Prostate: Is the detrusor ring of the bladder related to lower urinary tract symptoms caused by benign prostatic hyperplasia?

To date, the etiology of lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) remains uncertain
.

Recently, researchers from the United States published an article in Prostate in which they quantitatively analyzed the anatomical features of magnetic resonance imaging (MRI) to assess new independent factors
of symptoms.

The study was designed as a retrospective, single-institution study that assessed untreated men
who underwent prostate MRI within three months of the International Prostate Symptom Score (IPSS) between June 2021 and February 2022.
The parameters measured by MRI include: the size of the detrusor ring (DMR) around the bladder outlet, the mean apparent diffusion coefficient (ADC) of the central gland (CG), the volume of fissure (LH), the volume of the pelvic cavity, the volume of the prostate prostate protrusion (IPP) in the bladder, the CG volume, the volume of the peripheral zone (PZ), the prostate urethral angle (PUA), and the PZ background ordinal score
.
Multivariate logistic regression and receiver manipulation characterization are used to analyze factors for moderate/severe (IPSS≥8) and severe LUTS/BPH (IPSS≥20
).

A total of 303 men (mean age: 66.
1 [SD: 8.
1]) were included.

154 showed moderate or severe symptoms, of which 28 were severe and 149 were asymptomatic/mild
.
Increasing age [p=0.
02; chance (OR): 1.
05 (1.
01-1.
08)], PUA [p=0.
02; OR: 1.
05 (1.
01-1.
09)], LH volume [p=0.
04; OR: 1.
02 (1.
00-1.
05)], and DMR size [p<0.
001; OR: 5.
0 (3.
01-8.
38)] or area [p< measured by diameter 0.
001;OR:1.
92(1.
47-2.
49)] was significantly independently associated with moderate/severe symptoms and negatively correlated
with BMI[p=0.
02; OR: 0.
93(0.
88-0.
99)].
For every 1 cm increase in DMR diameter, the patient's chances of developing moderate/severe symptoms increase by about
5 times.
An increase in DMR size [diameter p<0.
001; OR: 2.
74 (1.
76-4.
27) or area p<0.
001; OR: 1.
37 (1.
18-1.
58)] was independently associated
with severe symptoms.
The optimal standard cut-off for DMR diameter for moderate/severe symptoms is 1.
2 cm [sensitivity: 77.
3; specificity: 71.
8; AUC: 0.
80 (0.
75-0.
84)].

Multivariate logistic regression analysis of moderate and severe symptoms using bladder neck diameter or bladder neck area

In summary, dilation of DMR around the bladder outlet is a new anatomical factor and is independently associated with moderate and severe LUTS/BPH.

Original source:

Kiran R Nandalur， David Walker， Hong Ye et al.
Impact of the bladder detrusor muscular ring on lower urinary tract symptoms due to benign prostatic hyperplasia： A quantitative MRI analysis .
Prostate.
Nov 2022.