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PubMed1998

[Treatment of benign prostatic hyperplasia].

Due to innovative pharmacological and endoscopic/interventional concepts of therapy, the strategies of facing the benign prostatic hyperplasia have undergone a significant diversification within the last ten years. In addition to phytotherapeutic drugs, which have been in clinical use for decades, alpha receptor blockers and blockers of DHT-synthesis have gained increasing importance. More or less convincing instrumental competing methods have been developed as an alternative to the transurethral resection of the prostate or the transvesical prostatectomy. Regarding the altered age pyramid structure and decreasing financial means, guidelines for the diagnosis and therapy of the BPH-syndrome are consequently being developed in order to support the establishment of an individual therapy of BPH, to increase the efficacy of therapy and to be able to get along with the existing financial barriers. The development of the International Prostate Symptoms Score (IPSS) is regarded essential for this effort.

Diagnosis, Differential↗
PubMed1993

[The role of LH-RH analogue in benign prostatic hyperplasia].

In our study 7 patients considered high risk for any surgical and anesthetic intervention, with benign prostatic hyperplasia, whose 2 with permanent catheter, were treated for 6 months with luteinizing hormone-releasing hormone analogue. The treatment resulted in an average decrease in prostatic volume of 21.7%; reduced the serum PSA/PAP values of 52% and 43%, respectively; 4 pz improved their symptom score (1 pz removed the permanent catheter), 2pz kept stationary and 1 pz made worse. No particular side effects were presented and all patients finished the therapy. We conclude that LH-RH analogue therapy should be restricted to selected patients and then it will have to be continued for a long period of time.

Aged↗
PubMed2005

The evolution of laser therapy in the treatment of benign prostatic hyperplasia.

The 2 basic principles of laser therapy for benign prostatic hyperplasia (BPH), based on the final tissue effect, are laser vaporization and laser coagulation. In laser vaporization techniques, higher-density laser thermal energy is used; effects range from complete tissue vaporization to incision, resection, or enucleation of the obstructing prostatic tissue. Interstitial laser coagulation (ILC) requires lower therapeutic temperatures. The urethral preservation and lack of tissue evaporation/resection with ILC make this treatment different from conventional transurethral free-beam laser prostatectomy. The Indigo(R) Optima Laser treatment system is the most widely used ILC system. Unlike other BPH laser therapies, Indigo ILC can be satisfactorily performed using pure local anesthesia in an office or outpatient setting. Favorable treatment outcomes are seen in a large percentage of patients, with minimal adverse events. Such favorable results depend on proper surgical technique and operator experience.

Journal Article↗
PubMed2004

[Analysis of the diagnostic criteria of bladder outlet obstruction in benign prostatic hyperplasia].

OBJECTIVE: To analyze the value of the diagnostic criteria for bladder outlet obstruction in benign prostatic hyperplasia (BPH). METHODS: A total of 358 patients with BPH were divided into 3 grades according to fibrous urethrocystoscopy information on the severity of obstructions, which were classified as Grade 1 (slight), Grade 2 (moderate), and Grade 3 (severe). By Schäfer's graph they were divided into 7 grades, represented by 0 to VI. We analyzed the volume of prostate, maximum flow rate (Qmax), residual urine volume, International Prostatic Symptom Score (IPSS) and detrusor instability. Statistical analysis ANOVA (analysis of variance) was made, spearman correlation evaluated and the coefficient of determination measured. RESULTS: Of all the patients, 27 were classified as Grade 1, 236 as Grade 2 and 95 as Grade 3. Eighty-four patients had detrusor instability. The volumes of the prostate ranged from 16 ml to 145 ml, averaging (47.04 +/- 15.61) ml. The mean maximum flow rate was (10.02 +/- 2.12) ml/min and the mean residual urine volume was (84.06 +/- 36.50) ml. With the increase of the severity of obstruction, the volume of the prostate increased (F = 4.216, P < 0.05), IPSS rose (F = 8.408, P < 0.001), the maximum flow rate decreased (F = 22.43, P < 0.001), the residual urine volume rose (F = 163.232, P < 0.001), the incidence of detrusor instability increased (F = 23.637, P < 0.001) and Schäfer's grades were elevated (F = 202.897, P < 0.001). The volume of the prostate, the maximum flow rate (Qmax), residual urine volume, IPSS detrusor instability and Schäfer's grades were all correlated significantly with the severity of the obstruction. The correlation index and coefficient of determination were r = 0.29, R2 = 0.08; r = 0.35, R2 = 0.12; r = -0.69, R2 = 0.47; r = 0.60, R2 = 0.36; r = 0.33, R2 = 0.11; r = 0.72, R2 = 0.52; respectively. The correlation between the urethrocystoscopy information and Schäfer's graph on the severity of the obstruction were the best criteria of all. CONCLUSION: The severity of the obstruction at urethrocystoscopy correlates well with that at urodynamic investigation. Such criteria could improve the sensitivity and specificity of the diagnosis of bladder outlet obstruction.

Aged↗
PubMed1997

Evaluation of benign prostatic hyperplasia treatments: how can we improve the outcome measures and success criteria?

Treatment evaluation in benign prostatic hyperplasia (BPH) is complicated by a number of interdependent factors. The evaluation of the individual patient is influenced by the risk:benefit ratio and health related quality of life and this, in turn, is interrelated with the evaluation of therapeutic options. Current outcome measures include subjective measurements (e.g. symptom scores and patient reports) and objective measurements (e.g. uroflow and prostate volume). In order to improve outcome measures it is important to use health-related quality-of-life scales and symptom- and bother-associated scores. In addition, the patient should complete frequency and volume charts, and possibly use home flowmetry; transitional zone measurements may also play a role in finding a better treatment strategy. It is also important to consider the adverse effects and complication rates of invasive and pharmacological treatments (including their influence on quality of life) and economic factors such as the cost of treatment, the cost of following guidelines and the durability and failure rate associated with treatment. In order to manage the increasing number of BPH patients who seek care effectively it is important to share care with the GPs, but this will require improved guidelines, better data and better outcome measurements.

Cost-Benefit Analysis↗
PubMed1993

Ultrasonically determined patterns of enlargement in benign prostatic hyperplasia.

A series of 430 men aged 40 to 79 years underwent transrectal ultrasonography (TRUS) as part of a community survey of benign prostatic hyperplasia (BPH). We describe a reproducible method of prostate volume estimation and discuss the implications of prostate dimension changes in BPH. The mean prostate and adenoma volumes for the group were 32 ml (SD 14) and 15 ml (SD 11) respectively. The antero-posterior dimension of the prostate (APD) had the strongest correlation with gland volume compared with the transverse dimension (TD) and length (L). The mean ratio of adenoma volume to prostate volume was 0.45 (SD 0.13) and this increased with increasing gland volume. There was a modest correlation between the ratio and prostate volume. BPH is characterised by a proportionally greater increase in the APD compared with L and TD and by an increasing adenoma/prostate ratio. TRUS is useful in assessing the type and extent of adenoma and prostate enlargement in BPH.

Adult↗
PubMed2006

Silodosin, a new alpha1A-adrenoceptor-selective antagonist for treating benign prostatic hyperplasia: results of a phase III randomized, placebo-controlled, double-blind study in Japanese men.

OBJECTIVE: To verify the efficacy and safety of the new alpha1A-adrenoceptor-selective antagonist silodosin compared with tamsulosin and placebo in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: This randomized, double-blind, placebo-controlled study was conducted at 88 centres in Japan. Men aged > or = 50 years with an International Prostate Symptom Score (IPSS) of > or = 8, a quality-of-life (QoL) score of > or = 3, a maximum urinary flow rate (Qmax) of < 15 mL/s, a prostate volume of > or = 20 mL and a postvoid residual urine volume of < 100 mL were eligible for enrolment. Patients were randomized to receive silodosin 4 mg twice daily, tamsulosin 0.2 mg once daily, or placebo, for 12 weeks. The primary endpoint was the change in IPSS from baseline. Safety was assessed by adverse events, physical examination, vital signs and laboratory tests. RESULTS: In all, 457 patients were randomized (silodosin 176, tamsulosin 192 and placebo 89). The change in the total IPSS from baseline in the silodosin, tamsulosin and placebo groups was -8.3, -6.8 and -5.3, respectively. There was a significant decrease in the IPSS vs placebo in the silodosin group from 1 week. In the early-stage comparison, silodosin showed a significant decrease in IPSS vs tamsulosin at 2 weeks. The change in QoL from baseline was -1.7, -1.4 and -1.1 in the silodosin, tamsulosin and placebo groups, respectively; silodosin showed a significant improvement in the QoL score vs placebo. In the subgroup of patients with severe symptoms (IPSS > or = 20) silodosin also gave a significantly better improvement than placebo (-12.4 vs -8.7). The incidence rates of adverse events and drug-related adverse events were, respectively, 88.6%, 82.3% and 71.6% and 69.7%, 47.4% and 36.4%, respectively. The most common adverse event in the silodosin group was abnormal ejaculation, which occurred more often in the silodosin than in the tamsulosin group (22.3% vs 1.6%). However, only five men (2.9%) discontinued treatment for abnormal ejaculation. CONCLUSION: Silodosin was generally effective in the absence of obtrusive side-effects. This study suggests that silodosin is clinically useful for treating LUTS associated with BPH.

Adrenergic alpha-Antagonists↗
PubMed2002

Three-year follow-up of laser prostatectomy versus transurethral resection of the prostate in men with benign prostatic hyperplasia.

OBJECTIVES: To present our 3-year data comparing laser prostatectomy and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Laser prostatectomy was one of the first new minimally invasive treatment modalities for BPH, and few reports of the long-term results of this treatment regimen have been published. METHODS: One hundred men with BPH in whom medical therapy had failed were randomized to undergo either laser prostatectomy or TURP. Preoperative measurements included American Urologic Association symptom score, prostate-specific antigen, uroflowmetry, and transrectal ultrasonography (TRUS). Laser prostatectomy was performed using the potassium titanyl-phosphate/neodynium:yttrium aluminum-garnet laser. TURP was performed in a standard manner with video monitoring. Patients were seen in follow-up at 1, 3, 6, and 12 months and every 12 months thereafter, with the following data obtained: symptom score, peak urinary flow rate, prostate-specific antigen level, and TRUS volume. RESULTS: A total of 100 patients were entered into the study, with 50 patients in each treatment group. The mean age was 68.2 years (range 45 to 90) for the laser patients and 67.4 years (range 54 to 82) for the TURP group. The mean symptom score decreased from 22.0 to 9.9 at 36 months of follow-up for the laser patients compared with 21.2 to 7.7 for the TURP patients. The mean peak flow rate increased from 8.2 to 12.3 mL/s at 36 months for the laser group with a similar increase from 7.3 to 12.8 mL/s for the TURP patients. The mean TRUS volume for the laser patients decreased from 33.9 to 32.9 cm3 at 36 months compared with a mean TRUS volume of 29.6 cm3 preoperatively for the TURP patients that decreased to 26.3 cm3 at 36 months. CONCLUSIONS: At 36 to 72 months of follow-up, the durability of results achieved by the patients in the laser cohort was similar to that for patients undergoing TURP.

Aged↗
PubMed1994

Urodynamic changes in benign prostatic hyperplasia patients treated by transurethral microwave thermotherapy.

Our study describes the results obtained in 44 patients with benign prostatic hyperplasia (BPH) who underwent transurethral microwave thermotherapy (TUMT) and their follow-up at 12 months. Prostatron, a prostatic TUMT device which comprised a microwave heat generator and a cooling system, was used at our centre. Forty-four out of the 60 patients given the treatment had a 12-month follow-up to be evaluated. The evaluation of subjective symptoms, according to the Boyarsky symptom score, demonstrated a significant rate of response (p < 0.0005). The analysis of pressure-flow recordings demonstrated a reduction of mean detrusor opening pressure (p < 0.0005), a reduction of detrusor pressure at maximum flow 12 months after treatment (p < 0.0005) and an improvement of mean values of maximum flow after treatment (p < 0.0005). This study shows that TUMT, though it cannot be considered an alternative to surgical or endoscopic therapy of BPH for severely obstructed patients, can produce improvement of both subjective and objective parameters of mild prostatic bladder outflow obstruction.

Aged↗
PubMed1994

Thermosensitive stent (Memotherm) for the treatment of benign prostatic hyperplasia.

Recently, more and more alternative therapeutic methods have been used for the treatment of benign prostatic hyperplasia (BPH). We will report on therapeutic results with a new thermosensitive stent system (Memotherm). This wire mesh stent has been designed especially for urological purposes. It is made of Nitinol, a thermoreactive material, and gains its maximum expansion force al body temperature. Due to the properties of the material the stent is flexible and can adapt to the anatomical conditions of the prostatic part of the urethra. Because of individual variations in the length of the prostatic part of the urethra, the system is available in lengths from 2 to 8 cm. The knitted structure for the first time allows atraumatic removal. Between April, 1992, and September, 1993, we treated a total of 54 BPH patients with the stent system. Mean patient age was 76.1 +/- 7.6 years (61-98). Mean prostatic volume was 51.9 +/- 25 ml (20-150), and the length of the applicated stents was 32.3 +/- 9.5 mm (20-70). Patient selection for stent treatment was carried out with regard to the preoperative risk status of this patient group. Fourteen (26%) of the patients treated were able to micturate before operation; in 40 (74%) urinary drainage was accomplished by means of an indwelling catheter. Following stent application, 53 out of 54 patients were able to micturate. With the first group (preoperative voiding ability), maximum flow had increased from 4.5 ml/s to a mean of 15.8 ml/s, while residual urine volume had decreased from 194.4 ml to 11.8 ml and the AUA 6 Symptoms Score had improved from 24 points to 3.5 points 6 months after stent application. All differences were statistically significant (P < 0.02). With the second group (no preoperative voiding ability), the AUA 6 Symptoms Score had improved from 25 points to 3.9 points (P < 0.02) 6 months after the operation, at which time the mean maximum flow rate was 14.8 ml/s and residual urine volume 14.8 ml. There was no statistically significant difference between the patients who were able and those who were unable to micturate before operation. One case of epididymitis was the only major complication observed after stent placement. Frequent urgency symptoms (30 out of 54 patients; 55.5%) subsided after a mean period of 1 week. The Memotherm stent offers an interesting therapeutic alternative for BPH risk patients.

Aged↗
PubMed2001

[Transurethral electrosurgery in the treatment of benign prostatic hyperplasia].

The article is devoted to topical problem of modern urology, one of the lines of surgical treatment of benign prostatic hyperplasia (BPH)--transurethral electrosurgery. Physical principles which are the basis of transurethral electrosurgical interventions and influence of transurethral electrosurgery on prostatic tissue are described. Methods of necessary preoperative examination of patients with BPH are presented. The most often used transurethral electrosurgical technique for destruction of hyperplastic prostatic tissue is described. The results of 5-year use of combination of transurethral electroresection and electrovaporisation in the treatment of BPH and its complications are presented. Ways of prophylaxis of possible complications are proposed.

Adult↗
PubMed2003

[Interstitial laser coagulation for benign prostatic hyperplasia: clinical results of the Indigo diode laser system].

We report our experience with interstitial laser coagulation of the prostate (ILCP) using an Indigo 830j diode laser system for benign prostatic hyperplasia (BPH). From March 1998 to November 2000, we treated 45 patients between 51 and 95 years old (average 71.5) with symptomatic BPH. The mean prostatic volume before ILCP was 62.0 cm3. We experienced no serious complications. Three months after ILCP, the mean international prostate symptom score (I-PSS) quality of life (QOL) index and post-void residual volume (PVR) decreased significantly from 18.0 to 9.2, from 4.4 to 2.1 and from 103.6 ml to 44.5 ml, respectively. The mean maximum flow rate (MFR) increased from 7.6 ml/sec at baseline to 9.2 ml/sec 3 months after ILCP, but the difference was not statistically significant. Before and after ILCP, 8 patients were available to evaluate pressure-flow study data. The detrusor pressure at the maximum flow rate decreased significantly from 118.3 cmH2O at baseline to 78.6 cmH2O 3 months after ILCP. The improvement of the I-PSS, QOL index, MFR and PVR continued and at 24 months reached 5.7, 1.8, 11.6 ml/sec and 54.6 ml, respectively. In our assessment of the questionnaire addressing the patient's satisfaction after the treatment, the majority of the patients who answered the questionnaire were pleased with the results of ILCP. We assessed the relation of the overall treatment efficacy with the number of punctures and the total amount of the laser energy delivered, but we did not find any relation. Our clinical results suggest that the ILCP using Indigo 830j is an effective modality and the short-term treatment efficacy is favorable.

Aged↗
PubMed1996

Prostatic and extraprostatic alpha-adrenoceptors--contributions to the lower urinary tract symptoms in benign prostatic hyperplasia.

The beneficial effects of alpha-adrenoceptor antagonists on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH), and the lack of correlation between LUTS on the one hand and prostatic enlargement and/or outflow obstruction on the other, have focused interest on the role of extraprostatic alpha-adrenoceptors in the pathogenesis of LUTS. In addition to their well documented site of action on prostatic and lower urinary tract smooth muscle, alpha-adrenoceptors antagonists may act at the level of the spinal cord, ganglia, and nerve terminals to influence the sympathetic and parasympathetic outflows to the bladder, bladder neck. prostate, and external urethral sphincter. A more complete understanding of the role of alpha-adrenoceptors in the overall autonomic control of the lower urinary tract will be required to design agents that can improve alpha-adrenoceptor antagonist treatment of BPH.

Adrenergic alpha-Antagonists↗
PubMed2006

Is benign prostatic hyperplasia (BPH) an immune inflammatory disease?

OBJECTIVES: Chronic inflammation has been documented for years in benign prostatic hyperplasia (BPH), but only now has it become evident as a major factor in disease progression. This review highlights the immunologic key features of chronic inflammation in BPH and the present interpretation of these changes in the development and progression of BPH. RESULTS: Almost all BPH specimens show inflammatory infiltrates at histologic examination, but correlation to bacterial or other foreign antigens has not been established. Recognition of prostate secretion products by autoreactive T cells and animal models on experimental prostatitis demonstrate an autoimmune component to chronic inflammation. The infiltrate consists predominantly of chronically activated CD4(+) T lymphocytes, which are permanently recruited to prostate tissue via elevated expression of interleukin 15 (IL-15) and interferon gamma (IFN-gamma), proinflammatory cytokines produced by smooth muscle and T cells, respectively. With the appearance of infiltrates, T cell-derived cytokine production of IFN-gamma, IL-2, and transforming growth factor beta increases, the former two ultimately reaching 10-fold and the latter 2-fold higher levels in fully developed BPH than in normal prostates. As "mature" BPH nodules develop, IL-4 and IL-13 expression increases >2-fold, corresponding to a T-helper (Th)0/Th2 cytokine pattern. Dysregulation of the immune response in BPH may occur via elevated expression of proinflammatory IL-17, which stimulates a multifold production of IL-6 and IL-8, key executors of stromal growth in BPH. CONCLUSIONS: These data strongly suggest that BPH is an immune inflammatory disease. Unravelling the specific nature of immune dysregulation may help design novel drugs with these specific targets in mind.

Autoimmunity↗
PubMed2002

Benign prostatic hyperplasia: solutions to an ageing problem.

As the population ages, the demand for treatment of the symptoms of benign prostatic hyperplasia has never been higher. Equally the choice of treatments has never been greater. This review considers the medical and surgical options.

Adrenergic alpha-Antagonists↗
PubMed1998

The predictive value of baseline variables in the treatment of benign prostatic hyperplasia using high-energy transurethral microwave thermotherapy.

OBJECTIVE: To evaluate the combination of patient age, prostate size, grade of outlet obstruction and total amount of energy, all independent predictive variables of treatment outcome in patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) treated with high-energy transurethral microwave thermotherapy (HE-TUMT), and thus provide nomograms for predicting treatment outcome after HE-TUMT. PATIENTS AND METHODS: Between October 1993 and July 1996, 247 patients with LUTS and BPH were treated with HE-TUMT using the Prostatron device, software version 2.5 (EDAP Technomed, Lyon, France). The World Health Organisation Response Evaluation Criteria were used to evaluate the outcome. Patient age, prostate volume, total amount of energy and grade of outlet obstruction were categorized using the Akaike information criterion (AIC). The probabilities of a good/intermediate vs a poor response at 26 weeks according to the AIC were calculated. RESULTS: Nomograms are presented providing the estimated probability (95% confidence interval) for a good/intermediate response of the evaluation of the International Prostate Symptom Score at 26 weeks by categories of prostate volume, total amount of TUMT energy and age, and of maximum urinary flow rate by categories of bladder outlet obstruction (linear passive urethral resistance ratio, linPURR) and total amount of energy, and of linPURR by categories of prostate volume and total amount of energy. The total amount of energy appeared to have the most impact in the prediction of good/intermediate and poor response in all three response evaluation criteria. CONCLUSIONS: These nomograms may assist urologists in making clinical recommendations for the treatment of men with LUTS and BPH using HE-TUMT.

Adult↗
PubMedDate not supplied

[Morphological changes in prostatic tissue of patients with benign prostatic hyperplasia treated with permixon].

A pilot trial has been performed to assess effects of permixon on prostatic tissue in patients with benign prostatic hyperplasia (BPH). A total of 49 BPH and control patients entered the trial. 36 patients of the study group were randomized into 3 subgroups of 12 patients each. Permixon was taken in a standard dose of 320 mg/day for 3, 6 and 12 months, respectively. Mean duration of BPH was 3.7 years (0-8 years). Mean value of PCA was 6.0 ng/ml. The control group of 13 patients were not given permixon. Multifocal prostatic biopsy was performed in all the patients before and after the treatment or follow-up. Stromal-parenchymatous correlation in the study group significantly increased (by 59%)--from 3.28 (0.25-9.61) to 5.22 (1.20-10.67) (p = 0.0002). For the control group this correlation was insignificant. Permixon-treated patients demonstrated inhibition of prostatic epithelium proliferative activity by 32% (p = 0.0001) and a rise in the stage of proliferative centers development from stage II-III to IV-V. Intensity of inflammation in prostatic tissue decreased by 53% in the study group and insignificantly in the control group. Thus, permixon treatment of BPH leads to a significant rise in stromal-parenchymatous correlation due to inhibition of proliferative activity of prostatic epithelium and attenuation of inflammation.

Aged↗
PubMed2005

BXL628, a novel vitamin D3 analog arrests prostate growth in patients with benign prostatic hyperplasia: a randomized clinical trial.

OBJECTIVE: To evaluate the effect of BXL628, a vitamin D3 analog, on prostate volume in patients with benign prostatic hyperplasia (BPH). METHODS: We conducted a phase II, double blind, randomized, placebo controlled, clinical study. Patients eligible were aged>or=50 years, had a diagnosis of BPH and a prostate volume>or=40 ml. Eligible patients were randomized and given either BXL628 150 mcg daily or placebo for 12 weeks. All randomized patients underwent at baseline and at the end of study pelvic MRI to measure prostatic volume, uroflowmetry (Qmax), American Urological Association Symptom Index (AUASI), serum PSA, testosterone, dihydrotestosterone and luteizing hormone. RESULTS: A total of 119 patients were randomized: 57 patients to BXL628 and 62 to placebo. The percentage change of prostate volume at 12 week was -2.90 in the BXL628 group vs. +4.32 in the placebo group (p-value<0.0001). The estimated difference between treatments (BXL628 minus placebo) was -7.22% (95% confidence limit -9.27 to -5.18). Considering Qmax, mean change vs. baseline was -0.30 in BXL628 vs. +1.50 in the placebo group: this finding was not statistically significant. The mean change of the AUASI total score at final visit vs. baseline was -1.77 in the BXL628 group vs. -3.45 in the placebo group (p=not significant). CONCLUSION: BXL628 was able to arrest prostate growth within 12 weeks in men aged>or=50 years with prostatic volume>or=40 ml. Its unprecedented mechanism of action may offer a new opportunity for the treatment of BPH.

Aged↗