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PubMed1994

Terazosin in the treatment of hypertension and symptomatic benign prostatic hyperplasia: a primary care trial.

BACKGROUND: Terazosin, an alpha 1 blocker initially used as an antihypertensive, was approved in 1993 for use in the treatment of benign prostatic hyperplasia (BPH) symptoms. This study was designed to determine the safety and efficacy of terazosin in treating patients with concomitant BPH and hypertension. METHODS: Middle-aged men with essential hypertension were enrolled by their primary care physicians in community practice. Those with symptoms of benign prostatic hyperplasia were identified by a Boyarsky scale score. The study was a 12-week, dose-escalation, open-label protocol for men aged 45 years and older. RESULTS: Enrollment in the study totaled 5365 patients. Of these, 1483 had Boyarsky scores of > or = 7, indicating symptomatic BPH. All patients with elevated blood pressure at the beginning of the study, including those with symptomatic BPH, showed significant reduction in blood pressure at the end of the 12-week trial. The patients with symptomatic BPH had statistically significant improvement in their BPH voiding symptoms. In the 1483 patients with BPH symptoms, terazosin produced a mean reduction of 55% in overall Boyarsky scores, 57% in obstructive symptom scores, and 54% in irritative symptom scores. In patients with baseline blood pressure < or = 150/90 mm Hg, blood pressure reductions were statistically significant but clinically irrelevant. Adverse events were mild. CONCLUSIONS: Terazosin is safe and effective in treating concomitant hypertension and BPH.

Adrenergic alpha-Antagonists↗
PubMed2005

Combination therapy for the pharmacological management of benign prostatic hyperplasia: rationale and treatment options.

The management of symptomatic benign prostatic hyperplasia (BPH) continues to evolve, with new techniques and forms of medical management being introduced and traditional surgical techniques being used less frequently. Medical management of BPH has evolved from nonspecific alpha-adrenoceptor antagonists to uroselective alpha-adrenoceptor antagonists and 5-alpha reductase inhibitors. Traditionally, alpha-adrenoceptor antagonists have been used for relief of lower urinary tract symptoms (LUTS) as a result of BPH and are known for their quick onset of action. 5-alpha Reductase inhibitors have proven useful for the prevention of BPH progression as measured by prostate volume, disease progression, incidence of acute urinary retention and the need for subsequent BPH-related surgery. Recent studies have shown that the combination of an alpha-adrenoceptor antagonist and a 5-alpha reductase inhibitor has significantly better efficacy than either drug alone or placebo. Currently, alpha-adrenoceptor antagonists are used in the acute setting or for short-term relief of LUTS. The combination of an alpha-adrenoceptor antagonist and a 5-alpha reductase inhibitor is used for the longer term management of BPH symptoms and to prevent progression of BPH and perhaps avoid surgical intervention.

Adrenergic alpha-Antagonists↗
PubMed2004

Volumetric density of elastic and reticular fibers in transition zone of controls and patients with benign prostatic hyperplasia.

OBJECTIVES: To analyze the volumetric density (Vv) of elastic and reticular fibers in the transition zone of controls and patients with benign prostatic hyperplasia (BPH). METHODS: Prostatic tissue samples were obtained from 25 patients (age range 63 to 79 years, mean 68) with clinical symptoms of bladder outlet obstruction who had undergone open prostatectomy. The control group was composed of 25 transition zone samples from prostates obtained during autopsy of adults aged younger than 30 years (killed in accidents). The Vv of the elastic and reticular fibers was determined in 25 random fields per prostate, using the point-count method with an M-42 grid test system. The data were analyzed using the Kolmogorov-Smirnov, Shapiro-Wilk W, and Mann-Whitney U tests. The Vv of these components was determined by stereologic methods. RESULTS: The Vv in the control and BPH groups was 12.47% +/- 3.6% and 16.55% +/- 9.11% in the elastic system fibers (difference not statistically significant) and 22.75% +/- 1.66% and 29.33% +/- 1.08% in the reticular fibers (difference statistically significant), respectively. CONCLUSIONS: Reticular fibers showed a statistically significant increase in the BPH samples, and this finding suggests that stromal network fibers play a significant role in BPH.

Adolescent↗
PubMed2005

[Benign prostatic hyperplasia and sexual dysfunction].

Lower urinary tract symptoms of benign prostatic hyperplasia, erectile dysfunction and ejaculatory disorders are often associated. The severity of sexual dysfunction is positively associated with increasing severity of urinary tract symptoms. Current treatment of BHP produce some effects, positive as well as negative, on the sexual function. It is important to remember this, when you choose a treatment for a patient who report regular sexual activity.

Humans↗
PubMed2002

[With alpha blockers, finasteride and nettle root against benign prostatic hyperplasia. Which patients are helped by conservative therapy?].

Symptomatic benign prostatic hyperplasia (BPH), which a man has a 50% chance of developing during the course of his lifetime, should receive stage-related treatment. While Vahlensieck stage I disease requires no therapy, stages II and III are indications for medication. Established medications for the treatment of BPH in current use are alpha-blockers, finasteride, and the phytotherapeutic agents pumpkin seed (cucurbitae semen), nettle root (urticae radix), the phytosterols contained in Hypoxis rooperi, rye pollen and the fruits of saw palmetto (sabalis serrulati fructus). If the patient responds, these medicaments can be given life-long, or intermittently. The hard criterion for the rational use of drug treatment of BPH is, over the long term, the reduction in the number of prostate operations. In stage IV disease surgical measures--after prior compensation of renal function--are to the fore.

Adrenergic alpha-Antagonists↗
PubMed1998

Transurethral microwave thermotherapy for benign prostatic hyperplasia--experience with the Prostcare.

Transurethral microwave thermotherapy for benign prostatic hyperplasia with the Prostcare has been used in our department since April 1992. Our research has mainly been focused on strategies for development of the apparatus, accessories, and treatment performance to find an optimal means of treatment. The development to high-power thermotherapy has demonstrated a significant improvement in symptom and quality-of-life scores, maximal flow rate, and residual and voided urinary volume after 6 months. Pressure-flow data have additionally demonstrated a significant decrease in the minimal urethral opening pressure. The improvement in outcome after high-power thermotherapy is associated with an increased short-term morbidity as compared with low-power treatment. The outcome is dependent on several factors: power and intraprostatic temperatures, treatment performance technique, configuration of heat distribution of the antennae, and the localization of maximal heat in the prostatic urethra.

Aged↗
PubMedDate not supplied

[Holmium laser treatment of benign prostatic hyperplasia].

Transurethral laser adenomectomy was performed in 37 patients with benign prostatic hyperplasia (BPH) aged 49-73 years (mean age 68 years) under epidural anesthesia. The intervention lasted 35-90 minutes (mean--55 minutes). Ho-YAG-laser was used (Versa Pulse, Coherent; 80 W, impulse regime, 2.09 microm, 50-100 Hz). 32 patients had intercurrent diseases (essential hypertension, diabetes mellitus, etc.). If the procedure technique was not violated, the postoperative period ran uneventfully. Coagulative effect of Ho-laser minimizes blood loss. Foley catheter was inserted. 12-24-h continuous irrigation of the urinary bladder was carried out. The drainage of the bladder with urethral catheter took 1-3 days. All the patients were discharged from hospital on postoperative day 5-7. Their condition was satisfactory. The patients were followed up for 8 months. Positive changes in urodynamics were recorded: I-PSS dropped from 21.4 to 11.2, maximal urine flow rate increased from 7.3 to 20.2 ml/s. Residual urine volume diminished to 0-30 ml compared to 190 ml before the operation. Secondary bleeding was absent. Minimal traumaticity and minimal blood loss allow to recommend laser adenomectomy both for BPH with and without intercurrent diseases.

Aged↗
PubMed1995

Minimally invasive surgery for benign prostatic hyperplasia--a review.

A whole range of new therapies for benign prostatic hyperplasia (BPH) is now being developed and evaluated. The traditional treatments for the benign enlarge and obstructing prostate, including open prostatectomy and more recently, transurethral resection of the prostate (TURP), are discussed, laying the groundwork for a detailed discussion of the different new minimally invasive modalities. These new modalities are discussed in three sections: modifications of TURP, non-ablative minimally invasive procedures and ablative minimally invasive procedures. Medications are not discussed. TURP remains predominant in the treatment of the obstructing benign prostate, but modalities like stents, microwave or radiofrequency or focused ultrasound-induced prostate thermotherapy as well as laser prostatectomy in its various forms and modifications may provide a wide selection for the urologist today. Although none of these have improved the effectiveness of TURP, the rates of morbidity in some are better, extending the limits of treatment. Costs too are a concern with some of these modalities being prohibitively expensive, whilst in others, savings in hospital stay and lesser morbidity may outweigh an expensive initial outlay. Many of these treatments are still evolving and well-constructed, prospective, randomised and long-term trials are required. Until one or more of these new treatments improve much further, TURP will remain the mainstay of BPH treatment.

Humans↗
PubMed1991

Experience with the Peponen capsule in the management of benign prostatic hyperplasia.

Sixty patients in Stages I and II of benign prostatic hyperplasia were treated with Peponen capsule. Out of them 26 took the drug for 10 months, 22 for at least 7, and 12 for at least 4 months. The daily dosage was 3 x 2 capsules in the first month and 3 x 1 capsule for the rest of the time. On the ground of urodynamic test results and changes in subjective complaints, more than 80% of the patients experienced improvement. The therapy intensified the uroflow, appeased dysuria, the difficult and painful discharge, and reduced the frequency of nocturnal urination.

Humans↗
PubMed2000

A monthly period of symptoms associated with benign prostatic hyperplasia.

The number of times that a man with benign prostatic hyperplasia awoke each night with the urge to urinate (nocturia) was analyzed for randomness by Bartlett's Kolmogorov-Smirnov white noise test and for a periodic component by Fourier analysis. The data series (n = 1549) was not white noise; it had a peak periodic component of 25 days, with a range of 21 to 37 days. The possibility that the monthly period of nocturia is a general phenomenon and is coupled to a monthly menstrual period, and the implications for more accurate diagnosis and new modes of therapy, are discussed.

Fourier Analysis↗
PubMed1995

[A single session of transurethral balloon laser thermotherapy for benign prostatic hyperplasia].

BACKGROUND: The objective of this study is to evaluate the efficiency of a new method of transurethral balloon laser thermotherapy (TUBAL-T) using prostalase in patients with benign prostatic hyperplasia. METHODS: From September 1993 to March 1994, 21 men were treated with a single session of TUBAL-T for the relief of bladder outlet obstruction secondary to benign prostatic hyperplasia. Thirteen of them had hormonal therapy before TUBAL-T and have no mediation after treatment (group A). Eight men had no hormonal therapy before and after TUBAL-T (group B). The clinical efficacy of this modality was evaluated by analysing the subjective and objective responses following the treatment. The laser balloon, equipped with a cooling system for preservation of urethral mucosa, delivers a Nd:YAG laser into the prostate. Treatment was performed by using a laser powder of 30 to 50 watts for 40 minutes. At 3 months after treatment, the clinical efficacy was evaluated by subjective symptom score, and residual urine volume, uroflowmetry and prostatic volume by transrectal ultrasound as objective data. RESULTS: In group A, subjective symptom scores decreased by an average of 72.8%, the average uroflow rates and the peak uroflow rates increased by an average of 44% and 45.9%, the post-void residual urine volume rates decreased by an average of 58.4% and ultrasonography showed that the prostatic volume decreased in 8 men but increased in 5 men. In group B, symptom score decreased by an average of 85.1%, the average uroflow rates and the peak uroflow rates increased by an average of 46.2%, the post-void residual urine volume rates decreased by average of 83.4% and ultrasonography showed that the prostatic volume decreased by an average of 35.6%. CONCLUSION: During the treatment and follow-up period, no adverse effect was detected. These results suggest that TUBAL-T for the relief of bladder outlet obstruction secondary to BPH is a useful therapy.

Aged↗
PubMedDate not supplied

LHRH agonists. A nonsurgical treatment for benign prostatic hyperplasia.

Luteinizing hormone-releasing hormone (LHRH) agonist, when administered in a continuous, nonpulsatile manner, causes desensitization of the LHRH receptor complex on the gonadotroph cells in the anterior pituitary gland. Biosynthesis and secretion of luteinizing hormone cease, and testicular androgenic production is inhibited. When used in this capacity, LHRH agonists can be an effective treatment for benign prostatic hyperplasia. After 4 to 6 months of therapy, prostatic volume decreases by 25% to 30%, voiding symptoms improve significantly in approximately 25% to 33% of patients, and the peak urinary flow rate increases substantially (more than 15 ml/second) in approximately 25% to 33% of patients. During the first month of treatment, serum luteinizing hormone, follicle-stimulating hormone, testosterone, dihydrotestosterone, 17 beta-estradiol, and prostate-specific antigen decline to low values and remain low throughout treatment. Prostatic 5 alpha-reductase activity and androgen receptor content also decrease with treatment. Side effects are significant: impotence, decreased libido, and hot flushes are the most common. Because the effect of LHRH agonist therapy on the serum testosterone concentration is reversible, treatment of benign prostatic hyperplasia with an LHRH agonist must be considered life-long therapy. Thus, this therapy should be reserved for patients who are impotent or who are poor surgical risks.

Amino Acid Sequence↗
PubMed1994

Tissue ablation in benign prostatic hyperplasia with high intensity focused ultrasound.

In a phase I clinical trial the morphological impact and safety of high intensity focused ultrasound administered transrectally for tissue ablation in prostates from 22 patients undergoing subsequent prostatectomy were evaluated. Location and size of the tissue lesions correlated well with the predefined target area and revealed sharply delineated coagulative necrosis in all cases. Intervening tissues, such as the rectal wall and posterior prostate capsule, were invariably intact. In a subsequent phase II clinical trial the effectiveness of transrectal high intensity focused ultrasound as a novel minimally invasive treatment modality for 50 patients with symptomatic benign prostatic hyperplasia was determined. The maximum urinary flow rate (ml. per second) increased from 8.9 +/- 4.1 to 12.7 +/- 6.4 at 3 months in 44 patients, 12.4 +/- 5.6 at 6 months in 33 and 13.1 +/- 6.5 at 12 months in 20. During the same period the post-void residual volume (ml) decreased from 131 +/- 120 to 48 +/- 41, 59 +/- 42 and 35 +/- 30, respectively, and the American Urological Association symptom score (points) decreased from 24.5 +/- 4.7 to 13.3 +/- 4.4, 13.4 +/- 4.7 and 10.8 +/- 2.5, respectively. These data demonstrate that transrectal high intensity focused ultrasound is capable of inducing coagulative necrosis in the human prostate via a transrectal approach while preserving intervening and adjacent tissue. A 47% (+4.2 ml. per second) improvement in uroflowmetry and a 53% (-13.7 points) decrease in the American Urological Association symptom score 1 year after treatment clearly prove that transrectal high intensity focused ultrasound is a novel and safe minimally invasive treatment option for benign prostatic hyperplasia.

Aged↗
PubMed1998

Benign prostatic hyperplasia in older men.

Urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) may adversely affect quality of life in many older men. Evaluation of patients with BPH should be focused on excluding complicating factors such as urinary tract infection, renal dysfunction, and malignancy. Watchful waiting is an appropriate option for men in whom such complicating conditions have been excluded. For those men who elect to be treated, therapy using alpha blockers (terazosin, doxazosin) or 5-alpha reductase inhibitors (finasteride) should be offered initially. Surgical treatment is generally reserved for patients who do not have a sufficient response to medical therapy and those with absolute indications for intervention, such as complete retention, recurrent infection or hematuria, renal insufficiency, and bladder stones.

5-alpha Reductase Inhibitors↗
PubMed2005

Is benign prostatic hyperplasia a risk factor for chronic renal failure?

PURPOSE: Benign prostatic hyperplasia (BPH) and chronic renal failure (CRF) are common medical conditions in older men. Based on the low prevalence of CRF in clinical trials recent American Urological Association guidelines have not recommended routine serum creatinine screening in men presenting with lower urinary tract symptoms. However, chronic renal failure is a well described complication of obstructive BPH. MATERIALS AND METHODS: A structured MEDLINE review of the literature on the association between BPH and CRF from 1966 to 2003 was performed. RESULTS: Most studies were referral based and did not represent the full spectrum of BPH in men. The definition of renal failure varied from a serum creatinine cutoff of 1.5 to 3.0 mg/dl. Differentiating acute and chronic renal failure, and acute and chronic urinary retention was often not done. Various combinations of chronic retention with large residual urine volumes (greater than 300 ml), detrusor instability and decreased bladder compliance were associated with chronic renal failure. Ureterovesicular junction obstruction from bladder remodeling in chronic urinary retention was the most commonly proposed mechanism for CRF. However, episodic acute urinary retention, urinary tract infections and secondary hypertension may also have a role. Studies showed significant improvement in renal function after prostate surgery but the acuity of renal failure was generally not known. CONCLUSIONS: The extent of the association between BPH and CRF is unknown and more community based, observational studies are needed. However, an association exists and it should be considered in men presenting with obstructive BPH or CRF.

Humans↗
PubMed1990

Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind, placebo-controlled study.

Whilst prostatectomy remains the "gold standard" for the treatment of outflow tract obstruction due to benign prostatic hyperplasia, medical treatment--if only for symptomatic relief--appears to be an attractive alternative. Most of the pharmacological agents in use block the hormonal or the sympathetic neurological pathways that influence prostate growth and function. All of these drugs are known to have side effects. Sixty patients with outflow obstruction due to benign prostatic hyperplasia (BPH) were entered into a double-blind, placebo-controlled study to evaluate the effect of a 6-month course of the pollen extract, Cernilton. There was a statistically significant subjective improvement with Cernilton (69% of the patients) compared with placebo (30%). There was a significant decrease in residual urine in the patients treated with Cernilton and in the antero-posterior (A-P) diameter of the prostate on ultrasound. However, differences in respect of flow rate and voided volume were not statistically significant. It is concluded that Cernilton has a beneficial effect in BPH and may have a place in the treatment of patients with mild or moderate symptoms of outflow obstruction.

Aged↗
PubMed2002

Symptomatic benign prostate hyperplasia: impact on partners' quality of life.

OBJECTIVES: Symptomatic benign prostate hyperplasia (BPH), besides affecting patients' quality of life through lower urinary tract symptoms (LUTS), and related acute events, may affect their partners' quality of life as well. The present study was focused on exploring partner morbidity in cases of symptomatic BPH patients being evaluated for surgical treatment. METHODS: The study group was comprised of 50 couples where male partners suffered from symptomatic BPH and was referred for further evaluation and, possibly, surgical treatment. Male subjects were asked to fill out the IPSS form, while the female partners were, separately, asked to fill out another structured questionnaire about 7 items (sleep disturbance, social disruption, performance of essential tasks, psychological impact, sex life, fear of cancer, fear of surgery). Data were analyzed in relation to the severity of symptoms (IPSS), patient's and partner's age, couple's age difference, marriage duration, mode and place of living. RESULTS: Partners' morbidity due to their husband's condition was comprised of sleep disturbance (28%); disruption of social life (30%) positively related to IPSS and negatively to the symptom duration; inability to take care of essential tasks outside and inside their house (8%); psychological burden (66%) positively related to the wife's age, the couple's age difference and the marriage duration; inadequate sex life (48%); fear of prostate cancer (62%); and fear of surgery (82%). CONCLUSIONS: Partners of patients with symptomatic BPH experience significant morbidity because of their husband's condition. The severity of patients' symptoms, however, is not always related to partners' morbidity. Partners should be adequately informed of the benign nature of the disease, as well as, the possible operating risks.

Adult↗
PubMed1996

Sexual function before and after transurethral microwave thermotherapy for benign prostatic hyperplasia.

The effect of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) on the ability of achieving erection and ejaculation was studied in one hundred and twenty patients. The patients underwent a single TUMT session for one hour without complementary treatment during the follow-up period of one year. A self-administered questionnaire on sexual functions was used. Our results showed that, despite individual reductions, there was an overall improvement in the ability to achieve erection. It was concluded that TUMT did not have any major adverse effects on sexual functions. However, it was not possible to predict that TUMT will improve sexual functions for the individual patient. Improvement of symptoms and a better quality of life may influence the results.

Aged↗