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PubMed1995

[Pharmacotherapy in benign prostatic hyperplasia].

To avoid an operation, there are innumerable pharmaceutics on sale for the treatment of the benign prostatic hyperplasia. For this reason we have to distinguish between pharmaceutics without effect and those with proved action on the hyperplastic metaplasia. The symptoms can often be lessened at the initial stage by way of drugs with ineffective action (phytopharmaceutics); there could not yet be proved any effect on the biology of the prostatic hyperplasia. We make use of this therapeutic at the initial stage. Some of the substances with a real effect (alpha-receptor blockers, alpha-reductase inhibitors) do not necessarily provide an effective result in all cases. In addition to that, these therapeutics of partially serious side effects have to be taken for life. Here immediately arises the question of how it could be managed financially.

5-alpha Reductase Inhibitors↗
PubMed1992

Efficacy of terazosin in patients with benign prostatic hyperplasia.

Terazosin, a selective, long-acting alpha 1-adrenergic blocker, was evaluated in 44 men with benign prostatic hyperplasia. The dose was titrated from 2 to 20 mg nightly depending on improvement in symptoms and flow rate. All men completed at least 3 months of therapy, 26 had 6 months and 19 received 9-12 months of terazosin. There was an average increase of 2 ml/s in the peak urinary flow rate compared to baseline. This was statistically significant at the 3-month level. Residual urine decreased under treatment at each 3-month time interval. Prior to initiation of terazosin the mean was 165 ml, and it was 62, 100, and 41 ml at 3, 6 and 9 months respectively. There was a statistically significant improvement in both the obstructive and irritative symptom scores. Side effects were minimal; only 1 patient discontinued terazosin due to a hypotensive episode. Terazosin was found to be safe and effective in the dose range of 2-20 mg taken at bedtime in men with symptoms related to benign prostatic hyperplasia. The present study did not identify any baseline parameters such as initial prostate volume, peak flow rates, or obstructive or irritative symptom scores that correlated with clinical outcome.

Adrenergic alpha-Antagonists↗
PubMed1991

Benign prostatic hyperplasia--video image analysis and its relationship to androgen and epidermal growth factor receptor expression.

Androgens are essential for the development and maintenance of the prostate. However, prostatic growth may be mediated by epidermal growth factor (EGF) and the expression of the EGF receptor (EGFR) may be influenced by the androgenic milieu. We have characterized the expression of cytosolic androgen receptor (ARc), nuclear salt extractable androgen receptor (ARn) and EGFR in 89 consecutive cases of benign prostatic hyperplasia, 84 of which were treated by transurethral prostatic resections. Image analysis morphometry was performed on the histological sections to determine the epithelial content of the gland. Our results indicate that there is a vast heterogeneity of receptor expression in benign prostatic hyperplasia. Expression of ARc ranged from zero to 1312 fmol/gm. tissue (mean +/- SD 265 +/- 290), ARn ranged from zero to 531 fmol/gm. tissue (mean +/- SD 145 +/- 98) and EGFR ranged from zero to 316 fmol/gm. tissue (mean +/- SD 121 +/- 76). A statistically significant association was found between expression of ARn and EGFR, and these were both significantly correlated with the epithelial content of the gland.

Cell Nucleus↗
PubMed2001

Comparative early results of the sandwich technique and transurethral electroresection in benign prostatic hyperplasia.

No study has yet reported the comparative results of the sandwich technique and transurethral electroresection in the management of benign prostatic hyperplasia. Thirty patients with benign prostatic hyperplasia were divided into two groups, each consisting of 15 patients. The first group underwent the sandwich technique (transurethral electrovaporization-transurethral electroresection-transurethral electrovaporization) and the second group had transurethral electroresection alone (TURP). Preoperatively all patients underwent a digital examination and the determination of prostatic volume by transrectal ultrasonography, and a symptom score (IPSS), the maximal flow rate (Q (max)), post-void residual urine (PVR). Six months after the operation, all the variables were remeasured and the values compared with those before treatment and between the groups. The improvements in symptom score, residual urine and maximum flow rate were slightly better after the sandwich technique than after TURP but the differences between the two groups were not statistically significant. Additionally, lower amounts of irrigant solution were used (P>0.05) and operative time was shorter in the sandwich group (P>0.05). Although the duration of catheterization in the sandwich group was lower than that of the TURP group (1.6 and 2.26 days respectively (P<0.05)), three patients (20%) required catheterization. Although the improvements in the objective parameters 6 months after, early indications showed that the sandwich technique results were almost the same as after TURP. There might be several advantages of this technique, particularly the fact that no blood transfusion is required and earlier removal of urethral catheter.Prostate Cancer and Prostatic Diesases (2001) 4, 242-244.

Journal Article↗
PubMed1995

The effect of zanoterone, a steroidal androgen receptor antagonist, in men with benign prostatic hyperplasia. The Zanoterone Study Group.

PURPOSE: Zanoterone (100 to 800 mg.) versus placebo was studied in 463 patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Study end points were maximum urinary flow rate, American Urological Association symptom index, prostate volume, prostate specific antigen and sex steroid concentrations after 6 months of treatment. RESULTS: Mean increases in maximum urinary flow rate were 2 to 3-fold over placebo, although only the 200 mg. group had significant results (1.7 ml. per second, p = 0.026). There were no statistically significant differences between the zanoterone and placebo groups in symptom index or prostate volume. Estradiol and testosterone concentrations, and the incidence of breast pain and gynecomastia increased significantly with zanoterone compared with placebo. Prostate specific antigen levels decreased significantly. CONCLUSION: Zanoterone did not demonstrate a favorable risk-to-benefit profile for the treatment of benign prostatic hyperplasia.

Aged↗
PubMed2005

[Evaluation of sexual activity after prostatic surgery for benign prostatic hyperplasia assessed by pre-operative and post-operative questionnaire].

AIM: Different authors showed a 5-40% incidence of erectile dysfunction after prostatic surgery for benign prostatic hyperplasia. The aim of our study was to evaluate the effect of prostatic surgery due to benign prostatic hyperplasia on sexual activity. METHODS: We evaluated 56 patients (mean age 63 years, range 49-70) who underwent transurethral resection of the prostate (30 patients, mean age 64 years, range 56-70) and open prostatectomy (26 patients, mean age 59 years, range 49-70) with a questionnaire regarding the presence of sexual dysfunction before and 3, 6, 12 months after surgery. All patients were not affected by previous or present metabolic, neurological, cardiovascular diseases. RESULTS: Twenty percent of the patients with a normal sexual activity before treatment presented erectile dysfunction after surgery. However, 35% of patients with erectile dysfunction before treatment presented an improvement of their erectile function after surgery. CONCLUSIONS: A high incidence of erectile dysfunction was observed in patients undergoing prostatic surgery. Patients with erectile dysfunction should also recover a normal behaviour after prostatic surgery as well as an improvement of the erectile dysfunction.

Aged↗
PubMed1994

Randomized comparison of balloon dilation and transurethral incision for treatment of symptomatic benign prostatic hyperplasia.

The concept of relieving the symptoms of benign prostatic hyperplasia (BPH) by dilating the urethral has existed for centuries. Thirty patients with a clinically estimated prostate gland size of 25 g or less were randomized to either balloon dilation (BDP) or transurethral incision of the prostate (TUIP). The mean pretreatment Madsen-Iverson symptom scores in the two groups were 15.0 +/- 4.9 (SD) and 15.4 +/- 4.4, respectively. The early response rates were 87% fo BDP and 86% for TUIP, with the mean symptom scores declining to 3.4 +/- 2.8 after dilation and 4.2 +/- 6.6 after incision. Among the 14 patients who initially responded to BDP, 2 have been lost to follow-up, 1 died of unrelated causes at 17 months with no urinary symptoms, 2 remain in response at 32 and 38 months, and the other 9 (75% of those available for evaluation) have developed recurrences. Among the 12 patents who responded to TUIP, 2 have been lost to follow-up, 8 remain in response at 14 to 48 months, and 2 (20%) developed recurrences by 44 months of follow-up. In the short term, both BDP and TUIP are effective for treating bladder outlet obstruction in men with relatively small prostates. However, the effect of dilation appears to be less durable than that of incision.

Aged↗
PubMed1999

Contact laser prostatectomy compared to TURP in prostatic hyperplasia smaller than 40 ml. Six-month follow-up with complex urodynamic assessment.

OBJECTIVE: To compare the efficacy and safety of contact laser vaporization (CLV) of the prostate and transurethral resection of the prostate (TURP). MATERIAL AND METHODS: Fifty patients with symptomatic prostatic hyperplasia with prostate volumes less than 40 ml were randomized to CLV or TURP treatment. All patients had infravesical obstruction confirmed preoperatively by pressure-flow studies. RESULTS: CLV lasted longer (51 +/- 13 min versus 34 +/- 12 min; p < 0.001), caused less bleeding (57 +/- 49 ml versus 175 +/- 133 ml; p < 0.001) and required longer bladder drainage time (4.3 +/- 6.1 versus 1.7 +/- 0.8 days; p < 0.01) than TURP. At 6-month follow-up, both treatments had improved objective urinary parameters and effectively reduced subjective symptoms. There were no significant differences between the study groups in symptoms scores (DanPSS-1), peak urinary flow rates (Qmax) and post-void residuals (PVR). Six months after treatment the detrusor pressure at peak urinary flow rate (PdetQmax) was 38.3 +/- 9.7 cm H2O in CLV patients and 31.3 +/- 9.9 cm H2O in TURP patients (NS). CLV treatment caused less retrograde ejaculation than TURP (1/16 potent CLV men versus 13/16 potent TURP men; p < 0.001). CONCLUSIONS: Contact laser prostatectomy proved to be a safe procedure which improved subjective and objective urinary parameters during 6-month follow-up as effectively as TURP in the treatment of symptomatic infravesical obstruction caused by minimal or moderate benign prostate enlargement.

Aged↗
PubMed1996

Long-term outcome of prostatic stent treatment for benign prostatic hyperplasia.

OBJECTIVES: To evaluate the long-term result of prostatic stent treatment for patients with benign prostatic hyperplasia (BPH). METHODS: We reviewed our experience with prostatic stents in 24 patients with bladder outlet obstruction caused by BPH for whom up to 63 months of follow-up data were available. RESULTS: Prostatic stents were successfully placed in 24 of 25 patients enrolled in the study. All 9 patients treated for urinary retention voided spontaneously after stent placement. In 14 (93%) of 15 patients with nonretention, voiding symptoms decreased by 50% or more. The stent was removed in 9 patients for persistence of symptoms, symptom recurrence, or stent migration. Nine patients died of unrelated causes during the follow-up period. The stents functioned adequately in these patients until death. In the remaining 6 patients, the stent was still in place at the last follow-up visit (range 12 to 52 months, average 35) after placement, and their Madsen-Iversen symptom scores ranged from 3 to 10. Fourteen patients underwent cystoscopy 1 to 37 months after stent placement. Epithelium did not completely cover the stent in any of these patients; however, no stone formation was noted. CONCLUSIONS: Prostatic stents can be effective in relieving bladder outlet obstruction caused by BPH. They appear to be most useful in patients at high surgical risk and with a limited life expectancy. However, stent removal, which can be difficult, may be required in more than one-third of patients. We recommend prostatic stent placement primarily in patients who would otherwise be relegated to an indwelling catheter.

Aged↗
PubMed1988

Urodynamic and histological correlates of benign prostatic hyperplasia.

The tissue obtained from transurethral prostatectomies was evaluated histologically and correlated to the clinical findings in 81 patients with benign prostatic hyperplasia. A median of 9 hematoxylin and eosin-stained tissue slides per patient were examined, each containing from 1 to 15 curettings. The patients were divided into 3 groups according to the following histology: predominantly stromal hyperplasia (39 patients), predominantly glandular hyperplasia (29 patients), and equal proportions of stromal and glandular hyperplasia (mixed group, 19 patients). There was no significant difference among the groups in patient age and duration of symptoms. The weight of resected tissue was significantly lower in the stromal group (median 16 mg.), compared to the glandular group (median 20 gm.) and the mixed group (median 25 gm.). Additionally, 29 of the 81 patients had chronic inflammation characterized by multifocal infiltrates of lymphocytes. These patients had significantly larger prostates (median 25 gm.) compared to those without lymphocytic infiltration (median 15 gm.). Sixty-five patients had a 3-month followup examination. Preoperatively there was no difference among the groups in maximum flow at uroflowmetry but at 3-month followup the stromal group had a median maximum flow of 13 ml. per second compared to 16.8 ml. per second in the glandular group and 21.5 ml. per second in the mixed group. These findings document histologically what has been reported from a clinical perspective: the clinical prostatism/benign prostatic hyperplasia complex is a spectrum of histological entities, and the small prostate with predominantly stromal hyperplasia responds less favorably to transurethral resection as determined by urodynamic evaluation.

Aged↗
PubMed1991

[Clinical evaluation of balloon dilatation in patients with benign prostatic hyperplasia].

Balloon dilatation of the urethra was performed on 38 patients (aged 61 to 89 years) with benign prostatic hyperplasia. Of the 38 patients, 34 (89.5%) achieved improvement of symptoms including urinary retention and difficulty on urination and no recurrence of symptoms was observed during a follow-up period. The maximum flow rate remarkably increased after the treatment in the patients and there was no increase of residual urine volume in 17 patients followed up for 6 to 12 months. The balloon dilatation of the prostatic urethra proved to be useful for patients with benign prostatic hyperplasia.

Aged↗
PubMed1993

Transurethral microwave hyperthermia for benign prostatic hyperplasia: the Leuven clinical experience.

Local microwave hyperthermia, delivered transurethrally or transrectally, is a new treatment modality for benign prostatic hyperplasia. We started transurethral application, delivering 915-MHz microwaves at the prostatic urethra using a helical microwave antenna incorporated in a Foley catheter. This hyperthermia was given without a urethral surface cooling system. Thermophysical testing of the applicator proved therapeutic efficacy in vitro and in vivo. Pathologic studies demonstrated hyperthermia-induced lesions in the periurethral prostatic tissues and permitted us to hypothesize a working mechanism of transurethral hyperthermia. Clinical Phase I and II studies showed clinical efficacy in patients with urinary retention or prostatism secondary to benign hyperplasia, especially in bilobar or trilobar prostatic configurations. While awaiting results of further pathologic and thermophysical experimental work and ongoing Phase II and III studies, we consider transurethral hyperthermia an investigational but promising conservative treatment modality for benign prostatic hyperplasia.

Belgium↗
PubMed2001

Prostate cancer, benign prostatic hyperplasia and physical activity in Shanghai, China.

BACKGROUND: Studies suggest that increased levels of physical activity might decrease the risk of prostate cancer. We ascertained lifetime measures of activity in a population-based case-control study of prostate cancer in Shanghai, China to investigate physical activity in a population where the incidence of prostate cancer is low but rising. METHODS: In all, 238 men with prostate cancer, diagnosed 1993-1995, were identified through a rapid reporting system. A second group of 206 men with benign prostatic hyperplasia (BPH) was matched to prostate cancer cases, and 471 age-matched and population-based controls were identified from urban Shanghai. Through personal interviews, we ascertained all daily, occupational, and recreational activities at ages 20-29, ages 40-49, and in 1988 to generate hours spent sleeping, sitting, in moderate activity, and in vigorous activity. Time spent per week in different activities was converted to metabolic equivalents (MET-h) and energy expended. RESULTS: Time spent in, MET-h of, and energy expended in physical activities were not consistently related to either prostate cancer or BPH when compared to controls. Few men reported regular vigorous activity. Occupational activity, based on an energy expenditure index using job titles, was suggestively associated with a decreased risk of BPH, but not associated with prostate cancer. Associations did not vary according to age or stage of prostate cancer at diagnosis. CONCLUSIONS: Our results, based on regular physical activity, occupational activity, hours in activities, MET-h, and energy expended, did not support a protective role of physical activity in prostate cancer or BPH for men in a low-risk population.

Adult↗
PubMed1995

Variability of pressure-flow analysis parameters in repeated cystometry in patients with benign prostatic hyperplasia.

Urodynamic investigation becomes increasingly important in the diagnosis of bladder outflow obstruction in patients with benign prostatic hyperplasia. To date, different methods for evaluation of the pressure-flow relationship and quantification of the grade of obstruction are available. Models for pressure-flow analysis are briefly explained. The variability of the parameters is investigated by evaluation of 75 patients in whom 2 sequential voidings during urodynamic investigation were analyzed. The results showed that in 87% of these patients individual maximum flow differences of first and second voidings were less than 2 ml. per second. Individual detrusor pressure at maximum flow differences were less than 15 cm. water in 80% of these patients, while in 80% the intra-individual variation of the pressure-flow results was less than 15 cm. water for the minimal voiding pressure parameters (minimal urethral opening detrusor pressure and urethral resistance factor). For the pressure-flow parameter that defines the theoretical urethral lumen during voiding, the variation was less than 1.5 mm.2 in 84% of the patients. Patients with larger intra-individual differences are discussed. We concluded that the observed, aforementioned differences can be regarded as an indication of normal intra-individual variability of voiding during urodynamic investigation. This intra-individual variability, however, seldom leads to a change in the clinical grade of bladder outflow obstruction. We conclude that investigators involved in therapeutic trials of benign prostatic hyperplasia must be aware of this intra-individual variability of micturition, since this variability is greater than the refined scale of the pressure-flow analysis models.

Humans↗
PubMed2000

Role of transurethral biopsy sampling of the prostate to diagnose prostate cancer in men undergoing surgical intervention for benign prostatic hyperplasia.

PURPOSE: Newer minimally invasive surgical procedures are being used to treat men with significant benign prostatic hyperplasia (BPH). These modalities do not allow retrieval of prostate tissue for histologic review. The goal of our study was to assess the value of transurethral biopsies in detecting prostate cancer in men who would undergo surgical intervention for BPH. MATERIALS AND METHODS: Between September 1997 and January 1999, 422 men undergoing transurethral resection of the prostate (TURP) had transurethral biopsies obtained before completing the TURP. Pathology reports as well as prostate-specific antigen (PSA) results were reviewed and analyzed to determine when cancer was present. RESULTS: Pathological examination revealed that cancer was found in 53 men (12.5%). The transurethral biopsies detected cancer in 32 of 53 (60.4%). No cancers were found in the transurethral biopsy specimen only. Of the 21 cancers missed by transurethral biopsy, 7 were stage T1b. PSA level >10 ng/mL increased the likelihood of finding cancer. CONCLUSIONS: Transurethral biopsy sampling is unreliable for detecting prostate cancer in men with clinically significant BPH. Significant cancers are missed if transurethral biopsies are used to determine the presence of carcinoma before minimally invasive surgical therapy for BPH.

Adult↗
PubMed1997

Adherence to Agency for Health Care Policy and Research guidelines for benign prostatic hyperplasia.

PURPOSE: We determined adherence rates to guideline recommendations for the diagnosis and treatment of benign prostatic hyperplasia published and distributed by the Agency for Health Care Policy and Research in 1994. MATERIALS AND METHODS: Measures of care were developed based upon Agency for Health Care Policy and Research guideline recommendations approved by the Health Care Financing Administration and the American Urological Association (AUA). A random 4-state sample of 2,000 inpatient records with a principal diagnosis of hyperplasia of the prostate (ICD-9-CM code 600) and principal procedure code of 60.2 was selected by the Health Care Financing Administration and abstractions were performed. We assessed reliability and validity and determined results for each of the following measures of care: 1) documentation of indications for a transurethral resection of the prostate; 2) documentation of appropriate preoperative assessment; 3) documentation of indications for an inpatient excretory urogram (IVP) and/or sonogram when the procedures were performed and 4) documentation of surgical time and grams of tissue removed. Adherence rates for all measures of care were determined. RESULTS: Of the 4-state sample of inpatient cases 1,828 cases met entry criteria for the study. Of the cases 93% had at least 1 symptom and/or score, and/or an anatomical abnormality documented before surgery. An AUA score was documented in the inpatient medical record in 7.5% of the cases. Recommendations for preoperative evaluation included urinalysis, a digital rectal exam and determination of preoperative creatinine. All of these were documented in 475 (26%) cases. Of the 1,828 cases 216 (12%) had an IVP or sonogram performed in the inpatient setting. In 36% indications were documented when sonograms were performed; 74% had documented indications when IVPs were performed. Excluding laser transurethral resections of the prostate, surgical time and tissue amounts were documented and recorded in 1,424 transurethral resections of the prostate cases (91%). CONCLUSIONS: Adherence to selected Agency for Health Care Policy and Research guideline recommendations is documented infrequently in the medical record.

Humans↗
PubMed1993

[New microwave transurethral hyperthermia for benign prostatic hyperplasia--clinical evaluation].

Several types of hyperthermic apparatuses are employed to treat benign prostatic hyperplasia (BPH). As the prostate surrounds the urethra, we believed that transurethral heating allowed for more efficient and uniform heating. A new effective apparatus for this objective was developed. The size of our hyperthermic apparatus was about 52 x 45 x 20 centimeters and the originating frequency was 2,450 +/- 30 MHz. We used T-type thermocouples as temperature sensors. The transurethral applicator had a cooling system. Thirty patients complaining of obstructive symptoms due to BPH were treated. Hyperthermia was performed 3-6 times for each patients (two times per week). Each procedure was performed for 60 minutes. The temperature was controlled at 39 degrees C on the urethral surface (43 degrees C at prostate). The overall efficacy of this treatment was effective in 23 of the 30 patients (76.7%). In addition, there were no severe complications. As the size of this apparatus was miniaturized, it could be used at the bed side.

Aged↗
PubMed1990

Evaluation of flow electromyography in patients with benign prostatic hyperplasia.

Combined uroflowmetry and external sphincter electromyography studies were done both preoperatively and postoperatively in patients with benign prostatic hyperplasia. In 56 patients preoperative electromyography during voiding showed silent or markedly suppressed activity in 41 patients (73.2%), while the remaining 15 patients (27.8%) revealed active electromyography. In the postoperative studies, 12 patients revealed active electromyography even after the release of obstruction. The urine flow rate following operation was not drastically improved in the active electromyography group compared to the silent electromyography group. We suppose that long-term urethral obstruction with prostatic adenoma could influence the function of relaxation of the external sphincter muscle in some patients with benign prostatic hyperplasia.

Aged↗