Intravesical Prostatic Protrusion and Surgical Outcomes in Benign Prostatic Hyperplasia: A Magnetic Resonance Imaging-Based Evaluation

Objective: This study aimed to investigate the impact of preoperative intravesical prostatic protrusion (IPP) measurements obtained via magnetic resonance imaging (MRI) on postoperative outcomes in patients undergoing transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Material and Methods: A retrospective review was performed on 160 patients who underwent monopolar TURP at our clinic between January 2021 and December 2023. IPP was measured on sagittal MRI images as the vertical distance from the bladder base to the tip of the prostate protruding into the bladder. Patients were divided into three groups according to IPP length: Group A (IPP <5 mm, n=25), Group B (5 mm ≤ IPP <10 mm, n=30), and Group C (IPP ≥10 mm, n=38). Preoperative and postoperative data, including prostate-specific antigen (PSA) levels, International Prostate Symptom Score (IPSS), average urinary flow rate (Qavg), and maximum urinary flow rate (Qmax), were collected and analyzed across the groups. Results: The mean age of the patients was 65.3 ± 6.7 years. PSA levels were significantly higher in Group C compared to Group A (p=0.014). Prostate volume and the volume of resected tissue were significantly greater in Group C than in Groups A and B (p<0.001). Postoperatively, all groups showed significant decreases in PSA and IPSS values, along with significant increases in Qmax and Qavg. The improvement in Qmax after TURP was significantly greater in Groups B and C compared to Group A (p=0.019). However, the reduction in IPSS scores did not differ significantly among the groups (p=0.727). Conclusion: IPP correlates positively with prostate volume, PSA levels, and the amount of resected tissue. TURP significantly improves urinary function and symptom scores regardless of IPP length. However, the improvement in Qmax is more pronounced in patients with a higher IPP. IPP measurement may serve as a useful parameter in the surgical decision-making process for BPH patients. Keywords: intravesical prostatic protrusion, benign prostatic hyperplasia, transurethral resection of the prostate, magnetic resonance imaging, urinary function.