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PubMed1998

Predictability of conventional tests for the assessment of bladder outlet obstruction in benign prostatic hyperplasia.

BACKGROUND: The degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) is most accurately quantified by pressure flow studies (PFS), although these studies are more invasive and complicated than conventional tests. We examined how precisely conventional tests predicted the PFS-assessed degree of BOO. METHODS: The study population consisted of 232 BPH patients who had undergone routine conventional tests and PFS. Correlation of the conventional test results with the degree of BOO assessed by PFS was examined by Spearman's correlation coefficients. Regression and subgroup analyses were performed to predict the degree of BOO using the conventional test results as the explanatory variables. RESULTS: The degree of BOO correlated with prostate volume, the degree of endoscopic obstruction, and to a lesser extent, with the maximum flow rate (Qmax) and age. The predictability of conventional tests alone, or in combination, for BOO, was approximately 60% to 70%, which is not acceptable for investigational use. However, almost all patients with a prostate volume larger than 30 mL, or with severe obstruction on urethroscopic findings, had an obstructed bladder outlet. CONCLUSION: PFS is mandatory when the precise evaluation of the degree of BOO is required, and patients are highly likely to have an outlet obstruction when they have a prostate larger than 30 mL, or severely obstructed posterior urethra on endoscopy.

Aged↗
PubMed2006

The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia.

OBJECTIVES: To evaluate the relationship between metabolic syndrome and annual prostatic growth rates in benign prostatic hyperplasia (BPH) patients. METHODS: The 78 BPH patients with lower urinary tract symptoms included in this prospective study were divided into two groups according to whether they had a diagnosis of metabolic syndrome. This diagnosis was made according to the most recent consensus report of the National Cholesterol Education Program's Third Adult Treatment Panel. Blood pressure, body weight, body height, and waist and hip circumferences were measured. The body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Biochemical analyses including serum glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), insulin, and prostate-specific antigen (PSA) were performed. Total prostate (TP) volume and transitional zone (TZ) volume were measured by transrectal ultrasound. Annual TP and TZ growth rates were calculated. RESULTS: BPH patients with metabolic syndrome (first group) had significantly higher median body weight, BMI, serum glucose, serum triglyceride, and PSA levels but lower serum HDL-C level, compared with BPH patients without metabolic syndrome (second group, p<0.05). Median annual TP growth rate (1.0 ml/yr) and median annual TZ growth rate (1.25 ml/yr) were significantly higher in the first group versus the second group (0.64 ml/yr and 0.93 ml/yr, respectively, p<0.05). CONCLUSIONS: The present study demonstrates a further increase in prostate growth in BPH patients with metabolic syndrome. Future studies are needed to confirm our results and to explain underlying mechanisms.

Aged↗
PubMed2006

An examination of treatment patterns and costs of care among patients with benign prostatic hyperplasia.

OBJECTIVE: To examine utilization and costs of care for benign prostatic hyperplasia (BPH)-related services in a large cohort of commercially insured persons. METHODS: Pharmacy and medical claims data were obtained from 61 US healthcare plans. Men aged > or = 45 years who were newly diagnosed with BPH between January 2000 and March 2001 were identified. Each patient was followed for 12 months after diagnosis; utilization and costs were calculated for common procedures and disease-related events. Costs were estimated based on health plan payments. Univariate statistics were provided for relevant measures. RESULTS: A total of 77 040 patients were selected (mean age, 58.1 years). Thirty-six percent of patients had 1 or more urologist visits in the year after diagnosis. Two thirds of patients had a prostate-specific antigen test, whereas 7% had a prostate biopsy. A total of 14 392 patients (18.7%) received an alpha blocker during follow-up; 1860 patients (2.4%) received a 5-alpha reductase inhibitor. Approximately 2% of patients had a surgical procedure (either invasive or minimally invasive); transurethral prostatectomy costs averaged approximately dollar 5600, consisting of mean (standard deviation) costs of dollar 794 (dollar 470) for the procedure and dollar 4810 (dollar 8487) in associated inpatient costs. Re-treatment was common (18.7%) among patients with a surgical procedure, at a mean cost of dollar 1888 (dollar 1636). CONCLUSION: Most patients newly diagnosed with BPH appear to undergo watchful waiting in the year after diagnosis. Although rates of surgical intervention and adverse events at 1 year are low, these events are costly. Strategies to prevent or delay the need for surgery, such as regular examinations, testing, and use of pharmacotherapy where indicated, may further reduce the need for surgical intervention.

Aged↗
PubMed1987

5-Fluorouracil (5-Fu) in the treatment of prostatic hyperplasia.

A prospective study of 5-Fu in the treatment of prostatic hyperplasia was commenced in 1981. The short term results were fair in 70% of 43 patients. Atrophy of the glandular tissue could be observed on histopathologic examination. The study showed that the larger the glandular component the better was the therapeutic effect. If abundant fibromuscular tissue was present in the gland the treatment was unsatisfactory. Abnormal anatomy of the bladder neck, represented a contraindication to medical treatment.

Adult↗
PubMed1995

Doxazosin. An update of its clinical pharmacology and therapeutic applications in hypertension and benign prostatic hyperplasia.

Doxazosin is a long-acting alpha 1-adrenoceptor antagonist structurally related to prazosin and terazosin. Its antihypertensive effect is produced by a reduction in the smooth muscle tone of peripheral vascular beds resulting in a decrease in total peripheral resistance without significant effect on cardiac output or heart rate. In benign prostatic hyperplasia, doxazosin's effect of relieving bladder outflow obstruction is produced through a reduction in prostatic tone mediated via alpha 1-adrenoceptor blockade. In most comparative trials doxazosin has proven to be equally effective as the comparator drug in the treatment of mild to moderate hypertension. It has been used in a variety of patient populations including the elderly, Blacks, smokers, and patients with concomitant disease states such as renal dysfunction, hypercholesterolaemia, non-insulin dependent diabetes mellitus (NIDDM) and respiratory disease. Doxazosin has also been used successfully in combination with beta-adrenoceptor antagonists, diuretics, calcium channel antagonists, and angiotensin-converting enzyme inhibitors in patients with hypertension that is uncontrolled with monotherapy. Doxazosin has a beneficial effect on some of the risk factors associated with coronary heart disease including elevated serum lipid levels, impaired glucose metabolism, insulin resistance and left ventricular hypertrophy. Modest decreases in total cholesterol, low density lipoprotein cholesterol and triglycerides are seen with doxazosin therapy while small increases in high density lipoprotein cholesterol and the high density lipoprotein cholesterol/total cholesterol ratio are consistently reported. Some studies have reported an improvement in glucose tolerance although this effect has been more consistently seen in nondiabetic patients than in patients with NIDDM. Additionally, doxazosin produces a similar reduction in left ventricular hypertrophy to other antihypertensive agents. Modelling-based calculations suggest that doxazosin significantly reduces the risk of developing coronary heart disease in patients with mild to moderate hypertension, although this remains to be confirmed in long term prospective studies. Doxazosin appears to be a promising agent in the treatment of urinary symptoms associated with benign prostatic hyperplasia. Similar to other alpha 1-adrenoceptor antagonists, doxazosin treatment produces increases in peak and mean urinary flow rates and improves other objective and symptomatic measures.(ABSTRACT TRUNCATED AT 400 WORDS)

Carbohydrate Metabolism↗
PubMed2006

[Experiences in the treatment of benign prostatic hyperplasia with high power potassium-titanyl-phosphate (KTP) laser].

UNLABELLED: Benign prostatic hyperplasia (BPH) exist in about 70% men after 60 years old. High power KTP laser is a new tool for the treatment of BPH. MATERIAL AND METHOD: 49 men were treated by photoselective vaporisation of the prostate (PVP) from August 2003 to May 2004. Thirty patients with follow-up period longer than 12 weeks (12 to 26 weeks) were analyzed. Preoperative prostate volume ranged from 31 to 136 cc. PSA range, estimated before treatment, was normal in all patients (pts). International Prostate Symptom Score (I-PSS) estimated before treatment was over 24 and Quality of Life (QoL) was over 3 in all pts. The maximum peak urinary flow (Qmax) before treatment ranged from 7.2 to 14.1 ml/s. RESULTS: One patient was catheterized with Foley catheter at the finish of the procedure. Two pts required catheterization in the first day after treatment. In two pts increasing of body temperature to 38 degrees C was observed in the first day after treatment. Twenty four hours after treatment haematuria required catheterization was observed in one patient. Seven days after treatment in 4 pts massive haematuria was observed (two required hospitalisation). In one patient because of urinary retention 4 weeks after PVP transurethral resection of the prostate was performed. Four weeks after PVP I-PSS decreased from 24 to 20 and after 12 weeks to 15. The Qmax increased and ranged from 11.3 ml/s to 17.1 ml/s 4 weeks after PVP and 12 weeks after PVP ranged from 15.1 to 22.8 ml/s. CONCLUSIONS: Photoselective vaporization of the prostate reduces I-PSS in all patients 12 weeks after procedure. Short follow-up period and a limited number of patients in study group cannot lead to ultimate conclusions. However the results encourage to undertaking further studies on PVP for the treatment of BPH.

Adolescent↗
PubMed1993

Review of current medical treatment of benign prostatic hyperplasia.

Over the last 5-10 years new treatment modalities have appeared at an increasing pace. The emerging pharmacological treatment modalities have all been used on a large scale. The exact indications and limitations of these methods have not yet been definitely established. Careful analysis of the symptomatology is crucial in counselling the patient. The Danish prostatic symptom score model is proposed. However, treatment benefits should exceed harm and there must be a reasonable cost-effectiveness. The established clinical experience with pharmacological agents that reduce prostatic size and/or the tone in the prostate are effective in the treatment of benign prostatic hyperplasia. Selective alpha 1 blockers seem to be useful in patients with uncomplicated benign prostatic hyperplasia and mild to moderate symptoms. The side effects of hormone therapy are inhibitive for use in patients with a benign disease. Data currently available indicate a role for 5 alpha-reductase inhibitors yet to be defined.

Adrenergic alpha-Antagonists↗
PubMed2002

Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia.

PURPOSE: We studied the relationship of nocturia with the International Prostate Symptom Score in men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Baseline symptom score and the change in the score by treatment were analyzed in 219 consecutive Japanese men with BPH using basic statistics, and correlation, cluster and principal component analyses. RESULTS: The average nocturia score was the middle of that of the 7 symptoms at baseline and by far the highest after treatment. Hence, the score change was the smallest. Analysis of baseline scores demonstrated that all symptoms were the initial component in principal component analysis with individual symptom scores correlating with the total symptom score and quality of life index. However, the correlation was least for nocturia. Observations were similar when analyzing the score change by treatment. These results indicate that the nocturia score is least specific to symptoms associated with BPH or least sensitive to the therapeutic effect on symptoms. This finding may be related to the high nocturia score in the age matched control population. CONCLUSIONS: The nocturia score of the International Prostate Symptom Score behaves differently in the symptom complex of BPH in Japanese men, partially because it is most confounded by the aging factor.

Aged↗
PubMed1996

Testosterone metabolism in primary cultures of epithelial cells and stroma from benign prostatic hyperplasia.

We studied the metabolism of testosterone in primary cultures of prostate epithelial cells and fibroblasts obtained from patients with benign prostatic hyperplasia (BPH). The conversion of 3H-testosterone in both cell cultures was predominantly to the oxidative pathway, with the formation of 3H-androstenedione increasing with cell number and time of incubation. Although we also detected some 5 alpha-reductase activity in these cells, the activity in the stroma component (0.00688 pmol/mg protein/min) was nonetheless insignificant when compared to the 5 alpha-reductase activity in the tissue of origin (0.0616 pmol/mg protein/min) and well below the 17 beta-hydroxysteroid dehydrogenase activity of the same cells (0.0518 pmol/mg protein/min). The aromatase activity in our cells was also measured by two separate techniques, but neither the deuterium procedure nor the production of oestrone from androgen precursors yielded any positive results, suggesting that under these experimental conditions there was no aromatase activity within the cells. The shift from the reductive to the oxidative pathways in these primary cell cultures was reminiscent of the androgen-metabolizing enzyme profiles seen in poorly differentiated prostate cancer. Whether this transition is an obligatory step in the development of hormone refractiveness remains to be elucidated.

17-Hydroxysteroid Dehydrogenases↗
PubMed2000

Meta-analysis of clinical trials of permixon in the treatment of symptomatic benign prostatic hyperplasia.

OBJECTIVES: Permixon is a compound extracted from the fruit of the American dwarf palm tree, Serenoa repens. Controversy regarding the use of phytotherapeutic agents in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is significant. We analyzed all available clinical trial data of the Permixon preparation to determine its clinical efficacy compared with placebo. METHODS: All published clinical trial data on Permixon (11 randomized clinical trials and 2 open label trials), involving 2859 patients, were used. These trials were disparate in size (from 22 to 592 patients) and duration (from 21 to 180 days). Peak urinary flow rate and nocturia were the two common end points. The statistical analysis was based on a random effects meta-analysis. RESULTS: The average +/- SE placebo effect on the peak urinary flow rate was an increase of 0.51 +/- 0.51 mL/s. The estimated effect of Permixon was a further increase of 2.20 +/- 0.51 mL/s (P <0.001). Placebo was associated with a reduction in the mean number +/- SE of nocturnal urinations of 0.69 +/- 0.15. A further reduction of 0.50 +/- 0.01 episodes of urination (P <0.001) occurred that was attributable to Permixon. Some heterogeneity was found among the studies. Treatment duration did not appear to impact either of these effects. CONCLUSIONS: This meta-analysis of all available published trials of Permixon in the treatment of men with benign prostatic hyperplasia revealed a significant improvement in peak flow rate and reduction in nocturia greater than with placebo.

Androgen Antagonists↗
PubMed1994

Hyperthermia as a treatment modality in benign prostatic hyperplasia.

OBJECTIVE: To review the current status of hyperthermia (heating the prostate up to 45 degrees C) as a treatment modality for benign prostatic hyperplasia (BPH). METHODS: Hyperthermia versus thermotherapy is defined, the techniques and equipment are presented, and the current English literature regarding safety and efficacy is reviewed. RESULTS: Both transrectal and transurethral heat applications are very safe procedures. Most studies evaluating the efficacy have been nonrandomized and uncontrolled. The 50-70 percent symptom improvement rate should be compared with the natural history of the disease and the considerable placebo effect. The few controlled studies produced contradictory results. CONCLUSIONS: At the present time, hyperthermia has not been shown, in scientifically well-designed studies, to be a treatment modality with measurable and durable outcome in BPH.

Clinical Trials as Topic↗
PubMed1989

[Effects of the preparation of xiao long ling on experimental prostatic hyperplasia in mice].

The results of the experiments indicate that the prostatic hyperplasia caused by Testosteroni Propionatis in mice, cotton oil-induced local swollen ears of mice and the proliferation of granuloma produced by subcutaneous implantation of cotton pill in rats are inhibited significantly by the preparation of Xiao Long Ling. Xiao Long Ling depresses the increase of vascular permeability induced by a variety of inflammatory media such as histamine, 5-HT and PGE. Xiao Long Ling is found capable of inhibiting the platelet aggregation induced by ADP as well as depolymerizing the aggregated platelets.

Animals↗
PubMed1997

Changes in the prevalence of benign prostatic hyperplasia in China.

OBJECTIVE: To understand the rapid increase of benign prostatic hyperplasia (BPH) in China by a comparative study of the nutrition status and BPH morbidity between urban and rural areas. METHODS: A study was conducted in 1993-1995 in Beijing on the influence of diet on the prevalence of BPH in 413 rural and 419 urban male inhabitants over 40 years of age. RESULTS: The results indicated distinctive differences in dietary patterns and the prevalence of BPH between rural and urban inhabitants. CONCLUSION: The changing prevalence of BPH in China can be attributed to the increased daily intake of total calories, fat and animal protein, and the decreased daily intake of vegetables and whole grain, the sources of phytoestrogens.

Adult↗
PubMed1993

[Pharmacological treatment of benign prostatic hyperplasia].

Over the last five to ten years, new treatment modalities have appeared at an increasing pace. The emerging pharmacological treatment modalities have all been used on a large scale. The exact indications and limitations of these methods have not yet been definitely established. Careful analysis of the symptomatology is crucial in counseling the patient. The Danish Prostatic Symptom Score model (DAN-PSS) is proposed. However, treatment benefits should exceed harm and there must be a reasonable cost-effectiveness. Pharmacological agents that reduce prostatic size and/or the tone in the prostate are effective in treatment of benign prostatic hyperplasia. Selective alpha-1 blockers seem to be useful in patients with uncomplicated benign prostatic hyperplasia and mild to moderate symptoms. The side effects of hormone therapy are prohibitive for use in patients with a benign disease. Data currently available indicate a yet to be defined role for 5-alpha-reductase inhibitors.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

[Prostaplant treatment of benign prostatic hyperplasia].

80 patients aged 48 to 91 years with verified benign prostatic hyperplasia (BPH) stage I and II, having contraindications to surgery, received prostaplant, extract of Sabal serrulata palm fluit, in a dose 320 mg once a day. The treatment resulted in improvement of subjective and objective parameters (the total IPSS score improved by 32.3%, quality of life by 36.4%; maximal urine flow rate by 27.4%, respectively). Residual urine volume reduced in patients of group I by 26.8%, in patients of group II by 25.5%. The drug tolerance was good. 3 patients failed treatment. Good and satisfactory effects were achieved in 69 and 8 patients, respectively. Therefore, prostaplant is effective in BPH.

Aged↗
PubMed1992

Patient recruitment to and cost of a prospective trial of medical treatment for benign prostatic hyperplasia.

409 consecutive patients, referred by general practitioners for assumed benign prostatic hyperplasia (BPH), were evaluated for inclusion into a hormone therapy trial for BPH. 97 patients were excluded initially. Upon examination of the 312 remaining patients, 221 were found to be ineligible for various reasons and 11 refused to participate. Other patients were excluded after a second, more extensive examination and 5 patients withdrew during the trial. We are now left with 66 patients (16.1% of the patients initially referred), of which approximately 33 are receiving placebo treatment. The financial costs for the hospital to carry out a drug trial with approximately 65 evaluable patients is estimated to exceed 40,000 pounds.

Aged↗
PubMed1994

Transurethral resection of the prostate for benign prostatic hyperplasia--a local review.

There has been a recent resurgence of interest in the role of transurethral resection of the prostate for benign prostatic hyperplasia in view of the introduction of new modalities. We have conducted a retrospective analysis of 175 cases operated from October 1988 to June 1989 with an aim to ascertain the present mortality and morbidity rates associated with this procedure. The main presenting symptoms were acute retention of urine (54%) and bladder outlet obstruction (33%). The average weight of the prostate resected was 24.2 gm and 3% of specimens revealed malignant changes on histology. Seventy-five percent of the patients have post-operative stay of 5 days or less. Urinary tract infection was the commonest complication (16%). Clot retention requiring re-scope occurred in 2% of our patients. Twelve percent (12%) of our patients developed acute retention post-operatively but only 2% required re-scope as the rest resolved conservatively. We had one mortality in our series as a result of post-operative pneumonia. After 6 months follow-up, 4% complained of mild urinary incontinence and another 4% noted retrograde ejaculation. Six percent developed urethral strictures which required surgical treatment. Three years after the procedure, we retrieved the case notes of our cohort to analyse long-term results. We note that ninety-eight percent of our patients were discharged after nine months follow-up. This includes the 4% who complained of mild stress incontinence at 6 months follow-up. The remaining 2% was discharged after 24 months because of recurrent urethral stricture.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗