Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size



To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery.


The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3 months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression.


Among patients with prostate volume < 50 mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3 months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50 mL.


Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.

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This research was supported by Hanmi Healthcare Inc. (H20180764).

Author information




MS: project development, data collection, manuscript writing. WJB: data collection. CYO: project development, manuscript writing. YSL: data collection. JSC: data collection.

Corresponding author

Correspondence to Cheol Young Oh.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The Institutional Review Board of Hallym University Sacred Heart Hospital, Republic of Korea, approved this study (No. 2018-07-023).

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A waiver of informed consent was granted due to the retrospective nature of this study.

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Shim, M., Bang, W.J., Oh, C.Y. et al. Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size. World J Urol 38, 1997–2003 (2020).

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  • Benign prostatic hyperplasia
  • Lower urinary tract symptom
  • Prostate
  • Urethra