Benign prostatic hyperplasia (BPH) is a common condition in elderly men and represents a major cause of lower urinary tract symptoms (LUTS) globally (1). The condition is characterized by nonmalignant enlargement of the prostate gland, which may lead to bladder outlet obstruction and adversely affect quality of life (2). Its occurrence rises with advancing age, affecting approximately half of men over 50 years and up to 90% of those older than 80 years (3).

LUTS associated with BPH include both storage and voiding symptoms such as frequency, urgency, nocturia, weak stream, and incomplete bladder emptying (4). The International Prostate Symptom Score (IPSS) is widely used for quantifying symptom severity and guiding treatment decisions (5).

Traditionally, prostate size has been used as a parameter to assess disease severity; however, it does not always correlate well with symptoms or obstruction (6). Recently, intravesical prostatic protrusion (IPP), measured via ultrasound, has gained attention as a better predictor of bladder outlet obstruction (7). IPP represents the extent to which the prostate protrudes into the bladder lumen and is thought to reflect the degree of obstruction more accurately (8).

Several studies have demonstrated a strong association between IPP and urodynamic parameters, including flow rate and residual urine volume (9,10). Higher grades of IPP have been linked to more severe LUTS and poorer response to medical therapy (11).

Given its simplicity and non-invasive nature, IPP measurement can be easily incorporated into routine clinical evaluation (12). However, data from Indian populations remain limited.

This study aims to assess the association between intravesical prostatic protrusion and LUTS severity among patients with BPH attending a tertiary care center.

Study Setting

This study was conducted at Deccan College of Medical Sciences and Owaisi Hospital over a period of 12 months.

Study Population

120 male patients diagnosed with BPH were included.

Inclusion Criteria

• Age ≥ 50 years
• Clinical diagnosis of BPH
• Presence of LUTS

Exclusion Criteria

• Prostate cancer
• Urethral stricture
• Neurogenic bladder

Statistical Analysis

Data were analyzed using SPSS version 25. ANOVA was used for comparison between groups. Pearson correlation assessed relationship between IPP and IPSS. p < 0.05 was considered significant.

A total of 120 patients diagnosed with benign prostatic hyperplasia were included in the final analysis. All participants completed the study protocol over the 12-month period.

Baseline Characteristics

The mean International Prostate Symptom Score (IPSS) at baseline was 16.4 ± 6.2, indicating moderate symptom severity in most patients. The baseline clinical parameters are summarized in Table 1.

Table 1: Baseline Characteristics of Study Participants (n = 120)

Distribution of Intravesical Prostatic Protrusion (IPP)

Grade II IPP was the most frequently observed category (36.7%), followed by Grade I and Grade III, each accounting for 31.7% of cases. The detailed distribution of patients across IPP grades is presented in Table 2.

Table 2: Distribution of Patients According to IPP Grade

Association Between IPP and Symptom Severity

A progressive increase in symptom severity was observed with higher grades of IPP. Patients with Grade I IPP had a mean IPSS of 8.2 ± 3.1 (mild symptoms), whereas those with Grade III IPP demonstrated significantly higher scores (22.5 ± 4.6), reflecting severe symptoms. The differences between groups were statistically significant as determined by one-way ANOVA (F = 56.3, p < 0.001). These findings are detailed in Table 3.

Table 3: Comparison of IPP Grade with Mean IPSS

Relationship Between IPP and Post-Void Residual Volume

Post-void residual (PVR) urine volume increased significantly with higher IPP grades. Patients in Grade I had a mean PVR of 28.4 ± 10.2 mL, whereas those in Grade III exhibited markedly higher residual volumes (92.6 ± 18.4 mL). This trend was statistically significant (p < 0.001), as shown in Table 4.

Table 4: Comparison of IPP Grade with Post-Void Residual Volume

Correlation Analysis Between IPP and IPSS

Correlation analysis revealed a strong positive relationship between intravesical prostatic protrusion and symptom severity. As IPP increased, IPSS values also increased proportionately. The Pearson correlation coefficient was r = 0.68, indicating a moderate-to-strong positive correlation, which was statistically significant (p < 0.001). This relationship is illustrated in Figure 1.

Summary of Key Findings

• Higher grades of IPP were associated with significantly increased IPSS scores
• Post-void residual urine volume showed a rising trend with increasing IPP
• A statistically significant positive correlation was observed between IPP and LUTS severity.

Overall, the analysis demonstrates a strong association between intravesical prostatic protrusion and the clinical severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia.

This study demonstrates a strong association between intravesical prostatic protrusion and severity of LUTS in patients with BPH. The findings are consistent with previous studies that have identified IPP as a reliable predictor of bladder outlet obstruction (13,14).

The progressive increase in IPSS with higher IPP grades observed in this study supports the hypothesis that IPP reflects the mechanical component of obstruction (15). Unlike prostate volume, which has shown inconsistent correlation with symptoms, IPP appears to be more clinically relevant (16).

The significant correlation between IPP and post-void residual volume further reinforces its role in assessing disease severity (17). Patients with higher IPP grades demonstrated increased residual urine, indicating impaired bladder emptying (18).

These findings are in agreement with studies by Chia et al. and Tan et al., who reported similar associations (19,20). The use of ultrasound for IPP measurement offers a simple and cost-effective alternative to invasive urodynamic studies (21). Incorporating IPP assessment into routine evaluation may improve risk stratification and guide management decisions (22). Patients with higher IPP may benefit from early surgical intervention (23). However, limitations include single-center design and lack of urodynamic confirmation (24). Larger multicentric studies are needed (25).

Intravesical prostatic protrusion is significantly associated with the severity of LUTS and can be used as a reliable, non-invasive predictor in patients with BPH.

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