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The author describes one case of phyllodes type of atypical prostatic hyperplasia. This is a benign prostatic lesion characterised by atypical epithelial hyperplasia and pleomorphism of the stromal elements. There is a resemblance with cystosarcoma phyllodes of the female breast. There have been described only a few cases of such atypical hyperplasia.
Transurethral microwave thermotherapy (Prostalund unit made by Lund Instruments) was given to 49 patients with benign prostatic hyperplasia. The prostate was heated transurethrally for 60 min. Only one procedure was performed. Temperature regimens were different: prostatic tissue was heated to 50 degrees C, 55 degrees C and 60 degrees C (14, 17 and 18 patients, respectively). The response assessed 6 months after the treatment was the best in the group on the highest temperature regimen.
The therapeutic goal of treating benign prostatic hyperplasia (BPH) through early detection and effective therapy is to relieve the symptoms, improve patients' quality of life, decrease postvoid residual urine volume, and prevent the associated morbidity when the condition remains untreated. Alpha1-adrenoreceptor antagonists, e.g. doxazosin, terazosin, tamsulosin and alfuzosin, relax the bladder outlet to improve urinary flow, by reducing prostatic smooth muscle tone through the blockade of sympathetic adrenergic receptors. Doxazosin gastrointestinal therapeutic system (GITS) is a controlled-release formulation developed to enhance the pharmacokinetic profile of the drug while simultaneously minimizing possible adverse effects and reducing the need for dose titration. While both doxazosin standard and GITS are indicated for hypertension, they are also useful in the pharmacologically or naturally normotensive patient with BPH. In a cross-over trial comparing doxazosin GITS and tamsulosin, doxazosin gave a significantly greater improvement from baseline in symptoms. Results from recent trials (e.g. Medical Therapy of Prostatic Symptoms, MTOPS) showed that doxazosin was significantly more effective than the 5alpha-reductase inhibitor finasteride in relieving lower urinary tract symptoms, irrespective of prostate volume. The MTOPS trial showed clearly that over the long term, the combination of doxazosin and finasteride was more effective than either agent alone in significantly improving symptoms and reducing the clinical progression of BPH. Both doxazosin standard and GITS are well-tolerated, long-term therapies that are equally effective in younger and older men, and not associated with causing sexual dysfunction.
Terazosin selectively antagonises alpha 1-adrenoceptor-mediated contraction of the prostate, prostatic capsule, proximal urethra and bladder base, and consequently reduces urethral pressure, bladder outlet resistance and urinary symptoms associated with symptomatic benign prostatic hyperplasia. The efficacy of terazosin is reflected in increases in peak urinary flow rate, and reductions in obstructive and irritative symptom scores compared with placebo, and reductions in residual urinary volume from baseline. Clinical improvements begin to occur within 2 weeks and have been sustained for up to 2 years. The most marked treatment effects tend to occur in patients with more severe pretreatment urinary flow abnormalities. The relatively long duration of action of terazosin, allowing once-daily administration, offers a potential clinical advantage over other alpha 1-adrenoceptor antagonists although formal compliance studies have not been reported. Terazosin is generally well tolerated, but caution is recommended at treatment initiation and when dosage adjustments are made due to an increased risk of postural hypotension and related adverse effects at these times; such a risk has also been observed with several other alpha 1-adrenoceptor antagonists. Although publication of clinical trial results with terazosin is still evolving, this drug shows promise in the treatment of patients with mild to moderate symptomatic benign prostatic hyperplasia for whom surgery is not absolutely indicated. Terazosin also shows promise as a nonsurgical treatment alternative in patients with severe symptoms who are unfit for surgery and also in those who are on long waiting lists for surgery.
Benign prostatic hyperplasia (BPH) has a variable appearance on magnetic resonance imaging (MRI). This study reviews and categorizes the MRI findings of this entity in a sample of 26 men. Cases where atypical or suspicious changes are incidental findings should be reported to the urologist for further investigation. In addition, familiarity with both the appearance of the normal prostate and the changes caused by BPH is necessary when staging patients with known prostate cancer.
BACKGROUND: Standard severity criteria for benign prostatic hyperplasia (BPH) are needed to facilitate clinical and epidemiologic investigations in the common terminology. PATIENTS AND METHODS: A total of 692 BPH patients from 8 institutions were judged by specialized physicians for their overall disease severity and severity in 4 domains: symptom, function, anatomy, and quality of life (QOL). The items measuring severity in these 4 domains were the International Prostate Symptom Score (I-PSS) questionnaire, uroflowmetry, transrectal ultrasonography (TRUS), and questionnaires on bother and I-PSS QOL index, respectively. By Spearman's rank correlation and multiple regression analysis using physicians' judgement as the criterion variable (gold standard) the items and their cut-off levels were selected so that high predictivity, practicality and clinical significance were maintained, while the number of items in use was minimized. RESULTS: The item(s) and their ranges of values for each severity grade were summarized as follows; the evaluation domain (the selected item(s): range of mild, moderate, severe): symptom (I-PSS: 0-7, 8-19, 20-35), function (maximum flow rate and residual urine volume: > or = 15 mL/s and < 50 mL, > or = 5 mL/s and < 100 mL, < 5 mL/s or > or = 100 mL), anatomy (prostate volume on TRUS: < 20 mL, < 50 mL, > or = 50 mL), QOL (QOL index: 0 and 1, 2 to 4, 5 and 6). The overall severity was efficiently predicted when defined according to the combinations of severity grades of the 4 domains. These criteria predicted physicians' judgement with accuracy of about 80% for overall severity and severity of individual domains. CONCLUSION: The proposed criteria are valid, practical, and would be useful for the common scale of the BPH severity in clinical and epidemiologic studies.
The objective of this study was to critically review the published literature on the role of phytotherapeutic agents and phytosterols (also referred to as plant extracts) in the medical management of benign prostatic hyerplasia. Data sources included a bibliographic database that was searched to retrieve articles on benign prostatic hyperplasia with a time constraint of 1985-1993. Indexing terms used included plant extracts, phytosterols, cernilton, paraprost and medical management. Studies selected were randomized trials incorporating plant extracts. English abstracts were reviewed for articles published in other languages and these reviews are noted. English articles were critically reviewed based on study design, patient selection, length of follow up, postulated mechanisms of action and benign prostatic hyperplasia subjective and objective outcome measures. A number of plant extracts are being used in the management of benign prostatic hyperplasia, predominantly in Europe. These plant extracts, which are biochemically heterogenous, have been found to act through a variety of mechanisms: an anti-inflammatory effect, a decrease in globulin, a direct cytotoxic effect, anti-prolactin activity and bladder compliance modification. More importantly, these plant extracts have not been associated with the side effects of chemical castration. Their alleged efficacy may be based upon a mechanism which is currently not understood and a combination of these extracts with accepted medications may have the potential of improving the overall efficacy of medical therapy in the treatment of benign prostatic hyperplasia. Despite the shortcomings of the published trials, there is enough evidence to warrant additional study in the form of randomized control trials using scientific validated outcome measures. Using validated scores with patients of mild to moderate symptomatology would help to further elucidate the relative efficacy of cernilton, curbicin and permixon.
The efficacy of treatment for benign prostatic hyperplasia (BPH) is presently under critical consideration. In addition, various new therapeutic modalities are currently being evaluated. When medicamentous treatment is planned, in particular, the natural history of the disease must be carefully considered. Summarized data from several studies indicate that spontaneous improvement of symptoms may occur within 3-6 months, while in most cases deterioration takes a longer period of time. As intraprostatic urethral pressure depends on prostatic volume as well as on tone of the prostate smooth muscle, different medical treatment modalities seem reasonable. The dynamic component of the smooth muscle cells may be influenced by alpha-blockers. Administration of selective alpha 1-blockers will be advantageous as these have fewer side effects. Prostate volume represents the static component, which can be influenced by hormone treatment. Androgen deprivation via surgical castration must now be regarded as of historical interest only. Antiandrogens or LH-RH analogues have undesirable side effects and are expensive, making such treatment unacceptable for routine use. 5 alpha-Reductase inhibitors may emerge as a new treatment form allowing androgen suppression with a low rate of side effects. As it has been proposed that estrogens play an important role in the regulation of prostatic growth, aromatase inhibitors, which inhibit metabolization from androgens to estrogens, may receive special attention in the near future. Based on the theory that androgens may be of special importance for the epithelium, while estrogen action may be concentrated on the stroma, a combined treatment with inhibitors of 5 alpha-reductase plus aromatase may be even more effective.(ABSTRACT TRUNCATED AT 250 WORDS)
Transurethral radiofrequency thermotherapy for symptomatic benign prostatic hyperplasia was performed in 50 selected patients, using the THERMEX II device. High surgical risk patients were included, among them 13 previously catheterized ones, because of unresolved retention for more than 6 months. The treatment consisted of a three-hour single session at 47 degrees C. Follow-up studies were carried out at 1, 3, 6 and 12 months using Madsen score, maximum flow rate, residual urine volume determinations and prostate bulk measurement by transrectal ultrasound. Subjective and objective improvement (of more than two parameters) was noticed in 62% of the patients. Prostatic volume did not change. In the retention group 54% of the patients remained free of catheter. Postoperative histology in 8 cases that failed to respond, revealed focal haemorrhagic and necrotic changes in periurethral glandular tissue. This is a promising method for selected high risk patients that achieves reasonable but not comparable results to TURP and requires further investigation in larger patient groups with BPH.
PURPOSE OF REVIEW: Prevalence of benign prostatic hyperplasia (BPH) is increasing with the aging population worldwide. Knowledge of the natural history of BPH is crucial for primary, secondary and tertiary prevention of its progression. This review examines the evidence of the natural history of BPH, highlighting the group of patients with mild symptoms and the risk factors for progression. RECENT FINDINGS: Several community and clinical studies have demonstrated the progressive nature of BPH. Different surrogate endpoints, which include symptom score, peak urinary flow rate, prostate volume, and the occurrence of acute urinary retention and need for surgery, have been described. Prostatic specific antigen and prostate volume are the two most common predictors of clinical progression and are helpful to the clinician for identifying high-risk patients. SUMMARY: With further understanding of the natural history and the predictors of progression of BPH, management can be better tailored according to risk stratification and the results of clinical trials of effectiveness can be better interpreted.
A histologic change in the prostate, benign prostatic hyperplasia (BPH), is a normal part of aging. However, BPH disease, defined here as a life-altering urinary condition caused by BPH requiring prompt medical intervention, is a serious medical disorder associated with major complications, surgical intervention, and severe lifestyle interference. BPH disease is preventable. The rationale for BPH disease prevention rests on four pillars of evidence: (1) BPH disease generally is a progressive disorder; (2) complications and severe lifestyle interference from BPH disease are common and serious; (3) men at greatest risk of BPH disease can be identified using prostate-specific antigen (PSA) level higher than 1.5 ng/mL as a surrogate marker for an enlarged prostate; and (4) 5alpha-reductase inhibitors (5ARIs) reduce the primary androgen responsible for prostate growth (dihydrotestosterone), shrink the prostate, and arrest the disease process regardless of symptom status. Thus, we now can identify men with an enlarged prostate at risk for BPH disease who may be candidates for preventive therapy with 5ARIs, regardless of urinary symptoms or bother.
The grading of severity of benign prostatic hyperplasia (BPH) was attempted by scoring clinical manifestations associated with the disease. The total score (0 to 100 points) is the sum total of subjective and objective one, each of which is 50 points at its maximum. Subjective score is composed of symptom score (0 to 25 points) evaluating 5 each obstructive and irritative symptoms and quality of life (QOL) score (0 to 25 points). Objective score consists of functional and anatomical scores. Functional score (0 to 25 points) is calculated by scoring maximum flow rate and residual urine. Anatomical score (0 to 25 points) is calculated by the score of prostatic volume. Seventy-seven BPH patients have been evaluated by this scoring system. The mean values of 4 kinds of scores (symptom, QOL, functional and anatomical scores) were about 8-9 points and thus comparable each other. The total score was 35.4 +/- 12.3 in the average and divided into 6 grades: Grade 0; < 10, Grade 1; > or = 10, Grade 2; > or = 20, Grade 3; > or = 30, Grade 4; > or = 40, Grade 5; > or = 50. The present scoring and grading systems appear to be appropriately formulated to estimate the global severity of BPH patients. Further studies to apply the system to evaluation of therapeutic responses would be mandatory to examine its validity.
OBJECTIVES: To determine the detailed pattern of prostatic interstitial temperature change during rollerball electrovaporization and loop electrosurgery in patients with benign prostatic hyperplasia (BPH). METHODS: Four patients with symptomatic BPH necessitating prostate surgery were subjected to rollerball electrovaporization on one side of their prostate glands, as well as contralateral loop electrosurgery. Continuous temperature readings were recorded from 20 to 24 interstitially implanted fiber-optic thermosensors using a novel stereotactic thermal mapping technique. Ultrasound and video endoscopic visualization were used to evaluate and quantify the spatial relationship between the thermosensors and the rollerball or loop. RESULTS: The patterns of temperature change during rollerbal electrovaporization and loop electrosurgery were substantially similar. Temperatures decreased steeply and significantly with increasing distance from both the rollerball (P < 0.001) and loop (P < 0.001). Marked mean temperature increases occurred at 1 to 2 mm from both the rollerball (30.8 degrees C, 95% confidence interval [CI] 27.8 to 33.8 degrees C) and loop (34.8 degrees C, 95% CI 24.0 to 45.6 degrees C), and temperatures at this distance were significantly higher than those at greater distances (P < 0.05). At 3 to 5 mm, the mean temperature increases declined by 58% for the rollerball and 68% for the loop. Further declines of 68% and 63%, respectively, were observed at 6 to 10 mm, and at distances exceeding 10 mm the temperature changes were minimal (0.5 degree C [95% CI 0.3 to 0.8 degree C] for the rollerball and 0.5 degree C [95% CI 0.1 to 0.8 degree C] for the loop). There was no change in temperature at any of the thermosensors near the neurovascular bundles and rectum. CONCLUSIONS: The patterns of temperature change with rollerball electrovaporization and loop electrosurgery are closely similar. Interstitial temperature changes during use of the rollerball and loop are transient and highly localized, posing minimal risk of unintended thermal damage to adjacent tissues, including the neurovascular bundles and rectum.
Although various heat treatments of benign prostatic hyperplasia have shown promising results, their morbidity-particularly urinary retention-should not be underestimated. Temporary stents are an appealing solution to this problem. Some of these are removable, whereas others are biodegradable. The various stent designs and the early clinical results are reviewed. The authors believe that temporary stents will encourage the use of alternatives to transurethral resection.
BACKGROUND: Pathologically, benign prostatic hyperplasia (BPH) is not considered a precursor for prostate carcinoma. However, because the two conditions share not only a similar hormonal environment within the prostate but also several common risk factors, it is possible that men with BPH may be at increased risk of prostate carcinoma due to these shared factors. METHODS: To elucidate this further, the authors used Swedish nationwide population-based record-linkage data to assess prostate carcinoma risk up to 26 years after the diagnosis of BPH among 86,626 men. RESULTS: Overall, relative to the general population, patients with BPH experienced little, if any, excess risk of prostate carcinoma (2% excess incidence after 10 years of follow-up). However, patients with BPH with and without surgical intervention experienced different prostate carcinoma risk patterns. Those undergoing transvesicular adenomectomy had a significant 22% lower incidence and a 23% lower mortality after the first 5 years of follow-up and those undergoing transurethral resection had a significant 10% higher incidence but a 17% lower mortality. In contrast, after the first 5 years, patients with BPH who did not receive surgical intervention experienced significant excesses of both prostate carcinoma incidence (18%) and mortality (77%). CONCLUSIONS: The differences in prostate carcinoma incidence and mortality by BPH treatment type suggest that factors related to treatment or health reasons underlying the selection of treatment influence subsequent prostate carcinoma risk. Further studies are needed to confirm the minimal excess risk of prostate carcinoma among BPH patients overall and the possible impact of BPH treatment methods on subsequent prostate carcinoma risk.
The authors examined 119 patients with the histological finding of benign prostatic hyperplasia (BPH). Before the planned operation of the prostate (transurethral resection or open prostatectomy) the authors examined in all patients the level of the prostate specific antigen (PSA) and the prostate volume by sonography. Of 119 patients 70 (58.8%) had elevated serum levels of PSA and in 35 (29.4%) the PSA level was higher than 10 ng/ml. The authors demonstrated a highly significant (p < 0.0001) linear relationship of the PSA serum level and volume of prostate in patients with BPH. Based on the results of simple regression analysis they elaborate an equation for the prostate volume: PSA ng/ml = (3.26 + 0.12 x volume of prostate (ml) +/- 8.44). By adding the value of the standard deviation of PSA the authors created an interval in which are most of the patients with BPH. The authors recommend supplementary examinations (transrectal sonography and biopsy of the prostate) in patients where there is a disproportion between the PSA level and the prostate volume.
OBJECTIVE: To compare the effects of transurethral incision and resection of the prostate in patients with small to medium benign prostatic hyperplasia. PATIENTS AND METHODS: Patients were assessed preoperatively using the Madsen-Iversen symptom score, post- void residual urine volume, urinary flow and cystoscopy. Those eligible for the study were randomized to undergo either transurethral incision or resection of the prostate. Follow-up visits were scheduled at 2-3.6, 12, 24 and 60 months post-operatively with an assessment by symptom score and urinary flow rate; most patients also underwent cystoscopy at 24 and 60 months. RESULTS: The maximum urinary flow rate was significantly higher in those undergoing resection than incision at all but the last follow-up visits. Cystoscopy 24 months after surgery showed adhesions between the lateral lobes, closed incisions or obstructing prostatic lobes in most of the patients undergoing incision, but not in those resected (P < 0.001, chi-square test). During follow-up, a second transurethral procedure was carried out for persistent or recurrent symptoms, combined with a maximum urinary flow rate of < 10.0 mL/s, in 10 patients who underwent incision and in three who were resected (P = 0.039, chi-square test). CONCLUSION: Transurethral resection is preferable to transurethral incision of the prostate in the treatment of small to medium benign prostatic hyperplasia.
Poor operative risk patients with benign prostatic hyperplasia were treated as outpatients with local hyperthermia without sedation, for 1 hour, twice weekly. As a result of the treatment it was possible in 61% to remove indwelling catheters and voiding was resumed for up to 61 months after treatment. 70% of those without indwelling catheters improved clinically and remained so for 67 months after completion of treatment. There were no side-effects or sequellae of the treatment. Because of its safety, simplicity of application and good results, it is recommended as the treatment of choice for poor operative risks.