""></span>mm or greater in their community-based study&#46; They also showed that men with an IPP of 10<span class="elsevierStyleHsp" style=""></span>mm or greater were more likely to use medications for BPO&#47;LUTS compared with those with an IPP lower than 10<span class="elsevierStyleHsp" style=""></span>mm&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Lee et al&#46; showed that a higher IPP grade is associated with a higher risk of clinical progression in benign prostate enlargement&#46; Thus&#44; they suggested that the IPP is a useful non-invasive predictor for clinical progression in benign prostate enlargement&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In this study&#44; the IPP vertical was not associated with the BOO index&#46; However&#44; the IPP transverse was correlated with the BOO index&#46; It showed the IPP transverse is more important than the IPP vertical for evaluating the BOO in TRUS setting&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The IPP was measured by TRUS in this study&#44; whereas the TAUS was used in other studies&#46; The TAUS for evaluating the prostate is easily performed in patients with rectal pathologies that underwent rectal surgery&#46; And it is a non-invasive method for the upper urinary tract&#46; On the other hand&#44; for TAUS of the prostate&#44; a filled bladder is essential&#46; The loss of acoustic window &#40;an empty bladder&#41; makes measurement of the IPP difficult and unreliable&#46; Yuen et al&#46; showed that the mean IPP decreases with increasing bladder volume&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> We measured the IPP by TRUS in this study&#46; Although the TRUS is more invasive than the TAUS&#44; the TRUS is more accurate for the measurement of the IPP and a filled bladder is not essential&#46; And the TRUS is very popular for the evaluation of the LUTS in Korea&#44; even at private clinics&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study has several limitations&#46; First&#44; in spite of the prospective study&#44; the number of patients is small&#46; The recruitment of patients was very difficult because the PFS is very uncomfortable and invasive&#46; Although the BOOI was not statistically significantly correlated with the IPP vertical and transverse&#44; the IPP vertical and transverse were increased in patients with BOO&#46; It is possible that a statistically significant correlation between the IPP and the BOO would have been found if the number of patients in each group had been larger&#46; Secondly&#44; the TRUS is more invasive than the TAUS&#46; However&#44; the TRUS gives more accurate information&#44; and it is a popular tool for the evaluation of LUTS in Korea&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion&#44; The IPP vertical measured by TRUS showed significant correlation with the prostate volume and TZV&#44; but not with the severity of symptoms&#44; quality of life&#44; or BOOI&#46; Nevertheless&#44; the IPP transverse on TRUS was correlated with the BOOI&#46; These conclusions might have implications for decision-making in patients with BPO&#47;LUTS&#44; especially invasive treatment&#46; Further clinical research with a larger cohort is mandatory to confirm the relation between the BOOI and the IPP&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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          "identificador" => "xres100621"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Objectives"
            2 => "Materials and methods"
            3 => "Results"
            4 => "Conclusions"
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        1 => array:2 [
          "identificador" => "xpalclavsec87786"
          "titulo" => "Keywords"
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        2 => array:2 [
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          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Objetivos"
            2 => "Material y m&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
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          "identificador" => "xpalclavsec87785"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of interest"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2011-06-08"
    "fechaAceptado" => "2011-06-14"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec87786"
          "palabras" => array:3 [
            0 => "Benign prostate hyperplasia"
            1 => "Ultrasound"
            2 => "Urodynamic study"
          ]
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      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec87785"
          "palabras" => array:3 [
            0 => "Hiperplasia benigna de pr&#243;stata"
            1 => "Ecograf&#237;a"
            2 => "Estudio urodin&#225;mico"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the relationship between intravesical prostatic protrusion &#40;IPP&#41; on transrectal ultrasonography &#40;TRUS&#41; and pressure-flow study &#40;PFS&#41; findings in patients with benign prostatic obstruction&#47;lower urinary tract symptoms &#40;BPO&#47;LUTS&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between March 2006 and August 2009&#44; we reviewed medical records of 87 patients who underwent TRUS and PFS for the evaluation of their LUTS&#46; The patients were classified by the IPP vertical degree&#58; less than 5<span class="elsevierStyleHsp" style=""></span>mm &#40;group A&#41;&#44; 5&#8211;10<span class="elsevierStyleHsp" style=""></span>mm &#40;group B&#41;&#44; over than 10<span class="elsevierStyleHsp" style=""></span>mm &#40;group C&#41;&#46; The extent of bladder outlet obstruction &#40;BOO&#41; was calculated as the bladder outlet obstruction index &#40;BOOI&#41; by the PFS&#46; The obstruction was defined as the BOOI over 40&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean age was 71&#46;1 years&#44; and mean IPP vertical was 8&#46;23<span class="elsevierStyleHsp" style=""></span>mm&#46; The IPP vertical showed significant correlation with prostate volume &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;688&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and transitional zone volume &#40;TZV&#41; &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;645&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; but there was no correlation between IPP and International Prostate Symptom Score &#40;IPSS&#41;&#44; maximal flow rate&#44; post-voided residual urine &#40;PVR&#41; and BOOI&#46; The IPP transverse was significantly correlated with BOOI &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;213&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The IPP vertical showed significant correlation with prostate volume and transitional volume&#44; but not with severity of symptom&#44; quality of life&#44; and parameters of PFS&#46; However&#44; the IPP transverse on TRUS was correlated with BOOI&#46;</p>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la relaci&#243;n entre el grado de protrusi&#243;n prost&#225;tica intravesical &#40;PPI&#41; vertical en la ecograf&#237;a transrectal &#40;ETR&#41; y los hallazgos del estudio de presi&#243;n-flujo &#40;EPF&#41; en pacientes con obstrucci&#243;n prost&#225;tica benigna&#47;s&#237;ntomas del tracto urinario inferior &#40;OPB&#47;STUI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Entre marzo de 2006 y agosto de 2009&#44; se revisaron los registros m&#233;dicos de 87 pacientes a los que se les realiz&#243; ETR y EPF para la evaluaci&#243;n de los STUI&#46; Se clasific&#243; a los pacientes por el grado de PPI vertical&#58; menos de 5<span class="elsevierStyleHsp" style=""></span>mm &#40;grupo A&#41;&#44; 5-10<span class="elsevierStyleHsp" style=""></span>mm &#40;grupo B&#41;&#44; y m&#225;s de 10<span class="elsevierStyleHsp" style=""></span>mm &#40;grupo C&#41;&#46; El grado de obstrucci&#243;n de la salida vesical se calcul&#243; como el &#237;ndice de obstrucci&#243;n de la salida vesical &#40;IOSV&#41; en el EPF&#46; La obstrucci&#243;n se defini&#243; como el IOSV por encima de 40&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La media de edad fue de 71&#44;1 a¿nos y la PPI vertical media fue de 8&#44;23<span class="elsevierStyleHsp" style=""></span>mm&#46; La PPI vertical mostr&#243; una correlaci&#243;n importante con el volumen prost&#225;tico &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;688&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y el volumen de la zona transicional &#40;VZT&#41; &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;645&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; pero no hubo correlaci&#243;n entre la PPI y la Puntuaci&#243;n Internacional de los S&#237;ntomas Prost&#225;ticos&#44; la tasa m&#225;xima de flujo&#44; la orina residual tras la micci&#243;n y el IOSV&#46; La PPI transversal estaba considerablemente correlacionada con el IOSV &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;213&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La PPI vertical mostr&#243; una correlaci&#243;n importante con el volumen de la pr&#243;stata y el volumen de transici&#243;n&#44; pero no con la gravedad de los s&#237;ntomas&#44; la calidad de vida y los par&#225;metros del EPF&#46; Sin embargo&#44; la PPI transversal en ETR guardaba correlaci&#243;n con el IOSV&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Park SC&#44; et al&#46; Relaci&#243;n entre la protrusi&#243;n prost&#225;tica intravesical y los hallazgos del estudio de presi&#243;n-flujo en pacientes con obstrucci&#243;n prost&#225;tica benigna&#47;s&#237;ntomas del tracto urinario inferior&#46; Actas Urol Esp&#46; 2012&#59;36&#58;165&#8211;70&#46;</p>"
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            "imagen" => "gr1.jpeg"
            "Alto" => 749
            "Ancho" => 1000
            "Tamanyo" => 138715
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The measurements of intravesical prostate protrusion vertical and transverse by transrectal ultrasound&#46;</p>"
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1457
            "Ancho" => 1825
            "Tamanyo" => 195874
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Relation between intravesical prostate protrusion vertical and other parameters&#46; The prostate volume and transitional zone volume are correlated with intravesical prostate protrusion vertical&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1392
            "Ancho" => 1837
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Relation between intravesical prostate protrusion transverse and other parameters&#46; The intravesical prostate protrusion transverse is correlated with bladder outlet obstruction index&#46;</p>"
        ]
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      3 => array:7 [
        "identificador" => "tbl0005"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">PSA&#58; prostate specific antigen&#59; T-zone&#58; transitional zone&#59; MFR&#58; maximal flow rate&#59; QoL&#58; quality of life&#59; IPSS&#58; International Prostate Symptom Score&#59; IPP&#58; intravesical prostatic protrusions&#46;</p>"
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              "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pressure flow study</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Non-obstruction &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Equivocal &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Obstruction &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;385&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PSA &#40;ng&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostate volume &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T-zone volume &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MFR &#40;ml&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;778&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Post-voided residual urine volume &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>95&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>80&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>92&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>74&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;814&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QoL score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;695&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IPSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;5&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">T-zone volume &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">MFR &#40;ml&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Post-voided residual urine volume &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">95&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>102&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">72&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">QoL score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;776&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 21735786
Original language: English

DOI:10.1016/j.acuroe.2012.05.005

The statistics are updated each day

Year/Month	Html	Pdf	Total

2023 March	2	2	4
2019 October	1	0	1
2019 August	2	2	4
2018 March	3	0	3
2018 February	59	2	61
2018 January	55	1	56
2017 December	47	1	48
2017 November	47	2	49
2017 October	53	3	56
2017 September	71	2	73
2017 August	61	3	64
2017 July	65	3	68
2017 June	136	25	161
2017 May	92	1	93
2017 April	60	3	63
2017 March	66	9	75
2017 February	55	2	57
2017 January	56	0	56
2016 December	101	5	106
2016 November	52	3	55
2016 October	55	4	59
2016 September	70	9	79
2016 August	78	3	81
2016 July	44	4	48
2016 June	55	4	59
2016 May	52	17	69
2016 April	61	10	71
2016 March	71	10	81
2016 February	65	12	77
2016 January	60	10	70
2015 December	33	8	41
2015 November	38	9	47
2015 October	42	7	49
2015 September	24	2	26
2015 August	44	8	52
2015 July	63	3	66
2015 June	20	2	22
2015 May	19	1	20
2015 April	13	8	21
2015 March	29	7	36
2015 February	10	1	11
2015 January	30	5	35
2014 December	35	5	40
2014 November	15	6	21
2014 October	24	3	27
2014 September	31	3	34
2014 August	36	3	39
2014 July	24	1	25
2014 June	16	4	20
2014 May	6	1	7
2014 April	14	3	17
2014 March	16	2	18
2014 January	3	3	6
2013 December	6	1	7
2013 November	15	2	17
2013 October	18	5	23
2013 September	4	2	6

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