UROLOGY - ORIGINAL PAPER TRUS versus transabdominal ultrasound as a predictor of enucleated adenoma weight in patients with BPH A tool for standard preoperative work-up? Konstantinos G. Stravodimos Æ Andreas Petrolekas Æ Theodoros Kapetanakis Æ Stavros Vourekas Æ Georgios Koritsiadis Æ Ioannis Adamakis Æ Dionysios Mitropoulos Æ Constantinos Constantinides Received: 24 January 2009 / Accepted: 27 February 2009 / Published online: 7 April 2009 Ó Springer Science+Business Media, B.V. 2009 Abstract Background Despite being formally included in the assessment of patients presenting with lower urinary tract symptoms (LUTS), transrectal ultrasonography (TRUS) is not routinely offered to these patients. This tactic however might not be optimum since data exist on the superiority of TRUS over transabdominal ultrasound in accurately predicting prostate volumes. We aimed to evaluate TRUS as a standard tool in the evaluation of patients with benign prostate hyperpla- sia (BPH) with a special focus on the potential impact it might have on the decision of open versus transurethral surgery. Patients and methods Seventy-one patients present- ing with LUTS due to BPH and eventually managed with open surgery based on their preference and prostate volume were included in the protocol. TRUS was performed in all patients preoperatively and calculations of the transition zone were made. These were compared with respective transabdominal cal- culations of the prostate volume as well as the enucleated specimen weight (W). Results TRUS slightly underestimated W by 4.4% (95% CI 10.5, 1.7) while transabdominal ultrasound overestimated it by 55.7% (95% CI 31.8, 79.6). Regression analysis indicated TRUS as a better predictor of W (R 2 = 0.817, P \ 0.0005) followed by transabdominal ultrasound (R 2 = 0.669, P \ 0.0005). Strictly based on European Association of Urology (EAU) criteria, transabdominal measure- ments miscategorized 25 cases by falsely assigning them to the open surgery ( [ 80 cc) group while TRUS did so for four cases. Conclusion TRUS is more accurate than transab- dominal ultrasound in predicting adenoma volume in patients with BPH and its standard use might lead to fewer open approaches, with consequent less mor- bidity and hospitalization. Keywords Transition zone Á Prostate Á Transrectal ultrasonography Introduction Transrectal ultrasonography (TRUS) constitutes a helpful tool in preoperative assessment of patients with benign prostatic hyperplasia (BPH). It is a K. G. Stravodimos Á A. Petrolekas Á T. Kapetanakis Á S. Vourekas Á G. Koritsiadis Á I. Adamakis Á D. Mitropoulos Á C. Constantinides First Urology Department, University of Athens Medical School, ‘Laiko’ General Hospital, 17 Ag Thoma St., 11527 Athens, Greece T. Kapetanakis (&) Resident in Urology, 49 Thisseos St., P. Faliro, 17562 Athens, Greece e-mail: kapetanak@med.uoa.gr; thodoriskap@yahoo.com 123 Int Urol Nephrol (2009) 41:767–771 DOI 10.1007/s11255-009-9554-9