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22]

Original Article

Transrectal Doppler Sonography of Benign Prostatic

Enlargement in Nigerian Men
Olubukola Olayinka Fanimi1, Christianah Mopelola Asaleye1, Abdulkadir Ayo Salako2, Oluwagbemiga Oluwole Ayoola1, Tewogbade Adeoye Adedeji3,
Bukunmi Michael Idowu1*
1
Department of Radiology, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile‑Ife, Osun State, Nigeria, 2Department of
Surgery, Urology Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile‑Ife, Osun State, Nigeria, 3Department of Chemical Pathology, Obafemi Awolowo
University Teaching Hospitals Complex, Ile‑Ife, Osun State, Nigeria

Abstract
Background: Transrectal ultrasonography  (TRUS) is the best route for examining the prostate gland because of transducer proximity,
elaboration of zonal anatomical details, and Doppler assessment of prostatic arteries’ hemodynamics. Materials and Methods: This was a
cross‑sectional study of 300 men with benign prostatic enlargement (BPE) and 300 healthy age‑matched controls. The resistive index (RI)
of the left capsular, right capsular and urethral arteries were assessed by TRUS and correlated with these parameters: maximum urine flow
rate (Qmax), total prostatic volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), presumed circle area ratio, and
the  International Prostatic Symptoms Score (IPSS). Results: The RI of capsular and urethral arteries correlated significantly with Qmax, TPV,
TZV, TZI, and  IPSS. Of the three different RIs evaluated, the RI of UA showed the strongest correlation with Qmax (r =- 0.51; P < 0.0001).
The RIs were significantly higher in obstructive BOO than the non‑obstructive group (Qmax of <15 ml/sec and ≥15 ml/sec, respectively).
The mean RI values were 0.73 ± 0.05 vs. 0.63 ± 0.04 for the RCA; 0.73 ± 0.05 vs. 0.62 ± 0.04 for the LCA; and 0.73 ± 0.06 vs. 0.62 ± 0.05
for the UA in the BPE and controls, respectively (P < 0.001). The TPV values were 52.36 ± 28.67 and 18.28 ± 4.26 in BPE and controls,
respectively (P < 0.001).Conclusion: Prostatic artery RIs are elevated in BPE. Increase in RI correlated with increase in TPV, TZV and TZI,
urinary symptoms’ severity, poor QOL, and the severity of BOO.

Keywords: Benign prostatic enlargement, bladder outlet obstruction, prostatic artery resistive index, transrectal Doppler ultrasound,
uroflowmetry

Introduction international prostatic symptoms score  (IPSS), quality of

life (QOL) score, and postvoidal residual (PVR) volume.[1]
Benign prostatic hyperplasia  (BPH) is the most common
benign pathological condition affecting elderly males, resulting Many ultrasonographic technologies such as B‑mode, Color
in benign prostatic enlargement (BPE), and can be complicated Doppler Ultrasonography  (CDUS), and power Doppler
by lower urinary tract symptoms  (LUTS) and/or bladder ultrasonography have been used in the study of BPH and its
outlet obstruction (BOO). BPH is the second most common hemodynamics through either transrectal or transabdominal
indication for surgical intervention in men above the age of route. However, transrectal ultrasonography (TRUS) is the most
60 years worldwide.[1] useful for assessing the volume of BPH,[2‑4] delineating the zonal
anatomy of the prostate,[5] and for demonstrating the TZI which is
Parameters of this disease which could be evaluated include
a good parameter for predicting acute urinary retention in patients
intraprostatic arteries (capsular and urethral arteries) resistive
index  (RI), total prostatic volume  (TPV), transitional zone
Address for correspondence: Dr. Bukunmi Michael Idowu,
volume  (TZV), transitional zone index (TZI), presumed Department of Radiology, Obafemi Awolowo University/Obafemi
circle area ratio  (PCAR), maximum urine flow rate  (Qmax), Awolowo University Teaching Hospitals Complex, P. M. B 5538, Ile‑Ife,
Osun State, Nigeria.
E‑mail: [email protected]
Received: 18-10-2018 Revised: 06-12-2018 Accepted: 17-01-2019 Available Online: 13-05-2019

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DOI: How to cite this article: Fanimi OO, Asaleye CM, Salako AA, Ayoola OO,
10.4103/JMU.JMU_102_18 Adedeji TA, Idowu BM. Transrectal Doppler sonography of benign prostatic
enlargement in Nigerian men. J Med Ultrasound 2019;27:169-76.

© 2019 Journal of Medical Ultrasound | Published by Wolters Kluwer - Medknow 169

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Fanimi, et al.: Prostatic arteries Doppler in BPE

with BPH.[4] Addition of Doppler ultrasound to TRUS makes it The IPPS was assessed based on calculated values from
useful for visualizing the prostatic vascular architecture.[6,7] the answers given by the individuals to seven questions
concerning urinary symptoms and one question concerning
Nelson and Pretorius revealed that the RI obtained by Doppler
the quality of life.[11] Each question concerning urinary
imaging correlates with vascular resistance because velocity
symptoms allows the patient to choose one out of six answers
is related to both blood flow and pressure.[8] They postulated
indicating increasing severity of the particular symptom. The
that RI might be the most relevant index for analyzing small
answers are assigned points from 0 to 5. The total score can
vessels in the prostate.[8] Other researchers have also reported
range from 0 to 35  (asymptomatic to very symptomatic).
that BPH leads to increased prostatic vascular resistance and
Symptoms are categorized as follows: mild  (symptom  ≤7),
elevated prostatic resistive index (PRI).[3,8‑10]
moderate  (symptom score of 8–19), and severe  (symptom
The purpose of this study was to describe the transrectal power score of 20–35).[11]
Doppler ultrasound findings in patients with BPE in our locality
Venepuncture of the antecubital vein of all BPE patients
and correlate the  Prostatic arteries Resistive Index (PRI) with
was done under sterile conditions without any preference
various clinicofunctional parameters of BPE.
for a specific period of time. A syringe was used to collect
5 ml of venous blood into a plain sample bottle; the samples
Materials and Methods collected were left to clot for 30 min, and the serum was
This was a prospective, cross‑sectional study carried out at separated and stored in the freezer for bulk assessment of
the radiology department of Obafemi Awolowo University PSA.
Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Uroflowmetric assessment
between February 2014 and June 2015. Three hundred patients
Uroflowmetry was done for each BPE patient by the urologist
with BPE and 300 age‑matched controls were recruited
using Albyn Medical uroflowmetry machine with an inbuilt
consecutively.
printer (Albyn Medical Ltd, Dingwall, Ross‑Shire, Scotland,
The patients were men aged 40–90  years with serum UK). When the BPE patients had a strong desire to void, they
prostatic‑specific antigen (PSA) ≤10 ng/ml, clinicoradiological were instructed to hold their urine while the uroflowmeter was
diagnosis of BPE using history and physical findings of an prepared for the voiding study for about 10–15 s. The patients
enlarged prostate gland on digital rectal examination (DRE) were then instructed to void normally into the collecting
along with findings of an enlarged prostate gland on cylinder of the uroflowmeter. Several automated parameters
transabdominal ultrasound scan (TAUS).  An equal number including the Qmax were generated as a function of time. The
of age‑matched and apparently healthy control group was also Qmax was the only parameter selected and recorded for each
recruited. The control group was made up of men in whom BPE patient with BPE.
had been excluded by the absence of LUTS, the presence of
normal prostate gland texture on DRE, and a prostatic size <25 Abdominal and transrectal ultrasonographic evaluation
cm3 on TAUS. All sonographic examinations were done by the first author,
a fourth‑year resident in radiology under the supervision of a
Individuals with clinical and sonographic features suggestive consultant radiologist. The radiologists were blinded to the status
of the following diseases were excluded from the study: of the patients so as to eliminate bias. An abdominal sonographic
BOO with severe hydronephrosis or creatinine levels of more evaluation was carried out with the patients lying supine on the
than 132.5 µmol/l, prostatitis, urinary bladder stone, urethral examining couch. This was done to rule out some of the exclusion
stricture as confirmed by retrograde urethrography, acute criteria such as severe hydronephrosis and urinary bladder stones.
urinary retention, neurogenic bladder, bladder or prostate
cancer, BPE patients on drug treatment, history of prostatic A transrectal biplanar endocavitary probe with a frequency
range of 5.0–10.0 MHz of a Mindray real‑time ultrasound
resection, previous lower urinary tract surgery, anal stenosis,
scanner model DC‑7  (Shenzhen Mindray Bio‑medical
and previous extensive rectal surgery. Approval for the study
Electronics, Nanshan, Shenzhen, China) was used for the
was granted by the hospital’s ethics and research committee,
TRUS. All the participants were scanned in left lateral
and a written informed consent was obtained from all the
decubitus position with both knees flexed toward the chest
study participants.
and participant’s head was comfortably positioned on a pillow.
Clinical and laboratory assessment Coupling gel was generously applied to the probe surface,
Clinically, all study participants were assessed by full history and a double latex sheath was used to cover the surface of the
and physical examination which included general and DREs. transrectal probe and secured to its base. The probe was then
Other routine laboratory and radiological investigations were gently inserted into the rectum by directing the tip of the probe
ordered for all the BPE patients. These included urinalysis, toward the sacrum to follow the curve of the rectum until the
urine microscopy, culture and sensitivity  (urine MCS), probe was properly positioned into the rectum. The surface
serum prostate specific antigen (PSA), and abdominopelvic of the probe was inclined anteriorly to locate the prostate
ultrasound (used to exclude other associated pathologies). The gland. The transducer output and receiver gain settings were
clinical assessment was coordinated by the referring urologist. optimized for each patient.

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Fanimi, et al.: Prostatic arteries Doppler in BPE

Multiple transverse and sagittal sections were obtained to the area of maximum horizontal section of the prostate to the
visualize the transitional zone (TZ) and the whole prostatic area of a presumed circle with a circumference equal to that of
outline. The transverse diameter  (TD) and anteroposterior the maximum horizontal section.[13,14] Prerequisite parameters
diameter (APD) of the whole prostate and the transition zone for PCAR were obtained using TRUS, and PCAR was
at the largest cross‑sectional area were measured and recorded. calculated and recorded for only the BPE patients [Figure 3].
Furthermore, the superoinferior diameters (SID) of the whole
prostate and the TZ were measured on the midline sagittal During power Doppler imaging, care was taken to minimize
images and at their largest sagittal diameter respectively and probe pressure on the rectal wall, and an empty or nearly
also recorded [Figures 1 and 2]. empty urinary bladder was ensured so that compression effect
by either the probe or full urinary bladder was minimized,
TPV and TZV were calculated using the ellipsoid formula: which would have increased the intraprostatic pressure and
Volume  =  0.52  ×  TD  × APD  ×  SID.[12] Transition Zone alter the PRI. The power Doppler gain was set to just below
Index (TZI) = TZV/TPV. The PCAR is defined as the ratio of the threshold so that blood flow was identified with minimum
background noise, and the low flow setting was used for
optimal visualization of low flow intraprostatic vessels in
the TZ and both sides of the peripheral zone (PZ). Then, the
pulsed wave spectral Doppler images were obtained from the
left capsular artery (LCA), right capsular artery (RCA), and

Figure 1: Transrectal sonogram (mid-transverse section) of benign

prostatic enlargement showing the slightly compressed peripheral
zone by an enlarged inner gland (EIG, Enlarged Inner Gland = central
zone + transitional zone). Line 1: Transverse diameter of the enlarged
transitional zone; Line 2: Transverse diameter of the whole prostate gland;
Line 3: Anteroposterior diameter of the enlarged transitional zone; Line 4:
Anteroposterior diameter of the enlarged whole prostate gland. TC: True Figure 2: Transrectal sonogram (midsagittal section) of benign
capsule prostatic enlargement showing the slightly compressed peripheral
zone by an enlarged inner gland (EIG, Enlarged Inner Gland = central
zone + transitional zone). Line 1: Superoinferior diameter of the enlarged
transitional zone; Line 2: Superoinferior diameter of the enlarged whole
prostate

Figure 3: Transrectal sonogram (midtransverse image) of benign prostatic

enlargement showing presumed circle area ratio calculation. I: The area
of maximum horizontal section of the whole enlarged prostate gland;
II: The area of a presumed circle with a circumference equal to that of Figure 4: Transrectal triplex power Doppler sonogram of the right capsular
the maximum horizontal section artery at the posterolateral aspect of an enlarged prostate gland

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Fanimi, et al.: Prostatic arteries Doppler in BPE

Figure 5: Transrectal triplex power Doppler sonogram of the left capsular Figure 6: Transrectal triplex power Doppler sonogram of the urethral artery
artery at the posterolateral aspect of an enlarged prostate gland in the periurethral area of an enlarged prostate gland

urethral artery (UA) on the transverse section of the prostate

Table 1: Demographic characteristics of study
[Figures 4‑6].[11]
participants
Data analysis was done using the Statistical Package for Characteristics BPE group (n=300) Controls (n=300)
Social Science  (SPSS) software for windows,  version 16 Age
(SPSS Inc., Chicago, IL, USA). Mean ± standard deviations Mean±SD (years)* 67.92±8.96 67.32±10.60
were generated for the TPV, TZV, TZI, PCAR, RI, and Clinical parameters
other normally distributed continuous variables while the IPSS** 18.0 (0.0‑35.0) NA
categorical variables were reported as frequencies and Qmax (ml/s) 11.86±6.89 NA
percentages. Correlation was determined using Pearson’s Symptom severity, n (%)
correlation for normally distributed data or Spearman’s Mild (IPSS 0‑7) 57 (19.0) NA
correlation for data that were not normally distributed. Moderate (IPSS 8‑19) 106 (35.3) NA
Student’s t‑test was used to determine differences in mean Severe (IPSS 20‑35) 137 (45.7) NA
of the parameters. One‑way analysis of variance (ANOVA) BOO, n (%)
was used to compare means of variables where there were Obstructed 214 (71.3) NA
three or more groups. P ≤ 0.05 was considered as statistically Nonobstructed 86 (28.7) NA
significant. *t=0.749, df=598; P=0.454, **Median (range) values. NA: Not applicable;
BOO: Bladder outlet obstruction, BPE: Benign prostate enlargement,
IPSS: International Prostatic Symptoms Score, SD: Standard deviation,
Results Qmax: Maximum urine flow rate

There were 600 participants in this study comprising 300 BPE

patients and 300 apparently healthy age‑matched controls. and those with nonobstructed BOO were statistically
There was no statistically significant difference in the mean age significant [Table 3].
of the BPE group (67.92 ± 8.96 years) and that of the control Within the BPE group, there was a negative correlation
group (67.32 ± 10.60 years); P = 0.454. between the intraprostatic arteries RI (RCA, LCA, and UA) and
The mean Qmax for the BPE group was 11.86  ±  6.89  m/s. Qmax as well as a positive correlation between the intraprostatic
The median value of the IPSS for BPE patients was 18.0 arteries RI and the following variables: TPV, TZV, TZI, and
(range = 0.0–35.0). The frequency of the symptom severity IPSS [Table 4].
based on IPSS is shown in Table  1. The severity of BOO A point‑biserial correlation analysis using the classification
in the BPE patients was further categorized into obstructed of BOO into either obstructed or nonobstructed showed
group with 214  (71.3%) patients and nonobstructed group significant correlation between the RI of intraprostatic arteries
with 86 (28.7%) patients using Qmax <15 ml/s as obstructed and grade of BOO. There was a positive correlation between
and Qmax ≥15 m/s as nonobstructed. the RI of RCA, LCA, and UA with the grade of BOO with r
values 0.34, 0.23, and 0.40, respectively (P < 0.001).
There were significant differences in the mean RI of the
LCA, RCA, and UA between the BPE patients and the The receiver operating characteristic  (ROC) coordinates at
controls [Table 2]. The mean values of the TPV, TZV, TZI, cutoff RI values of  ≥0.70 for the RCA, LCA, and UA are
and PCAR for the BPE patients and the controls are also shown in Table 5. One‑way ANOVA for differences in mean
shown in Table 2. The differences between the intraprostatic Doppler parameters by symptom severity (based on IPSS) is
arteries mean RI of BPE patients with obstructed BOO shown in Table 6.

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Fanimi, et al.: Prostatic arteries Doppler in BPE

Table 2: Transrectal ultrasound parameters among benign prostate enlargement and controls (n=600)
Characteristics BPE patients (n=300) Controls (n=300) t df P
PRI
RI (RCA) 0.73±0.05 0.63±0.04 31.192 598 <0.0001
RI (LCA) 0.73±0.05 0.62±0.04 31.226 598 <0.0001
RI (UA) 0.73±0.06 0.62±0.05 27.463 598 <0.0001
Prostatic volume
TPV (ml) 52.36±28.67 18.28±4.26 20.360 598 <0.0001
TZV (ml) 26.63±21.33 NA
TZI 0.47±0.14 NA
PCAR 0.76±0.07 NA
RCA: Right capsular artery, LCA: Left capsular artery, UA: Urethral artery, TPV: Total prostatic volume, TZV: Transition zone volume, TZI: Transition
zone index, PCAR: Presumed circle area ratio, RI: Resistive index, PRI: Prostatic resistive index, NA: Not applicable, TRUS: Transrectal ultrasound,
BPE: Benign prostate enlargement

Table 3: Variable differences between benign prostate enlargement patients with obstructed and nonobstructed benign
prostate enlargement
Variables Obstructed (n=214) Nonobstructed (n=86) t df P
RI (RCA) 0.74±0.04 0.71±0.04 6.191 298 <0.0001
RI (LCA) 0.74±0.05 0.72±0.04 4.096 298 <0.0001
RI (UA) 0.75±0.05 0.70±0.05 7.629 298 <0.0001
TPV (ml) 58.93±30.99 36.16±10.71 6.667 298 <0.0001
TZV (ml) 32.03±22.73 13.31±7.40 7.49 298 <0.0001
TZI 0.51±0.13 0.36±0.10 9.564 298 <0.0001
PCAR 0.77±0.08 0.74±0.05 2.513 298 0.012
IPSS* 20.27±8.77 10.89±5.64 9.202 298 <0.0001
*Mann‑Whitney U‑test applied. RCA: Right capsular artery, LCA: Left capsular artery, UA: Urethral artery, TPV: Total prostatic volume, TZV: Transition
zone volume, TZI: Transition zone index, PCAR: Presumed circle area ratio, IPSS: International prostate symptom score, RI: Resistive index

Discussion to the fact that BPE usually starts from the TZ which is supplied
by the UA. Glandular enlargement leads to an increase in
The term “BPE” rather than “benign prostatic hypertrophy
vascular resistance thereby resulting in increased RI secondary to
(BPH)” is preferable in the absence of histological
elevated intraprostatic pressure. Therefore, as the TZ significantly
confirmation.[15] BPE is common in our population with a
enlarges, it compresses the PZ and its blood supply (left and right
community prevalence of about 24%[16] and also accounts for
capsular arteries) against the true capsule of the prostate gland.
up to 27% of obstructive uropathy cases.[17] Although pressure
flow studies (PFS) are considered the most reliable method This implies that among the intraprostatic arteries, the UA is the
for evaluating BOO, they are invasive and complicated.[18] first and the worst affected over time in the hemodynamics of
TRUS is a promising alternative to PFS because of its minimal BPE. The opinion that RI is sensitive to intraprostatic pressure in
invasiveness.[19,20] patients with BPE, whereby the enlarged inner gland compresses
on the capsule of the prostate, is corroborated by Shinbo et al.[18]
The mean TPV in this study (52.36 ± 28.67 ml) is lower than that However, Berger et al.[27] reported that vascular damage within
reported by Abdelwahab et al.[21] (75.1 ± 44.7 ml in 82 men with the prostate gland induces prostatic enlargement.
BPE) but higher than that of Chung et al.[22] (41.7 ± 8.99 ml in
110 men with BPE). These disparities may be due to differences A point‑biserial correlational analysis in the BPE patients
in sample size and differences in disease severity.[23,24] On the showed a significant correlation between the intraprostatic
other hand, the mean TPV values obtained in this study for arteries RI and BOO. The UA RI showed the strongest
both BPE patients and controls fall within the range reported by correlation with BOO while the LCA RI showed the weakest
some previous studies.[12,21,25] The mean TZV (26.63 ± 21.33 ml) correlation with BOO. These findings are similar to those
of our BPE patients is similar to that reported by Greene reported by Ozdemir et al.[9] while Tsuru et al.[28] documented
et al. (24.81 ± 14.4 ml)[26] while our mean TZI (0.47 ± 0.14) is a significant correlation between RI of the two capsular arteries
lower than that reported by Tsuru et al. (0.51 ± 0.19).[10] and BOO but no correlation between RI of the UA and BOO.
The reason for this discrepancy could not be fully explained.
In the BPE patients, there were significant negative correlations
between the RI of the three intraprostatic arteries and BOO (as Furthermore, statistically significant differences were noted
measured by uroflowmetry), with UA RI showing the strongest in the relationship between the degree of severity of BOO
correlation with Qmax among the three arteries. This may be due (i.e., obstructed BOO vs. nonobstructed BOO) and the three

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Fanimi, et al.: Prostatic arteries Doppler in BPE

intraprostatic arteries. As the severity of BOO increases, the We correlated the resistive indices of the prostatic arteries
PRIs increase which is the same pattern reported by earlier with each of the prostatic parameters such as TPV, TZV, TZI,
researchers.[3,9,10,18,21] Increasing severity of BOO (as assessed PCAR, and IPSS. There were statistically significant positive
by uroflowmetry) is associated with progressive reduction in correlations among RI of RCA, LCA, and UA with TPV, TZV,
peak urine flow rate. Therefore, as severity of BOO worsens, TZI, and IPSS, respectively. These findings are corroborated
Qmax decreases and PRIs increase. by previous studies.[9,21,22,28]
There was no correlation between RI of RCA and LCA with
Table 4: Correlation between prostatic resistive index PCAR, but a very weak correlation was observed between
and other Doppler parameters among benign prostate UA, RI, and PCAR. These imply that as PCAR increases, no
enlargement patients (n=300) increase is seen in RI RCA and RI LCA, respectively. This is
in contrast to the report of Tsuru et al.[28] who obtained an r
Variables r P
value of 0.334 (P < 0.001) with the capsular arteries, and a
RI (RCA) versus
value of 0.018 (P > 0.05) for the UA.
Qmax −0.415 <0.0001
TPV (ml) 0.447 <0.0001 The prostatic neurovascular bundles run craniocaudally
TZV (ml) 0.450 <0.0001 along the posterolateral aspects of the gland.[29] Furthermore,
TZI 0.430 <0.0001 a rich plexus of veins (periprostatic venous plexus)
PCAR 0.108 0.061 encompasses the prostate gland between the true fibrous
IPSS* 0.437 <0.0001 capsule of the gland and the lateral prostatic fascia; these are
RI (LCA) versus visible landmarks on sonograms.[29] They are seen outside
Qmax −0.352 <0.0001 the prostate gland as a number of tortuous echo‑void tubular
TPV (ml) 0.403 <0.0001
structures disposed along the lateral borders of the gland on
TZV (ml) 0.437 <0.0001
B‑mode imaging.[6] The prostate gland is supplied by the
TZI 0.446 <0.0001
prostatic artery, which is usually one of the two terminal
PCAR 0.129 0.025
IPSS* 0.410 <0.0001
branches of prostaticovesical artery  (a branch of internal
RI (UA) versus
iliac artery).[6] The anechoic tubular prostatic artery has a
Qmax −0.511 <0.0001 curvilinear course which may be impossible to demonstrate
TPV (ml) 0.508 <0.0001 with longitudinal scan.[6] The prostatic artery divides into two
TZV (ml) 0.539 <0.0001 groups of intraprostatic arteries which are the UA (supplies
TZI 0.482 <0.0001 the periurethral region) and capsular arteries  (supply the
PCAR 0.229 <0.0001 peripheral zone on both sides).[6,29] The capsular and urethral
IPSS* 0.493 <0.0001 arteries supply two‑third and one‑third of the glandular
*Spearman’s correlation applied. Qmax: Maximum (peak) urine flow rate, prostate volume, respectively. [6] The prostatic and both
RCA: Right capsular artery, LCA: Left capsular artery, UA: Urethral artery,
capsular arteries mainly course along the posterolateral
TPV: Total prostatic volume, TZV: Transition zone volume, TZI: Transition
zone index, PCAR: Presumed circle area ratio, IPSS: International prostate border of the prostate sending branches that perforate the
symptom score, RI: Resistive index capsule of the prostate gland and enter the peripheral zone.

Table 5: Receiver operating characteristic coordinates for resistive index in the right capsular artery, left capsular artery,
and urethral artery
RI Area under P
the curve
0.70 0.71 0.72 0.73 0.74 0.75
RCA
Sensitivity (%) 87.0 81.5 76.0 67.1 58.2 45.2 0.705 <0.0001
Specificity (%) 39.0 44.1 54.2 62.7 71.2 79.7
Overall predictability (%) 73.2 70.8 69.8 65.8 61.9 55.1
LCA
Sensitivity (%) 86.3 79.5 74.0 63.7 54.8 47.3 0.651 0.001
Specificity. (%) 30.5 40.7 50.8 59.3 66.1 69.5
Overall predictability (%) 70.3 68.4 67.3 62.4 58.0 53.7
UA
Sensitivity (%) 82.2 78.1 73.3 65.1 58.9 51.4 0.760 <0.0001
Specificity (%) 50.8 55.9 61.0 72.9 76.3 84.7
Overall predictability (%) 73.2 71.7 69.8 67.3 63.9 60.9
RCA: Right capsular artery, LCA: Left capsular artery, UA: Urethral artery, RI: Resistive index, BPE: Benign prostate enlargement, ROC: Receiver
operator characteristic curve

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Fanimi, et al.: Prostatic arteries Doppler in BPE

Table 6: One‑way analysis of variance for differences in mean Doppler parameters by symptom severity
Variables Symptom severity (IPSS) F df P
Mild (n=57) Moderate (n=106) Severe (n=137)
RI (RCA) 0.70±0.04 0.73±0.05 0.75±0.04 25.077 2, 296 <0.0001
RI (LCA) 0.70±0.04 0.73±0.05 0.75±0.05 24.630 2, 296 <0.0001
RI (UA) 0.70±0.04 0.72±0.05 0.76±0.05 32.009 2, 296 <0.0001
TPV (cm3) 37.16±11.49 45.78±19.37 63.76±34.64 25.071 2, 296 <0.0001
TZV (cm3) 15.04±8.83 21.34±14.48 35.53±25.45 27.776 2, 296 <0.0001
TZI 0.39±0.12 0.44±0.14 0.52±0.14 22.815 2, 296 <0.0001
PCAR 0.75±0.05 0.75±0.05 0.77±0.09 1.768 2, 296 0.172
BWT (cm) 0.34±0.06 0.42±0.10 0.48±0.13 36.144 2, 296 <0.0001
Scheffe post hoc analysis for intergroup differences
Mild versus moderate (P) Mild versus severe (P) Moderate versus severe (P)
RI (RCA) 0.002 <0.0001 0.001
RI (LCA) <0.0001 <0.0001 0.005
RI (UA) 0.014 <0.0001 <0.0001
TPV (cm3) 0.146 <0.0001 <0.0001
TZV (cm3) 0.152 <0.0001 <0.0001
TZI 0.109 <0.0001 <0.0001
BWT (cm) <0.0001 <0.0001 <0.0001
BWT: Bladder wall thickness; ANOVA: Analysis of variance, RCA: Right capsular artery, LCA: Left capsular artery, UA: Urethral artery, TPV: Total
prostatic volume, TZV: Transition zone volume, TZI: Transition zone index, PCAR: Presumed circle area ratio, IPSS: International prostate symptom
score, RI: Resistive index

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