Relationship between Prostate Volume and International Prostate Symptom Score (IPSS) Degree of Tamed Prostate Enlargement on Transabdominal Ultrasonography (TAUS) and Transrectal Ultrasonography (TRUS) Examination

Introduction: IPSS is the gold standard in measuring clinical symptoms of BPH.1 Prostate volume has been said to have a close relationship with the development of BPH.9 The aim of this study was to determine the relationship between prostate volume as measured by transabdominal ultrasonography (TAUS) and transrectal (TRUS) to the degree of IPSS. Methods: An analytic observational study with a cross sectional design was carried out on 303 BPH patients at the General Hospital of Kariadi Hospital, Semarang. The data obtained from the TAUS, TRUS and IPSS prostate volume were obtained from medical records for the period 2015 2020. The data were then analyzed by using the chi square test. Results: Patients with BPH have a TAUS prostate volume in classification I of 0 people 0%, classification II of 16 people (5.3%), classification III of 96 people (31.7%), classification IV of 102 people (33.7%) and classification V of 89 people (29.4%). While TRUS in classification I was 0% (0 people), classification II was 11 people (3.6%), classification III was 92 people (30.4%), classification IV was 110 people (36.3%) and classification V of 90 people (29.7%). IPSS obtained severe IPSS degrees, namely 192 people (63.4%), moderate degrees of 111 people (36.6%), and mild degrees 0% (0 people). The results of the Chi Square test obtained a p-value of 0.000 (p <0.05), indicating that there was a significant relationship between prostate volume, whether examined by transabdominal or transrectal ultrasound, and the degree of IPSS. The correlation coefficient r = 0.925 indicates a very strong relationship between prostate volume as measured by both transabdominal and transrectal ultrasound with the degree of IPSS, a positive result shows that the increase in prostate volume, the degree of IPSS will also increase. Conclusion: There is a significant relationship between prostate volume as measured by both TAUS and TRUS and the degree of IPSS.


Introduction
The International Prostate Symptom Score (IPSS) is an IPSS questionnaire containing 8 questions

Study design
This study was an observational analytic study with a cross sectional approach, which was conducted at Dr.
Kariadi, Semarang. The data taken in this study are secondary data from patient medical records. The data recorded were the subject's age, prostate volume based on TAUS and TRUS examinations, and the IPSS value.

Population
Subjects involved in this study were all BPH patients who recorded transabdominal and transrectal ultrasound examination results in medical records at the Kariadi General Hospital Semarang between 2015 and 2020. Subjects will be excluded from the study if there is one of the following criteria, namely only undergoing Either TAUS or TRUS, did not undergo IPSS value measurements, was diagnosed with urinary tract stones, and / or diagnosed with malignancy.

Variables
The prostate volume obtained from TAUS and TRUS

Data analysis
Data obtained from the subject's medical records will be analyzed descriptively and correlatively. Subject baseline data, prostate volume, and IPSS scores were reported descriptively. The relationship of prostate volume obtained from TAUS and TRUS examinations with the degree of IPSS was analyzed using the chisquare test.

Results
This study involved a total of 303 subjects, with the largest age range being 60-69%. The age distribution of the subjects can be seen in Table 1. In this study, it was found that the age of most of the research subjects was 60-69 years, while at a more advanced age (70-79 years) it was found that the number of subjects was the least. This is in accordance with other studies which state that the occurrence of prostate atrophy at a later age will reduce the prevalence of BPH in this population. [14][15][16] The results of this study are in accordance with the theory which states that as you age, the incidence of benign prostatic enlargement also increases. BPE or Benign Prostatic Enlargement occurs in approximately 70% of men over the age of 60 years. 11 The causes of BPE are related to the aging process which results in decreased levels of male hormones, especially testosterone. The testosterone hormone in the prostate gland is converted into dihydrotestosterone. 12 Based on the TAUS and TRUS examinations, the prostate volume of the most study subjects was in the IV classification category and none of the study subjects was categorized as classification I. The distribution of the prostate volume of the study subjects can be seen in Table 2 21 An increased risk for men over 50 years of age is associated with general weakness including weakness in the bladder (detrusor muscle) and loss of function. changes due to the influence of old age reduce the ability of the bladder to maintain urine flow in the adaptation process by obstruction due to prostate enlargement, causing symptoms of urinary disorders or LUTS.22 Based on the chi-square correlation test, there was a significant relationship between prostate volume based on TAUS and TRUS and the degree of IPSS (p = 0.000). The correlation coefficient value is 0.925, which means that prostate volume based on TAUS and TRUS has a very strong positive correlation with the degree of IPSS. As prostate volume increases, the degree of IPSS will also increase ( Table 4 and Table 5).

Discussion
Based on theory, patients with BPH will complain of both obstructive and irritating symptoms. Obstructive symptoms include poor streams, having to wait a long time at the onset of micturition (hesitancy), intermittency, straining, dripping at the end of the micturition (terminal dribbling), and feeling uneasy. satisfied after the proxy (incomplete emptying).

Irritating symptoms include frequent micturition
(frequency), difficult to hold back (urgency), urinating more than once at night (nocturia), and pain during urination (dysuria). 17 This collection of obstructive and irritative symptoms is what became known as LUTS. 18 These symptoms can be measured using the IPSS score. 19 This theory supports the findings of this study, namely that, there was a significant relationship between prostate volume as measured by TAUS and

Conclusion
There was a significant relationship (p = 0.000) between prostate volume examined by both transabdominal and transrectal ultrasonography and the degree of IPSS. The canadian journal of urology.