Exploration Of The Bladder Criteria For Surgical Treatment Of Benign Prostatic Hyperplasia

PurposeNew bladder ultrasound test and urine biomarkers can be used to diagnose and predict the results of BPH.We evaluated the diagnostic role of these indicators,and their sensitivity to structure and function changes of the bladder in BPH.MethodsFrom 2014-06 to 2016-01 we prospectively enrolled 355 cases of patients.Baseline characteristics:IPSS,prostate volume,flow rate,bladder outlet obstruction index BOOI,ultrasound new indicators(DWT detrusor thickness,bladder wall thickness BWT,intravesical prostatic protrusion IPP),urine biomarkers(nerve growth factor NGF,brain-derived neurotrophic factor BDNF,prostaglandins PG).Patients were all treated with transurethral thulium laser reseetion of the prostate.After 6 months and 12 months follow-up.Preoperative and postoperative data were compared.Logistic regression analysis,ROC curve and AUC were done.Proposing cut-off value of BPH-caused bladder damage,and build bladder Standard for BPH surgery(IBFS international bladder function score),based on ROC analysis of efficacy results.ResultsThe study enrolled 355 patients,with an average follow-up of 12 months(range:6-15 months).The 328 people completed the follow up,with 27 people lost(7.60%dropout rate).Logistic regression analysis selected Qmax,DWT,BWT,IPP,NGF as independent factors related to BOOI(P<0.05).302 patients were significantly improved in symptoms and urinary flow rates 6 months after surgery(P<0.05),ultrasound(BWT,DWT and IPP),urine(NGF,BDNF,PG)had a significant change at 6 months after surgery compared with preoperative data(p<0.05).26 patients had no significant improvement in symptoms and urinary flow rates,as DWT,BWT,NGF,at 6 months after surgery compared with preoperative data and baseline parameters were more serious.(P>0.05).ROC analysis and calculation of AUC:DWT AUC was 0.786(95%Cl 0.759-0.814,the cut-off value 2.875mm,sensitivity 0.73 and specificity 0.83),IPP AUC was 0.762(95%CI0.663-0.801,the cutoff-value 18.215 mm,sensitivity 0.65 and specificity 0.78),NGF AUC was 0.723(95%Cl 0.654-0.791,sensitivity 0.68,specificity 0.84).DWT had a better diagnostic value than IPP and NGF as the AUC was greater.Bladder Standard cut-off value(DWT 2.875mm,IPP 15.215mm,NGF 1.052pg/mg,Qmax 10.45 ml/s,PVR 47.03ml),thereby constructing IBFS based on the ROC analysis of curative effect of patients.IBFS cut-off value is 8 point,AUC was 0.868(95%Cl 0.789-0.947).ConclusionThe prostate and bladder parameters ultrasound IPP,DWT and urine NGF were measured as noninvasive,sensitive indicators for status of prostatic bladder.The higher the value of DWT,IPP and NGF before treatment,the worse the result of treatment.Threshold for bladder standard(DWT 2.875mm,IPP 15.215mm,NGF 1.052pg/mg,Qmax 10.45 ml/s,PVR 47.03ml).Bladder standard IBFS score at 8 predicted the best outcome of thulium laser surgery.