Different Volume Of The Prostate Surgery In Patients With Bladder Outlet Obstruction Of Sonography Video Urodynamic Research

Objectives:To study the incidence and proportion of acute urinary retention and bladder stones in patients with benign prostatic hyperplasia（BPH）and bladder outlet obstruction（BOO）requiring hospitalization.To study the characteristics of sonographic urodynamics（SVUDS）in BPH/BOO patients with different volume of prostate and analyze the relationship among the parameters;To explore the value of SVUDS in the evaluation of male BPH/BOO patients,and to improve the accuracy of early diagnosis and treatment of benign prostatic hyperplasia.Methods:A retrospective analysis from August 2019 to January 2023,301 BPH patients who required prostatectomy due to bladder stones or repeated urinary retention and were diagnosed as BOO（BOOI>40,Schaefer>Grade II）in the Second Affiliated Hospital of Guilin Medical University and Shaoyang Hospital Affiliated to University of South China were retrospectively analyzed.SVUDS examination was completed before operation.Collect patient clinical,examination and SVUDS data and visualize the collected data.Patients were divided into three groups based on prostate volume（PV）size:Group 1 small volume prostate:PV≤30ml（n=27）;Medium volume prostate in group 2:30ml PV 60ml（n=89）;Large volume prostate in group 3:PV≥60ml（n=185）.Statistical analysis were performed by one-way ANOVA,Mann-Whitney U and Kruskal-Wallis H test.The constituent ratio of complications was treated by chi-square test.Spearman correlation analysis was used to further characterize the relationship between prostate volume and the degree of bladder outlet obstruction among the noninvasive parameters that differed.Results:1.In 301 patients with BPH/BOO requiring surgical treatment,the grouping of different prostate volumes:Group 1 27 cases（8.97%）,PV 24ml（20,29）;89cases（29.57%）in group 2,PV 45ml（39.5,50.5）;185 cases（61.46%）in group 3,PV was 83ml（67.5,104.5）.PV increased with age and IPSS decreased with PV,but there was no significant difference between groups（P>0.05）.There was a significant positive correlation between PV and Age（P=0.048,Spearman’s r_s=0.191）.2.The incidence of acute urinary retention（AUR）in patients with BPH/BOO requiring surgical treatment was lower than that of bladder stones（BS）（103 cases,34.2%vs198 cases,65.8%）.The AUR prostate volume Md（P25,P75）was 90（65,110）ml and BS was 58.5（40,75）ml,and the PV was significantly greater in patients with AUR than in patients with BS（P=0.000 0.001）.The results of intergroup comparison:（1）The incidence of AUR in different PV groups was 1.00%vs 14.60%vs 84.50%;The incidence of BS in different PV groups was 13.10%vs 37.40%vs 49.50%;The incidence of AUR and BS in BPH/BOO patients increased with PV.The incidence of AUR and BS in group 3（PV≥60ml）was significantly higher than that in group 2（30ml PV60ml）and group 1（PV≤30ml）,while the incidence of these two complications was not statistically different between group 2 and group 1.（2）The percentage of AUR and BS in different PV groups was 3.7%vs 96.3%in group 1;16.9%vs83.1%in group 2;47%vs 53%in group 3.This indicates that the proportion of AUR in BPH/BOO surgery patients showed an increasing trend with the increase of PV,and BS showed a decreasing trend with the increase of PV,but the proportion of AUR in the group was significantly lower than that of BS.3.There were significant differences in Pdet Qmax,footpoint,BOOI,Schaefer grade,IPP,IPP-volume and BWT among different PV groups（P<0.05）.There were no significant differences in IPSS,Qmax,Pdetmax,BCI,curvature and PVR among different PV groups（P>0.05）.Pairwise comparison of the parameters with significant differences is as follows:（1）Pdet Qmax and footpoint had no significant difference between group 1 and group 2,but had significant difference between group 1 and group 3,group 2and group 3;The Pdet Qmax and footpoint of group 3 were significantly higher than those of group 1 and group 2.（2）There was no significant difference in BOOI and Schaefer grade between group 1 and group 2,and between group 2 and group 3;There was significant difference between group 1 and group 3（p<0.05）Of these,BOOI and Schaefer grades were significantly greater in group 3 than in group 1.（3）IPP,IPP-volume and BWT were significantly different among different volume groups.Among them,group 3 was significantly larger than group 1 and group 2,and group 2 was significantly larger than group 1.4.Correlation analysis was performed for non-invasive parameters with significant differences,in patients with BPH/BOO surgery（BOOI>40,Schaefer grade≥III）:（1）The degree of Schaefer’s obstruction（Ⅲ-Ⅵ）was positively correlated with PV,IPP,IPP-volume and BWT.Spearman’s correlation coefficient rs were 0.219,0.292,0.281 and 0.205respectively.（2）PV was moderately or strongly correlated with IPP,IPP-volume and BWT,with Spearman’s correlation coefficient（rs）of 0.540,0.629 and 0.457 respectively.PV and Schaefer grade were more closely related to IPP and IPP-volume.Conclusions:1.In patients with BPH/BOO who require hospitalization for surgery,the complication of bladder stones is more common than acute urinary retention,but the incidence of urinary retention increases and the incidence of bladder stones decreases as the prostate volume increases.2.In BPH/BOO patient,that degree of bladder outlet obstruction increased with the increase of prostate volume,but different invasive urodynamic parameters had different efficacy in judging BOO,and the detrusor pressure at maximum flow rate(P_detQmax)and footpoint were better index for BOO evaluation.3.Non-invasive parameters:Prostate protrusion into bladder distance（IPP）,IPP-volume and bladder wall thickness（BWT）were positively correlated with prostate volume and BOO degree.IPP and IPP-volume be better non-invasive parameters for evaluating BPH/BOO.4.Urodynamic sonography combined with non-invasive parameters reflect the degree and mechanism of male BOO more comprehensively than conventional urodynamic examination.