IPP and Changes in IPSS in Benign Prostatic Hyperplasia (BPH) Patients Treated with ?1-Blocker


  • Muhammad Ishak Faculty of Medicine, Andalas University, Padang, West Sumatra; M. Djamil General Hospital, Padang, West Sumatra
  • Etriyel MYH Faculty of Medicine, Andalas University, Padang, West Sumatra; M. Djamil General Hospital, Padang, West Sumatra
  • Peri Eriad Yunir Faculty of Medicine, Andalas University, Padang, West Sumatra; M. Djamil General Hospital, Padang, West Sumatra




benign prostatic hyperplasia (BPH), IPSS, intravesical prostatic protrusion (IPP), ?1-blocker


Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostate gland caused by the proliferation of epithelial cells and stroma, causing Lower Urinary Tract Symptoms (LUTS). One of the ways to treat BPH is through medical therapy with ?1-blockers. The success of medical therapy is influenced by many factors, one of which is Intravesical Prostatic Protrusion (IPP).  This study was a comparative prospective study that aimed to find the effect of IPP on response to therapy with ?1-blockers in BPH patients. IPSS was used as a measuring tool. IPP was examined using transabdominal ultrasound. The study was conducted from July 2020 to December 2020. Data were analyzed using the one way ANOVA average comparison test and Pearson correlation test. A sample of 30 patients was divided into 3 groups based on the IPP degree, namely grade I (<5mm), grade II (5-10mm) and grade III (> 10mm). There were no significant differences in the mean initial IPSS scores in each group, namely 19.6, 18.90, and 21.30 (p = 0.216). There was a significant decrease in mean IPSS after 1 month of ?1-blocker therapy. In addition, there was also found a significant correlation between the IPP value and the decrease in the final IPSS with a negative correlation. There is a significant correlation between the IPP degree and the decrease in IPSS in BPH patients after receiving ?1-blocker therapy as the higher the IPP degree, the lower the final IPSS improvement.


Abrams, P., Kaplan, S., de Koning Gans, H. J., & Millard, R. (2006). Safety and tolerability of tolterodine for the treatment of overactive bladder in men with bladder outlet obstruction. Journal of Urology, 175(3). https://doi.org/10.1016/S0022-5347(05)00483-0

Basuki, P. (2015). Hiperplasia prostat benigna. In P. Basuki (Ed.), Dasar-dasar urologi (3rd ed.). Sangung Seto.

Chapple, C., & Abrams, P. (2013). Male lower urinary tract symptoms (LUTS) an international consultation on male LUTS Fukuoka, Japan, September 30 October 4, 2012. Monreal: Societe Internationale d’Urologie.

Chia, S. J., Heng, C. T., Chan, S. P., & Foo, K. T. (2003). Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU International, 91(4). https://doi.org/10.1046/j.1464-410X.2003.04088.x

Dhingra, N., & Bhagwat, D. (2011). Benign prostatic hyperplasia: An overview of existing treatment. In Indian Journal of Pharmacology (Vol. 43, Issue 1). https://doi.org/10.4103/0253-7613.75657

Dmochowski, R. R. (2005). Bladder outlet obstruction: Etiology and evaluation. Reviews in Urology, 7 Suppl 6.

Gratzke, C., Bachmann, A., Descazeaud, A., Drake, M. J., Madersbacher, S., Mamoulakis, C., Oelke, M., Tikkinen, K. A. O., & Gravas, S. (2015). EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. In European Urology (Vol. 67, Issue 6). https://doi.org/10.1016/j.eururo.2014.12.038

Gravas, S., Cornu, J. N., Gacci, M., Gratzke, C., Herrmann, T. R. W., Mamoulakis, C., Rieken, M., Speakman, M. J., Tikkinen, K. A. O., Karavitakis, M., Kyriazis, I., Malde, S., Sakalis, V., Schouten, N., & Smith, E. J. (2022). EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). European Association of Urology.

Greco, K. A., & McVary, K. T. (2008). The role of combination medical therapy in benign prostatic hyperplasia. In International Journal of Impotence Research (Vol. 20, Issue SUPPL. 3). https://doi.org/10.1038/ijir.2008.51

Kent-Hoo, N. G., Ayob, M. A., Irna, M., Salim, M., Abduljabbar, H. N., & Supriyanto, E. (2014). Prostate volume measurement using transabdominal ultrasound scanning. Advances in Environment, Biotechnology and Biomedicine.

Lee, A., Lee, H. J., Lim, K. bin, Huang, H. H., Ho, H., & Foo, K. T. (2016). Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow? Asian Journal of Urology, 3(1). https://doi.org/10.1016/j.ajur.2015.10.002

Lee, L. S., Sim, H. G., Lim, K. bin, Wang, D., & Foo, K. T. (2010). Intravesical prostatic protrusion predicts clinical progression of benign prostatic enlargement in patients receiving medical treatment: Original Article: Clinical Investigations. International Journal of Urology, 17(1). https://doi.org/10.1111/j.1442-2042.2009.02409.x

Lim, K. bin, Ho, H., Foo, K. T., Wong, M. Y. C., & Fook-Chong, S. (2006). Comparison of intravesical prostatic protrusion, prostate volume and serum prostatic-specific antigen in the evaluation of bladder outlet obstruction. International Journal of Urology, 13(12). https://doi.org/10.1111/j.1442-2042.2006.01611.x

Madersbacher, S., Sampson, N., & Culig, Z. (2019). Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: A mini-review. In Gerontology (Vol. 65, Issue 5). https://doi.org/10.1159/000496289

Oelke, M., Giuliano, F., Mirone, V., Xu, L., Cox, D., & Viktrup, L. (2012). Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. European Urology, 61(5). https://doi.org/10.1016/j.eururo.2012.01.013

Park, H. Y., Lee, J. Y., Park, S. Y., Lee, S. W., Kim, Y. T., Choi, H. Y., & Moon, H. S. (2012). Efficacy of alpha blocker treatment according to the degree of intravesical prostatic protrusion detected by transrectal ultrasonography in patients with benign prostatic hyperplasia. Korean Journal of Urology, 53(2). https://doi.org/10.4111/kju.2012.53.2.92

Parsons, J. K. (2010). Benign prostatic hyperplasia and male lower urinary tract symptoms: Epidemiology and risk factors. In Current Bladder Dysfunction Reports (Vol. 5, Issue 4). https://doi.org/10.1007/s11884-010-0067-2

Presti Jr, J. C. (2000). Neoplasms of the prostate gland. Smith’s General Urology, 399–406.

Reis, L. O., Barreiro, G. C., Baracat, J., Prudente, A., & D’Ancona, C. A. (2008). Intravesical protrusion of the prostate as a predictive method of bladder outlet obstruction. International Braz J Urol, 34(5). https://doi.org/10.1590/s1677-55382008000500012

Roehrborn, C. G., & McConnell, J. D. (1994). Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. The Journal of Urology, 151(4), 869–874.

Seo, Y. M., & Kim, H. J. (2012). Impact of intravesical protrusion of the prostate in the treatment of lower urinary tract symptoms/benign prostatic hyperplasia of moderate size by alpha receptor antagonist. International Neurourology Journal, 16(4). https://doi.org/10.5213/inj.2012.16.4.187

Shin, S. H., Kim, J. W., Kim, J. W., Oh, M. M., & Moon, D. G. (2013). Defining the degree of intravesical prostatic protrusion in association with bladder outlet obstruction. Korean Journal of Urology, 54(6). https://doi.org/10.4111/kju.2013.54.6.369

Tanagho, E. A. (1995). Urinary obstruction and stasis. Smith’s General Urology.

Tanguay, S., Awde, M., Brock, G., Casey, R., Kozak, J., Lee, J., Nickel, J. C., & Saad, F. (2009). Diagnosis and management of benign prostatic hyperplasia in primary care. In Journal of the Canadian Urological Association (Vol. 3, Issue 3 SUPPL. 2). https://doi.org/10.5489/cuaj.1116

Terris, M. K. (2002). Ultrasonography and biopsy of the prostate. In P. C. Walsh, A. B. Retik, E. D. Vaughan, A. J. Wein, L. R. Kavoussi, & A. C. Novick (Eds.), Campbell’s urology (8th ed.). WB Saunders.

Tjahjodjati, Soebadi, D. M., Umbas, R., Purnomo, B. B., Widjanarko, S., Mochtar, C. A., Tarmono, Rasyid, N., Noegroho, B. S., Prasetyawan, W., Danarto, H. R., Warli, S. M., Hamid, A. R. A. H., Syahri, S., & Hakim, L. (2017). Panduan penatalaksanaan klinis: Pembesaran prostat jinak (Benign prostatic hyperlasia/BPH) (3rd ed.). Ikatan Ahli Urologi Indonesia.

Topazio, L., Perugia, C., de Nunzio, C., Gaziev, G., Iacovelli, V., Bianchi, D., Vespasiani, G., & Finazzi Agrò, E. (2018). Intravescical prostatic protrusion is a predictor of alpha blockers response: Results from an observational study. BMC Urology, 18(1). https://doi.org/10.1186/s12894-018-0320-0

Zul, M. I. (2019). Analisis faktor resiko penyakit benign prostate hyperplasia (BPH) pada pasien di RSUP Dr. M. Djamil Padang tahun 2019 [Thesis]. Universitas Andalas.