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PubMed1996

[Urodynamic evaluation of alpha-1 blocker tamsulosin on benign prostatic hyperplasia using pressure-flow study].

BACKGROUND: In order to evaluate the precise effect of alpha-1 blocker on benign prostatic hyperplasia, symptomatic and urodynamic parameters were compared between before and after 4 week administration of tamsulosin hydrochloride (0.2 mg/day) on 18 patients with untreated benign prostatic hyperplasia. METHODS: Symptoms were scored with international prostate symptom score (I-PSS) and urodynamic parameters were measured with pressure-flow study. RESULTS: The total score of I-PSS decreased significantly although the peak urinary flow rates, average flow rates or post-void residuals did not show a significant improvement after the treatment. On the other hand, the statistical analysis of pressure-flow studies revealed a significant decrease of vesical pressure at opening, at peak flow and at end of voiding after the treatment. In one patient, in whom the voided volume and urinary flow rate kept the same level throughout the treatment course, the total energy expelled from the bladder was calculated with the formula given as W = integral (pQ)dt. Both the detrusor work and vesical work (sum of detrusor contraction and abdominal straining) showed a marked decrease after the treatment. CONCLUSIONS: It is suggested that alpha-1 blocker relieves overload of the detrusor and improves symptoms by reducing the energy demands for bladder emptying, even in case the flow rate does not improve. The urodynamic procedure including pressure flow study is a useful means for not only diagnosing bladder outflow obstruction but also assessing overload or impaired contractility of the detrusor.

Adrenergic alpha-Antagonists↗
PubMed2002

[Prophylaxis for infectious complications of transurethral resections for prostatic hyperplasia].

A clinical-and-laboratory analysis was done in 76 patients who had undergone transurethal resection (TUR) for benign hyperplasia of the prostate (PH). Included into a complex clinical-and-laboratory examination were bacteriological urine tests, with the causative agent isolated and identified, analysis of the course of the affection, assessment of X-ray findings, clinical analyses of urine and blood. With the purpose of preventing pyo-septic complications before surgery and postoperatively, cephtasidim (fortum), a broad-spectrum antibiotic, was prescribed. The analysis of the clinical studies made suggests to us that a rational antibiotic prophylaxis involving the use of cephtasidim in those patients presenting with benign PH makes the risk of development of the post-TUR PH infectious complications getting lower.

Antibiotic Prophylaxis↗
PubMed1995

Visual laser ablation of the prostate (VLAP): an effective alternative treatment of benign prostatic hyperplasia.

A total of 75 patients suffering from benign prostatic hyperplasia (BHP) were treated with visual laser ablation of the prostate (VLAP) using the Nd-Yag laser. Preoperative evaluation consisted in determination of urinary flow and residual urine, assessment of voiding symptoms and urodynamic evaluation. Postoperatively, the same evaluation was performed at 3 and at 6 months. VLAP is a relatively simple technique with a low perioperative morbidity and short time results are comparable to classical transurethral resection of the prostate. Therefore VLAP seems to be an effective alternative treatment method for BPH which may replace classical transureteral resection of the prostate in a selected number of cases.

Aged↗
PubMedDate not supplied

Doxazosin for benign prostatic hyperplasia in primary care.

The incidence of benign prostatic hyperplasia (BPH) is increasing, and an estimated one quarter of men older than 60 years have both BPH and hypertension. Medical management of BPH is now an effective alternative to surgery, and primary care physicians are treating more patients for this condition. Alpha-adrenergic blockers reduce the tone of prostatic smooth muscle, and doxazosin, a selective alpha-1 adrenergic blocker, is effective and well tolerated in the treatment of BPH. Doxazosin can be given in a convenient once-daily dose, and its efficacy is maintained in the long term. Patients with BPH who are already being treated for hypertension with doxazosin need no alteration in their dosage regimen, and doxazosin can be used as a single agent to treat both conditions. Selective alpha-adrenergic blockers are likely to be used increasingly by primary care physicians in the treatment of BPH.

Adrenergic alpha-Antagonists↗
PubMed1984

Electromyography of the external urethral sphincter in patients with prostatic hyperplasia.

We analyzed quantitatively the action potential of external urethral sphincter muscles by electromyography in 9 patients with benign prostatic hyperplasia and in 13 patients without micturition disturbances. In patients with benign prostatic hyperplasia the motor unit potentials had a mean amplitude of 290 plus or minus 40 microV., duration 5.0 plus or minus 0.1 msec. and phases 3.9 plus or minus 0.1. The control group values were 310 plus or minus 20 microV., 5.5 plus or minus 0.1 msec. and 3.8 plus or minus 0.1, respectively. There was a significant difference in duration, which was probably due to the difference in age of the 2 groups. An inverse relationship between age and duration was proved in the patients examined.

Action Potentials↗
PubMed1998

Benign prostatic hyperplasia.

Insight into the dysfunctional physiology of benign prostatic hyperplasia has expanded appropriate therapies. As the proportion of the population to whom BPH will be a problem increases our attention is directed to evolution in clinical management.

Adrenergic alpha-Antagonists↗
PubMed1979

Benign prostatic hyperplasia in a squirrel monkey (Saimiri sciureus).

Benign prostatic hyperplasia was diagnosed at necropsy in a middle-aged squirrel monkey (Saimiri sciureus). Grossly, the prostate gland was asymmetrically enlarged and had an irregular surface. Microscopically, both cystic glandular hyperplasia and fibromuscular, nodular hyperplasia were identified.

Animals↗
PubMed1996

Is screening for prostate cancer necessary in men with symptoms of benign prostatic hyperplasia?

In this report, we review the critical issues concerning the early detection of prostate cancer in patients presenting with symptoms of benign prostatic hyperplasia (BPH). Only with the recent introduction of serum prostate-specific antigen (PSA) testing and transrectal ultrasonography (TRUS)-guided biopsy has the question arisen to what extent the treating physician has a responsibility to rule out prostate cancer before recommending treatment-or watchful waiting-for men with clinical BPH. Uneasiness and uncertainty also result from the development of alternative therapies that do not provide tissue for pathological analysis, or alter serum PSA levels in a poorly predictable fashion. Current early detection strategies, in this clinical situation, pose unique problems, largely because of the great degree of overlap in serum PSA among men with localized prostate cancer and BPH. The underlying goal is to distinguish patients with BPH alone from those with clinically significant, but organ-confined and potentially curable prostate cancer. Treatment for prostate cancer may take precedence over BPH management strategies, while at the same time address the symptoms associated with coexistent clinical BPH. The issues discussed in this report should aid the clinician in the evaluation of patients with clinical BPH. Further studies are clearly needed that may ultimately enhance our ability to discriminate patients with clinically significant organ-confined prostate tumors from those with BPH alone.

Adult↗
PubMed1997

High energy thermotherapy versus transurethral resection in the treatment of benign prostatic hyperplasia: results of a prospective randomized study with 1 year of followup.

PURPOSE: We compared the outcome of transurethral resection of the prostate and high energy microwave thermotherapy in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Of 52 patients with symptomatic benign prostatic hyperplasia 21 (mean age plus or minus standard deviation 69.6 +/- 8.5 years) were treated with transurethral resection of the prostate and 31 (mean age 69.3 +/- 5.9 years) were treated with high energy microwave thermotherapy. Patients were assessed using the Madsen symptom score, measurements of voiding parameters, transrectal ultrasound and cystometry, including pressure-flow analyses. Examinations were repeated at fixed intervals for up to 12 months after treatment. RESULTS: After transurethral resection and thermotherapy there was significant improvement in all clinical parameters. At 1 year of followup symptomatic improvement was 78% in the transurethral resection group versus 68% in the thermotherapy group, with improvements in free flow rate of 100 and 69%, respectively. Both groups had significant relief of bladder outlet symptoms. No serious complications occurred in either group, while 1 patient in each group required repeat treatment. CONCLUSIONS: Satisfactory results were obtained after both treatments, with improvements following high energy microwave thermotherapy being in the same range as those after transurethral resection of the prostate.

Aged↗
PubMed2006

Economic impact of surgical intervention in the treatment of benign prostatic hyperplasia.

The economic burden of benign prostatic hyperplasia (BPH) on our health care system is significant and likely to continue to grow given the burgeoning elderly population. Coincident with the rising number of annual physician office visits and expenditures for BPH has been a dramatic shift in the disease's management, from surgical to medical care. However, long-term cost data call into question the appropriateness of medical therapy as the initial treatment approach for all men with BPH, particularly those with moderate to severe symptoms. Although there has been a paradigm shift away from traditional BPH surgery, there has been renewed interest in the treatment of BPH with novel surgical techniques and minimally invasive surgeries. The economics of surgical interventions for BPH are discussed.

Journal Article↗
PubMed1996

Usefulness of Cernilton in the treatment of benign prostatic hyperplasia.

A total of 89 patients with benign prostatic hyperplasia (BPH) were treated pharmacologically for 4 months: 51 received Cernilton and 38 Tadenan (controls). Significant subjective improvement was found in 78% of the patients in the Cernilton group compared to only 55% of the Tadenan-treated patients. The obstructive and irritative symptoms responded best to the therapy. In the Cernilton-treated patients a significant improvement in the uroflow rate, decrease in residual urine and in prostate volume were found. This study shows that Cernilton is an effective therapy for patients with BPH.

Aged↗
PubMed2003

Prostate-specific antigen as an estimator of prostate volume in the management of patients with symptomatic benign prostatic hyperplasia.

OBJECTIVES: To assess the ability of serum prostate specific antigen (PSA) to estimate prostate volume (PV) to aid in the management of patients with benign prostatic hyperplasia (BPH). METHODS: From 1989 to 2002, data were collected from 2264 patients complaining of lower urinary tract symptoms (LUTS) who visited the Department of Urology of the University Medical Centre Nijmegen, The Netherlands. Baseline PV and serum PSA was determined using standard techniques. All patients who had a baseline PV < or =200 ml, as well as a baseline serum PSA 0-10 ng/ml, were included. Patients with a history of prostate surgery, prostate cancer and conditions other than BPH at baseline were excluded. A log-transformed linear regression model was used to estimate PV. Receiver-operating characteristic (ROC) curves were constructed to evaluate the ability of serum PSA to estimate threshold PVs in men with BPH, and to select the optimal serum PSA cut-off values. RESULTS: The analyses included 1859 patients with a mean age of 63.5 years, mean baseline PV 43.9 ml, and mean baseline PSA value 3.1 ng/ml. PV as well as serum PSA increases with age. Linear regression analyses showed that PV and serum PSA have an age-dependent log-linear relationship, where 42% of the variance of PV can be explained by PSA and age. ROC's area under the curves (AUC) reveal that PSA has a good predictive value for assessing 'prostate enlargement', with AUC around 82% in the overall age groups irrespective of the PV cut-off values. Optimal serum PSA cut-off values for the overall study population irrespective of age are 2.0 ng/ml to detect PV >30 ml and 2.5 ng/ml to detect PV >40 ml. CONCLUSIONS: This study suggests that serum PSA can estimate prostate enlargement sufficiently accurately to be useful for therapeutic, especially medical, management. It is well accepted that the outcome of pharmacotherapy for BPH depends on baseline PV. Therefore, in the absence of reliable direct measurement of PV, serum PSA determination may be used to optimise patient management.

Adult↗
PubMed2004

Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia.

PURPOSE: To our knowledge we report the first multicenter, prospective, randomized study comparing holmium laser enucleation (HoLEP) and transurethral prostate resection (TURP) for obstructive benign prostatic hyperplasia. MATERIALS AND METHODS: From January to October 2002, 100 consecutive patients with symptomatic obstructive benign prostatic hyperplasia were randomized at 2 centers to surgical treatment with HoLEP (52 in group 1) or TURP (48 in group 2). Patients in the 2 groups were preoperatively assessed by scoring subjective symptoms questionnaires. Preoperative and perioperative parameters were also evaluated, the latter at 1, 6 and 12 months of followup. RESULTS: At baseline all patients had obstruction (Schäfer grade greater than 2). At the 1, 6 and 12-month followups no statistically significant differences were observed between the 2 groups in terms of urodynamic findings and subjective symptom scoring. In the HoLEP group mean total time in the operating room +/- SD was significantly longer than for TURP (74 +/- 19.5 vs 57 +/- 15 minutes, p < 0.05), while catheterization time (31 +/- 13 vs 57.78 +/- 17.5 minutes, p < 0.001 and hospital stay (59 +/- 19.9 vs 85.8 +/- 18.9 hours, p < 0.001) were significantly shorter in the HoLEP group. Transient stress and urge incontinence were more common in the HoLEP group, although at the 12-month followup results were comparable. The overall complication rate was comparable in the 2 groups. Erectile function was also maintained in the followup period from baseline in each group, as expected. CONCLUSIONS: HoLEP and TURP were equally effective for relieving obstruction and lower urinary tract symptoms. HoLEP was associated with shorter catheterization time and hospital stay. At 1 year of followup complications were similar in the 2 groups.

Aged↗
PubMed2003

Cytokine expression pattern in benign prostatic hyperplasia infiltrating T cells and impact of lymphocytic infiltration on cytokine mRNA profile in prostatic tissue.

The aim of the study is to characterize the type of immune response in benign prostatic hyperplasia (BPH) tissue. BPH tissue-derived T cells (n = 10) were isolated, activated (PMA + ionomycin), and analyzed for intracellular reactivity with anti-IFN-gamma and IL-2, -4, -5, -6, -10, and -13, as well as TNF-alpha and -beta by four-color flow cytometry. Lymphokine release was tested using Th1/Th2 cytokine bead arrays. The amount of IFN-gamma and IL-2, -4, -13, and TGF-beta mRNA expressed in normal prostate (n = 5) was compared with that in BPH tissue separated into segments with normal histology (n = 5), BPH histology with (n = 10) and without (n = 10) lymphocytic infiltration, and BPH nodules (n = 10). Expression of lymphokine receptors was analyzed by immunohistology, flow cytometry, and RT-PCR. We found that 28 +/- 18% of BPH T helper cells were IFN-gamma(+)/IL-4(-) Th1 cells, 10 +/- 2% were IFN-gamma(-)/IL-4(+) Th2, and 12 +/- 6% were IFN-gamma(+)/IL-4(+) Th0 cells. In relation, cytotoxic and double-negative BPH T lymphocytes showed a slight decrease in Th1 and Th0 in favor of Th2. In double-positive BPH T lymphocytes, the trend toward Th2 (35 +/- 15%) was significant (Th1: 12 +/- 7%; Th0: 5 +/- 4%). Lymphokine release upon stimulation was found in the case of IL-2, IL-5, IFN-gamma, and TNF-alpha > 4 microg; of IL-4 > 2 microg; and of IL-10 > 1 microg/ml. Expression of lymphokine mRNA in tissue was increased (2- to 10-fold) in infiltrated BPH specimens with and without BPH histology. The infiltrated BPH specimens with normal histology differed from those with BPH histology, most evident by the significant decrease in IFN-gamma and the increase in TGF-beta mRNA expression. Infiltrated BPH specimens with BPH histology expressed significantly more IFN-gamma (5-fold), IL-2 (10-fold), and IL-13 (2.8-fold) when compared with noninfiltrated BPH specimens. BPH nodules, however, showed the highest level of expression of IL-4 and IL-13, with only intermediate levels of IFN-gamma and very low levels of IL-2 mRNA. Immune response in histologically less transformed BPH specimens is primarily of type 1, whereas in chronically infiltrated nodular BPH and especially within BPH nodules, it is predominantly of type 0 or type 2.

Adult↗
PubMed2005

Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction.

OBJECTIVE: To assess benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), both considered to be associated with urogenital ageing, in ageing men in a cross-sectional population study, comparing them with healthy controls by using symptom scores and contrast-enhanced colour Doppler ultrasonography (CDUS). PATIENTS, SUBJECTS AND METHODS: Transrectal CDUS and quantitative measurement of colour pixel intensity (CPI) are excellent minimally invasive techniques for assessing normal and pathological blood flow. CDUS was performed using the microbubble-based ultrasound enhancer for evaluating prostate, bladder neck and corpus cavernosum vascularity in young healthy men, men with BPH, and men with severe vascular damage (diabetes mellitus type 2). Resistive index measurements and computer-assisted quantification of CPI were used to objectively evaluate perfusion. The International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) were applied to quantify the symptoms. RESULTS: In patients with BPH, perfusion of the transition zone (TZ) of the prostate was significantly lower and the resistive index of the TZ significantly higher (both P < 0.001) than in healthy controls. The perfusion patterns of men with BPH and those who also had severe vascular damage (diabetes mellitus type 2) showed that vascularity in the latter group was lower in the prostatic TZ and the corpora cavernosa. In patients with BPH the IPSS, quality-of-life and IIEF scores were significantly worse than in the control group. Men with concomitant atherosclerosis had even worse symptom scores. CONCLUSION: These results strongly support the hypothesis that age-related impairment of blood supply to the lower urinary tract is important in the development of BPH and ED. Vascular damage may cause chronic ischaemia and thus be a contributing factor in the pathogenesis of BPH and ED.

Adult↗
PubMed1985

Correlated biochemical and stereological studies on testosterone metabolism in the stromal and epithelial compartment of human benign prostatic hyperplasia.

The growth and function of the human prostate is dependent upon a continuous supply of androgens, mainly 5 alpha-dihydrotestosterone, the 5 alpha-reduced metabolite of testosterone. Within the human prostate dihydrotestosterone is thought to be the intracellular mediator of androgen action. Although it is well documented that dihydrotestosterone is evenly distributed between the stromal and epithelial compartment of the prostate, the anatomical localization of dihydrotestosterone formation within the normal and hyperplastic prostate is still not established. To provide further insight into this problem we have measured, under conditions approximating the in vivo state, dihydrotestosterone formation in prostates obtained from 4 men with normal prostates and 36 men with benign prostatic hyperplasia. In addition to this we have performed histometric analysis of the cellular composition of the samples incubated, in order to correlate the morphological and the histochemical findings. Dihydrotestosterone is the major metabolite, and androstanediol and androstenedione were formed in smaller quantities. Under the given conditions metabolite formation from testosterone increased linearly for 60 minutes and the half maximum rate of dihydrotestosterone formation (Km) was observed at about 1.25 X 10(-6) M testosterone, a value similar to that reported for rat prostatic nuclei and human prostatic tissue. Dihydrotestosterone formation was higher in hyperplastic prostates than in the normal prostate. (Student's t test: p less than 0.05). The stroma in both the normal and hyperplastic tissue converts testosterone to dihydrotestosterone very actively. No significant relation was found between dihydrotestosterone formation and the per cent distribution of the stromal and epithelial compartment in any sample studied. In conclusion, our results are compatible first with the thesis that the rate of dihydrotestosterone formation is increased in the hyperplastic prostate and secondly with the concept that the rate of dihydrotestosterone formation is approximately the same in the epithelial and stromal compartments of the prostate.

Androstane-3,17-diol↗
PubMed1994

Treatment response with transurethral radiofrequency thermotherapy for symptomatic benign prostatic hyperplasia.

One hundred and two patients with benign prostatic hyperplasia were treated by transurethral radio-frequency thermotherapy (TURT) device (Thermex-II, Direx, Israel) with 47.5 degrees C in single session for 2 hours and 30 minutes from November 1992 to October 1993. Among them, 83 patients, who were followed up for more than 3 months were included in this study. Twenty-seven (32.5%) patients had a history of acute retention. Pretreated values of the mean Madsen-Iversen symptom score, maximum urine flow rate, postvoiding residual urine volume, prostate volume and prostate specific antigen (PSA) were 15.4, 6.5 ml/sec, 61.3ml, 43.2ml and 0.77 ng/ml respectively. Madsen-Iversen symptom score, maximum urine flow rate were measured at 2 weeks, 1, 3 and 6 months after TURT. The residual urine volume, prostate volume and PSA level were measured at 3 and 6 months after TURT. During the follow up, the symptom score started to decrease significantly at 1 month (9.9, p < 0.01) after TURT, and gradually decreased up to 6.9 at 3 months. The maximum flow rate showed initial significant improvement at 2 weeks (8.1 ml/sec., p < 0.01), but no significant interval change was observed thereafter. The residual volume decreased significantly at 3 months (41.3 ml, p < 0.01) and no decrement was noted until 6 months. Neither the prostate volume nor PSA value changed significantly at 3 or 6 months after TURT. The improvement, which was defined as a change of 50% or more in at least one of subjective or objective symptoms showed in 63.9% (53/83) at 3 months and 57.1% (32/56) at 6 months. Both subjective and objective improvements at 3 and 6 months after treatment showed in 24.1% and 19.6%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Management of benign prostatic hyperplasia by transurethral laser ablation in patients treated with warfarin anticoagulation.

Transurethral laser ablation of the prostate gland was used to treat benign prostatic hyperplasia in 10 patients on warfarin anticoagulant therapy who had either significant clinical symptoms or who were in urinary retention. Anticoagulant therapy did not require alteration at any stage during treatment. All patients noticed improvements in symptom score assessments, flow rates and residual urine volumes following this procedure, and no significant complications were encountered. The hemostatic nature of neodymium:YAG laser energy as applied in this procedure appears to result in a technical improvement upon conventional transurethral resection for the treatment of symptomatic benign prostatic hyperplasia in patients taking warfarin anticoagulant therapy.

Aged↗