Role of Intravesical Prostatic Protrusion in Predicting Lower Urinary Tract Symptoms in Men with Benign Prostatic Enlargement: Hospital Based Prospective Comparative Study

Abstract

Introduction: Intravesical prostatic protrusion (IPP) reflects the degree of prostatic protrusion into the bladder and may serve as a non-invasive marker of obstruction in benign prostatic enlargement (BPE). We tend to evaluate the association of IPP with lower urinary tract symptoms (LUTS) and compare predictive performance with prostate size for obstruction-related outcome in patients.

Methods: Hospital-based prospective study was conducted from August to December 2025 and included 380 men aged >50 years presenting with LUTS attributed to BPE. IPP and prostate size were measured on trans abdominal ultrasound. Symptoms were assessed using the International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, Peak flow rate (Qmax) and post-void residual urine (PVR). A bladder outlet obstruction (BOO) surrogate outcome was defined as Qmax <=10 mL/s and/or PVR >=100 mL.

Results: Mean age and prostate size was 65.04 years and 43.6 g respectively. Mean IPP was 6.3 ± 4.2 mm. IPP was positively correlated with IPSS (rho=0.366, p<0.001), QoL (rho=0.315, p<0.001), and PVR (rho=0.270, p<0.001), and inversely correlated with Qmax (rho=-0.301, p<0.001). Mean IPSS increased across IPP grades (9.4, 12.5, and 16.2 for grades 1-3). BOO surrogate was present in 121/380 (31.8%) and increased across IPP grades (23.3%, 33.6%, 46.2%). IPP demonstrated higher discrimination for BOO surrogate than prostate size (AUC 0.621 vs 0.578).

Conclusion: Higher IPP correlates significantly with greater LUTS, poorer QoL, lower urinary flow rate and larger residual urine. Hence, it is a better predictor of LUTS and BOO than prostate volume in men with BPE.