Presentation
Patient on treatment for bladder outlet obstruction (BOO). Previously, magnetic resonance imaging (MRI) showed PIRAD2. For ultrasound follow-up.
Patient Data
The prostate gland trans-abdominally measures 133.2 grams with diffusely enlarged and herniating prostatic median lobe intravesically (median lobe measures 4.3 x 4.4 cm in size) with an approximate intravesical prostatic protrusion measurement (IPPM) of 4 cm. The prostatic capsular outline, peri-prostatic tissues, and seminal vesicles grossly look normal. No pelvic adenopathy.
The urinary bladder is optimally distended with a pre-micturition capacity of 273.4 cc and an immediate post-void volume of 150.74 cc. No bladder diverticulum or gross wall thickening nor gross trabeculae.
An incidental, small sized simple anechoic, thin-walled, and posteriorly acoustically enhancing cystic lesion measuring 1.62 x 1.40 cm in size is noted at the superomedial right renal cortex. No hydroureteronephrosis bilaterally.
Case Discussion
Diffuse prostatomegaly with diffusely enlarged and herniating prostatic median lobe intravesically with resultant partial bladder neck compression resulting into significant post-voiding bladder residue (150.74 cc) suggesting partial bladder outlet obstruction (BOO). Hypertrophic prostatic median lobe predominance may indicate the benignity of the prostatic enlargement, even if not in all the cases2.