Effect of lower urinary tract anatomy measured on three-dimensional reconstruction using magnetic resonance imaging on the treatment of benign prostatic hyperplasia decision

Background: To examine the impact of urinary tract anatomical parameters on treatment decisions for benign prostatic hyperplasia (BPH) in patients with lower urinary tract symptoms (LUTS). Methods: Male patients with a prostate volume (PV) greater than 25 mL, presenting with LUTS/BPH, and treated at Jinhua People’s Hospital between June 2021 and May 2024 were included in this study. Patients were categorized into surgery-required (NS) and non-surgery-required (non-NS) groups based on uroflowmetry results and the International Prostate Symptom Score (IPSS). Magnetic Resonance Imaging (MRI) with three-dimensional (3D) reconstruction was utilized to accurately measure urinary tract anatomical parameters. Results: A total of 119 patients were included, with 51.3% requiring surgery. Binary logistic regression analysis identified bladder wall volume (BWV) Odds Ratio (OR) 1.286; 95% Confidence Internal (95% CI), 1.105 to 1.497; p = 0.001), intravesical prostatic protrusion (IPP) (OR 1.585; 95% CI, 1.165 to 2.157; p = 0.003), and prostatic urethral angle (PUA) (OR 1.158; 95% CI, 1.036 to 1.294; p = 0.01) as significant predictors of the need for surgery. Receiver operating characteristic curve analysis revealed optimal cutoff values for distinguishing the need for surgery: BWV of 47 mL (area under the curve (AUC): 0.837), PUA of 47.15◦ (AUC: 0.903), and IPP of 8.45 mm (AUC: 0.922). The sensitivity, specificity, and accuracy of BWV, IPP and PUA were 68.9%, 86.2% and 75.6%; 86.9%, 82.8% and 82.4%; and 82.2%, 87.9% and 81.5%, respectively. The combined area under the curve for the three parameters was 0.979. Conclusions: Measurements of BWV, PUA and IPP are effective in determining whether patients with LUTS/BPH require surgery.

LUTS/BPH; Urinary tract anatomy parameters; Magnetic resonance imaging; Surgery

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