Role of transrectal ultrasound in evaluating prostate pathologies in obstructive luts

Aim: To evaluate the efficacy of Transrectal ultrasound in evaluating the diseases of the prostate in men presenting with lower urinary tract symptoms and its impact on management and treatment outcomes.
Methods: This is aprospective randomized control study conducted in the Department of Urology in Government Kilpauk Medical College Hospital and GoverntmentRoyapettah Hospital, Chennai during the period March 2018 to March 2019. 67 patients with obstructive LUTS above the age of 30 years, were included in this study.Patients with symptoms of LUTS due to urinary tract infections, neurogenic bladder, trauma, chronic kidney diseases andpatients with significant medical and psychological condition precluding interventions and who did not consent for the study were excluded from our study. Both Transabdominal and Transrectal ultrasound is performed in all these patients preoperatively and calculations of the prostate volume (both total and transition zone) was made. If any suspicious lesions or nodules were present, these patients would be subjected to MRI followed by TRUS guided biopsy of these lesions. All these would be compared with respective transabdominal calculations of the prostate volume and findings as well as the intraoperative and postoperative assessment along with histopathological reports.
Results: Patients’ ages ranged between 40 and 80 years with a peak age incidence at sixth decade. Transition Zone (TZ) volume estimation on both transrectal and transabdominal ultrasound showed transrectal method was more accurate. However there is no statistically significant difference between TRUS and Transabdominal volumetric analysis. TRUS showed to have advantage in diagnosing other prostate pathologies and helpful in the decision making regarding management. In our study, 54 BPH, 7 prostate cancer and 6 inflamatory prostate pathologies were diagnosed.
Conclusion:The volumetric analysis of BPH showed more accurate and superior results with transrectal ultrasound when compared to transabdominal USG. Measurements of the transition zone of the prostate by transrectal ultrasoundare more accurate than those for the whole prostate to predict enucleated or resectedweight. The assessment of the transition zone volume may be sufficiently reliable to be usedin the clinical management of benign prostatic hyperplasia and helpful to choose modalityof the surgery. Also TRUS showed advantageous in evaluation and management plans in patients with other prostate pathologies.