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PubMed1999

Evaluation of interstitial diode laser therapy for treatment of benign prostatic hyperplasia.

In the last decade, a number of new device technologies were developed for benign prostatic hyperplasia (BPH) therapy. These technologies were introduced in an effort to reduce the morbidity of BPH therapy associated with conventional electrocautery transurethral resection of the prostate (TURP). While morbidity is reduced, the aim of new therapy is to achieve near equivalence in efficacy of outcome measures, namely, improved voided flow rate and reduced symptom score. To gain acceptance by urologists, these technologies should be easy to apply and should reduce the economic cost of BPH treatment. The Indigo 830e diode laser system offers simplified laser therapy from a miniaturized solid-state system. This pilot study demonstrates outcome equivalence to TURP in preliminary evaluation and shows an acceptable side effect profile.

Aged↗
PubMedDate not supplied

[Diagnosis of infravesical obstruction in patients with benign prostatic hyperplasia].

To improve reliability of the diagnosis of infravesical obstruction (IVO) in patients with benign prostatic hyperplasia (BPH), we examined 80 BPH patients (mean age 58.2 +/- 2.1 years). The examination included evaluation of complaints by IPSS, ultrasound investigation with determination of prostatic size and residual urine, and urodynamic tests: uroflowmetry, miction cystometry. We came to the conclusion that symptoms of BPH, size of the gland, amount of residual urine and maximal volumetric miction velocity not always evidence for IVO. To raise reliability of IVO diagnosis we propose the following formula: D1 = 0.818 x S(max) +0.0006 x S(min) +0.215 x Q(max) - 0.478 x Q(aver), where D1 is a discriminant function; S(max) is a maximal linear size of the prostate; S(min) is a minimal linear size of the prostate; Q(max) is maximal volumetric flow rate; Q(aver) is mean volumetric flow rate. If D1 > or = 2.85, IVO is definite. If D1 < or = 2.85, IVO absence is more probable. Thus, the proposed formula provides more reliable diagnosis of IVO in BPH patients than assessment of clinical indices.

Humans↗
PubMed1986

Predictive value of low maximum flow rate in benign prostatic hyperplasia.

Among 84 patients with prostatism selected for transurethral resection of the prostate, 18 had a maximum flow at spontaneous uroflowmetry less than or equal to 7 ml/sec. Preoperatively there was no significant difference between patients with maximum flow less than or equal to 7 ml/sec (Group 1) and patients with maximum flow greater than 7 ml/sec (Group 2) in age, duration of symptoms, symptom scores, bladder volume, residual urine, and detrusor pressure at maximum flow. Patients in Group 1, however, had significantly lower urethral resistance and bladder volume independent maximum flow than patients in Group 2. Postoperatively, patients with preoperative maximum flow less than or equal to 7 ml/sec improved significantly in symptom scores and urodynamic findings apart from bladder volume and detrusor pressure at maximum flow. There were no significant differences between groups in postoperative symptom scores or urodynamic findings. We conclude that preoperative maximum flow rates less than or equal to 7 ml/sec at spontaneous uroflowmetry were related to high urethral resistance and not detrusor decompensation among patients with prostatism, and that patients with maximum flow rates less than or equal to 7 ml/sec fared as well postoperatively as patients with maximum flow greater than 7 ml/sec.

Aged↗
PubMed1990

Internal urethrotomy of the prostatic urethra or transurethral resection in benign prostatic hyperplasia.

Transurethral resection of the prostate is the most common technique for the treatment of benign prostatic enlargement. The inconveniences of prostatic resection are retrograde ejaculation and bladder neck stenosis in small prostates. A randomized prospective trial was done to compare the results of conventional transurethral resection of the prostate in 22 patients and urethrotomy of the prostatic urethra in 27 with respect to postoperative retrograde ejaculation, persistent urinary symptomatology and maximal flow rates. After a mean followup of 25 months we concluded that internal urethrotomy of the prostatic urethra is the operation of choice in patients with a prostate of up to 30 gm.

Follow-Up Studies↗
PubMed1999

A prospective randomized trial evaluating tissue effects of finasteride therapy in benign prostatic hyperplasia.

Finasteride is widely used for the treatment of benign prostatic hyperplasia (BPH). Its therapeutic efficacy is believed to be mediated through selective inhibition of prostatic 5alpha-reductase (type II). This prospective, controlled, randomized study examines various relationships between changes in tissue 5alpha-reductase isozyme activity, epithelial proliferative index and morphology in men with BPH treated with finasteride for 6 months, and correlates these with clinical response. Thirty-one patients presenting with symptomatic bladder outflow obstruction were prospectively randomized to receive either finasteride or placebo (2:1) for 24 weeks. Of these, 27 men aged 55-80 y (median 69 y) completed the study, including 18 patients on treatment. Symptom score determination, uroflow and prostate volume were assessed at baseline and end of study. Prostatic tissue was obtained by ultrasound-guided needle biopsy at baseline and by transurethral resection (TURP) at end of study for biochemical and morphometric analysis. Epithelial proliferation was examined quantitatively in the resected tissue using MIB-1 antibody to Ki-67 and counting the percentage of positively staining cells. Type II 5alpha-reductase activity was strongly inhibited by finasteride in resected BPH tissue, with over 100-fold decrease in V(max) (P=0.001), whereas the type I isozyme was inhibited 5-fold (P=0.005). Selective inhibition of type II 5alpha-reductase was demonstrated in all treated patients. No significant difference in epithelial proliferation was observed between the finasteride and placebo groups. Epithelial proliferation was, however, greater in prostatic tissue with histological manifestation of inflammation (2.02% vs 0.89%, P=0.001). Positive correlation between the total epithelial volume and the ratio of transition zone volume/total prostate volume was observed in the placebo group (r=0.834), whereas there was no such correlation in men taking finasteride (r=-0.300), consistent with a reduction in epithelial content in the treatment group. Improvement in uroflow and reduction in prostatic volume in patients treated with finasteride did not reach statistical significance. This study shows that finasteride causes inhibition of 5alpha-reductase activity in human BPH tissue with selectivity for the type II isozyme. In spite of this, no significant effects in epithelial proliferation or tissue morphology were demonstrated. The presence of inflammation was, however, associated with significantly greater proliferative activity. The power of this study was limited by the small number of recruited patients, and a larger study would be required for further investigation of morphological changes induced by finasteride in BPH tissue and their biochemical basis.

Journal Article↗
PubMed1993

[Treatment of urinary incontinence in the patient operated on for benign prostatic hyperplasia].

A potential complication of prostatic adenomectomy and TURP is urinary incontinence. The incidence of this problem ranges from 0.1 to 1%. we reviewed our experience with 15 patients who were incontinent between 10 to 24 months after prostatectomy. We treated these patients with bladder training. At first, patients were evaluated for the type and extent of incontinence. Perineal exercise were taught in detail, tested for their correct use via simultaneous and abdominal examination. Patients were evaluated weekly for compliance. No pharmaceutical agents were used. All the 15 patients improved in the number of incontinence episodes 5 patients achieved total continence, while only one showed a little change. We conclude that patients who are incontinent after prostatectomy can improve with a well-done behavioral training program.

Aged↗
PubMed1995

Imaging of the prostate. Benign prostatic hyperplasia.

Imaging studies of the prostate and urinary tract in patients with BPH include ultrasonography, intravenous urography, urethrography, CT scans, and MR imaging. Ultrasound can assess for upper tract changes, determine post void residuals, estimate prostatic volume, and demonstrate zonal anatomy and internal changes within the prostate. Intravenous urography is indicated for patients with hematuria, urinary tract stones, and other atypical histories. Urethrography provides information in the post prostatectomy patients with residual symptoms. CT scans and MR imaging are expensive and have no routine use in evaluating patients with BPH.

Humans↗
PubMed1997

[Laser treatment of benign prostatic hyperplasia].

Transurethral resection of the prostate (TURP) has been the gold standard for BPH for over 50 years. For the last five years laser treatment of BPH has been developed as a new modality. The principles of laser surgery and the options available in clinical practice today are outlined. A survey of indications, patient selection, results and complications are given based on the authors' own experience and reports from the international literature.

Anesthesia, Local↗
PubMed1997

[Short hospital stay in the treatment of benign prostatic hyperplasia using transurethral resection].

INTRODUCTION: Prostate TUR is the most common approach used in the surgical management of BPH. The highest expenditure portion of this treatment occurs during the post-operative. PATIENTS AND METHOD: 42 cases of prostate TUR were analyzed by GRD type, prostate weight, hospital stay and complications in the peri- and post-operative periods. Both the approach used and the degree of patient's satisfaction are analyzed. RESULTS: Mean prostate weight is 46 g (range 23-69). 45% cases involve GRD 336 and 55% GRD 337. Mean hospital stay for the procedure was 2.5 days. 2.3% of the series developed long-lasting temperature, 2.3% required transfusion and 2.3% a second intervention. Around 81% patients are satisfied with the results. CONCLUSIONS: It is possible to reduce costs by reducing hospital stay without impairing care quality and patient satisfaction.

Adult↗
PubMed2000

Seminal plasma contains "BPSA," a molecular form of prostate-specific antigen that is associated with benign prostatic hyperplasia.

BACKGROUND: We previously reported that levels of BPSA, a modified form of prostate-specific antigen (PSA), are significantly elevated in prostate transition-zone tissue exhibiting nodular hyperplastic changes associated with the presence of benign prostatic hyperplasia (BPH). BPSA was purified and found to contain a characteristic clip between Lys182 and Ser183. We now describe the identification of BPSA in seminal plasma. METHODS: PSA was purified from seminal plasma by immunoaffinity chromatography. The purified PSA was further resolved by hydrophobic interaction chromatography, and the individual PSA forms were analyzed by gel electrophoresis and N-terminal amino-acid sequencing. RESULTS: BPSA comprised about 8% of the PSA in pooled seminal plasma, and was identical to BPSA purified from prostate tissues. BPSA was cleanly resolved from all active and inactive forms of PSA. Other inactive forms of PSA in seminal plasma consisted largely of PSA clipped at Lys145, though about 30% of the inactive seminal plasma PSA was intact, mature PSA. CONCLUSIONS: BPSA represents a distinct form of inactive PSA in the seminal plasma that may represent a specific marker for the biochemical changes associated with nodular development in the prostate transition zone found in patients with BPH.

Biomarkers↗
PubMed1987

Immunocytochemical localization of estrogen receptors in spontaneous and experimentally induced canine benign prostatic hyperplasia.

Estrogens are believed to play a critical role in the etiology of canine benign prostatic hyperplasia (BPH); however, the mechanism has not been elucidated. To gain insight into this problem, we investigated the immunocytochemical localization of estrogen receptors (ER) in normal prostates, spontaneous BPH, and experimentally induced BPH by using a monoclonal ER antibody (H222). In all canine prostates the majority of ER was localized in nuclei of the same histological components: (1) transitional epithelium and subjacent stroma of the prostatic urethra, (2) periurethral prostatic ductal epithelium, and (3) prostatic stroma. ER content in the stroma was highest in the periurethral region of the prostate. Among the different groups of dogs, differences in ER location were seen only in the glandular epithelium. No ER was found in the glandular epithelium of normal prostates of young untreated dogs. In striking contrast, glandular epithelium of spontaneous BPH contained specific nuclear ER staining, though this staining was heterogeneous and was observed in only a minority (less than 10%) of the acinar epithelial cells. ER-positive acini in BPH were located predominantly in the periurethral region. These data demonstrate anatomical and biochemical heterogeneity of prostatic components and indicate that the estrogen sensitivity of prostatic cells is heterogeneous. If estrogen does play a role in BPH, it appears to act selectively rather than uniformly throughout the prostate. We reasoned that if glandular epithelial ER are involved in the development of spontaneous BPH, one might expect to find the same location of ER in BPH that was induced experimentally by specific types of treatment with androgens +/- estradiol. However, among hormone-treated dogs the presence of ER-positive prostatic glandular epithelium varied with the type of hormonal treatment but did not correlate with the experimental induction of glandular BPH. Some treatment groups with induced BPH had ER-positive prostatic glandular epithelial nuclei (with the same extent and pattern of ER localization as in spontaneous BPH); however, other treatment groups with induced BPH had ER-negative glandular epithelium. These data indicate either that glandular epithelial ER may not be involved in the pathogenesis of canine BPH or that there may be different types of BPH that have different etiologies. Possible mechanisms by which estrogen may affect the canine prostate are discussed in light of these new data on ER location.

Androgens↗
PubMed1993

Prostatic surgery for benign prostatic hyperplasia: meeting the expanding demand.

We describe changes in the pattern of surgery for benign prostatic hyperplasia (BPH) in Scotland between 1971 and 1989. The data are based on an analysis of routinely collected Scottish hospital in-patient statistics for primary prostatic operations on men with a diagnosis of BPH (ICD Code 600.0). Primary operation age-adjusted rates for BPH increased from 8.9 to 15.8 per 10,000 male population from 1971 to 1989. This was accompanied by a reduction in bed day use for BPH surgery from 49,500 bed days in 1971 to 36,000 in 1989. Case fatality for all surgery for BPH also fell steadily and can no longer be regarded as a relevant measure of prostatectomy outcome. Virtually all surgical intervention is now transurethral resection (TUR), forming 94% of surgery for BPH in 1989 compared with only 32% in 1971. The increase in surgical procedures carried out for BPH has been greater in younger age groups. If the pattern of increasing surgical intervention in the management of BPH over the past few years continues and there is an increased demand for treatment, and if the reported demographic changes occur, there will be a need for an additional 9 new consultant urologists in Scotland by 2001. Even if present operation rates hold steady, population changes alone will produce enough work for 2 more urologists.

Age Factors↗
PubMed1996

Free to total prostate-specific antigen (PSA) ratio improves the discrimination between prostate cancer and benign prostatic hyperplasia (BPH) in the diagnostic gray zone of 1.8 to 10 ng/mL total PSA.

OBJECTIVES: Improved discrimination between prostate cancer (PC) and benign prostatic hyperplasia (BPH) is clearly needed. Our aim in this study was to evaluate whether the free to total prostate-specific antigen (PSA) ratio would be useful in the gray zone of 1.8-10 ng/mL total PSA range. METHODS: In a consecutive series of 435 clinic patients referred for prostate evaluation, 308 had a total PSA < 10 ng/mL (92 had PC and 216 BPH). Free and total PSA were measured, and the free to total PSA ratio calculated. RESULTS: Total PSA values were significantly different between the two groups. For the 200 patients with a total PSA < 6 ng/mL, no significant difference in total PSA values were seen (P = 0.411), whereas free to total PSA ratios remained statistically different (P < 0.001). Receiver operating characteristic (ROC) curve analysis comparing the performances of total PSA over the ratio of free to total PSA showed a clear advantage for the ratio at all sensitivity levels. CONCLUSIONS: These data demonstrate that in a significant number (n = 308) of prostatic patients in the diagnostic gray zone of 1.8-10 ng/mL total PSA, the routine use of free to total PSA might be advantageous in discriminating between cancer and benign hyperplasia. This advantage remained for total PSA < 4 ng/mL. Further study is warranted to confirm these findings in an unselected population.

Aged↗
PubMed1999

Percent of free serum prostate-specific antigen and histological findings in patients undergoing open prostatectomy for benign prostatic hyperplasia.

PURPOSE: To determine which pathologic features of the surgical specimen in men undergoing open prostatectomy for benign prostatic hyperplasia (BPH) correlate with preoperative and postoperative total, free prostate-specific antigen (PSA) levels and the free-to-total PSA ratio. METHODS: Forty-four patients, undergoing open prostatectomy for BPH without evidence of prostate cancer in systematic biopsies and clinical prostatitis, were included in this prospective study. Each prostatectomy specimen was weighed and each slide was evaluated for inflammation (acute prostatitis, chronic-active prostatitis and chronic-inactive prostatitis), prostatic intraepithelial neoplasia, transitional/squamous metaplasia, cystic ductal dilation, leiomyoma-resembling stromal cell proliferation, leakage of prostatic secretion, infarction and prostatic calculi. RESULTS: The mean preoperative (and postoperative) total PSA and free PSA levels were 6.1 +/- 4.3 (1.14 +/- 0.87) and 1.7 +/- 1.6 (0.24 +/- 0.19) ng/ml, respectively. The mean prostatic and transition zone volume was 83.9 +/- 28.4 and 55.4 +/- 27.6 cm(3), respectively. Both total PSA and free PSA levels were correlated with total gland volume (p = 0.0001; p = 0.002) and the volume of the surgical specimen (p = 0.003; p < 0.05) and, upon stepwise logistic analysis, patients with a total gland volume of <50 cm(3) had an odds ratio of 11 (CI 1.6-71.3) for having a free-to-total ratio of <18%. No minimal change pathology or prostatic inflammation were associated with preoperative total or free PSA levels. The free-to-total PSA ratio was higher in the group of patients with histologically acute and moderate to severe chronic-active prostatitis (mean ratio 27 +/- 12%) than in patients with chronic-inactive prostatitis and minimal chronic-active prostatitis (mean ratio 0.19 +/- 13%; p = 0.05), showing an odds ratio of 5 (CI 1.1-22.1) for having a free-to-total PSA ratio of <18%. CONCLUSIONS: Prostate volume and, in particular, transition zone volume seem to influence both free and total PSA levels in men with BPH. The free-to-total PSA ratio seems to be influenced by the presence of histological prostatitis in the surgical specimen. In particular, patients with a prostate volume of <50 cm(3) and an inactive form of prostatitis seem to have a relatively higher risk of having a free-to-total PSA ratio of <18%.

Aged↗
PubMed2001

Similar symptoms and confounding conditions: benign prostatic hyperplasia versus hyperglycemia.

The traditional approach to diagnosing men with symptoms associated with benign prostatic hyperplasia (BPH) based on the American Urological Association symptom index may be limiting. There are often concurrent conditions that may be responsible for the urinary complaints of men with BPH, namely hyperglycemia. Both conditions manifest many of the same symptoms and complaints by patients, but treatment of one can lead to a missed diagnosis of the other.

Aged↗
PubMed2000

Cell kinetics and differentiation after hormonal-induced prostatic hyperplasia in the dog.

BACKGROUND: Our aim was to characterize the immunophenotypical changes in canine prostate epithelium after hormonal-induced benign prostatic hyperplasia (BPH). METHODS: Castrated dogs (aged 1-2 and 9-12 years) were treated with vehicle (group C), androstanediol (group A), or androstanediol plus estradiol (group AE). Surgical prostate biopsies were obtained before and after castration and after hormonal treatment. Tissue sections were stained using antibodies specific for basal cells (34betaE12), transiently proliferating (TP)/amplifying cells (RCK103), and luminal exocrine cells (RGE53). RESULTS: Castration resulted in a marked reduction in specific immunoreactivity associated with luminal secretory cells and basal cells in young dogs. In older dogs the number of basal cells remained constant. Hormonal treatment (AE) resulted in an increased number of cells with an immunophenotype that was associated with the TP/amplifying cell compartment and hyperplastic luminal epithelium. CONCLUSIONS: The relative increase in TP/amplifying cells in hormonally induced BPH in the dog is in line with a stem-cell-derived proliferation. Moreover, the finding of androgen-independent basal cells in the prostate of older dogs may contribute to the enhanced risk of development of BPH with increasing age.

Age Factors↗
PubMed1993

Connection between the length of the heating antenna and volume of the prostate in transurethral thermotherapy for benign prostatic hyperplasia.

From June 1990 to June 1991, 79 poor surgical risk patients with benign prostatic hyperplasia (BPH) were treated with transurethral hyperthermia. The patients were divided into 2 treatment groups. In group I, 40 patients were treated by two 2-hour sessions at 44.5 degrees C and a heating antenna of 1 cm long. In group II, 39 patients received one 3-hour treatment session at a temperature of 46 degrees C and a 2-cm-long heating antenna. The mean follow-up period was 7.9 months for group I and 8.4 months for group II patients. In group I, 22 of 40 patients (55%) showed subjective and objective improvement. In group-II patients a major improvement was noted in 25 of 39 patients (64%). The patients in both groups were subdivided into those with prostates smaller or larger than 50 ml. Significantly better treatment results were obtained in patients with prostates smaller than 50 ml in group-I and group-II patients. The mean Madsen-Iversen score, residual urine and maximum flow rate improved significantly in 47% of groups-I patients with larger prostates and 62% of those with prostates < 50 ml (p < 0.05), and in 50% of group-II patients with prostates > 50 ml and 82% of those with prostates < 50 ml (p < 0.01). A temperature of 46 degrees C with a 2-cm-long heating antenna in patients with prostates < 50 ml gave the best treatment results (82%).

Aged↗
PubMed2001

Sexual function in patients with benign prostatic hyperplasia.

Sexual health has significant impact on quality of life among men with benign prostatic hyperplasia (BPH). The degree of sexual dysfunction matches the severity of lower urinary tract symptoms (LUTS). Treatment of BPH affects not only LUTS, but sexual function as well. Medical, surgical, and minimally invasive therapies differ in their effect on erectile function, ejaculation, and sexual satisfaction. Choice of treatment modality takes into account baseline sexual function and patient expectations. This review outlines the relationship between LUTS and sexual function and how they change with the currently available treatments.

Humans↗