Shekar, M G (2009) Effect of Intravesical Prostatic Protrusion (IVPP) on Lower Urinary Tract Function and Management. Masters thesis, Stanley Medical College, Chennai.
|
Text
180400209shekar.pdf Download (325kB) | Preview |
Abstract
INTRODUCTION : Intravesical prostatic protrusion (IVPP) is represented as a severe parameter of the Bladder outlet obstruction (BOO) due to Benign prostatic hypertrophy (BPH) traditionally and it is considered based on the experience that it can be cured only by surgical management. But till date it is not made standard in various association guidelines and in standard textbooks except for a few publications in literature. In symptomatic Benign prostatic hypertrophy patients, there is no consensus or clear practical guidelines to define the presence and severity of obstruction, other than the pressure-flow study. The latter has been traditionally regarded as the 'reference' gold standard but the technique is invasive, uncomfortable for the patient, time-consuming and expensive and not available, especially in most developing countries. The various standard non invasive measures used for finding the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy are IPSS score(International prostatic symptoms score), Uroflowmetry and Postvoid residual urine estimation(PVR). Eventhough these are not considered significant to asses the severity of Bladder outlet obstruction on individual basis they are at present used in combination to asses the severity. Each one has their own pitfalls to be a single standard non invasive mode for assessing the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy. Cystoscopy and Pressure flow study are reliable in assessing the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy but both are invasive. AIM : To correlate Intravesical prostatic protrusion(IVPP) with International prostate symptoms score (IPSS),Quality of life index(QOL), Uroflowmetry, Postvoid urine (PVR) and Pressure Flow study (PFS) and to asses whether the presence and increasing grades of Intravesical prostatic protrusion are directly correlated with the severity of Bladder outlet obstruction due to Benign prostatic hypertrophy. Response of patients with Intravesical prostatic protrusion of same grade to surgical therapy and drug therapy are compared to decide which modality of management is best. MATERIALS AND METHODS : 1. Prospective study. 2. Period of study is from June 2006 to June 2009. 3. Age Range- 50 to 80 years. 4. The sample size is 100. 5. The patients with co morbid illness such as Diabetes Mellitus (DM), Hypertension (HTN) ,Tuberculosis (TB) etc and associated neurological conditions are excluded from the study. Patients with a known history of previous lower urinary tract surgery, prostate or bladder carcinoma, bladder calculi, or neurological deficit are also excluded from the study. CONCLUSION : The increasing grades of IVPP are significantly directly correlated with IPSS score, Q max and Postvoid residual. Among the three Qmax is the best correlated one. The Prostatic volume and QOL index do not correlate well with IVPP. 2. IVPP have a very good positive and negative predictive value and also a good accuracy rate in comparison with all other parameters in predicting the BOO. This is especially very significant in increasing grades of protrusion. Thus the IVPP correlates significantly with BOO; it should be used as one of the variables initially assessed in men with LUTS, being a less invasive (than pressure-flow studies in every patient) and a more cost-effective way to stratify patients with LUTS for further management. The surgical intervention statistically proved to be superior to medical treatment in IVPP patients, especially most significant in Grade II & III IVPP patients. In patients presented with AUR along with IVPP surgery proved the efficacy for succeful trial voiding. The patients failed medical treatment voided succefully after TURP.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Intravesical Prostatic Protrusion (IVPP) ; Lower Urinary Tract ; Function ; Management. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 09 Aug 2017 02:34 |
| Last Modified: | 09 Aug 2017 02:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2563 |
Actions (login required)
 |
View Item |
