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PubMed1994

Prostatism and the burden of benign prostatic hyperplasia on elderly men.

All men aged 40-79 years registered with two group general practices in Central Scotland were enumerated. Four hundred and ten men (249 in the working age group 40-64 years and 161 in retirement ages 65-79 years satisfied predetermined criteria for clinical benign prostatic hyperplasia (BPH) of prostatic weight > 20 g in the presence of urinary dysfunction and without evidence of malignancy. Despite a higher prevalence of BPH among the retirement group (428/1000) compared with men of working ages (202/1000), there were virtually no statistically significant differences between the two groups in terms of annoyance and interference in daily living activities caused by urinary dysfunction, frequency of urinary symptoms, or medical consultations for BPH. Although elderly men with BPH changed their lifestyle as a result of urinary dysfunction, only a low proportion of them disclosed their difficulties to a doctor. Increased education of the public and health care professionals about the nature and magnitude of the problem of BPH in elderly men is required.

Activities of Daily Living↗
PubMed2000

A comparison of fluid absorption during transurethral resection and transurethral vaporization for benign prostatic hyperplasia.

OBJECTIVES: To compare the absorption of irrigant fluid during transurethral vaporization of the prostate (TUVP) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Thirty patients with clinical benign prostatic hyperplasia were randomly assigned to undergo TURP or TUVP; 1.5% glycine +1% ethanol solution was used as the irrigating solution. The volume of irrigant absorbed during surgery was estimated from the ethanol concentration in the patient's expired breath, sampled every 10 min. RESULTS: In both groups, the estimated absorbed fluid volume increased with the duration of surgery (P < 0.05). At the end of surgery, the mean (median, range) fluid absorption during TUVP was 672 (606, 0-1400) mL and during TURP was 1347 (975, 453-2965) mL; the difference was statistically significant (P < 0.05). CONCLUSION: Although TURP has a greater associated risk of fluid absorption than TUVP there may still be severe fluid absorption with the latter. Even though TUVP is potentially less harmful than TURP in poor-risk patients, ethanol monitoring is beneficial for increasing patient safety.

Absorption↗
PubMed1996

Transurethral microwave thermotherapy for benign prostatic hyperplasia. Subjective response and urodynamic changes.

Results of transurethral microwave thermotherapy for benign prostatic hyperplasia were good after 1 year in 68% of 66 cases. Despite good correlation between subjective assessment of results and improvement in urodynamic parameters, no predictive factors for probably successful outcome could be identified. Diminution in frequency of micturition (diurnal from 8.8 to 6.8 times, nocturnal from 3.0 to 1.6 times), increased flow rates (Q max from 8.8 to 14.2 ml/s) and reduction of detrusor pressures during voiding (Pdet max from 86.9 to 75.0 cm H2O) were significant, but the change in residual volume (from 52 to 37 ml) was of lesser degree (all mean values). Transurethral microwave thermotherapy can be tried for relief of moderate obstruction when transurethral prostatic resection involves risk, or the patient himself requests noninvasive treatment.

Aged↗
PubMed1995

DNA base modifications and antioxidant enzyme activities in human benign prostatic hyperplasia.

The authors have studied DNA base damage and activities of antioxidant enzymes in human benign prostatic hyperplasia (BPH) tissues and surrounding disease-free tissues removed from prostate glands of 15 patients. In these tissues, endogenous levels of various typical hydroxyl radical-induced products of DNA bases and activities of catalase and superoxide dismutase were measured. The majority of patients had higher levels of DNA base lesions and lower activities of enzymes in BPH tissues than in normal prostate tissues. When activities of both enzymes were lower in BPH tissues than in normal tissues, the increases in the amounts of DNA base lesions over control levels were most prominent. In the case of similar enzyme activities in both BPH and normal tissues, no changes in levels of DNA base lesions were observed. These results suggest a possible association between antioxidant enzyme activities and levels of DNA base lesions in BPH tissues. Some of the identified DNA lesions are known to be premutagenic and may play a role in carcinogenesis. Although a possible link between BPH and prostate cancer is controversial, BPH patients with both decreased antioxidant enzyme activities and increased levels of DNA lesions may be at risk of developing prostate cancer.

Antioxidants↗
PubMedDate not supplied

[Treatment of arterial hypertension in patients with benign prostatic hyperplasia].

Arterial hypertension (AH) is encounted in 20-30% of patients with benign prostatic hyperplasia (BPH). Alpha1-adrenoblockers have limited application in such patients and should be used as a first-line therapy only in those BPH patients who already receive them for BPH. In other cases AH is managed with thiaside diuretics, beta-adrenoblockers, ACE inhibitors or calcium antagonists. A drug of choice for correction of urination disorders in BPH hypertensive patients is alpha1A-adrenoblocker tamsulozin.

Adrenergic alpha-Antagonists↗
PubMed1994

Benign prostatic hyperplasia. Current pharmacological treatment.

During the past decades, pharmacological treatment of symptomatic benign prostatic hyperplasia (BPH) has become a fairly established modality. Approaches include blockade of alpha-adrenoreceptors and suppression of androgens. Patients eligible for drug treatment are those with mild to moderate symptoms of BPH and no strong indications for surgery. alpha-Receptor blockers generally improve urinary symptoms and peak urinary flow rates 2 to 4 weeks after introduction of therapy. Because of minor adverse effects, selective alpha 1-blockers are preferred over nonselective drugs. Prazosin, terazosin and alfuzosin are extensively studied and widely used in BPH treatment. Terazosin might be preferred to prazosin and alfuzosin because it can be administered once daily, but a disadvantage is higher cost. Doxazosin and tamsulosin (amsulosin; YM 617) are drugs currently under clinical investigation in the treatment of BPH. Antiandrogen therapy induces reduction in prostate volume and relief in symptoms of bladder outlet obstruction. However, the only drug which seems to be of major interest in BPH treatment is finasteride. Other drugs [gonadotrophin-releasing hormone (GnRH) agonists, progestogens and flutamide] are associated with frequent and sometimes severe adverse effects, such as impotence, flushing and loss of libido. Finasteride has fewer adverse effects and is well tolerated, but needs to be administered for at least 6 to 12 months to obtain maximum effect. Future approaches in medical treatment of BPH might be combination therapy of alpha 1-blockers and finasteride.

Adrenergic alpha-Antagonists↗
PubMed1996

Underdetection of clinical benign prostatic hyperplasia in a general medical practice.

OBJECTIVE: To measure detection of clinical benign prostatic hyperplasia (BPH) in a general medicine practice. DESIGN: Self-administered questionnaire and retrospective ambulatory medical record review. SETTING: Hospital-based general medicine practice. PATIENTS: Two hundred and four men aged 50 years and older. MEASUREMENTS AND MAIN RESULTS: Clinical information was obtained from a self-administered questionnaire containing the American Urological Association symptom index and the BPH Impact Index bother scale, and from retrospective review of ambulatory medical records for the previous 24 months. Thirty percent of patients had moderate to severe urinary tract symptoms, and 67% of these individuals were bothered by the symptoms. Only 52% with moderate to severe symptoms recalled any discussion with their primary care physician about their symptoms. There was medical record documentation of a review of urinary tract symptoms in only 18% and a prostate examination in only 64%. Patients with more symptoms and bother tended to recall a discussion of urinary tract symptoms with their physician. However, moderate to severe symptoms and bother were not associated with increased documentation of a history of urinary tract symptoms or prostate examination. CONCLUSIONS: Clinical BPH was underdetected in a general medicine practice. Because many men do not complain to their physicians about urinary tract symptoms and reduced quality of life, perhaps primary care physicians should pay more attention to recognizing this common condition of older men.

Family Practice↗
PubMed1980

Phenoxybenzamine reduces bladder outlet obstruction in benign prostatic hyperplasia. A urodynamic investigation.

Nine patients with bladder outlet obstruction attributable to benign prostatic hyperplasia were treated with 15 mg of phenoxybenzamine daily. Spontaneous urinary flow, water cystometry, simultaneous pressure-flow-EMG, and the urethral closure pressure profile were measured before and at the end of 4 weeks of treatment with phenoxybenzamine. A significant reduction in residual urine volume and a significant increase in the first sensation and bladder capacity were found. All voiding pressure parameters were significantly reduced and flow rates significantly increased. Urethral closure pressure decreased significantly.

Aged↗
PubMedDate not supplied

Benign prostatic hyperplasia in older men.

The evaluation and treatment of older men with benign prostatic hyperplasia (BPH) is complicated by the highly variable clinical presentation of men with BPH, which ranges from minor urinary symptoms to acute urinary retention. Treatment choices have expanded with recent advances in medical and surgical therapies. Surgical treatment includes open prostatectomy and transurethral prostatectomy as well as newer technologies that are less invasive and that result in fewer long-term side effects. Response to treatment depends on the patient and should be directed at symptom relief.

Aged↗
PubMed1991

A comparison of transurethral and transrectal microwave hyperthermia in poor surgical risk benign prostatic hyperplasia patients.

From 1987 to 1989, 36 poor surgical risk patients with benign prostatic hyperplasia (BPH) were treated with transrectal or transurethral microwave hyperthermia. Most of the 36 patients treated (85%) had severe signs and symptoms of urinary outflow obstruction. Of the patients 22 (61%) underwent transrectal and 14 (39%) underwent transurethral hyperthermia. Followup ranged from 10 to 28 months (mean 19 months) for the transrectal hyperthermia group and 7 to 16 months (mean 10 months) for the transurethral hyperthermia group. The patients were given 6 hyperthermia sessions of 30 minutes each with the temperature controlled on the rectal or urethral surface at 45C. Hyperthermia was well tolerated with mild acute toxicity and no late complications were observed. In the important subjective and objective parameters, major improvement was noted more frequently in the 14 transurethral than in the 22 transrectal hyperthermia treated patients (p less than 0.05). The Food and Drug Administration severity score, prostate volume, post-voiding residual volume and urethral flow showed substantial improvement in 79, 86, 79 and 79%, respectively, of the 14 transurethral hyperthermia treated patients compared to 41, 45, 82 and 82%, respectively, for the 22 transrectal hyperthermia treated patients. A prospective randomized trial comparing transrectal and transurethral hyperthermia is required to define the role of each treatment mode in patients with BPH.

Aged↗
PubMed1995

Responders and non-responders to treatment of benign prostatic hyperplasia with transurethral microwave thermotherapy.

One hundred and seventy two patients with benign prostatic hyperplasia (BPH) were treated with transurethral microwave thermotherapy (TUMT) using Prostcare (Bruker Spectrospin). The treatment was performed with an effect of 52 W and a frequency of 915 MHz, which was generally well tolerated and no serious side effects were observed. In the majority of the patients there was an improvement of subjective symptoms with a significant decrease in Madsen and bothering scores after treatment. In the total patient group, Qmax and voided urine volume were increased slightly, but not statistically significantly. The patients were divided in responders and non-responders, based on Madsen symptom score after 3 months or if complementary treatments were necessary during the follow up period of one year. No significant differences between the groups were observed regarding pretreatment variables except that patients in the responder group experienced the treatment more painful than non-responders. Qmax in the responder group was significantly improved at 6 and 12 months follow up. PSA levels increased significantly after the treatment. Routine evaluation using flow rate, estimation of prostatic size, measurement of residual urine volume and cystoscopy does not give sufficient information for predicting treatment outcome.

Aged↗
PubMed1992

[A study of bladder function in benign prostatic hyperplasia].

A study of bladder function was performed on 106 patients with benign prostatic hyperplasia (BPH), 21 of whom had cerebrovascular disease (CVD). The incidence of overactive bladder in 21 patients with CVD was 57% and was significantly higher than the 25% in 86 patients without CVD. The incidence of cases having residual urine of over 100 ml, was in the order of low compliance bladder, overactive bladder and normal bladder. The mean value of maximum voiding pressure in overactive bladder was higher than that in normal bladder. The high pressure was improved after the operation for BPH. Improvement of overactive bladder after the operation was seen in 9 of 13 patients without CVD while in 2 of 6 patients with CVD.

Aged↗
PubMed1994

Primary culture of smooth muscle cells from benign prostatic hyperplasia.

Primary cultures of smooth muscle cells (SMCs) were derived from the human prostate obtained from four patients with symptomatic benign prostatic hyperplasia (BPH) undergoing open prostatectomy, using collagenase digestion and preferential adhesion techniques. SMCs attached to the plastic substrate by 6 to 10 h, proliferated by 2 to 3 days, and reached confluency by 10 to 14 days with a "hill-and-vallery" pattern. Immunocytochemical staining of cultured SMCs using anti human muscle-specific actin monoclonal antibody (HHF35), confirmed that more than 90% primary cultured cells were positive for HHF-35. Transmission electron microscopy of SMCs revealed dense myofibrils (6-8 nm width) showing focal density, and was compatible to smooth muscle cells. This primary culture will be utilized to provide a useful model to investigate the character of smooth muscle cells and their role in the development of BPH.

Cell Division↗
PubMedDate not supplied

[The mechanism of action of the alpha-adrenoblocker prazosin on bladder function in patients with benign prostatic hyperplasia].

Prazosin treatment effects were evaluated in two groups of patients with benign prostatic hyperplasia (BPH). 10 patients of group 1 have previously undergone epicystostomy for acute urine retention. They received prazosin for 7 days 5 mg/day. 9 patients of group 2 had no direct indications for adenomectomy and therefore received conservative treatment: one or two 3-week prazosin courses (5 mg/day). All the patients were examined before and after prazosin treatment. As shown by routine methods of investigation and rheocervicocystography, alpha-adrenoblockers, prazosin in particular, promote positive changes in cervical circulation of the bladder. This reduces detrusor hypoxia leading to bioenergetic normalization in the smooth muscles. Clinically, the response manifests in improved reservoir function of the bladder (increased effective volume, lowered pollakiuria). It is concluded that prazosin and other alpha-adrenoblockers are highly effective drugs in conservative treatment of BPH.

Acute Disease↗
PubMed1996

Relationship of ultrasonic and histologic findings in benign prostatic hyperplasia.

We compared the ultrasonic and histologic findings in 25 patients with benign prostatic hyperplasia (BPH) who underwent retropubic subcapsular prostatectomy. Preoperative ultrasonograms showed a fine echogenic pattern in one case, a rough echopenic pattern in four cases, and a combination of these patterns in 20 cases. In cases exhibiting a mixed pattern, we analyzed each region individually. Ultrasonic and histologic findings were compared in a total of 45 regions. In the 21 regions with a fine echogenic pattern, 14 regions corresponded to those with complicated hyperplastic glands, one region with small cystic atrophic glands, and six regions with a mixture of the two types on histology in observation. In the 24 regions with a rough echopenic pattern, 20 regions corresponded to those with large cystic atrophic glands and an equal volume of large and small cystic atrophic glands were found in the other four. Thus, the echogenic structures observed in patients with BPH were determined by the presence of complicated hyperplastic glands and small cystic atrophic glands.

Aged↗
PubMed1995

[Status of phytotherapeutic drugs in treatment of benign prostatic hyperplasia].

Phytotherapeutic preparations are still commonly used for the treatment of symptomatic benign prostate hyperplasia (BPH) in Germany; in recent years there has even been an increase in their use, so that sales now amount to more than DM 220 millions per year. The preparations most frequently used are extracts of Hypoxis rooperi, the roots of the stinging nettle, the fruits of the saw palmetto, pumpkin seeds and rye pollen. The suggested mechanisms of action have not been documented by scientific observation. This applies especially to the blocking effect on 5 alpha-reductase postulated with the doses used. Moreover, a critical analysis of the data available suggests that the effects of phytotherapy are no better than those of placebo treatment. Further studies are urgently needed, to compare the effects of phytotherapy with those of chemically defined drugs (alpha 1-receptor antagonists, 5 alpha-reductase blocker) that seem to have a beneficial influence on the pathomechanism underlying symptomatic BPH.

5-alpha Reductase Inhibitors↗
PubMed1992

Validation of a new quality of life questionnaire for benign prostatic hyperplasia.

In planning a longitudinal study to characterize the natural history of benign prostatic hyperplasia (BPH), we validated a new disease-specific quality of life questionnaire in a pilot study. We studied 110 men in Rochester, Minnesota who spanned the severity of BPH, from men with no known BPH to men who underwent surgery for this condition. Baseline data were obtained on all men, and the 30 who underwent prostatectomy were re-interviewed to test responsiveness. Reproducibility was examined on the pre-post responses (10 weeks apart) of the 37 men with BPH who did not undergo prostatectomy. Six of twelve question domains were retained in the final questionnaire on the basis of their responsiveness to change, reproducibility, internal consistency, and validity. These were: urinary symptoms, degree of bother due to urinary symptoms, BPH-specific interference with activities, general psychological well-being, worries and concerns, and sexual satisfaction. Most of the more generic measures were deleted.

Adult↗