Correlation between Anterior Bladder Wall thickness and Post-void urine Residue as indicators of Bladder Dysfunction in Nigerian men with Benign Prostatic Hyperplasia.

Abstract

Introduction:  BPH  is  associated  with  voiding dysfunctions; urodynamic study is the gold standard for diagnosis of voiding dysfunction but is invasive. Bladder wall thickness (BWT) and post-void urine residue (PVR) are non-invasive predictors of voiding dysfunction. Objective: To study the correlation between BWT and PVR in BPH. Methods: A hospital based cross-sectional prospective study of new BPH patients who presented to the urology clinics of Nnamdi Azikiwe  University  Teaching  Hospital, Nnewi. After initial clinical and laboratory evaluation, participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥ 200mls), prostate volume (PV) and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with abdominal probe frequency of 3.5 MHz. Bladder emptying efficiency (BEE) was calculated.    Anterior BWT was divided into two groups: < 5mm and ≥ 5mm. Data was analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. P- Value < 0.05 was considered significant. Results: Seventy seven men with a mean age of 66.66±10.74 years were included in the study. Sixty one percent had symptoms lasting > 12 months. The average anterior BWT, PVB, PVR, BEE, PV and PSA  were  4.55±1.02  mm,  260.98±57.44  mls,58.36±52.94 mls, 77.98±17.37%, 66.31±46.38 mls and 8.04±5.97 ng/ml respectively. There was a significant positive correlation between BWT and duration of symptoms (p = 0.044) and a significant negative correlation between BWT and BEE (p = 0.005). A positive but not significant correlation was found between BWT and PVR (p = 0.255). Fifty four (70.1%) had BWT< 5mm and 29.9% had BWT ≥ 5mm. The mean IPSS (p = 0.000), PV (P = 0.032) and PVR (p = 0.020) were significantly higher in the ≥ 5mm group. The ≥ 5mm group also had significantly lower BEE (p = 0.002). Conclusion: Voiding dysfunction was more severe in patients with BWT of 5mm or more. There was a positive correlation between anterior BWT and PVR and a significant negative correlation between BWT and BBE.