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PubMed2002

Indwelling catheter treatment and health-related quality of life in men with prostate cancer in comparison with men with benign prostatic hyperplasia.

Experiences from indwelling urinary catheter treatment periods were studied. Little is known of what is felt from a male perspective although catheter treatment is a common pre- and postoperative measure for men with prostate cancer and benign prostatic hyperplasia (BPH). Also studied were health-related quality of life (HRQOL) and sense of coherence (SOC). Men with catheter experience (prostate cancer n = 71, BPH n = 37) were selected from a larger questionnaire study. Assessment was made with study-specific questions together with the QLQ C-30 assessing HRQOL and the SOC questionnaire measuring sense of coherence. Data reduction method was applied to study specific variables to determine problem patterns. Correlation between HRQOL and SOC was determined. Results showed similar problem patterns in men with prostate cancer and BPH: discomfort in wearing catheter (e.g. uneasiness 48.2%), practical and psychosocial difficulties in handling and wearing catheter (e.g. attaching catheter 32.4%) and discomfort at installation (e.g. pain 29.7%). There was lack of knowledge about wearing and practical handling of the catheter. Having a cancer diagnosis did not add to uneasiness or practical problems. Life quality was correlated to SOC (p <or= 0.001).

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PubMed1999

Alcohol consumption, cigarette smoking, and risk of benign prostatic hyperplasia.

Alcohol consumption and cigarette smoking were evaluated in relation to development of benign prostatic hyperplasia (BPH) among 29,386 members of the Health Professionals Follow-up Study. Men who were 40-75 years old in 1986 and free of prior BPH surgery, diagnosed cancer at baseline, and prostate cancer at baseline and during follow-up were followed for incidence of BPH surgery from 1986 to 1994. Cases were men who reported BPH surgery between 1986 and 1994 (n = 1,813) or who scored > or = 15 points of 35 on seven lower urinary tract symptom questions modified from the American Urological Association symptom index in 1992 and 1994 (n = 1,786); noncases were men who scored < or = 7 points (n = 20,840). After controlling for age, race/ethnicity, body mass index, physical activity, and mutually for alcohol intake and smoking, moderate alcohol consumption was inversely related with total BPH (30.1-50 g/day vs. 0: odds ratio (OR) = 0.59, 95% confidence interval (CI) 0.51-0.70; p trend < 0.0001), although the relation was attenuated at high intake (> or = 50.1 g/day vs. 0: OR = 0.72, 95% CI 0.57-0.90). Current cigarette smoking was positively related to total BPH only among those who smoked 35 or more cigarettes/day (compared with never smokers: OR = 1.45, 95% CI 1.07-1.97). These findings suggest that moderate alcohol consumption and avoidance of smoking may benefit BPH.

Adult↗
PubMed1996

Age related urodynamic changes in patients with benign prostatic hyperplasia.

PURPOSE: We determined age related urodynamic changes in patients with untreated symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 222 patients (mean age 67.3 years, range 45 to 90) with the clinical diagnosis of symptomatic BPH was entered into a prospective protocol evaluating the international prostate symptom score (I-PSS), prostate volume, noninvasive uroflowmetry, residual volume and a pressure-flow study. To obtain a homogeneous study population only patients with a noninvasive maximum flow rate of 15 ml. per second or less and an I-PSS of 7 or more were eligible. RESULTS: There was no correlation between age and I-PSS (p > 0.05) but there was a statistically significant decrease in maximum flow rate (p = 0.045) and voided volume (p = 0.0013) with age. Prostate volume increased constantly from 31.3 to 64.4 ml. in patients 45 to 50 and older than 80 years, respectively (p < 0.0001). Pressure-flow studies revealed an age related decrease in cystometric bladder capacity (p = 0.0003) and invasive maximum flow rate (p = 0.0057) but no changes in detrusor pressure at maximum flow rate (p > 0.05), maximum detrusor pressure (p > 0.05) and linear passive urethral resistance relation (p > 0.05). The incidence of urodynamically proved bladder instability increased from 20 to 47% in men 45 to 50 and older than 80 years, respectively. CONCLUSIONS: The well established age related decrease in maximum flow rate and voided volume in patients with prostatism cannot be attributed to an increase in bladder outflow obstruction or impaired detrusor function. Because 60% of all men older than 80 years did not have urodynamic obstruction despite a decreased maximum flow rate of 10 to 15 ml. per second, all patients meeting these criteria and having symptoms bothersome enough to justify surgery should undergo pressure-flow studies before surgical intervention.

Age Factors↗
PubMed1990

Evolving patterns of tissue composition in benign prostatic hyperplasia as a function of specimen size.

The tissue composition in 36 transurethral resections and four prostate enucleations for benign prostatic hyperplasia (BPH) was quantitated by computerized morphometric techniques using 15 morphologic categories. Data were compared between seven consecutive weight ranges. Nodules of glandular and/or stromal tissue comprised only 5% of tissue in the smallest resections, while bladder neck and anterior fibromuscular tissue represented more than half the specimen. Non-nodular prostatic tissue from the transition zone was the dominant resected component in all but the largest specimens (enucleations) where nodules comprised most of the tissue. Though nodules comprised only 22% of the largest transurethral resections, their contribution to hyperplasia increased more rapidly than any other component. Glandular nodules with a high ratio of epithelium to stroma dominated at all weight ranges. It was concluded that tissue resected for BPH is quite heterogeneous, that nodules comprise most of the tissue only in specimens over 50 g in weight, and that the most common hyperplastic component is histologically normal tissue. Benign prostatic hyperplasia undergoes morphologic evolution with increasing weight, and epithelial-rich nodules are the most rapidly evolving component.

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PubMed1994

Relationship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia.

The relationship between the serum values of prostate specific antigen (PSA) and the extent of histological prostatitis was investigated in 42 patients undergoing transurethral resection of the prostate for benign hyperplasia (BPH) without clinical evidence of prostatitis. Histological prostatitis was divided into three groups: acute, chronic-active, and chronic-inactive inflammation. The extent of histological prostatitis was expressed as the number of prostatic acinar and ductal glands with inflammatory infiltrate per total number of glands (%). The serum PSA values significantly correlated with the extent of acute and chronic-active prostatitis (correlation coefficient r = 0.765 and 0.656, P < 0.01). A relationship between PSA values and the extent of chronic-inactive prostatitis was not found. In the immunohistochemical study, prostatic epithelial cells with acute and chronic-active inflammation showed negative staining for PSA antigen. These results indicate that histological acute and chronic-active prostatitis is considered an important factor for inducing the high increase in serum PSA values via the leak phenomenon.

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PubMed1995

[Clinical significance of urodynamic study in benign prostatic hyperplasia].

Urodynamic study, including UFR, cystometry, UPP, and EMG was carried out in 74 patients with benign prostatic hyperplasia (BPH) during the past 5 years. The correlations of prostate volume (57.3 +/- 6.3 ml), prostate length (4.94 +/- 1.23 cm) and detrusor pressure (6.54 +/- 4.73 kPa) were analysed. The results showed that urodynamic study plays an important role in indicating the time and method of operative treatment and predicting the prognosis of BPH operation. The fistularization of the bladder should be performed on the patients with the bladder disfunction. The measurement of the urethral resistance is of value in the diagnosis of posterior urethra obstruction than that of UFR.

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PubMed1997

The International Continence Society "Benign Prostatic Hyperplasia" Study: international differences in lower urinary tract symptoms and related bother.

PURPOSE: We investigated the international differences in the reporting of lower urinary tract symptoms and related bother in patients with symptoms suggestive of bladder outlet obstruction. MATERIALS AND METHODS: Multiple logistic regression analysis was used to evaluate international differences in the reporting of lower urinary tract symptoms and related bother in 1,271 patients from 12 countries who participated in the International Continence Society "benign prostatic hyperplasia" study. RESULTS: Country of origin was significantly associated with the prevalence of a large number of lower urinary tract symptoms (10 of 20), even after adjusting for potentially confounding variables, including physical and socio-demographic factors. Country of origin was also significantly associated with the reporting of bother but for a much smaller number of symptoms (2). CONCLUSIONS: In different countries lower urinary tract symptoms may be reported to different extents. Therefore, the results of studies in particular countries may not be generally applicable to other countries. It is likely that symptom scores will conceal this variation, necessitating consideration of individual symptoms (as in the International Continence Society "benign prostatic hyperplasia" study) or the development of country specific scoring systems. An alternative would be to focus on bother, which appeared to be much less sensitive to international differences.

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PubMed1998

Correlations between urethral elastance and histological architecture in patients with benign prostatic hyperplasia.

To investigate whether the properties of the flow-controlling zone (FCZ) in obstructive benign prostatic hyperplasia (BPH) would be affected by differences in the histological architecture of the prostate, we evaluated relationships between morphometric and urodynamic data. BPH specimens from 14 patients undergoing transurethral surgery were analysed by quantitative morphometry. The cross-sectional area and mean elastance of FCZ, together with other parameters, were calculated on a preoperative pressure-flow study. Correlations between these parameters and tissue composition were determined. Our study group comprised men with clinical and urodynamic evidence of infravesical obstruction secondary to BPH. No correlations were found between the area density or total volume of each histological element and the cross-sectional area of FCZ at peak flow rate. Neither area density nor total volume of each element correlated with the mean urethral elastance. Our results indicate that the histological architecture of the prostate in patients with obstructive BPH cannot predict the urethral elastance.

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PubMed2006

The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis.

OBJECTIVE: To assess the safety and efficacy of anticholinergics in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by a systematic review of published reports and a meta-analysis of the reported outcomes. METHODS: We searched Medline, Embase and Cochrane databases (1966-2006), and hand-searched relevant reference lists and conference proceedings, for studies on the use of anticholinergics in men with BPH or bladder outlet obstruction. Eligible studies were assessed for quality and foreign language studies were translated. We collected data on all reported outcomes, conducted meta- analyses on the maximum urinary flow rate (Q(max)), postvoid residual urine volume (PVR) and volume at first contraction, and calculated the acute urinary retention (AUR) rate. We used sensitivity analysis to confirm the findings. RESULTS: We identified five randomized controlled trials (RCTs) and 15 observational studies. Four RCTs incorporating 633 patients were included in the meta-analyses. Anticholinergics did not significantly alter Q(max) (0.1 mL/s, 95% confidence interval, CI, 0.6-0.7). The PVR was increased by 11.6 mL (95% CI 4.5-18.6) although there was no significant difference between AUR rates. The total International Prostate Symptom Scores (IPSS) were not significantly different, but there were improvements for IPSS storage subscores in one RCT. The AUR rate was 0.3% at the 12-week follow-up in 365 men in the RCTs and observational studies. CONCLUSION: Anticholinergic use in men with LUTS suggestive of BPH appears to be safe. Further studies are required to establish efficacy with a suitable precision.

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PubMed1994

[Laser prostatectomy as alternative to transurethral prostate resection in benign prostatic hyperplasia].

OBJECTIVE: Assessment of the results of laser prostatectomy, as a treatment for benign prostatic hyperplasia (BPH). DESIGN: Prospective case control study. SETTING: University Hospital Utrecht, the Netherlands. METHOD: Between February 1992 and May 1993, 54 men with their micturition complaints due to BPH were treated with laser prostatectomy (TULIP system). Results were assessed using the international prostatic symptom score (IPSS), the maximal flow and urodynamic tests. The results were compared retrospectively with results of transurethral resection of the prostate (TURP; n = 40): both groups were urodynamically identical. RESULTS: Of the 54 patients, 10 could not be evaluated 6 months after treatment (5 of them underwent TURP or a second laser prostatectomy). In 40 patients complete evaluation including urodynamics before and six months after treatment was possible. A significant decrease in the symptom score from 19.3 (SD: 7.6) to 6.3 (SD: 5.4) and increase of the maximal flow during pressure-flow studies from 9.6 to 15.8 ml per second were observed. The decrease of the voiding pressure at 6 months after TURP in comparison with laser prostatectomy was close to significance (p = 0.05); the other improvements after urodynamics were comparable. CONCLUSION: Laser prostatectomy is a promising new therapy for BPH.

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PubMed1996

Effects of the sabal serrulata extract IDS 89 and its subfractions on 5 alpha-reductase activity in human benign prostatic hyperplasia.

Extract from fruit of Sabal serrulata are used in the treatment of human benign prostate hyperplasia (BPH). Therefore, it is of interest whether this phytopharmacon has any influence on the androgen metabolism in the human prostate. It was found that the extract IDS 89 of Sabal serrulata inhibited dose dependently 5 alpha-reductase activity in the epithelium and stroma of human BPH, the mean inhibition being 29% and 45%, respectively. This inhibitory effect is mainly due to the saponifiable subfraction of IDS 89 showing a mean 5 alpha-reductase inhibition of 39% and 38% in epithelium and stroma, respectively. The inhibition was dose dependent and noncompetitive. At a testosterone concentration of 580 nM as substrate for 5 alpha-reductase, the main fatty acids of the extract IDS 89 gave rise to a percentual enzyme inhibition in the epithelium and stroma as follows: 51% and 42% (lauric acid), 5% and 0% (oleic acid), 43% and 34% (myristic acid), 2% and 0% (palmitic acid), respectively. The inhibitory effect of lauric acid was noncompetitive and dose dependent up to a concentration of 0.2 nM, the maximal inhibition in the epithelium and stroma being 52% and 45%, respectively. The nonsaponifiable subfraction, consisting mainly of phytosterols, showed a mean inhibition of 5 alpha-reductase in the epithelium and stroma of 15% and 10%, respectively. Finally, the hydrophilic subfraction, containing carbohydrates, amino acids, and polysaccharides, showed no inhibitory effect. The present in vitro studies suggest that the Sabal serrulata extract IDS 89 has an inhibitory effect on 5 alpha-reductase in the epithelium and stroma of human BPH. This inhibition is mainly due to the fatty acids of the saponifiable subfraction.

Cholestenone 5 alpha-Reductase↗
PubMed1998

Finasteride in the treatment of patients with moderate symptoms of benign prostatic hyperplasia.

This was a prospective study involving 27 patients with moderate symptoms of benign prostatic hyperplasia (BPH) treated continuously with 5 mg of finasteride daily for one year. There was improvement in clinical BPH symptoms in 22 patients (81.48%), increase in urinary flow rates by a mean of 2.2 mls/sec in 20 patients (74.07%) and a mean decrease in prostate volume of 20.9% in 25 patients (92.59%) comparable to the findings of the other investigators. No patient on finasteride therapy developed acute urinary retention suggesting reduced risk. The reversal in BPH progression stems from the ability of finasteride to reduce prostate volume thus relieving urinary obstruction and to decrease BPH symptoms and increase urinary flow rates. Finasteride therapy was well tolerated in this study. No adverse effect was observed except impotence in one patient (3.7%) and loss of libido in another patient (3.7%). For symptomatic relief in men with moderate obstructive symptoms of BPH, finasteride should be considered an effective alternative to watchful waiting. These findings warrant further investigations and may signal a positive change in the role of medical therapy in the future long term management of BPH.

5-alpha Reductase Inhibitors↗
PubMed2000

Impact of interventional therapy for benign prostatic hyperplasia on quality of life and sexual function: a prospective study.

PURPOSE: Treatment for benign prostatic hyperplasia (BPH), including minimally invasive therapy, can impair the quality of life. We prospectively determined the impact of 4 different interventional therapies on quality of life and sexual function. MATERIALS AND METHODS: A total of 173 patients were prospectively evaluated between February 1995 and August 1997. Treatment modalities consisted of standard transurethral resection of the prostate in 55 cases, transurethral microwave thermotherapy in 34, interstitial laser coagulation of the prostate in 42 and transurethral needle ablation in 42. Disease specific quality of life was assessed using the International Prostate Symptom Score quality of life assessment index and BPH impact index. In addition, a self-reporting questionnaire was completed before and 3 months after treatment to determine the impact on sexual function. RESULTS: All 4 treatment groups showed significant improvement in the symptom score, International Prostate Symptom Score quality of life assessment score and BPH impact index score. Satisfaction with treatment was highest in patients treated with transurethral resection or laser coagulation. A mild to moderate decrease in erectile function was noted in 26.5%, 18.2%, 18.4% and 20.0% of the transurethral resection, microwave thermotherapy, laser coagulation and needle ablation groups, respectively, but there was no significant difference of mean pretreatment and posttreatment erectile function or libido scores in any group. Ejaculation loss or severe decrease in ejaculate volume was reported by 48.6%, 28.1%, 21.6% and 24.3% of the patients, respectively. Interestingly, 20 of the 44 patients (45. 5%) with loss of ejaculation or severe decrease in ejaculate reported deterioration of the sex life, while only 2 (3.6%) of the 56 without any change in ejaculate volume reported such deterioration. The association of ejaculatory dysfunction with an adverse impact on sexual activity was highly significant (p <0.0001). CONCLUSIONS: Significant improvement in quality of life could be achieved with the present assessed interventional therapies. There was no significant change in sexual desire or erectile function with these therapies. Posttreatment sexual dysfunction appears to be mainly related to impaired ejaculatory function. Urologists should provide proper counseling regarding the possibility of this complication even in patients receiving minimally invasive treatment.

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PubMed1999

Differentiation of prostatic carcinoma and benign prostatic hyperplasia: correlation between dynamic Gd-DTPA-enhanced MR imaging and histopathology.

One of the major factors limiting the staging accuracy of conventional magnetic resonance imaging (MRI) for prostatic carcinoma, is the similarity in signal intensity between tumor and coexisting benign prostatic hyperplasia (BPH). As neovascularity is an independent indicator of pathological state, dynamic contrast-enhanced MRI may yield additional information. This study correlates the histopathological findings from 12 radical prostatectomy patients on a region-by-region basis, with pharmacokinetic modeling of dynamic contrast-enhanced (0.2 mmol dimeglumine gadopentetate/kg), fast multiplanar spoilt gradient-recalled echo images, using a two-compartment simplex minimization technique. Quantitative analysis demonstrated differences in the amplitude of the initial contrast upslope and contrast exchange rate between tumor and fibromuscular BPH (P<0.03 and P<0.03, respectively) and for the contrast exchange rate between tumor and fibroglandular BPH (P<0.04), providing improved delineation of intraprostatic tumor extent compared with conventional imaging techniques.

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PubMed1997

[Significance of 5-alpha-reductase inhibitors in therapy of benign prostatic hyperplasia with mild to modern symptoms].

Medical therapy in the treatment of symptomatic benign prostatic hyperplasia has changed very much during the last few years. Finasteride is a 5-alpha-reductase inhibitor, which inhibits the predominant intraprostatic isoenzyme II of 5-alpha-reductase and therefore DHT, which is-among other factors-essential for the physiological growth of the prostate. However, it also has an important influence on developing BPH. It was shown in several studies that finasteride can increase urinary flow rates, decrease the prostate volume, and improve the symptom score and PSA value. The objective improvement in urinary flow rates was only moderate, but better results were obtained in the improvement of patient symptoms. Large multicenter studies will be conducted to see if the efficacy of treatment can be improved by combination therapy with alpha-1-blockers.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2005

[Therapeutic effect of harnal and proscar in treating benign prostatic hyperplasia].

OBJECTIVE: To evaluate the therapeutic effect of harnal and proscar in treating benign prostatic hyperplasia (BPH). METHODS: Two hundreds and twenty-two patients with BPH were randomly assigned into 2 groups:harnal (0.2 mg/d) group (n = 112) and proscar (5 mg/d) group (n = 108). American Urologic Association Symptom Index (AUA-SI) scores, the maximal urinary flow rate (Qmax) and prostatic volume were analyzed in the 2 groups. RESULTS: After 12 weeks of treatment, 54.5% of the harnal group improved in AUA-SI score; 54.6% of the proscar group improved in AUA-SI score; and there was no significant difference between the 2 groups (P > 0.05). After 24 weeks of treatment, the proscar group (79.6%) had a greater improvement in AUA-SI score than the harnal group (64.3%) (P < 0.05); Qmax in the 2 groups was significantly increased than that before the treatment, and it is proportional to the therapeutic time. The prostatic volume in 2 groups had no significant change. CONCLUSION: Harnal and proscar can significantly improve BPH symptoms and the urinary flow rate. The therapeutic effect of harnal and proscar has their own characteristics.

5-alpha Reductase Inhibitors↗
PubMed1998

Inhibins, activins, and follistatins: expression of mRNAs and cellular localization in tissues from men with benign prostatic hyperplasia.

BACKGROUND: The transforming growth factor beta (TGF beta) superfamily of growth factors includes activins and inhibins, which have been shown to be present in the rat ventral prostate, and human prostate tumor cell lines, although their localization in benign prostatic hyperplasia (BPH) tissue is currently unknown. METHODS: BPH tissues were obtained at surgery, and the mRNA expression for the inhibin alpha, beta A, beta B subunits, the putative activin beta C subunit, the activin type II receptor (ActRII), and the activin binding protein, follistatin, was determined by reverse transcription polymerase chain reaction (RT-PCR) and Southern blot analysis. Antibodies specific for alpha, beta A, beta B, activin A, and follistatin were used to determine the localization of these proteins in BPH tissue specimens. RESULTS: Southern blot analysis confirmed that mRNA for ActRII, beta C subunit, and follistatin was present in all biopsy samples assayed. However, alpha, beta A, and beta B subunit mRNA expression was variable between patient samples. Immunohistochemistry demonstrated the predominant localization of beta A, beta B, and activin A proteins to the epithelium of BPH tissues. No immunoreactivity for the inhibin alpha subunit was detected; follistatin immunoreactivity was localized to the fibroblastic stroma. CONCLUSIONS: The compartmentalization of activin subunit proteins to the epithelium, and of follistatin to the stroma, suggests that a paracrine interaction occurs between the activin ligands and follistatin-binding proteins in BPH tissue.

Activin Receptors↗
PubMed1996

Comparison of the cellular composition of benign prostatic hyperplasia in Chinese and Caucasian-American men.

OBJECTIVES: To compare the cellular composition of benign prostatic hyperplasia (BPH) in Chinese and Caucasian-American men. METHODS: Surgical specimens of the prostate were obtained from 9 Chinese and 8 Caucasian-American men undergoing cystoprostatectomy for invasive transitional cell carcinoma. The mean ages of the Chinese and Caucasian-American men were 66.8 years and 66.4 years, respectively (P = 0.94). The mean prostate weight of the Chinese and Caucasian-American men was 53.4 g and 32.1 g, respectively (P = 0.01). Double immunoenzymatic staining with antibodies against actin and prostatic acid phosphatase and computer-assisted color image analysis were performed on whole-mount tissue sections. The percent area density of smooth muscle (SM), connective tissue (CT), epithelium (E), and epithelial lumen (L) were obtained by analyzing 30 fields from each specimen. RESULTS: The mean percent area density of SM, CT, E, and L in the prostate of Chinese men was 32%, 9.1%, 10.8%, and 48.5%, respectively. The mean percent area density of SM, CT, E, and L in the prostate of Caucasian-American men was 52.5%, 27.9%, 12.8%, and 7%, respectively. Overall, the prostates of Chinese men contained significantly more glandular lumen and significantly less SM and CT. CONCLUSIONS: The present study demonstrates that the cellular composition of BPH in the prostates of Caucasian-American and Chinese men is different. These cellular differences may account for previously observed differences in the incidence of clinical BPH.

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