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1. Prostate volume Dr Nuru

2. Why volume Dx and Rx of both benign & malignant prostate diseases. Predicting response to medical therapy Selection of surgical treatment modality PSA density Number of core biopsies Radiotherapy dose

3. Methods of measurement TAUS TRUS 3 D U S CT D R E C y s toscopy

4. T R U S , T A U S , C T v s A c t u a l W t

5. 163 pts 2 5 - 2 9 Radical prostatectomy TAUS, TRUS, CT with actual weight Ellipsoid formula E x c l usion c r i t e r i a T U R P A D T R a d i o t h e r a py

6. Factors affecting accuracy Experience ?? Bladder volume ? Seminal Vesicles and vasal ends Blood loss during RP Size of prostate

7. C o n c l u sion

8. DRE vs TRUS

9. 150 pts 4 grades used Prospective study 2012 - 2014 Exclusion criteria: < 45 years, known or suspected prostate carcinoma bony abnormality bedridden/severe co-morbid patients obese patients (BMI >30 kg/m2), patients with anal fissures, Grade III intravesical prostatic protrusion (IPP >10 mm).

10. Position DRE M odified lithotomy position TRUS left lateral decubitus position with knees and hips flexed 90°

11. DRE grading system Modified Romero DRE grading system ( L o d h ) Four grades Other grading systems Romero e t a l Barnes et al Tsui et al Reis et al T R U S (Aguirre et al ) classification of BPH Grade I -- <30 g, Grade II -- 30-50 g, Grade III -- 50-85 g and Grade IV -- >85 g

12. Lodh et al -- DRE BPH grading

13. Results

14. TRUS , DRE and Cystoscopy

15. Prospective study on 101 pts 2 1 7 - 2 1 8 DRE grading - Lodh et al Cystoscopy grading - Barnes et al Exclusion criteria: patients with suspicion of carcinoma of the prostate, anal fissures, urethral strictures, bony abnormality

16. Results

17. Conclusion Despite their inaccuracies, the DRE grading and endoscopic grading continue to be widely used in clinical practice. As prostate volume estimation is an important aspect of preoperative workup and the a vailability of TRUS is of the question at peripheral centers, these gradings can be useful alternatives for urologists in the management of prostatomegaly.

18. T h a n k y o u