DIFFERENCE IN HISTOPATOLOGICAL AND VASCULAR INDICES BETWEEN LATERAL LOBE AND INTRAVESICAL PROSTATIC PROTRUSION IN PATIENTS WITH BENIGN  PROSTATIC HYPERPLASIA REFRACTORY TO MEDICAL MANAGEMENT.

Sasanka Kumar Barua; Debang Sarma; Jyoti Prasad Morang; Rajeev T. P.; S.J. Baruah

Volume : VI, Issue : III, March - 2017

DIFFERENCE IN HISTOPATOLOGICAL AND VASCULAR INDICES BETWEEN LATERAL LOBE AND INTRAVESICAL PROSTATIC PROTRUSION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA REFRACTORY TO MEDICAL MANAGEMENT.

Sasanka Kumar Barua, Debang Sarma, Jyoti Prasad Morang, Rajeev T. P. , S. J. Baruah

Abstract :

Introduction and objectives: Benign prostatic hyperplasia (BPH) is the most common neoplasm affecting ageing male population worldwide. Introduction of combination medical therapy has revolutionized in the management of symptomatic benign prostatic hyperplasia. It has been observed that the alpha blockers are relatively ineffective in patient with intravesical prostatic protrusion (IPP). This study is being design to evaluate whether there exist any difference of vascular parameters and histopathology between lateral lobe and IPP. Methods: All symptomatic BPH patients attending the urology OPD from Feuary 2015 to Oct. 2016 are included in this study who are refractory to medical management and those with complication of bladder outflow obstruction due to BPH with IPP. Patients were evaluated with doopler ultrasound and resected specimens were send separately for histopathological examination with the pathologist blinded regarding the nature and origin of specimen. Results: 28 patients qualified included in the study. Ultrasonographically estimated average prostatic volume of the patients in our study is 59.68 gm (SD 27.59) ranging from 26 –146 gm, mean invesical prostatic protrusion is 19.11 mm (SD 6.511) ranging from 9–34 mm comprising. Mean intraprostatic resistive index measured by color doppler of lateral lobe is 0.7132 ( SD 0.139 and mean SE 0.026) and Intravesical prostatic protrusion mean resistive index is 0.642 with SD 0.117 in our study patients. On T– test we observed a statistically significant difference between resistive index of lateral lobe and intravesical prostatic protrusion (p value 0.045 , 95% CI 0.00156 – 0.13987) . Histopathology of 12 patients showed a difference with hyperplasia predominat of stromal componant in intravesical prostatic protrusion (IPP). In intravesical prostatic protrusion (IPP), stromal hyperplasia with or without chronic inflammatory cells more commonly seen in 11 (39%) patients and in 1 (3%) patient mainly chronic inflammatory changes were observed whereas this finding was absent in lateral lobe specimens. On statistical analysis using Chi–Square test this difference is statistatically significant ( p value <5%). Conclusion: Some degree of cellular abnormality as well as alteration of intraprostatic vascular parameters were observed in our study. However it needs to be confirmed in randomized control study involving large number of population, having symptomatic benign prostatic hyperplasia with intravesical prostatic protrusion who failed medical therapy.