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PubMed2001

Combination of ballistic lithotripsy and transurethral prostatectomy in bladder stones with benign prostatic hyperplasia: report of 120 cases.

PURPOSE: We report our experience with the combination of ballistic lithotripsy (BL) and transurethral resection of the prostate (TURP) in 120 patients with benign prostatic hyperplasia (BPH) and bladder stone(s). PATIENTS AND METHODS: The mean stone size, appreciated by measuring the greatest diameter, was 18.5 mm (range 10-80 mm). The mean prostate volume was 35.4 cc (26-62 cc). All procedures were monitored under direct endoscopic control with a videocamera. RESULTS: Lithotripsy and evacuation of fragments was performed in an average time of 27.5 minutes (10-80 minutes). The only intraoperative complication was mild hematuria in 38 patients (32%), which did not affect vision for TURP. The mean resection time was 42 minutes (range 15-65 minutes). Four patients experienced mild postoperative bleeding, and one patient had clot retention. The mean hospital stay was 1.2 days (range 1-4 days). CONCLUSIONS: Combined BL and TURP is effective, safe, and economical.

Aged↗
PubMed1983

Changes in dihydrotestosterone metabolism and the development of benign prostatic hyperplasia in the aging beagle.

Previous studies have demonstrated that the 2-3--fold abnormal elevation in prostatic dihydrotestosterone (DHT) content characteristically associated with canine benign prostatic hyperplasia (BPH) is due to a shift in the overall balance in the complex metabolism of DHT in the gland itself [1, 2]. Since the incidence of canine BPH increases with host age [3], the question arises as to whether the characteristic shift in DHT metabolism is associated with the general process of aging or with the specific development of BPH. To resolve this issue, the activities of prostatic androgen metabolism were quantitatively assayed in prostatic tissue from a large series of age-matched normal and BPH dogs ranging in age from 0.7-9.0 years. These analyses revealed that, regardless of the age of the host, there is a consistent statistical increase in several of the activities which produce DHT (i.e. 5 alpha-reductase, 3 alpha-HSOR oxidase, and 17 beta-HSOR reductase) without a concomitant increase in any of the activities which remove this steroid in BPH as compared to age-matched normal prostatic tissue. These results suggest that in canine BPH tissue the characteristic changes in DHT metabolism which increase the tissue's ability for net formation of DHT are specifically associated with the development of BPH itself and not due simply to the general process of aging per se.

17-Hydroxysteroid Dehydrogenases↗
PubMed2005

Serenoa repens treatment modifies bax/bcl-2 index expression and caspase-3 activity in prostatic tissue from patients with benign prostatic hyperplasia.

PURPOSE: Permixon is a lipidosterolic extract of Serenoa repens (SR) widely used to treat men with benign prostatic hyperplasia (BPH). We tested the effect of this drug on molecular mechanisms associated with apoptosis, such as the Bax-to-Bcl-2 expression ratio and caspase-3 activity, in prostatic tissue from men with symptomatic BPH treated for 3 months before surgery. MATERIALS AND METHODS: An open, multicenter pilot study of 2 parallel groups of patients with BPH was done. They were randomized to be followed for 3 weeks without any treatment before surgery (control group) or to receive 160 mg SR orally twice daily for a 3-month period preceding the same surgery. Surgery was ultimately performed in 17 controls and 12 patients by transurethral prostate resection or retropubic adenomectomy. Bax and Bcl-2 expression, and caspase-3 activity were determined by Western blot in 15 controls and 10 patients, and reported in blinded fashion. RESULTS: The Bax-to-Bcl-2 ratio, which is used as an apoptotic index, was significantly increased in the prostatic tissue of treated patients. The level of the intact 116 kDa poly (adenosine diphosphate-ribose) polymerase form, an enzyme involved in the cell death apoptotic pathway, was also found to be decreased in prostatic tissue from SR treated patients, suggesting increased caspase 3 activity in the prostate. CONCLUSIONS: Permixon increased molecular markers involved in the apoptotic process, ie the Bax-to-Bcl-2 expression ratio and caspase-3 activity. This could have clinical relevance due to the improvement in symptoms produced by treatment with this drug.

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PubMed1996

Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia.

Serenoa repens (Permixon) has been available for several years for the treatment of men with benign prostatic hyperplasia (BPH). The drug is the n-hexane lipidosterolic extract of the dwarf American palm (also known as Serenoa repens) and is a complex mixture of various compounds. A number of pharmacodynamic effects have been demonstrated with the lipidosterolic extract of Serenoa repens (LSESR), suggesting multiple mechanisms of action including in vitro inhibition of both type 1 and type 2 isoenzymes of 5 alpha-reductase and interference with binding of dihydrotestosterone to cytosolic androgen receptors in prostate cells. In controlled clinical trials in men with BPH, oral administration of Serenoa repens 160 mg twice daily for 1 to 3 months was generally superior to placebo in improving subjective symptoms, such as dysuria, as well as objective parameters. The frequency of nocturia was reduced by 33 to 74%, while urinary frequency during the day decreased by 11 to 43% and peak urinary flow rate increased by 26 to 50% with Serenoa repens. Corresponding values for placebo were 13 to 39%, 1 to 29% and 2 to 35%. The only large comparative trial conducted to date, in which > 1000 men with moderate BPH were randomised to receive Serenoa repens 160 mg twice daily or finasteride 5 mg once daily for 6 months, demonstrated similar efficacy between the two drugs. No statistically significant difference was demonstrated between treatment groups for improvement in patient self-rated quality-of-life scores and the primary end-point of objective symptom score; International Prostate Symptom Score improved by 37% with Serenoa repens compared with 39% with finasteride. In much smaller comparative trials, few significant differences were demonstrated between Serenoa repens and alpha 1-receptor antagonists, and larger randomised trials of adequate duration are required to better compare the clinical efficacy of these drugs. The most frequently reported adverse events in clinical trials with Serenoa repens have been minor gastrointestinal problems (e.g. nausea and abdominal pain). In conclusion, Serenoa repens is well tolerated and has greater efficacy than placebo and similar efficacy to finasteride in improving symptoms in men with BPH. Although there is a need for further comparative studies, particularly with alpha 2-receptor antagonists, available data indicate that Serenoa repens is a useful alternative to alpha 1-receptor antagonists and finasteride in the treatment of men with BPH.

Androgen Antagonists↗
PubMed2003

Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months.

PURPOSE: To compare the efficacy and safety of transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) during an 18-months follow-up. PATIENTS AND METHODS: A series of 59 patients older than 40 years were included in this study. The entry criteria were prostate size <70 g, maximum urinary flow rate (Q(max)) <15 mL/sec, International Prostate Symptom Score (IPSS) >13, and no suspicion of prostate cancer according to the clinical or laboratory findings. Of the patients, 26 (44%) were treated with TUNA and 33 (56%) with TURP. At 3 and 18 months of follow-up, Q(max), postvoiding residual volume (PVR), IPSS, and the quality of life (QOL) score were compared with the baseline values. The results were also compared in patients undergoing TUNA v TURP. RESULTS: Improvements in Q(max), PVR, IPSS, and QOL score were statistically significant for both groups at 3 and 18 months of follow-up. The increase in the mean Q(max) of the TURP group was higher than that in the TUNA group, whereas no significant differences were found in the two groups regarding improvements in IPSS and QOL score. There were no complications associated with the TUNA procedure, while 16 retrograde ejaculation, 4 erectile impairment, 2 urethral stenosis, and 1 urinary incontinence cases were observed after TURP. CONCLUSIONS: The TUNA procedure is an effective and safe minimally invasive treatment with negligible adverse effect for selected patients with symptomatic BPH compared with TURP. It should be considered as an alternative treatment option for younger patients who want to preserve sexual function.

Adult↗
PubMed2004

Correlation between lower urinary tract symptoms and urethral function in benign prostatic hyperplasia.

AIM: To examine the potential correlation between urethral function and lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). METHODS: Thirty-one patients with clinical BPH, who were confirmed to have benign prostatic enlargement (BPE) of 20 ml or more, were enrolled into the study. A mark-sheet questionnaire was used for obtaining the LUTS history. Multichannel pressure-flow urodynamic studies were performed and external urethral sphincter pressure (PEUS), intravesical pressure (PVES), and bladder neck pressure (PBN) were recorded both at maximum cystometric capacity and during voiding with 5-microtip transducers, for the purpose of detecting BPE-specific urodynamic findings at different levels within the urethra. RESULTS: There was a positive correlation between hesitancy and detrusor bladder neck dyssynergia (DBND) (P = 0.0011) and between incomplete emptying and low PBN at maximum cystometric capacity (P = 0.0425). The hesitancy proved to have no correlation with bladder neck opening time (TBNO). CONCLUSION: Urodynamic evaluation of urethral function was beneficial for attributing LUTS to clinical BPH. Among various parameters, DBND was the most specific to clinical BPH, suggesting it to be a situation where a steep rise in PBN or prostatic urethral pressure remains greater than the increasing PVES, resulting in sustained difficulty in opening the bladder neck and subsequently the subjective sensation of hesitancy.

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PubMedDate not supplied

Cost-effectiveness of tamsulosin, doxazosin, and terazosin in the treatment of benign prostatic hyperplasia.

OBJECTIVE: To evaluate the cost-effectiveness of tamsulosin, doxazosin, or terazosin as initial treatments for moderate benign prostatic hyperplasia (BPH) over a 3-year time horizon from a health-system-payer perspective. METHODS: A decision-analytic model is used to project the course of treatment at 6-month intervals over 3 years following initiation of therapy with tamsulosin, doxazosin, or terazosin. Treatment failure is defined as failure to attain and maintain a 25% improvement in the American Urological Association (AUA) symptom score from baseline. In the model, finasteride is added for patients who fail on their initial therapy and, in the event of finasteride treatment failure, patients progress to transurethral resection of the prostate (TURP) and, if needed, a second TURP. The ranges of values for treatment failure rates and clinical event cost parameters used in the decision model are derived from the literature. Only direct medical costs related to BPH and its treatment are included. Since 2 comparators are available generically (doxazosin and terazosin) drug acquisition costs are defined by the list prices at Drugstore.com. All costs are discounted by 3% per year. Effectiveness is measured as successful medical treatment without surgery over 3 years. RESULTS: For base-case model parameters, discounted BPH-related total direct medical costs over 3 years are 4084 dollars, 4323 dollars, and 4695 dollars for generic terazosin, generic doxazosin, and tamsulosin, respectively. The model estimates a medical treatment success rate (no TURP) at 3 years of 72.3% for tamsulosin, compared with 68.2% for both terazosin and doxazosin. The incremental cost for tamsulosin versus terazosin is 610 dollars over 3 years, which yields an incremental cost-effectiveness ratio of 14,609 dollars per success. Generic doxazosin is dominated (higher cost but equal effectiveness compared with terazosin). Higher rates of twice-daily (or 2 units per day) dosing are associated with higher incremental cost-effectiveness ratios. The decision-model results also are sensitive to the estimated costs of TURP and hypotensive adverse events. CONCLUSION: As an initial medical therapy for moderate BPH, tamsulosin is more effective than generic terazosin or doxazosin, with an incremental cost of about 203 dollars per year (or about 17 dollars per month) over 3 years.

Adrenergic alpha-Antagonists↗
PubMed1992

Indications for treatment of benign prostatic hyperplasia. The American Urological Association Study.

BACKGROUND: In 1990, a pilot study was begun that evaluated benign prostatic hyperplasia (BPH) at five clinical institutions. Data management and coordination of this study was performed at the Medical Practices Evaluation Center at Massachusetts General Hospital. Because of decreased patient enrollment, one institution was dropped. This was a randomized, prospective, clinical study that provided an initial overview of the trial and a rationale for the project. METHODS: Patients with clinically significant signs and symptoms of BPH were enrolled in this study. A symptom index consisting of seven items was used to document patient complaints of prostatic enlargement. Prostate size was determined using ultrasonography. Uroflowmetry (peak flow and mean flow) and residual urine volumes were documented. Abdominal ultrasonography was performed to rule out the presence of a dilated upper urinary tract. Cystoscopy was completed to determine the extent of prostatic and bladder neck obstruction. Trabeculations or cellules in the bladder, if present, were also documented. Conclusions. Preliminary results were obtained. The operative and nonoperative options depending on prostate size are shown in the figures of this article. The use of an interactive video disc has been beneficial in explaining the risks and benefits of each treatment option applicable to the patient in this randomized, controlled study.

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PubMed2000

Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study.

European physicians treat benign prostatic hyperplasia (BPH) with saw palmetto extract (SPE), while American physicians generally disregard SPE because "research is lacking." The authors investigated this discrepancy with a literature search and a clinical trial. The literature search began with MEDLINE, then expanded to "alternative" databases, including AGRICOLA, EMBASE, IBIS, and Cochrane, plus a manual search of unindexed herbal journals. The clinical trial was an experimental case study in which a 67-year-old man with symptomatic BPH was randomly administered SPE (160 mg standardized extract twice daily) or placebo. Outcome measures included the American Urological Association Symptom Index (AUASI), serum prostate-specific antigen, and prostate volume. Our expanded literature search revealed 58 clinical trials, whereas MEDLINE yielded only 19 clinical trials, or 33% of the total. Our clinical trial measured a baseline AUASI score of 20, which improved to 7 after unblinded administration of SPE. Subsequent double-blinded placebo produced a score of 14, and final single-blinded allotment of SPE produced a score of 11. Prostate-specific antigen was 10.3 ng/mL at baseline and 10.7 ng/mL at trial's conclusion. Baseline prostatic volume was 92 mL, and end volume was 75 mL. In conclusion, MEDLINE proved inadequate as a stand-alone search engine for locating information about an herbal medicine. Our experimental case study, similar to N = 1 research methodology, proved suitable for clinical evaluation of an herbal medicine in a rural private practice. SPE improved the patient's BPH. Unstandardized look-alike herbs may act as nontherapeutic placebos and may undermine consumer confidence in herbal medicine.

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PubMed1997

[Pattern of distribution of constitutive isoforms of NO synthase in the normal prostate and obstructive prostatic hyperplasia].

Nitric oxide (NO) is suggested as an important mediator for the regulation of biological processes. In the present study we tried to determine histochemically and immunohistochemically the localization and distribution of the constitutive NO-synthase Isoforms (bNOS and eNOS) of 14 normal non-obstructive and 12 hyperplastic obstructive human prostates. Differentiated nitrinergic innervation was shown for the prostate glands, fibromuscular stroma and blood vessels by NADPH-diaphorase staining and immunohistochemically with specific NOS antibodies. In the specimens with benign prostatic hyperplasia nitrinergic innervation seems to be distinctly reduced. The vascular distribution of NOS provides evidence for segmental differentiation of NO-mediated vascular regulation. The NADPH-diaphorase reaction was not confirmed immunohistochemically by the specific NOS antibody in the glandular epithelium. The distribution of NO synthase shows the importance of nitric oxide in the regulation of smooth muscle tone, blood flow and secretory function in the normal and hyperplastic human prostate.

Adult↗
PubMed2004

An economic evaluation of doxazosin, finasteride and combination therapy in the treatment of benign prostatic hyperplasia.

OBJECTIVE: The Proscar Long-Term Efficacy and Safety Study (PLESS) and the Medical Therapy of Prostatic Symptoms (MTOPS) study provide new evidence regarding the benefits of finasteride in the treatment of benign prostatic hyperplasia (BPH). The objective of this study was to utilize data from the PLESS and MTOPS studies to assess the cost-utility of finasteride and finasteride in combination with doxazosin, compared to doxazosin alone in men with moderate to severe BPH symptoms. METHODS: A semi-Markov decision analytic model was constructed to estimate the clinical consequences, costs and cost-utility of doxazosin, finasteride, and combination therapy. Analyses were conducted for a 15-year time frame from the perspective of the Ontario Ministry of Health and Long Term Care (MOHLTC). Results are reported stratified by baseline serum prostate-specific antigen (PSA) level according to all baseline serum PSA levels, patients with baseline serum PSA > 1.3 ng/ml, and patients with baseline serum PSA > 3.2 ng/ml. RESULTS: Compared to doxazosin alone, combination therapy was more expensive but more effective. Cost-utility ratios ranged from 27,823 dollars/QALY for patients with PSA > 3.2 ng/ml to 34,085 dollars/QALY for all patients. Finasteride, although dominated by doxazosin, may be cost-effective compared to watchful waiting in patients who fail doxazosin and do not choose to proceed to surgery. Compared to watchful waiting, cost-utility ratios for finasteride ranged from 35016 dollars/QALY for patients with PSA > 3.2 ng/ml to 44,336 dollars/QALY for all patients. Results were robust across a wide range of sensitivity analyses. CONCLUSIONS: Combination therapy is cost-effective compared to doxazosin with cost-utility ratios under 40,000 dollars/QALY across a wide range of scenarios. The cost-effectiveness of combination therapy increases as serum PSA level increases.

Adrenergic alpha-Antagonists↗
PubMed2006

Association of anthropometric measures with the presence and progression of benign prostatic hyperplasia.

The authors investigated the association of anthropometric measures with the presence and progression of components of benign prostatic hyperplasia (BPH) and a clinical outcome of BPH in a cohort of healthy, Caucasian men aged 40-79 years that was randomly selected from the Olmsted County, Minnesota, population beginning in 1990. Exclusionary criteria included prostate or bladder surgery, urethral surgery or stricture, or medical or other neurologic conditions that could affect normal urinary function. Height, weight, and waist and hip circumferences were measured. Components of BPH, including American Urological Association Symptom Index scores, peak urinary flow rate, and prostate volume, were assessed on a randomly selected subsample. Acute urinary retention was assessed through review of community medical records. There were few significant associations of anthropometric measures with the presence or progression of components of BPH or clinical outcome of BPH, and there were no instances where the point estimates for the BPH components suggested a dose-response effect. The authors conclude that anthropometric measures are not significantly associated with the presence or progression of BPH as measured by American Urological Association Symptom Index scores, peak urinary flow rate, prostate volume, or acute urinary retention. These data provide no evidence of a consistent significant relation between anthropometric measures and BPH.

Adult↗
PubMed2001

A study of prostane in the treatment of benign prostatic hyperplasia.

A clinical trial was conducted in a study group of 70 males diagnosed with symptomatic benign prostatic hypertrophy (BPH) (synonym of benign prostatic hyperplasia). They were administered Prostane, a herbal formulation, at a dose of two tablets a day for 1 year and monitored every 4 months during the study period. Analysis of the results showed an improvement in the symptom score of the American Urological Association symptom index rating. There was total relief in pain and haematuria in all the patients (100%); dribbling of urine decreased in 67%, dysuria in 50%, urgency in 60% and hesitancy in 40%. Blood urea levels were within the normal range in 70% of the patients and in the range 31-40 mg/dL in the remaining patients of the study group. Serum prostate specific antigen levels returned to normal in 56% of patients and were in the range 4.1-5.0 ng/mL in 25% of patients. There was a decrease in prostate specific antigen values which were >6 ng/mL in 9 patients at the commencement of the trial. Uroflowmetry studies showed that the peak flow increased from 12.6 to 30.7 s (p<0.001) and the void volume from 60.72 to 660 mL (p<0.001), the latent period reduced from 12.78 s to 2.61 s; the flow time from 57.01 s to 20.17 s and the residual volume from 620 mL to 20 mL (p<0.001). From these results, it is evident that Prostane was effective in alleviating symptoms, reducing prostate specific antigen values and normalizing uroflow dynamics in patients with benign prostatic hypertrophy.

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PubMed1996

Decrease in mortality from benign prostatic hyperplasia: a major unheralded health triumph.

PURPOSE: A systematic examination of all available mortality data from benign prostatic hyperplasia (BPH) between 1950 and 1990 was done to estimate the changing international mortality pattern of this condition. MATERIALS AND METHODS: Mortality data in which BPH was the underlying cause of death were abstracted from the World Health Organization mortality data base. These data were available from a variety of international countries (in many since 1950). RESULTS: Mortality rates have decreased with considerable magnitude in developed western countries between the early 1950s and late 1980s. This fact could reasonably be attributed to the improved management of the most severe complications of BPH and to improvements in surgery and anesthesia, which have made surgical interventions of the prostate possible in a greater proportion of men, and safer in the immediate and subsequent postoperative period. CONCLUSIONS: The decreases noted in western countries, such as the United Kingdom (where 8,700 fewer men die each year presently than would be expected if the BPH mortality rates from the early 1950s still applied), United States (13,681 fewer deaths) and France (2,884 fewer deaths), indicate a considerable but unheralded achievement for modern medicine. Unfortunately, these decreases have not been observed to the same extent in central and eastern Europe and South America, where the residual high mortality rates could be lowered by education, and the widespread availability of modern surgical and anesthetic equipment.

Cause of Death↗
PubMed2004

Eliciting preferences for drug treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia.

PURPOSE: There are 2 main medical preparations available for lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH). Choosing between an alpha-blocker and a 5alpha-reductase inhibitor requires trade-offs between their attributes or characteristics. We investigated the relative importance of and trade-offs between the attributes of the 5alpha-reductase inhibitor dutasteride and alpha-blockers in community dwelling men using a validated technique. MATERIALS AND METHODS: A discrete choice experiment was administered to 211 men older than 40 years who were randomly selected from the general United Kingdom population. Attributes investigated in the discrete choice experiment were time to symptom improvement, sexual and nonsexual side effects, the risks of acute urinary retention (AUR) and surgery, cost and prostate size decrease. Using regression analysis the relative importance of these attributes, the trade-offs that men are willing to make between these attributes and the willingness to pay for each attribute were estimated. RESULTS: All attributes were important to respondents. The most important attribute was side effects. The least preferred side effects was impotence, followed by decreased libido and dizziness. Respondents were willing to wait 13, 2 and 8 months longer for symptom improvement in exchange for decreased prostate size, and the risks of AUR and surgery, respectively. Men reporting moderate symptoms were less concerned about sexual side effects, time to symptom improvement and the risk of AUR compared with men reporting mild symptoms. CONCLUSIONS: Given the attribute levels of BPH medical treatment, overall community dwelling men preferred the 5alpha-reductase inhibitor over alpha-blockers. In the interests of shared decision making it is important to consider the importance of eliciting the preferences of patients with BPH.

Adrenergic alpha-Antagonists↗
PubMed2004

Development and validation of a quality-of-life scale for Chinese patients with benign prostatic hyperplasia.

OBJECTIVE: To develop and validate a quality of life (QoL) scale for Chinese patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: According to the QoL definition of the World Health Organisation, we adhered to the rigorous guidelines of instrument development to form a pool of items, selected items and validated the scale, using data from 256 patients with BPH. RESULTS: A 74-item QoL scale for BPH (prior test version; BPH-QLS), including five domains (disease, physical, social, psychological, satisfaction) was developed and had good reliability and validity. The test-retest correlation coefficient and Cronbach's alpha coefficient of the BPH-QLS were 0.892 and 0.966. Thirteen common factors were extracted according to the conceptual model. The correlations of the BPH-QLS with the Short Form-36, the International Prostate Symptom Score (IPSS), and IPSS QoL score, and a published BPH-specific QoL scale were 0.784, 0.493, 0.462 and 0.762, respectively. The BPH-QLS could be used to discriminate among patients with a different QoL. CONCLUSION: The new scale is reliable, valid and sensitive, and we recommend using the BPH-QLS in Chinese and Chinese-born patients worldwide to assist in clinical practice.

Aged↗
PubMed1990

Increased expression of genes for basic fibroblast growth factor and transforming growth factor type beta 2 in human benign prostatic hyperplasia.

It is now widely accepted that factors other than androgen are crucial in the normal and abnormal growth of the prostate, including human benign prostatic hyperplasia (BPH). Using a Northern blot analysis, we examined human normal and benign hyperplastic prostates for expressions of basic fibroblast growth factor (FGF), acidic FGF, transforming growth factor type beta 2 (TGF-beta 2), TGF-beta 1, and epidermal growth factor (EGF). Basic FGF mRNAs were detectable in all the prostates examined. In addition, levels of basic FGF expression were significantly higher in BPH than in normal prostate. Acidic FGF transcripts were undetectable except in one case of BPH. Although both TGFs were expressed in all the samples, TGF-beta 2 showed significantly increased levels of expression in BPH as compared to those in normal prostate, while TGF-beta 1 did not. No EGF was expressed in any of the prostates examined. These findings suggest that specific growth factors (basic FGF and TGF-beta 2) produced locally in the prostate may be involved in BPH development.

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PubMed2003

High-energy microwave thermotherapy in the treatment of benign prostatic hyperplasia.

INTRODUCTION: Transurethral microwave thermotherapy is an anesthesia-free, outpatient method of treating lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Our results with the use of this technique in 25 patients are reported. MATERIALS AND METHODS: Twenty-five patients with BPH, 8 of whom with complete urinary retention, were treated with high-energy transurethral microwave thermotherapy (HE-TUMT) (Prostatron system). Preoperative investigations included digital rectal examination, urinary free flow rate, PSA, urinalysis, urine culture, transrectal ultrasonography, urodynamic evaluation, International Prostatic Symptom Score (IPSS) and quality of life (QoL). Main selection criteria included: large prostate, high surgical risk, reluctance to undergo surgery. All patients were obstructed according to the Abrams-Griffith's nomogram. For the statistical analysis a repeated-measures, one-way ANOVA was performed on previously non-catheterized patients. RESULTS: Six of the 8 patients with catheter before treatment were able to urinate spontaneously with no significant post-voiding residual urine. In the 17 remaining patients, IPSS decreased from a mean of 18.5 at baseline to 7.30 and QoL from a mean of 3.9 to 1.2. Mean maximum flow rates during uroflowmetry increased from 8.5 to 16.9 ml/s. P(det) Q(max) decreased from a mean of 83.0 cm H(2)O at baseline to 50.7 cm H(2)O and Q(max) increased from a mean of 6.8 ml/s at baseline to 15.1 ml/s during the pressure-flow study. After TUMT, 13 patients were unobstructed and 4 equivocal according to the Abrams-Griffith's nomogram. CONCLUSION: Our study performed in a selected population of patients with BPH documents the efficiency and safety of HE-TUMT. This technique appears to be a valid therapeutic option, particularly in patients with high surgical risk.

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