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PubMed2004

Association of hypertension with symptoms of benign prostatic hyperplasia.

PURPOSE: We determined whether the intensity of benign prostatic hyperplasia (BPH) symptoms and arterial hypertension are associated. MATERIALS AND METHODS: Baseline data from a large sample of men seeking treatment for BPH symptoms were analyzed retrospectively. BPH symptom intensity (assessed by the International Prostatic Symptom Score [I-PSS] or urinary flow rate [Qmax]) and blood pressure were determined in 9,857 patients with BPH. Normotension was defined as a diastolic blood pressure of 90 mm Hg or less, the absence of the diagnosis hypertension and the lack of antihypertensive medication (in 4,725). Hypertension was concomitantly defined as a diastolic blood pressure of greater than 90 mm Hg (in 1,727), being diagnosed with hypertension (1,950) or the current prescription of anti-hypertensive drugs (3,360 patients). RESULTS: When age and presence of hypertension were used as the independent explanatory variables, each year of age contributed 0.13 points and measured hypertension 1.60 points to I-PSS as the dependent response variable. Similar results were obtained with Qmax as the dependent response variable. In a logistic regression procedure using age, I-PSS and Qmax as the independent explanatory variables, each year of age and each I-PSS point significantly increased the risk of being hypertensive by 5.3% and 5.0%, respectively, while Qmax did not yield a statistically significant contribution to that risk. CONCLUSIONS: We conclude that a significant, age independent association exists between BPH symptoms and hypertension. This finding indicates a common pathophysiological factor for both disease states such as increased sympathetic activity.

Age Factors↗
PubMed2005

Extraperitoneal laparoscopic prostatectomy (adenomectomy) for obstructing benign prostatic hyperplasia: transvesical and transcapsular (Millin) techniques.

PURPOSE: We describe extraperitoneal laparoscopic resection of large prostatic adenomas (<100 g) as an alternative to open simple prostatectomy by both the transcapsular or Millin and the transvesical approaches. PATIENTS AND METHODS: We have performed more than 20 laparoscopic prostatectomies (adenomectomies) for benign prostatic hyperplasia (BPH) for glands >100 g. The initial two cases, with follow-up longer than 1 year, are included in this report. Using an extraperitoneal approach, enucleation of the obstructing prostatic lobes was performed with the aid of a Harmonic Scalpel and laparoscopic claw forceps. Hemostatic sutures were placed at 5 and 7 o'clock. The urethrovesical junction (transvesical) or capsulotomy (Millin) were closed in an interrupted fashion using intracorporeal sutures. RESULTS: Both procedures were successful. The total operative time was 180 minutes for first the case and 120 minutes for the second. The adenoma removed was approximately 138 g in the first case and 102 g in the second case. The estimated blood loss was <50 mL and <200 mL, respectively. The postoperative courses were unremarkable. Analgesic requirements were minimal, and the patient was discharged on postoperative day 2 and 3, respectively. A follow-up examination at 1, 3, 6, and 12 months showed that the flow rate is >20 mL and the postvoiding residual volume 0, with normal continence and sexual potency in both men. CONCLUSIONS: Extraperitoneal laparoscopic simple prostatectomy is a simple straightforward technique. Minimal bleeding, a reduced transfusion rate, shorter hospitalization, and faster recovery are additional advantages. This minimally invasive technique is a reasonable alternative to open simple prostatectomy for large glands with reduced morbidity.

Adenoma↗
PubMed1997

The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists.

PURPOSE: We defined outcomes for men with a clinical diagnosis of benign prostatic hyperplasia. MATERIALS AND METHODS: We followed for 4 years 500 candidates for elective prostatectomy treated nonoperatively in 5 North American urology practices. RESULTS: There were 371 survivors with complete data at 4 years. Of 60 men with mild, 245 with moderate and 66 with severe baseline symptoms 10, 24 and 39%, respectively, had undergone surgery; 27, 31 and 27%, respectively, were on pharmacological therapy, and 63, 45 and 33%, respectively, were off active treatment at 4 years. Mild or moderate symptoms were noted at 4 years in 83, 59 and 23% of the patients, respectively, while 17, 41 and 77%, respectively, had severe symptoms or had undergone surgery. CONCLUSIONS: Outcomes for men with a clinical diagnosis of benign prostatic hyperplasia depend on initial symptom severity. However, the course of symptoms also varies among patients even with the same initial symptom severity.

Cohort Studies↗
PubMed2003

[Measurement and analysis of different serum PSA in patients with benign prostatic hyperplasia].

OBJECTIVES: To analyze the stability of different serum prostate-specific antigens (PSA) in patients with benign prostatic hyperplasia (BPH), and investigate their application value in the diagnosis of prostate disease. METHODS: One hundred and five patients with BPH were divided into 3 groups by their total PSA (tPSA) level, 67 in group A (tPSA < 4 micrograms/L), 26 in group B (4 micrograms/L < or = tPSA < or = 10 micrograms/L) and 12 in group C (tPSA > 10 micrograms/L). These patients were also divided into another 3 groups by age, 18 in group a (< or = 55 years old), 33 in group b (from 56 to 69 years old) and 54 in group c (> or = 70 years old). tPSA, free PSA (fPSA) and complexed PSA (cPSA) were measured by magnetism-particulate-immuno-chemistry luminescence method, the ratios of cPSA/tPSA, fPSA/tPSA, fPSA/cPSA were calculated in 105 patients with BPH, and their stabilities were compared in different tPSA level and age groups. RESULTS: The ratios of cPSA/tPSA, fPSA/tPSA and fPSA/cPSA were steadier than other PSAs in different tPSA level and age groups with BPH. CONCLUSION: The ratios of cPSA/tPSA, fPSA/tPSA and fPSA/cPSA probably have more application value in the diagnosis of prostate disease.

Adult↗
PubMed1997

[5-alpha-reductase inhibitors in benign prostatic hyperplasia].

Sixteen patients presenting benign prostate gland hyperplasia undergo conservative treatment with Finasterid over the period 1992 through 1995. Prior to treatment, in all patients the subjective complaints are assayed on the basis of the IPSS rating system for severity of complaints. Uroflowmetry along with evaluating the quantity of residual urine using an isotope method, and echographic determination of the prostate gland volume, are performed. During the six- to nine-month follow-up study, an increase in maximal urinary output by 3.2 ml/sec, as well as reduction of the prostate gland volume by 24.5 per cent are documented in 78 per cent of the patients against the background of alleviated subjective complaints in 69 per cent.

5-alpha Reductase Inhibitors↗
PubMed1987

Benign prostatic hyperplasia and uterine leiomyomas in a female pseudohermaphrodite: a case report.

A 60-year old female pseudohermaphrodite with congenital adrenal hyperplasia presented with acute retention of urine and a lower abdominal mass. At laparotomy a large uterus with multiple leiomyomas was removed. Transurethral resection of the obstructing bladder neck revealed benign prostatic hyperplasia. This patient demonstrates that benign prostatic hyperplasia may develop in the presence of androgens from an extratesticular source.

Adrenal Hyperplasia, Congenital↗
PubMed1994

Chromosome abnormalities in benign prostatic hyperplasia.

We combined conventional cytogenetic analysis and fluorescence in situ hybridization of short-term cultures of 28 samples from benign prostatic hyperplasia. Loss of the Y chromosome was the most common chromosome change, followed by trisomy 7. Trisomy 7, however, may be unrelated to the origin of benign prostate hyperplasia, in which the only and not very specific change seems to be the loss of the Y chromosome.

Adult↗
PubMed1999

Ethanol injection therapy of the prostate for benign prostatic hyperplasia: preliminary report on application of a new technique.

PURPOSE: We evaluate the efficacy of a new technique of minimally invasive treatment for benign prostatic hyperplasia involving direct injection of dehydrated ethanol. MATERIALS AND METHODS: Dehydrated ethanol was injected transurethrally with lumbar or sacral and urethral anesthesia in 10 patients with prostatic hyperplasia. Endoscopic injection was performed at 4 to 8 sites in the prostate and 3.5 to 12.0 ml. ethanol were used. RESULTS: There were no intraoperative complications but postoperative urinary retention occurred transiently in all patients which required catheterization for a mean of 8.8 days. Mean symptom score plus or minus standard deviation was 12.2+/-5.8 at 3 months postoperatively, which was significantly improved from 23.1+/-7.0 preoperatively (p<0.01). Mean quality of life score also improved significantly from 5.1+/-0.6 preoperatively to 3.2+/-1.5 at 3 months postoperatively (p<0.01), mean peak urinary flow rate increased from 8.0+/-2.2 (9 patients) to 13.1+/-3.6 ml. per second (p<0.05) and mean residual urine volume decreased from 129.1+/-55.3 (9 patients) to 49.3+/-34.7 ml. (p<0.05). There was no significant change in prostate volume. Acute epididymitis and chronic prostatitis occurred in 1 patient each. CONCLUSIONS: This technique can be performed as an outpatient procedure and appears to be safe and cost-effective. Retrograde ejaculation can be avoided.

Aged↗
PubMed1994

Histological evaluation of benign prostatic hyperplasia treated by long-term administration of chlormadinone acetate (CMA).

Although the clinical effects of attempted nonsurgical treatment of benign prostatic hyperplasia have been well documented, detailed histological evaluation of the effects of treatment appears to be limited. The effect of long-term administration of an antiandrogen, chlormadinone acetate (CMA), on benign prostatic hyperplasia was evaluated with histological comparison of two biopsy specimens, one before treatment and one after treatment. Secretory epithelium showed obvious regressive changes with occasional basal cell prominence after CMA treatment. Stromal elements, however, did not show any marked changes, except for occasional edematous loosening. Scores of multiple epithelial parameters tended to be correlated with clinical improvement in urinary obstructive symptoms, especially in patients with predominant glandular hyperplasia. These results suggest that long-term administration of the potent antiandrogen CMA to inhibit dihydrotestosterone-receptor binding might be a useful therapeutic maneuver in patients with glandular hyperplasia, without any deterioration of the stromal component.

Aged↗
PubMed2004

Sonographic assessment of postvoid residual urine volumes in patients with benign prostatic hyperplasia.

OBJECTIVE: To derive a formula that defines the postvoid residual (PVR) urine volume more accurately in patients with prostatic gland enlargement. DESIGN: Prospective. SETTING: Department of Radiology, University of Ilorin Teaching Hospital, Ilorin. SUBJECT: Fifty-two consecutive patients with benign prostatic hyperplasia. The mean age was 64.98+/-9.57 years. METHOD: PVR urine was evaluated by ultrasonography. Each patient had two examinations, the first of which was with a full bladder and the second of which was immediately after voiding. Two orthogonal diameters were measured on each bladder section (longitudinal and transverse) in the supine position. Fifty-two paired sets of ultrasonic measurements were thus obtained. Catheterized postvoid urine residue was regarded as the gold standard. RESULTS: Using these measurements, an equation--[PVR(CUBIC)=374.057+(-196.94+V1)+(32.5539+V1(2))+(-1.1480+V1(3)) where V1=average of the length (L), width (T), and the anteroposterior distance on transverse section (Dt) of the postvoid urinary bladder]--more accurate than previously existing ones was obtained by cubic regression analysis. Mean ultrasound estimated volume was 220.51 ml as against 220.76 ml after catheterization. The mean difference was 0.25 ml (not significant, p<0.01) with 95% confidence interval of +/-10 ml. With this equation, the ultrasonographic residual urine volume showed a higher correlation coefficient with the catheterized volume at p<0.01 (Pearson r=0.982, r2=0.96) than previously defined formulas. The standard error of the mean was 5.11 ml (mean=220.5+/-190.4 ml). CONCLUSION: With the above equation, we consider conventional transabdominal ultrasonography a reliable method for assessing the residual urine volume in patients with benign prostatic hyperplasia. This equation, though complex when compared to some of the pre-existing formulas, can be integrated into the memory of modern ultrasound machines for easy and faster computation.

Aged↗
PubMed2006

Pressure-flow studies in patients with benign prostatic hyperplasia: a study comparing suprapubic and transurethral methods.

AIM: To compare the use of the suprapubic puncture method versus the transurethral method in pressure-flow studies in patients with benign prostatic hyperplasia. METHODS: Twenty-three men with benign prostatic hyperplasia underwent both suprapubic and transurethral pressure-flow studies during a single session. Standard pressure-flow variables were recorded in all patients with both methods, enabling calculation of obstruction using commonly used grading systems, such as the urethral resistance algorithm, the Abrams-Griffith (AG) number and the Schaer linear nomogram. RESULTS: There were statistically significant differences between the methods in the mean values of maximum flow rate (P < 0.05), detrusor pressure at the maximum flow (P < 0.01), urethral resistance algorithm (P < 0.01), AG number (P < 0.01) and maximum cystic capacity (P < 0.01). Of the men in the study, 10 (43.5%) remained in the same Schaer class with both methods and 18 (78.3%) in the same AG number area. Using the transurethral method, 12 (52.2%) men increased their Schaer class by one and 1 (4.3%) by two. There were also differences between the suprapubic and transurethral methods using the AG number: 4 (17.4%) men moved from a classification of equivocal to obstructed and 1 (4.3%) from unobstructed to equivocal. CONCLUSION: The differences between the techniques for measuring intravesical pressure alter the grading of obstruction determined by several of the commonly used classifications. An 8 F transurethral catheter significantly increases the likelihood of a diagnosis of bladder outlet obstruction when compared with the suprapubic method.

Aged↗
PubMed2004

A systematic review of holmium laser prostatectomy for benign prostatic hyperplasia.

PURPOSE: We undertook a systematic review to assess the safety and efficacy of holmium laser prostatectomy compared to transurethral resection of the prostate. MATERIALS AND METHODS: We searched literature databases through August 2002. Holmium laser studies, including holmium laser resection of the prostate (HoLRP) and holmium laser enucleation of the prostate (HoLEP), of any design, and the transurethral prostatectomy (TURP) arms of randomized controlled trials (RCTs) with sample sizes greater than 50 patients, date restricted to 1995 onward, were included for comparison. RESULTS: Three RCTs comparing HoLRP and TURP, and 2 RCTs comparing HoLEP and TURP were identified. For each of the holmium procedures there was also 1 nonrandomized comparative study and a number of case series (HoLRP 13, HoLEP 10). With the exception of 1 randomized trial the quality of the available evidence was poor, with the other RCTs lacking information regarding methods of randomization, allocation concealment and blinding. The majority of studies were characterized by relatively short followup periods and significant losses to followup. In terms of safety the data suggest that the holmium laser procedures are superior to TURP with regard to a number of key indicators of blood loss (transfusion rates, postoperative bladder irrigation, duration of catheterization and length of hospital stay), although amount of blood loss was rarely reported. In terms of efficacy the holmium laser procedures appear to be similarly effective to TURP in relieving the symptoms of benign prostatic hyperplasia. CONCLUSIONS: Holmium laser prostatectomy is at least as effective as TURP for managing the symptoms of benign prostatic hyperplasia. However, at the present time the long-term durability of the holmium procedures with respect to TURP cannot be determined due to a lack of published studies with sufficient followup.

Holmium↗
PubMed2003

Growth factor expression in early stages of benign prostatic hyperplasia upon exposure to sustained delivery of androgens.

Benign prostatic hyperplasia (BPH) is a condition that affects a significant population of older males, yet its pathogenesis is not clearly understood. This study was designed to give broader insight into the early development of BPH by looking at changes in growth factor production in the ventral prostate. To accomplish this, Sprague Dawley rats (n = 16, 250-300 g) were randomly divided into four equal groups. Three treatment groups were each implanted with ceramic drug delivery devices that were designed to deliver continuous physiologic doses of testosterone (T), dihydrotestosterone (DHT), and androstenedione (AED) for ninety-day duration. Immuno-histochemical analysis for epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) indicated whether these growth factors were involved in early processes of BPH induced by the delivery of androgens. Histopathological evaluation demonstrated increased positive reactivity for both EGF and bFGF in all steroid treated animals compared to controls. A similar trend was observed in the vascular endothelium. This information could be helpful in developing new methods for early diagnosis of BPH, but more importantly this knowledge provides the literature with clues about the cellular responses encountered at the initiation of the disease process.

Androgens↗
PubMed2006

Expression analysis of peptide growth factors VEGF, FGF2, TGFB1, EGF and IGF1 in prostate cancer and benign prostatic hyperplasia.

Peptide growth factors play an important role in several intracellular processes, such as cellular growth and differentiation, angiogenesis and apoptosis, as well as in carcinogenesis, since they contribute significantly to the malignant transformation. The prostate gland is abundant in growth factors. The two most known prostatic diseases, prostate cancer (PCa) and benign prostatic hyperplasia (BPH), are among the most common diseases that affect elderly men. This study was conducted using a quantitative real-time RT-PCR method in order to determine mRNA expression levels of peptide growth factors VEGF, FGF2, TGFB1, EGF, and IGF1 in tissue specimens from 42 patients with PCa, 42 with BPH, and 10 normal prostate samples obtained post-mortem from young individuals, in order to examine their association with prostatic hyperplasia and neoplasia. Our results show that in PCa, growth factors VEGF, EGF and FGF2 are overexpressed, while TGFB1 and IGF1 have reduced mRNA levels. In BPH, transcript levels of FGF2 and EGF are normal, while VEGF, TGFB1 and IGF1 exhibit downregulation. Further statistical analysis revealed that PCa patients with high levels of PSA blood levels have decreased FGF2 expression (p=0.016). Additionally, cancer patients with low Gleason score (<7) have increased EGF (p=0.035) and IGF1 (p=0.031) mRNA levels. IGF1 levels are also elevated in tumors with TNM stages T1-T2 (p=0.030). In BPH, older patients have reduced EGF expression (p=0.018), while IGF1 is overexpressed in younger patients (p=0.041). Additionally, the co-expression pattern of the five studied growth factors differs significantly among normal, benign and malignant prostate. These results implicate VEGF, FGF2, TGFB1, EGF and IGF1 in the development of both PCa and BPH, rendering them potential targets for disease detection, monitoring and therapy.

Adult↗
PubMed2005

[Correlation of benign prostatic hyperplasia with hyperlipemia].

OBJECTIVE: To investigate relationship between benign prostatic hyperplasia (BPH) and hyperlipemia, and to clear out possible factors related to BPH etiology. METHODS: A total of 462 cases of BPH diagnosed by pathological examination were studied retrospectively. RESULTS: Of 462 cases, BPH with hyperlipemia was noted in 232 cases (50.22%). In comparison with the data of simple BPH, both prostate volume (P = 0.029) and residual urine (P = 0.03) were significantly increased in the BPH patients with hyperlipemia. Statistical analysis regarding the effects of different components of serum lipid on BPH clinical factors showed that the level of high density lipoprotein was significantly associated with both the enlargement of prostate volume (P < 0.05) and increasing of serum PSA (P < 0.05) Further study indicated that hypertension was demonstrated in 39.2% patients of BPH with hyperlipemia. Hyperlipemia accompanied with hypertension in BPH patients was significantly related to increased IPSS (P = 0.004). CONCLUSION: The situation of BPH with hyperlipemia is frequently noted in clinics, and the decreased level of high-density lipoprotein is significantly associated with the enlargement of prostate volume. Co-existence of hypertension with hyperlipemia in BPH patients greatly worsens the lower urinary tract symptoms (LUTS) of BPH. Hyperlipemia may be one of the risk factors in the processes of BPH growth and progression.

Aged↗
PubMed1990

Multichannel urodynamic studies in men with benign prostatic hyperplasia. Indications and interpretation.

Recent studies suggest that clinical "prostatism" encompasses at least four conditions that may be present singly or in combination: prostatic urethral obstruction, impaired detrusor contractility, detrusor instability, and sensory urgency. In addition, primary vesical neck obstruction may be present in the absence of benign prostatic hyperplasia (BPH). Thus, the purpose of diagnostic evaluation in men with BPH is to identify precisely the pathophysiology of the patient's symptoms so that rational therapy can be selected.

Humans↗
PubMed2000

A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride.

PURPOSE: We prospectively studied the effect of finasteride on chronic hematuria associated with benign prostatic hyperplasia. MATERIALS AND METHODS: We prospectively evaluated 57 patients with chronic intermittent hematuria who were randomized to a finasteride treated or a control arm. RESULTS: In the untreated control group hematuria recurred in 17 patients (63%) within a year but in only 4 (14%) in the finasteride group, which was a statistically significant difference (p <0.05). Surgery was required for bleeding in 7 controls (26%), while no patient on finasteride required surgery. CONCLUSIONS: Hematuria secondary to prostatic bleeding may be significant if not treated. Finasteride appears to be effective for suppressing hematuria caused by benign prostatic hyperplasia and should be considered as treatment.

Aged↗