Intravesical prostatic protrusion shows 2.67 odds of bladder outlet obstruction with higher measurement valuesNew data shows how prostate protrusion helps identify bladder issues

PURPOSE: To evaluate the diagnostic accuracy of intravesical prostatic protrusion (IPP) for detecting bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH), using urodynamic studies as the reference standard. MATERIALS AND METHODS: A systematic review and meta-analysis was performed in accordance with PRISMA-DTA guidance. Studies were included if they evaluated IPP in adult men with LUTS attributed to BPH and defined BOO using urodynamic criteria, specifically BOO index > 40. Data were extracted to construct 2 × 2 diagnostic tables. Pooled sensitivity and specificity were estimated using a bivariate random-effects model, and overall diagnostic performance was assessed using a summary receiver operating characteristic curve. A random-effects model was also used to estimate the association between IPP > 10 mm and BOO. RESULTS: Ten studies including 1253 men met inclusion criteria. Greater IPP was associated with increased odds of urodynamically confirmed BOO, with a pooled odds ratio of 2.67 (95% CI, 1.48-4.79; I² = 94.6%). The 95% prediction interval ranged from 0.32 to 22.49, indicating substantial between-study variability and uncertainty regarding the association in future populations. Diagnostic meta-analysis across study-defined IPP thresholds of approximately 10-12 mm demonstrated a pooled sensitivity of 71.0% and specificity of 75.5% for detecting BOO. The area under the summary receiver operating characteristic curve was 0.795, consistent with moderate overall diagnostic accuracy. CONCLUSIONS: Available evidence suggests that IPP is associated with urodynamically confirmed BOO and that a threshold of approximately 10 mm may provide moderate diagnostic accuracy. However, the certainty of these findings is limited by the observational design, relatively small sample sizes, methodological heterogeneity, and unclear risk of bias in several included studies. IPP may therefore be useful as an adjunct to other clinical findings but should not replace urodynamic evaluation when diagnostic certainty is required.