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Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing
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The prostatic middle lobe: clinical significance, presentation and management
Sammy Gharbieh1, Fairleigh Reeves2, Ben Challacombe2
1Guy's and St Thomas' NHS Foundation Trust, London, UK. sammy.gharbieh@gstt.nhs.uk.
Nature Reviews. Urology
|May 15, 2023
Summary
The prostatic middle lobe
Area of Science:
- Urology
- Medical Research
Background:
- Benign prostatic hyperplasia (BPH) management often overlooks the prostatic middle lobe's role.
- Middle lobe enlargement contributes to intravesical prostatic protrusion (IPP), causing bladder outlet obstruction (BOO) through a ball-valve mechanism.
Purpose of the Study:
- To highlight the significance of prostatic middle lobe enlargement in BPH presentation and management.
- To emphasize the clinical implications of intravesical prostatic protrusion (IPP) in predicting treatment outcomes.
Main Methods:
- Review of clinical presentations and management strategies for BPH.
- Analysis of the association between middle lobe enlargement, IPP, and treatment response.
- Evaluation of diagnostic methods for assessing IPP and its impact on BPH.
Main Results:
- Intravesical prostatic protrusion (IPP) is a strong predictor of bladder outlet obstruction (BOO) and failure of medical BPH therapy.
- Middle lobe enlargement is linked to mixed storage and voiding symptoms, varying with IPP severity.
- Standard assessments like uroflowmetry may not detect IPP, potentially misdirecting clinical decisions.
Conclusions:
- Radiological assessment of prostate morphology, particularly middle lobe enlargement and IPP, is crucial for BPH prognosis and surgical planning.
- BPH treatment strategies must account for prostate adenoma morphology, including middle lobe enlargement and IPP.
- Recognizing the role of the prostatic middle lobe and IPP can optimize BPH management and patient outcomes.
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