To define prostate and bladder sono-morphologic parameters that best predict the outcome of benign prostatic hyperplasia (BPH) in men treated with alpha1-adrenoreceptor antagonist.

Patients with BPH, candidates for medical treatment, were prospectively enrolled. Besides basic evaluation measures, all patients underwent transrectal ultrasonography. The main outcome was the response to treatment on the basis of International Prostatic Symptom Score, quality of life score, and maximum urine flow rate after taking daily oral dose of tamsulosin 0.4 mg for 6 months. The influences of baseline parameters on treatment response were statistically analyzed.

A total of 166 patients completed the study. From these, 59 (35.5%) had ineffective treatment after 6 months. According to logistic regression analysis, baseline International Prostatic Symptom Score storage subscore, maximum urine flow rate, and transrectal ultrasonography-measured sono-morphologic parameters (bladder wall thickness [BWT], ultrasound estimated bladder weight [UEBW], and intravesical prostatic protrusion [IPP]) were the independent predictors of ineffective treatment (P < .05). Using receiver operating characteristics analysis, BWT, UEBW, and IPP had adequate area under the curve (0.939, 0.897, and 0.876, respectively). At cutoff values of 9.3 mm, 34.5 g, and 12.9 mm, the positive and negative predictive values for BWT, UEBW, and IPP were 83.6% and 92.4%; 78.2% and 85.6%; 80.3% and 90.5%; respectively. Combination of these sono-morphologic parameters increased their positive predictive value to 97.6%.

Sonographic measurements of BWT, UEBW, and IPP might aid in determining patients with BPH at high risk of alpha1-adrenoreceptor antagonist monotherapy failure, in turn determining the initial need for additional medical therapy or surgical intervention.