Beyond prostate volume: uncovering the anatomical impact of intravesical prostatic protrusion on lower urinary tract symptoms

Objective: Benign prostatic enlargement (BPE) is a prevalent urological condition often leading to bladder outlet obstruction.Our prospective study aimed to evaluate the relationships between prostate volume and intravesical prostatic protrusion (IPP) in patients with lower urinary tract symptoms (LUTS) to determine if IPP is a reliable predictor of BPE.Methods: This cross-sectional observational study included 52 men with BPE.LUTS severity was measured using validated International Prostate Symptom Score (IPSS) and quality of life (QoL) scores.Both IPP and total prostatic volume (TPV) were quantified via transabdominal ultrasound.We used Spearman's correlation and Multiple Linear Regression, along with a Kruskal-Wallis test, to analyze relationships and variations among IPP grades (p < 0.05 was significant).Results: We found significant positive correlations between IPP and the IPSS (r = 0.532, p < 0.001) and QoL scores (r = 0.546, p < 0.001).The strongest correlation was with the IPSS Voiding sub-score (r = 0.592, p < 0.001).TPV did not show a significant relationship with IPSS (r = 0.256, p = 0.067).Multiple Linear Regression confirmed IPP was the only significant independent predictor for both IPSS (B = 7.734, p < 0.001) and QoL (B = 1.113, p < 0.001), controlling for TPV and age.Conclusions: IPP is a more reliable anatomical predictor of LUTS severity and QoL than TPV.The significant correlation between IPP and symptoms supports the "ball-valve" theory of obstruction.The simple and non-invasive assessment of IPP is a valuable clinical tool for predicting symptom severity and guiding treatment decisions in men with BPE.