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PubMed2002

Phytotherapy for benign prostatic hyperplasia.

Phytotherapy has become a more popular treatment option among American men with benign prostatic hyperplasia (BPH). The most popular herbal agent is saw palmetto (Serenoa repens), which is derived from the berry of the American dwarf palm tree. Pygeum africanum and beta-sitosterol are also used by many patients with BPH, either alone or in combination with saw palmetto. A significant limiting factor to our understanding of the use and effectiveness of phytotherapy is the lack of standardization of these products. Despite this lack of standardization and the variation in results that may be seen with herbal products, there is growing evidence from well-conducted clinical trials that phytotherapeutic agents may lead to subjective and objective symptom improvement beyond a placebo effect in men with BPH. In addition, histologic evidence has been presented demonstrating that saw palmetto causes atrophy and epithelial contraction within the prostate gland. Overall, it is likely that herbal therapy will continue to be used by a growing number of Americans to treat a variety of ailments. Physicians should attempt to remain open-minded regarding alternative approaches and educate themselves so that they may counsel patients in an informed and credible fashion.

Androgen Antagonists↗
PubMed1993

Hyperthermia and thermotherapy of benign prostatic hyperplasia: a critical review.

The indications, risks and benefits of surgical treatment of benign prostatic hyperplasia (BPH) have recently been scrutinized, and interest in the development of less invasive alternative nonsurgical approaches has emerged. Among the nonsurgical alternatives, thermal treatments have been clinically introduced for a few years but are still under evaluation. Microwaves and radiofrequency waves are generated by various devices applied by the transrectal or transurethral approach, with different treatment and temperature schedules. Results achieved with the various devices did not show large significant differences. Improvement is mainly observed by a decrease in irritative symptoms rather than by modifications of obstructive parameters. The placebo effect must not be underestimated in all these new alternative methods. Fifty percent of patients in retention and unfit for anesthesia voided satisfactorily after thermal treatment. Pathological studies of operative specimens after transurethral thermotherapy showed coagulative necrosis with destruction of smooth muscle and glandular components. The destruction of alpha-receptors or sensory nerves in the prostate stroma is a possible explanation for the reduction of irritative symptoms. No significant histological lesions were found however after transrectal hyperthermia. Various factors such as differences in tissue thermosensitivity, tissular architecture and thermoregulation related to variation in the prostate blood supply may all play a part in the final heating effect and determine the clinical response for a given patient. Better understanding of these various factors may improve patient selection. Although thermal treatment of BPH cannot be seen as a substitution for surgery, it may represent an alternative option in selected patients essentially to alleviate irritative symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Electromagnetic Phenomena↗
PubMed1980

Stromal 5 alpha-reductase activity is elevated in benign prostatic hyperplasia.

The activities of 5 alpha-reductase and 3 alpha (beta)-hydroxysteroid dehydrogenase were assayed in homogenates of stroma and epithelium obtained from 3 normal, 9 hyperplastic and 2 carcinomatous human prostates. Irrespective of the normal or abnormal condition of the prostate, the localization of 5 alpha-reductase was predominantly in stroma whereas the reductive and oxidative activities of 3 alpha (beta)-hydroxysteroid dehydrogenase were more evenly divided between stroma and epithelium. Furthermore, the mean specific activity of 5 alpha-reductase in hyperplastic stroma at 84.6 plus or minus 13.1 (plus or minus SEM) pmol 30 min-1 mg protein-1 was almost 3 times greater (Student's t-test, P < 0.05) than the corresponding value in normal stroma, 31.6 plus or minus 7.2 pmol mg protein-1 30 min-1. We conclude that the stroma is the primary site of conversion of testosterone to dihydrotestosterone in the human prostate owing to the prevalence in stroma of 5 alpha-reductase, and that benign prostatic hyperplasia is characterized by an increased amount of stromal 5 alpha-reductase activity.

3-Hydroxysteroid Dehydrogenases↗
PubMed1999

Efficacy of transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia.

BACKGROUND: We evaluated the efficacy and safety of transurethral needle ablation (TUNA) of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH) as one institute participating in a Japanese clinical trial. METHODS: Thirty-three patients with symptomatic BPH were treated with the TUNA procedure in our institute. The international prostate symptom score (IPSS), quality of life (QOL) score, residual urine volume (RV), prostate volume (PV) and peak urinary flow rates (Qmax) were measured and complications were assessed. RESULTS: We followed and evaluated 30 of the 33 cases. At 12 months there were significant improvements in the IPSS (20.7 to 11.2, P < 0.0001), QOL score (4.9 to 2.1, P < 0.0001), RV (46.6 to 22.6 mL, P < 0.01), PV (37.8 to 30.0 mL3, P < 0.002) and Qmax (8.00 to 11.0 mL/s, P < 0.002). There were no serious complications. CONCLUSION: This trial shows that the TUNA procedure is a safe and efficacious treatment for symptomatic BPH.

Aged↗
PubMed1998

Combination of pneumatic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia.

We present our experience with combined pneumatic lithotripsy and transurethral resection of the prostate (TURP) in 52 patients with bladder stone(s) and benign prostatic hyperplasia (BPH). All stones were fragmented with the pneumatic Swiss Lithoclast. Pneumatic lithotripsy and evacuation caused a mean increase of 16 minutes in operating time. No complications, other than mild hematuria, were observed intraoperatively because of pneumatic lithotripsy. We observed early and long-term complications related to the procedure in 13% of patients. The average hospital stay was 3.2 days. The combination of pneumatic lithotripsy and TURP appears to be an effective, safe, and economical treatment method for patients with bladder stone(s) and BPH.

Aged↗
PubMed1995

Levels of circulating intercellular adhesion molecule-1 in patients with metastatic cancer of the prostate and benign prostatic hyperplasia.

Current reports suggest a role for intercellular adhesion molecule-1 (ICAM-1) in the progression of malignancy. The availability of a new antibody makes it possible to measure circulating ICAM-1 (cICAM-1) in human body fluids including serum; this might help in monitoring tumour burden and in providing additional prognostic information. In this study, serum levels of cICAM-1 were measured by an ELISA assay in patients with benign prostatic hyperplasia (BPH; n = 20) and metastatic cancer of the prostate (CaP; n = 25). Serum ICAM-1 concentrations were also measured in a group of healthy men (n = 8). The mean +/- S.E.M. cICAM-1 level for BPH was 339.52 +/- 15.30 ng/ml compared with 263.55 +/- 18.54 ng/ml for CaP. Even though the difference between the two groups was significant (P < 0.005), there was a marked overlap between the individual values in both groups, thus minimising the prognostic value of these measurements in prostate cancer. Endocrine therapy had no notable effect on the serum levels of cICAM-1. The mean +/- S.E.M. cICAM-1 concentrations in serum from a younger group of healthy volunteers was 204.1 +/- 10.38 ng/ml, and this value was significantly lower than that measured in serum from either BPH or CaP. We also undertook some immunohistochemical studies to examine the distribution of ICAM-1 in prostate tissue. We observed focal epithelial cell membrane staining which was exceedingly patchy in both the BPH and cancer specimens. On the basis of these studies, we suggest that cICAM-1 levels do not provide additional information on patients with metastatic CaP.

Adult↗
PubMedDate not supplied

[Combined therapy of voiding irritative disorders after surgical treatment of benign prostatic hyperplasia with Andro-Gin].

The results of operative and rehabilitative treatment of benign prostatic hyperplasia (BPH) was analysed for 69 BPH patients with postoperative irritative disorders of voiding. The patients were divided into four groups by rehabilitative therapy: group 1 received antibacterial therapy; group 2--antibacterial therapy+alpha-adrenoblockers; group 3--antibacterial therapy+transrectal laser and magnetic physiotherapy; group 4--antibacterial therapy+alpha-adrenoblockers+transrectal laser and magnetic physiotherapy. The worst result was obtained in group 1, the best one in groups 3 and 4 (the response was compatible). Thus, the addition of physiotherapy to the complex of postoperative rehabilitation of patients operated for BPH is justified and provides treatment improvement.

Aged↗
PubMed2001

Impact of interventional therapy for benign prostatic hyperplasia on quality of life and sexual function.

Considering the epidemiologic impact of benign prostatic hyperplasia (BPH), the use of minimally invasive surgery in the treatment of this condition is one of the main ambitions of contemporary urology. Compared with the prevalence of BPH and LUTS in elderly men, only a small percentage of patients requires surgery for indications such as renal insufficiency, chronic retention, and infection. The majority of patients seek treatment because of the bothersome nature of their symptoms and expect improvement in their quality of life. The goal of interventional therapy is to restore the comfort and well being of the patients, including preserving their sexuality. Therefore, there is increased focus on the quality of life and sexual function in the evaluation of the outcome of interventional therapy for BPH.

Humans↗
PubMed1998

Induction of prostate apoptosis by doxazosin in benign prostatic hyperplasia.

PURPOSE: The molecular mechanisms underlying the therapeutic effect of the alpha1 blocker, doxazosin, on benign prostatic hyperplasia (BPH) are poorly understood. We evaluated the effect of doxazosin on cell proliferation and apoptosis in the prostatic glandular epithelium and stroma of patients with BPH. MATERIALS AND METHODS: We examined proliferative and apoptotic activities in prostate specimens of 22 men a mean of 65 years old with BPH before and after doxazosin treatment within the normal therapeutic range. Proliferative and apoptotic indexes were determined using Ki-67 nuclear antigen staining and the terminal transferase end labeling assay, respectively. The smooth muscle cell content in prostatic specimens was identified by smooth muscle alpha-actin, and desmin immunoreactivity and apoptotic indexes were correlated with prostatic stromal tissue regression and improvement in BPH symptoms. RESULTS: In response to doxazosin treatment there were no significant changes in the kinetics of cell proliferation in the prostatic epithelial or stromal cell population. Mean pretreatment baseline apoptosis was 1.9 and 1.0% for the epithelial and stromal prostate components, respectively. Mean apoptotic indexes significantly increased after 3 months of doxazosin treatment in the glandular epithelial (6%) and smooth muscle cells (15%). By 12 months after treatment epithelial apoptosis had decreased to constitutive levels, while the apoptotic index of prostatic stroma cells remained high. Doxazosin induced smooth muscle cell apoptosis correlated with prostatic stromal degeneration, decreased alpha-smooth muscle actin expression and improved BPH symptoms. CONCLUSIONS: These findings implicate the induction of prostate apoptosis by doxazosin as a potential molecular mechanism underlying the acute and chronic therapeutic responses of BPH to alpha1 blockade.

Adrenergic alpha-Antagonists↗
PubMed2004

Preventing progression in men with mild symptoms of benign prostatic hyperplasia: a potential role for phytotherapy.

Prevalence of benign prostate hyperplasia (BPH) is increasing with the aging population worldwide. Throughout the 20th century, men with minimally symptomatic BPH were generally advised to defer treatment. Treatment deferral or watchful waiting has always appeared reasonable because mild lower urinary tract symptoms suggestive of bladder outlet obstruction are not bothersome and are often regarded as part of the aging process, progression is usually slow, and symptoms often regress spontaneously. This review examines the evidence of the natural history of BPH, highlighting the group of patients with mild symptoms, the risk factors for progression, and the potential role of phytotherapy in this group of men.

Journal Article↗
PubMed1973

Morphological changes of benign prostatic hyperplasia in culture.

A technique is described for the culture of slices of benign prostatic hyperplasia (BPH) for periods of a week in organ culture. Under these conditions tissue repair took place, resulting in a covering layer of transitional epithelium which formed around the explant and spread out laterally as a monolayer. Autoradiography and studies with [(3)H]thymidine uptake suggested that the repair activity, which reached a peak at Day 3 in culture, was the centre of biochemical activity, overshadowing that of the rest of the explant. Necrosis of the explant base tended to develop abruptly during the first day of culture but thereafter remained stable. The epithelium was well preserved morphologically, but explant acid phosphatase activity fell progressively.No morphological response to testosterone (10(-5) mol/l) or stilboestrol diphosphate (10(-5) mol/l) was seen.Attention is drawn to a possible source of misinterpretation of results offered by the uptake of [(3)H]thymidine into DNA in organ culture.

Acid Phosphatase↗
PubMed2005

CA repeat polymorphism in the insulin-like growth factor-I gene is associated with increased risk of prostate cancer and benign prostatic hyperplasia.

Insulin-like growth factor-I (IGF-I) plays an important role in prostate growth, hyperplasia, and carcinogenesis. Circulating IGF-I levels may be modulated by a genetic cytosine-adenine (CA) repeat polymorphism in the promoter region of IGF-I. The association of the polymorphism with the risk of prostate cancer and benign prostatic hyperplasia (BPH) was explored in 303 patients with prostate cancer, 219 patients with BPH and 262 controls. The number of CA repeats ranged from 15 to 22 in case and control subjects. The 19-CA-repeat allele (19-allele) was more frequently observed in both the prostate cancer and BPH patients compared with the controls (prostate cancer versus control: P<0.001; BPH versus control: P=0.001). Compared with non-carriers of the 19-allele, men homo-zygous for the 19-allele had a significantly increased risk of prostate cancer [age-adjusted odds ratio (aOR) = 3.36, 95% confidence intervals (CI) = 1.30-8.67, P=0.012] or BPH (aOR = 3.53, 95% CI = 1.32-9.46, P=0.012), and those heterozygous for the 19-allele also had an intermediate increased risk of prostate cancer (aOR = 1.78, 95% CI = 1.25-2.53, P=0.001) or BPH (aOR = 1.66, 95% CI = 1.14-2.43, P=0.009). A gene dosage effect for the aORs was found with an increasing number for the 19-allele (P<0.001 in prostate cancer and P=0.001 in BPH). No significant association was found between the presence of the 19-allele and the tumor stage and grade at the time of diagnosis. In conclusion, the 19-allele of IGF-I appears to increase the risk of prostate cancer and BPH with a gene dosage effect in the Japanese population.

Alleles↗
PubMed1998

Surgical and nonsurgical invasive treatment of benign prostatic hyperplasia.

A third era in the surgical treatment of benign prostatic hyperplasia (BPH) utilizes less invasive treatment modalities. Transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA) and a wide variety of laser treatments are the most conspicuous new treatment modalities approved or awaiting approval. In general, the alternative treatments produce less improvement in symptoms and peak urinary flow rates (Q(max)) than open prostatectomy or transurethral resection of the prostate (TURP), which remains the "gold standard". However, most are promising, particularly because they are associated with low morbidity. Long-term outcome has yet to be assessed with any of the newer treatments and total costs are difficult to calculate. Most have proved safe, are feasible on an outpatient basis and which, provided a low retreatment rate, will presumably reduce the socioeconomic costs. Although differences are found in outcome, morbidity and costs, none of the newer treatments has demonstrated convincing superiority or established a well-defined niche. In the future, controlled randomized studies against well-documented treatments like TURP or transurethral incision of the prostate (TUIP), focusing on long-term outcome, quality of life and socioeconomic costs, are needed.

Journal Article↗
PubMed1992

The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association.

A symptom index for benign prostatic hyperplasia (BPH) was developed and validated by a multidisciplinary measurement committee of the American Urological Association (AUA). Validation studies were conducted involving a total of 210 BPH patients and 108 control subjects. The final AUA symptom index includes 7 questions covering frequency, nocturia, weak urinary stream, hesitancy, intermittence, incomplete emptying and urgency. On revalidation, the index was internally consistent (Cronbach's alpha = 0.86) and the score generated had excellent test-retest reliability (r = 0.92). Scores were highly correlated with subjects' global ratings of the magnitude of their urinary problem (r = 0.65 to 0.72) and powerfully discriminated between BPH and control subjects (receiver operating characteristic area 0.85). Finally, the index was sensitive to change, with preoperative scores decreasing from a mean of 17.6 to 7.1 by 4 weeks after prostatectomy (p < 0.001). The AUA symptom index is clinically sensible, reliable, valid and responsive. It is practical for use in practice and for inclusion in research protocols.

Adult↗
PubMed2004

Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents?

PURPOSE OF REVIEW: A substantial proportion of men with lower urinary tract symptoms have a combination of both 'storage' and 'voiding' symptoms, suggesting possible coexisting bladder outlet obstruction and bladder overactivity. Bladder overactivity is traditionally treated with anticholinergic drugs. However, guidelines from the European Association of Urologists make no mention of the possible therapeutic role of anticholinergic drugs for treating storage symptoms in such patients. It is a common perception that using an anticholinergic drug in men with bladder outlet obstruction runs the risk of inducing acute urinary retention, because of the inhibitory effect of anticholinergics on bladder contraction in the presence of outlet obstruction. This review focuses on recent data determining the efficacy of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia and the associated risk of acute urinary retention. RECENT FINDINGS: One recent study in men with urodynamically confirmed obstruction supports the assertion that anticholinergic drugs are safe in men with bladder outlet obstruction. Safety data from larger studies using anticholinergics in patients with overactive bladders supports these findings. SUMMARY: Efficacy and safety studies of anticholinergic medication in men with lower urinary tract symptoms/benign prostatic hyperplasia are few and far between, but preliminary data suggests they are not associated with a substantial risk of urinary retention nor with a substantial increase in residual urine volume.

Aged↗
PubMed1994

Low-power laser radiation for the treatment of benign prostatic hyperplasia: initial clinical experience.

Fifteen patients with significant bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) were entered in a Phase II open pilot study designed to evaluate the effectiveness of a low-power-slow-heating (15 W x 180 seconds) laser regimen. Laser prostatectomies were performed with a right-angle firing neodymium:YAG laser fiber. Perioperative morbidity was minimal. Nine patients (60%) were able to void on their own within 72 hours after the procedure. The mean postoperative need for catheter drainage was 3.8 days (range 1 to 12). With a mean follow-up of 5 months (range 3-15 months), the improvement of the mean peak urinary flow rate was from 12.8 to 29 mL/sec, the mean postvoiding residual volume was reduced from 100 to 35 mL, and the AUA Symptom Score improved from 28.5 to 6. None of the patients required retreatment, and all the patients were pleased with the outcome. These results suggest that the laser regimen used in our study is safe and effective for the treatment of BPH.

Aged↗
PubMed2005

[Analysis of the scientific evidence of the combination therapy in benign prostatic hyperplasia].

OBJECTIVE: The analysis of the scientific evidence of the combination therapy in Benign Prostatic Hyperplasia (BPH). METHODS: 5 published studies about combination therapy in BPH were analysed following the criteria of the Evidence Based Medicine (EBM). Hypothesis, variables, internal validity, results relevance, and the external validity of every study were analysed. RESULTS: Symptoms changes and maximal flow rate (Qmax) improvement were evaluated in four studies and only one analysed the BPH progression. Inclusion and exclusion criteria were similar in the 5 studies. The main reasons of a poor internal validity in 3 studies were the short follow-up, the missing percentage, the absence of a placebo group and a dosage bias. External validity were decreased in the 5 studies by the exclusion criteria and in 3 of them because high doses of alpha-blocker were given to achieve a therapeutic effect. The study with the highest scientific evidence (MTOPS) is the only that offers confidence intervals and number needed to treat. CONCLUSIONS: The Qmax and the symptoms improvement found in all the studies has a moderate clinical relevance. MTOPS study shows that BPH progression has a low incidence that can be highly reduced by means of combination therapy.

Adrenergic alpha-Antagonists↗
PubMed1995

Contact laser vaporization techniques for benign prostatic hyperplasia.

Contact laser applications for the relief of bladder outlet obstruction caused by an enlarged prostate are different from the noncontact Nd:YAG laser methods. The noncontact techniques rely on coagulation necrosis or high power-density vaporization. The pure contact Nd:YAG laser allows cutting, coagulation, and vaporization of tissue with minimal penetration beyond the contact surface. In the contact laser prostatectomy technique, the laser probe directly touches and vaporizes the prostatic tissue. This results in immediate removal of the obstructing tissue, in a manner similar to the standard electrosurgical transurethral resection (TURP), and offers the patient the potential for decreased catheter time and a more rapid resolution of symptoms. Our initial experience suggests that the contact technique (contact laser ablation of the prostate or CLAP) may be better suited for the smaller prostate gland (i.e., less than 20-30 g). For prostates larger than 30 g, a newly described procedure known as coagulation and hemostatic resection of the prostate (CHRP) can be used. This method combines initial noncontact coagulation of the prostate with vaporization of a channel. The goal of CHRP is to allow more rapid removal of the catheter with a continued improvement in urine flow secondary to the coagulation effects. The contact laser is specifically designed to vaporize tissue such as the prostate and allows immediate observation of a TUR defect. Improvements in the delivery system and in the size of the contact laser probes have made CLAP a useful modality for the treatment of symptomatic benign prostatic hyperplasia.

Follow-Up Studies↗