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Prostatic Hyperplasia (prostatic + hyperplasia)
Kinds of Prostatic Hyperplasia Selected AbstractsQuality Indicators for Benign Prostatic Hyperplasia in Vulnerable EldersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2007Christopher S. Saigal MD First page of article [source] Effects of ,1-Blockers for Lower Urinary Tract Symptoms and Sleep Disorders in Patients with Benign Prostatic HyperplasiaLUTS, Issue 2 2010Takahiro SAKUMA Objectives: We evaluated the association of lower urinary tract symptoms (LUTS) and sleep disorders (SD) in patients with benign prostatic hyperplasia (BPH). We also examined improvement of SD following the ,1-blocker therapy for LUTS. Methods: Sixty-eight male patients were enrolled in the study, consisting of 38 cases with LUTS and BPH (BPH group), and 30 men without significant LUTS or BPH (non-BPH group). The degree of LUTS and SD was evaluated by the International Prostate Symptom Score and the Pittsburg Sleep Quality Index (PSQI), respectively. The patients of BPH group then were treated with ,1-blocker for 4 weeks, and were re-examined by all the questionnaires to evaluate the therapeutic efficacies. Results: The correlation analyses showed a significant association of LUTS with SD in BPH group (r = 0.4995, P = 0.0068). Twenty cases (52.6%) in BPH group showed 5.5 or more PSQI scores. Following 4 weeks of ,1-blocker administration, the average PSQI decreased significantly from 6.3 to 4.8 points (P < 0.001). Significant improvement was observed in domains of "sleep quality" and "sleep disturbances" among PSQI (P = 0.0215 and 0.0391, respectively). Moreover, significant association between ,1-blocker induced improvements of nocturia and SD was identified in patients with 5.5 or more PSQI score at baseline (r = 0.445, P = 0.0334). Conclusion: These results suggested that SD is associated with LUTS among BPH patients and therapeutic effects of ,1-blockers on LUTS lead to improvements of SD. [source] Conversion to Silodosin in Men on Conventional ,1 -Blockers for Symptomatic Benign Prostatic HyperplasiaLUTS, Issue 1 2010Masahiko TANAKA Objectives:,1 -blockers have commonly been used as first-line medical therapy for symptomatic benign prostatic hyperplasia (BPH). Recently, a highly selective ,1A -adrenoceptor antagonist, silodosin, was developed in Japan. We examined the efficacy and safety of conversion from conventional ,1 -blockers to silodosin in men with BPH. Methods: Conversion to silodosin was proposed to consecutive patients on conventional ,1 -blockers for symptomatic BPH for at least 6 months. The effects of conversion were examined by the International Prostate Symptom Score, quality of life index, overactive bladder symptom score, peak flow rate, residual urine volume, and adverse events at 12 weeks. The efficacy of silodosin was also evaluated by patients' impression. Results: Eighty-one men underwent conversion, for the most part because of dissatisfaction with the efficacy of their current treatment in improving nocturia or weak stream. The International Prostate Symptom Score total score significantly improved from 12.7 ± 5.9 at baseline to 10.6 ± 5.4 at 4 weeks (P < 0.001) and 10.9 ± 5.8 at 12 weeks (P < 0.01). The progress was mostly due to improvement in voiding symptoms, although reduction of storage symptoms was also significant. The quality of life index also significantly decreased with conversion to silodosin. Efficacy as judged by patients' impression was 76% (37/49) at 12 weeks of treatment. None of the overactive bladder symptom score, peak flow rate, and residual urine volume exhibited significant change. No serious adverse events were observed during the study period. Conclusion: Conversion to silodosin may be beneficial in men who are dissatisfied with conventional ,1 -blockers for BPH, and be particularly useful in improving voiding symptoms. [source] Sexuality and Management of Benign Prostatic Hyperplasia with Alfuzosin: SAMBA ThailandTHE JOURNAL OF SEXUAL MEDICINE, Issue 9 2010Somboon Leungwattanakij MD ABSTRACT Introduction., Benign prostatic hyperplasia (BPH) is a common condition among elderly men. The aim of therapy is to improve lower urinary tract symptoms (LUTS) and quality of life (QoL) and to prevent complications. Aim., The primary objective was to assess the effect on ejaculatory dysfunction (EjD) of 6 months treatment with alfuzosin (XATRAL) 10 mg once daily (OD) in men with LUTS suggestive of BPH in Thailand. Secondary objectives were to evaluate the efficacy of alfuzosin on LUTS, bother score (International Prostate Symptom Score [IPSS] 8th question), erectile dysfunction (ED), onset of action, and tolerability. Methods., Overall, 99 men with moderate to severe LUTS suggestive of BPH (mean IPSS 18.9, bother score 4.3) were enrolled in an open-label study. Sexual function was evaluated at baseline and after 6 months treatment, using the International Index of Erectile Function-5 and the Male Sexual Health Questionnaire (MSHQ) ejaculation score, a new validated questionnaire assessing seven EjD symptoms. Main Outcome Measure., The main outcome measure is mean change from baseline to the end of treatment in the MSHQ Ejaculation score. Results., MHSQ ejaculation score significantly improved from 23.09 at baseline to 21.54 at 6 months (P = 0.022). Overall, 70% of patients perceived an improvement in LUTS within 1 week (36.3% within 3 days). IPSS total score significantly improved from 18.93 at baseline to 9.59 at 6 months (P < 0.001). IPSS voiding and irritative subscores also significantly improved. The percentage of patients with moderate or severe ED decreased from 35.3% at baseline to 21.8% at 6 months. Most adverse events were dizziness (3%) and orthostatic hypotension (1%) with minor intensity. No significant change in blood pressure and heart rate was observed. Conclusions., Alfuzosin 10 mg OD administered for 6 months provides a marked and rapid (within 1 week) improvement in LUTS and bother score while improving both ED and EjD. Leungwattanakij S, Watanachote D, Noppakulsatit P, Petchpaibuol T, Choeypunt N, Tongbai T, Wanamkang T, Lojanapiwat B, Permpongkosol S, Tantiwong A, Pripatnanont C, Akarasakul D, Kongwiwatanakul S, and Chotikawanich E. Sexuality and management of benign prostatic hyperplasia with alfuzosin: SAMBA Thailand. J Sex Med 2010;7:3115,3126. [source] Therapeutic Treatment for Benign Prostatic HyperplasiaBJU INTERNATIONAL, Issue 3 2007Robyn Webber No abstract is available for this article. [source] Correlation of intravesical prostatic protrusion with bladder outlet obstructionBJU INTERNATIONAL, Issue 4 2003S.J. Chia OBJECTIVES To determine the effect of intravesical protrusion of the prostate (IPP, graded I to III) on lower urinary tract function, by correlating it with the results of a pressure-flow study. PATIENTS AND METHODS In a prospective study men (aged> 50 years) with lower urinary tract symptoms were initially evaluated as recommended by the International Consultation on Benign Prostatic Hyperplasia, together with the IPP and prostate volume, as measured by transabdominal ultrasonography. These variables were then correlated with the results from a pressure-flow study. RESULTS The IPP was a statistically significant predictor (P < 0.001) of bladder outlet obstruction (BOO) compared with other variables in the initial evaluation. In all, 125 patients had significant BOO, defined as a BOO index of> 40. Of these men, 94 had grade III and 30 had grade I,II IPP. Seventy-five patients had a BOO index of < 40; 69 had grade I,II and six grade III IPP. In patients with BOO confirmed on the pressure-flow study, grade III IPP was associated with a higher BOO index than was grade I,II (P < 0.001). CONCLUSION The IPP assessed by transabdominal ultrasonography is a better and more reliable predictor of BOO than the other variables assessed. [source] Urtica dioica agglutinin: Separation, identification, and quantitation of individual isolectins by capillary electrophoresis and capillary electrophoresis,mass spectrometryELECTROPHORESIS, Issue 9 2005Markus Ganzera Abstract With benign prostatic hyperplasia (BPH) being a major health problem in ageing men, alternative therapeutic approaches (e.g., with phytopharmaceuticals) are of great interest. Based on pharmacological evidences, one of the most promising options in that respect are the lectins found in Urtica dioica (stinging nettle) roots. In this study the qualitative and quantitative analysis of individual isolectins in U. dioica extracts is described, which is the first report on using capillary electrophoresis (CE) for the analysis of lectins in plant material at all. By utilizing a 200 mM sodium acetate buffer (pH 3.75) a baseline separation and determination of four closely related isolectins was feasible within 20 min in the aqueous plant extracts. The individual compounds were identified based on reference compounds as well as data obtained from CE-mass spectrometry (MS) experiments. After modifying the optimized CE conditions to 100 mM ammonium formate buffer with pH 3.75 and a voltage of 15 kV, the isolectins were clearly assignable in positive electrospray ionization (ESI) mode. The quantitative results obtained by CE (the total lectin content varied from 0 to 0.42% in the samples) were accurate (recovery rates of spiked samples between 92.5 and 96.2%), precise (relative standard deviation < 5%) and in good agreement to those obtained by High-performance liquid chromatography (HPLC). As for peak resolution, assignable compounds and required separation time the newly developed CE method was clearly advantageous over the determination achieved by LC. [source] No effect of saw palmetto for benign prostatic hyperplasiaFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 3 2006Article first published online: 14 JUN 2010 [source] Complementary therapies for treating benign prostatic hyperplasiaFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2000Max H Pittler [source] Saw palmetto herbal blend causes involution of the prostatic epithelium in men with symptomatic benign prostatic hyperplasiaFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2000Article first published online: 14 JUN 2010 [source] The gene for polycomb group protein enhancer of zeste homolog 2 (EZH2) is amplified in late-stage prostate cancerGENES, CHROMOSOMES AND CANCER, Issue 7 2006Outi R. Saramäki Overexpression of the polycomb group protein enhancer of zeste homologue 2 (EZH2) has been found in several malignancies, including prostate cancer, with an aggressive phenotype. Amplification of the gene has previously been demonstrated in several malignancies, but not in prostate cancer. Our goal was to evaluate the gene copy number and expression alterations of EZH2 in prostate cancer. The copy number of EZH2 in cell lines (LNCaP, DU145, PC-3, 22Rv1), xenografts (n = 10), and clinical tumors (n = 191) was studied with fluorescence in situ hybridization. All cell lines had a gain of EZH2. Eight of the ten xenografts showed an increased copy number of the gene, including one case of high-level amplification (,5 copies of the gene and EZH2/centromere ratio ,2). 34/125 (27%) of untreated prostate carcinomas showed increased copy number, but only one case of low-level amplification (,5 copies of the gene and EZH2/centromere ratio <2), whereas half (25/46) of the hormone-refractory carcinomas showed increased copy number, including seven cases of low-level amplification and three cases of high-level amplification (P < 0.0001). Expression of EZH2 was significantly (P = 0.0009) higher in hormone-refractory prostate cancer compared with that in benign prostatic hyperplasia or untreated cancer, according to quantitative real-time RT-PCR assay. Also, the expression of EZH2 protein was found to be higher in hormone-refractory tumors than in hormone-naïve tumors by immunohistochemistry. The EZH2 gene amplification was significantly (P < 0.05) associated with increased EZH2 protein expression. The data show that amplification of the EZH2 gene is rare in early prostate cancer, whereas a fraction of late-stage tumors contains the gene amplification leading to the overexpression of the gene, thus indicating the importance of EZH2 in the progression of prostate cancer. © 2006 Wiley-Liss, Inc. [source] Combined effect of the finasteride and doxazosin on rat ventral prostate morphology and physiologyINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 3 2010Luis A. Justulin Jr Summary Finasteride (Fin) and Doxazosin (Dox), alone or in combination, have been widely used in treatment of benign prostatic hyperplasia (BPH) symptoms and recently have been suggested as potential drugs for prostate cancer (PCa)prevention and treatment. However, little is known about the effects of the combination therapy on prostate tissue morphology, physiology and matrix metalloproteinases (MMPs) activity, a special set of enzymes closely related to PCa progression and metastasis. In this study, adult Wistar rats were treated with Fin + Dox (25 mg/kg per day) and the ventral prostate (VP) was excised at days 3 and 30 of treatment to evaluate morphology, cell proliferation, death, transforming growth factor-beta1 (TGF-,1) protein expression, MMP-2, MMP-9 activities and MMP-2, MMP-9, TIMP-1 and TIMP-2 mRNA expression. Fin + Dox treatment induced a transient increase in testosterone (T) plasma concentration and a permanent reduction in dihydrotestosterone (DHT). The VP and epithelial cell proliferation were reduced and the stromal collagen fibre volume fraction and apoptosis of the epithelial cell were increased. Fin + Dox treatment also increased the TGF-,1 immunoreaction in the epithelium and in the stroma. The mRNAs for MMP-2, TIMPs-1 and -2 expressions after 30 days of treatment were decreased. The mRNA for MMP-9 was not detected in any of the groups analysed. Fin + Dox treatment for 30 days promoted a decrease in gelatinolytic activity of MMP-2 and an increase in MMP-9. In conclusion, combined treatment with Fin and Dox interferes in the epithelial cell behaviour and in the MMPs activity, potentially via TGF-,1-mediated and androgen pathways. Our results contribute to a better understanding of the clinical data and also of the molecular mechanisms behind isolated or combined Fin and Dox long-term treatment. [source] Effects of steroids on oxytocin secretion by the human prostate in vitroINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 1 2004S. J. Assinder Summary Oxytocin (OT) concentrations are elevated in prostate tissue of patients with benign prostatic hyperplasia (BPH). Oxytocin specifically increases growth, 5 , -reductase activity and contractility in the prostate. In the rat prostatic OT concentrations are regulated by gonadal steroids, with androgens reducing but oestrogens increasing OT concentrations. The regulation of prostatic oxytocin in man is not understood. This study investigates the effects of gonadal steroids on oxytocin production by the human prostate. Primary explants (approx. 1 mm3) of prostate tissue from patients with BPH were incubated in Dulbecco's modified Eagle's media in the absence or presence of 10 nmol/L testosterone (T), 10 nmol/L dihydrotestosterone (DHT), T or DHT plus 100 nmol/L of the anti-androgen cyproterone acetate (CPA), 55 pmol/L diethylstilbestrol (DES), or DES plus DHT. The amount of oxytocin secreted into the media after 3 days was measured by radioimmunoassay. Testosterone and DHT significantly increased oxytocin concentrations secreted into the media from 0.86 ± 0.11 ng/g of tissue (control) to 1.51 ± 0.14 ng/g (p < 0.01) and 1.54 ± 0.13 ng/g (p < 0.05), respectively. Incubation of tissue samples with CPA resulted in oxytocin concentrations similar to control levels. Treatment with DES caused a significant increase from 1.99 ± 0.71 to 3.98 ± 1.36 ng/g (p < 0.05). A similar increase was measured in media of tissue incubated in DES plus DHT (p < 0.001). The results demonstrate that, unlike the rat where androgens decrease oxytocin, in hyperplastic human prostate tissue both androgens and oestrogens increase oxytocin. This imbalance in the regulation of oxytocin may result in promoting prostatic overgrowth in the pathogenesis of BPH. [source] Clinical and biological significance of CXCR5 expressed by prostate cancer specimens and cell linesINTERNATIONAL JOURNAL OF CANCER, Issue 10 2009Shailesh Singh Abstract Chemokines and chemokine receptors have been shown to be involved in metastatic process of prostate cancer (PCa). In this study, we show primary PCa tissues and cell lines (LNCaP and PC3) express CXCR5, a specific chemokine receptor for CXCL13. Expression of CXCR5 was significantly higher (p < 0.001) in PCa cases than compared to normal match (NM) tissues. CXCR5 intensity correlated (R2 = 0.97) with Gleason score. While prostate tumor tissues with Gleason scores , 7, displayed predominantly nuclear CXCR5 expression patterns, PCa specimens with Gleason scores , 6 showed predominantly membrane and cytoplasmic expression patterns that were comparable to benign prostatic hyperplasia (BPH). Similar to tissue expression, PCa cell lines expressed significantly more CXCR5 than normal prostatic epithelial cells (PrECs), and CXCR5 expression was distributed among intracellular and extracellular compartments. Functional in vitro assays showed higher migratory and invasive potentials toward CXCL13, an effect that was mediated by CXCR5. In both PCa cell lines, CXCL13 treatment increased the expression of collagenase-1 or matrix metalloproteinase-1 (MMP-1), collagenase-3 (MMP-13), stromelysin-1 (MMP-3), stromelysin-2 (MMP-10) and stromelysin-3 (MMP-11). These data demonstrate the clinical and biological relevance of the CXCL13-CXCR5 pathway and its role in PCa cell invasion and migration. © 2009 UICC [source] Medical treatment of benign prostatic hyperplasia: physician and patient preferences and satisfactionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2010M. Emberton Summary Practice guidelines acknowledge the importance of patient preferences in determining the appropriate treatment of benign prostatic hyperplasia (BPH). Recent literature suggests that patient and physician perspectives and satisfaction with BPH treatment management may differ; this may have an impact on clinical outcomes and patient compliance. This review evaluates patients' and physicians' preferred treatment options for managing BPH and patient satisfaction with therapy. A Medline-based systematic review using the terms ,Benign prostatic hyperplasia' + ,Patient preference/perception/satisfaction' or ,Physician/urologist preference/perception' was performed. Patients prefer therapies affecting long-term disease progression over those that provide short-term symptom improvement, which contrasts with the beliefs of their physicians. The prescribing behaviour of urologists and primary care physicians can be very varied. Studies of patient satisfaction with specific treatments generally show a high level of overall satisfaction, but cross-study comparisons are limited because of heterogeneity in study design. The evidence to date suggests that patients' views and beliefs and those of their physician may not always be in agreement. Improved physician,patient communication will help determine the best treatment option for patients with BPH and may ensure greater compliance and treatment success. [source] A meta-analysis of the vascular-related safety profile and efficacy of ,-adrenergic blockers for symptoms related to benign prostatic hyperplasiaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2008J. C. Nickel Summary Objectives:, To evaluate the safety profile and efficacy of ,1-adrenergic receptor blockers (A1Bs) currently prescribed for benign prostatic hyperplasia (BPH). Data sources:, A systematic literature search of MEDLINE, the Cochrane Database and the Food and Drug Administration Web site through December 2006 identified double-blinded, prospective, placebo-controlled trials, evaluating agents commercially available by prescription for the symptomatic treatment of BPH. Review methods:, Data were reviewed by two investigators with the use of a standardised data abstraction form. Studies were evaluated for methodological quality using the Jadad scale. Studies with a score of < 3 were considered of weaker methodology. Results:, Of 2389 potential citations, 25 were usable for evaluation of safety data, 26 for efficacy. A1B use was associated with a statistically significant increase in the odds of developing a vascular-related event [odds ratio (OR) 2.54; 95% confidence interval (CI): 2.00,3.24; p < 0.0001]. The odds of developing a vascular-related adverse event were: alfuzosin, OR 1.66, 95% CI: 1.17,2.36; terazosin, OR 3.71, 95% CI: 2.48,5.53; doxazosin, OR 3.32, 95% CI: 2.10,5.23 and tamsulosin, OR 1.42, 95% CI: 0.99,2.05. A1Bs increased Qmax by 1.32 ml/min (95% CI: 1.07,1.57) compared with placebo. Difference from placebo in American Urological Association symptom index/International Prostate Symptom Score was ,1.92 points (95% CI: ,2.71 to ,1.14). Conclusions:, Alfuzosin, terazosin and doxazosin showed a statistically significant increased risk of developing vascular-related events compared with placebo. Tamsulosin showed a numerical increase that was not statistically significant. All agents significantly improved Qmax and symptom signs compared with placebo. [source] A practical guide to the evaluation and treatment of male lower urinary tract symptoms in the primary care settingINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2007M. T. Rosenberg Summary Aims:, Lower urinary tract symptoms (LUTS) are common in both men and women, and are among the most prevalent patient complaints heard by primary care physicians (PCPs). This article aims to provide PCPs with a logical algorithm for the assessment and initiation of treatment for LUTS in the male patient. Results:, Management of LUTS involves a focused history and physical, as well as the assessment of bother. In patients for whom treatment is warranted, a series of decisions regarding therapy should be considered. Male patients commonly suffer from storage and/or voiding symptoms. Treatment of male LUTS is commonly begun with agents that are aimed at remedying the outlet symptoms of benign prostatic hyperplasia (BPH). When this intervention is ineffective or when refractory symptoms persist, consideration should be given to treating the storage symptoms characteristic of overactive bladder (OAB). Discussion:, This article is intended to provide the PCP with a logical guide to the treatment of male LUTS. Benign prostatic hyperplasia and OAB predominate among the causes of these symptoms, and the PCP should be comfortable treating each. Recent data detailing the safety of the use of these treatments in the male patient are reviewed and incorporated into the algorithm. Conclusion:, Primary care physicians are in a unique position to successfully identify and treat male patients with LUTS. With this paper, they now have a tool to approach treatment logically and practically. [source] Managing enlarged prostate in primary careINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2006M. J. NASLUND Summary Assessment and treatment of benign prostatic hyperplasia, or enlarged prostate, has evolved considerably in recent years; clear evidence has accumulated for the progression of disease over time, the association between disease progression and negative outcomes, and the potential for medical management of this condition. Commensurate with the long-term preventive role of primary care, efforts can and should be made to treat the underlying condition of enlarged prostate as well as to manage the symptoms short-term. This review outlines evaluation of men presenting with lower urinary tract symptoms, examines the challenges for medical treatment and suggests how treatment choice can address these challenges. [source] Patients' satisfaction with a community-based, nurse-led benign prostatic hyperplasia assessment clinicINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2008Eilis McCaughan Abstract The increase in the prevalence of benign prostatic hyperplasia (BPH) is putting pressure on existing general practitioners' and urologists' services. Nurses are rising to the challenge by taking an active part in the assessment of this condition. It is important, however, to know users' views of these services. The aims of this study were to explore users' experience and perceptions of a community-based, nurse-led BPH clinic and to evaluate their satisfaction with the services provided. Out of a target population of 65 users, a random sample of 10 were interviewed and the rest (n = 55) were sent a questionnaire developed for the purpose of this study. The findings from both methods were consistent in showing an overwhelmingly positive evaluation of the appointment procedures, the environment of the clinic, the consultation process and the way they were treated. Users' concerns about the condition were addressed, as were their health promotion needs. This evaluation shows that specialist urology nurses have an important part in assessing, educating and reassuring users with BPH symptoms. [source] Editorial Comment to Short-term effects of crossover treatment with silodosin and tamsulosin hydrochloride for lower urinary tract symptoms associated with benign prostatic hyperplasiaINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2010Stavros Gravas md No abstract is available for this article. [source] Clinical guideline for male lower urinary tract symptomsINTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2009Yukio Homma Abstract: This article is a shortened version of the clinical guideline for lower urinary tract symptoms (LUTS), which has been developed in Japan for symptomatic men aged 50 years and over irrespective of presumed diagnoses. The guideline was formed on the PubMed database between 1995 and 2007 and other relevant sources. The causes of male LUTS are diverse and attributable to diseases/dysfunctions of the lower urinary tract, prostate, nervous system, and other organ systems, with benign prostatic hyperplasia, bladder dysfunction, polyuria, and their combination being most common. The mandatory assessment should comprise medical history, physical examination, urinalysis, and measurement of serum prostate-specific antigen. Symptom and quality of life questionnaires, bladder diary, residual urine measurement, urine cytology, urine culture, measurement of serum creatinine, and urinary tract ultrasonography would be optional tests. The Core Lower Urinary Tract Symptom Score Questionnaire may be useful in quickly capturing important symptoms. Severe symptoms, pain symptoms, and other clinical problems would indicate urological referral. One should be careful not to overlook underlying diseases such as infection or malignancy. The treatment should be initiated with conservative therapy and/or medicine such as ,1 -blockers. Treatment with anticholinergic agents should be reserved only for urologists, considering the risk of urinary retention. The present guideline should help urologists and especially non-urologists treat men with LUTS. [source] Efficacy and safety of dutasteride in Japanese men with benign prostatic hyperplasiaINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2009Taiji Tsukamoto Objectives: To assess the efficacy and safety of dutasteride in Japanese men with benign prostatic hyperplasia (BPH). Methods: This was a randomized, double-blind, placebo-controlled, parallel-group study. A total of 378 subjects with clinical BPH having an International Prostate Symptom Score (IPSS) of 8 points or greater, a prostate volume of 30 mL or greater, and a maximal urinary flow rate (Qmax) of 15 mL/s or less were randomized to receive placebo or dutasteride once daily for 52 weeks. Subjects were stratified according to tamsulosin use at baseline. The numbers of subjects with and without tamsulosin use were 242 and 136, respectively. IPSS, Qmax, prostate volume and drug safety were evaluated. Results: Continued improvement in IPSS was noted in the dutasteride group, and dutasteride significantly decreased IPSS compared with placebo. At week 52, dutasteride significantly improved Qmax and prostate volume compared with placebo. Drug-related sexual function events in the dutasteride group were infrequent and generally were not treatment limiting. Conclusions: Dutasteride improves urinary symptoms and flow rate and reduces prostate volume. In Japanese men with BPH, it is effective and generally well tolerated during the one-year treatment period. [source] Usefulness of single photon emission computed tomography imaging in the detection of lumbar vertebral metastases from prostate cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2008Tetsuo Nozaki Objective: To determine whether single photon emission computed tomography (SPECT) is useful in the detection of prostate cancer bone metastases in the lumbar vertebrae. Methods: Thirty-nine patients (12 with benign prostatic hyperplasia, 27 with prostate cancer) were considered and submitted to bone SPECT. All of them had increased uptake in lumbar vertebrae on bone scintigraphy. In those with prostate cancer, definitive diagnosis of bone metastases was established by magnetic resonance imaging (MRI). SPECT axial images were classified into five accumulation patterns: mosaic, large hot, diffuse, peripheral, and articular (or pediculate). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bone SPECT were calculated. Results: Overall, 116 vertebral lesions (49 metastatic, 67 degenerative) were studied. Mosaic, large hot and diffuse patterns were more frequently associated with metastatic lesions (84.2%, 70.3%, and 63.1% of the cases, respectively). On the other hand, peripheral and articular (or pediculate) patterns were mostly ascribed to degenerative lesions (100% and 87.5% of the cases, respectively). Sensitivity, specificity, PPV and NPV of bone SPECT were 95.9% (47/49), 73.1% (49/67), 72.3% (47/65), and 96.1% (49/51), respectively. Conclusions: Bone SPECT provides better accuracy than bone scintigraphy in differential diagnosis of lumbar vertebral lesions from prostate cancer. [source] ,1 -Adrenoceptor subtypes and lower urinary tract symptomsINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2008Debra A Schwinn Abstract: Benign prostatic hyperplasia (BPH) is a common cause of urinary outflow obstruction in aging men leading to lower urinary tract symptoms (LUTS). ,1 -Adrenoceptors (,1ARs) antagonists (blockers) have become a mainstay of LUTS treatment because they relax prostate smooth muscle and decrease urethral resistance, as well as relieving bladder LUTS symptoms. A review of key recent clinical trials suggests new insights into the role of specific ,1AR subtypes in the treatment of LUTS. [source] Long-term results of three different minimally invasive therapies for lower urinary tract symptoms due to benign prostatic hyperplasia: Comparison at a single instituteINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2007Takashi Ohigashi Objective: We analyzed the efficacy and durability of three different minimally invasive therapies (MIT) for lower urinary symptoms performed at a single institution based on a 5-year prospective cohort study. Methods: The pre- and postoperative evaluation was made in 103 patients with the following three MIT options: (i) transurethral microwave thermotherapy (TUMT, n = 34); (ii) transurethral needle ablation (TUNA, n = 29); and (iii) transrectal high intensity focused ultrasound (HIFU, n = 40). Results: All three treatments significantly improved the symptom scores up to 2 years after treatment. However, no statistical difference was observed in the efficacy between MIT. The percentage of men requiring the secondary treatment also showed no statistical differences. Cox's proportional hazards multivariate regression model revealed the baseline peak flow rate (Qmax) and total International Prostate Symptom Score (IPSS) but the types of MIT are independent significant factors for determining the long-term clinical results of MIT. Conclusion: Our data showed no statistical differences in either the efficacy or in the durability between the three MIT. The baseline Qmax and total IPSS are the significant factors for determining the long-term results of MIT. [source] Prostate-specific antigen adjusted for the transition zone volume as a second screening test: A prospective study of 248 casesINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006SEOK-HO KANG Aim:, This study was conducted to verify the effectiveness of prostate-specific antigen adjusted for the transition zone volume (PSATZ), and its availability as a second screening test for prostate cancer detection. Materials and methods:, Total prostate-specific antigen (PSA) and free PSA was measured in male patients who visited our outpatient department for voiding difficulty or screening for prostate cancer. Patients who had an intermediate PSA level between 4.0 and 10.0 ng/mL, with an apparently normal prostate on a digital rectal examination, were enrolled. PSATZ, free-to-total PSA ratio (F/T ratio) and PSA density (PSAD) were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative patients (benign) were conducted. Results:, Of 248 patients, 51 (20.6%) had prostate cancer and 197 (79.4%) had benign prostatic hyperplasia (BPH) on pathologic examination. Mean PSA, PSAD, F/T ratio and PSATZ were 7.48 ± 1.77 ng/mL, 0.23 ± 0.09 ng/mL per mL, 0.14 ± 0.08 and 0.71 ± 0.44 ng/mL per mL in patients with prostate cancer and 6.59 ± 1.60 ng/mL, 0.16 ± 0.07 ng/mL per mL, 0.21 ± 0.11 and 0.36 ± 0.30 ng/mL per mL in patients with benign, respectively. Receiver operating characteristics (ROC) curve analysis demonstrated that PSATZ predicted the biopsy outcome better than F/T ratio. With a cut-off value of 0.37 ng/mL per mL, PSATZ had a sensitivity of 74.5% and a specificity of 72.6% for predicting prostate cancer. The maximal cut-off value that preserves 100% of sensitivity was 0.2, and at this cut-off value, 16.1% of unnecessary biopsies could be reduced. Conclusions:, Prostate-specific antigen adjusted for the transition zone volume may be more useful than other strategies in detecting prostate cancer in patients with intermediate PSA levels of 4.0,10.0 ng/mL. It can be used as a second screening test to reduce unnecessary biopsy. [source] Influence of hypertension on lower urinary tract symptoms in benign prostatic hyperplasiaINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2003KIMIO SUGAYA Abstract Aim:, To clarify the influence of hypertension on lower urinary tract symptoms (LUTS) we examined the relationship between blood pressure, LUTS, and the effect of terazosin on LUTS in patients with benign prostatic hyperplasia (BPH). Methods:, The subjects were patients who had LUTS and BPH. They were treated with terazosin (1 mg, twice-a-day) for 12 weeks. Calculation of the International Prostate Symptom Score (IPSS), measurement of blood pressure, and uroflowmetry were performed before and after 12 weeks of therapy. Patients were divided into a normotensive (NT) group and a hypertensive (HT) group at the time of first examination. Results:, The IPSS for urinary frequency and nocturia in BPH-HT patients (n = 21; mean age, 71 years) were significantly higher than those in the BPH-NT patients (n = 21; mean age, 69 years) before the administration of terazosin. The total IPSS the BPH-HT patients was also significantly higher than that of the BPH-NT patients. There were no differences of uroflowmetric parameters between the two groups. After 12 weeks of therapy, systolic and diastolic blood pressure decreased in the BPH-HT patients, but not in the BPH-NT patients. However, the systolic pressure of the BPH-HT patients was still significantly higher than that of the BPH-NT patients. The score for each IPSS parameter decreased in both groups, but the difference of the score between the two groups increased. Conclusion:, Hypertension may worsen LUTS and may decrease the improvement of symptoms by terazosin. [source] Hydrogen,potassium ATPase inhibitors induce relaxation on rabbit prostatic strips in vitroINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2002Ihsan Bagcivan Summary Background : To determine the relaxant effect of omeprazole and lansaprazole, hydrogen,potassium (H+,K+) ATPase inhibitors, on rabbit prostatic tissue in vitro. Methods : Male New Zealand white rabbits were sacrificed and their prostatic tissues were removed. The prostatic stromal strips were mounted in organ baths and relaxation responses were obtained in precontracted tissues with phenylephrine, carbachol and potassium chloride (KCl). Relaxation responses were controlled in the presence of various antagonists to explain the mechanism for relaxation exerted by omeprazole and lansaprazole. Results : Omeprazole and lansaprazole caused similar relaxation responses in the prostatic strips precontracted with phenylephrine, carbachol and KCl. The addition of prostaglandin synthase inhibitor indomethacin, nitric oxide synthase inhibitor L-NAME, potassium channel blockers, glibenclamide and tetraethylammonium into the organ baths did not change the relaxations induced by omeprazole and lansaprazole in vitro. Conclusion : Omeprazole and lansaprazole cause a relaxation in prostatic stromal tissue precontracted with phenyephrine, carbachol and KC1 in vitro. This relaxant effect is independent of H+,K+ ATPase inhibition. Additionally, cyclooxygenase and nitric oxide pathways do not contribute to this relaxant effect. Further studies are required to determine whether these drugs may have a beneficial effect in the non-operative treatment of benign prostatic hyperplasia. [source] Effect of administration mode (patient vs physician) and patient's educational level on the Turkish version of the International Prostate Symptom ScoreINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2002Murat Bozlu Abstract Objectives: To compare the effectiveness of the International Prostate Symptom Score (IPSS) when administered by the physician to when self-administered by the patient. The effect of the patient's educational level on the IPSS was also evaluated. Methods: One hundred and seven previously untreated patients with symptomatic benign prostatic hyperplasia (BPH) completed the Turkish version of the International Prostate Symptom Score (Turkish I-PSS) and quality of life (QOL) questionnaires during a single office visit, first on their own and then with an interviewing physician. The patients were categorized into three groups according to their educational levels. Paired t -tests were performed to compare the total IPSS (tIPSS) and QOL results between the two testing modes. IPSS and QOL scores resulting from both modes were compared using a kappa test. Differences between the physician-assisted and self-administered scores among the different educational groups were further compared using a one-way anova test and Post Hoc Multiple Comparisons. To compare the objective effectiveness of tIPSS and QOL between the two testing modes, we selected the positive actual state, which was maximum urine flow (Qmax) of 15 mL/s or less and constructed receiver operating characteristics (ROC) curves for all patients. This estimation was constructed for each educational level. Results: There were no statistical differences in IPSS and QOL values obtained by the patients or physicians (P > 0.05). The ROC areas for tIPSS were 0.94 and 0.93, and the ROC areas for QOL scores were 0.97 and 0.91 for information obtained by physicians and patients, respectively. When IPSS answers and QOL scores were evaluated separately, consistency was found across both modes of administration. However, there were lower levels of consistency in answers to IPSS questions 2, 5 and 6 (P = 0.59;0.42; 0.52, respectively). There was no significant difference among the aforementioned data in the educational groups. Conclusion: Although the total IPSS and QOL scores were not affected by the different modes of administration, we recommend that the physicians should evaluate answers to questions 2, 5 and 6 carefully. The present study demonstrates that the educational level did not affect the IPSS and QOL when administered either by the physician or the patient. [source] Holmium laser enucleation for large (greater than 100 mL) prostate glandsINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2002Janaka A Hettiarachchi Abstract Background: To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands >,100 mL. Methods: Eighteen patients with preoperative prostate volumes >,100 mL underwent the HoLEP procedure. The criteria for surgery were determined by a preoperative International Prostate Symptom Score (IPSS), a prior failure of medical therapy, and urinary retention. Results: The mean preoperative IPSS and prostate gland size were 13.8 and 142.3 mL, respectively. The total energy used by the laser was 288.4 kJ. The mean catheter time was 23.8 h and, perioperatively, no patients had electrolyte abnormalities or required blood transfusions. The 3-week postoperative IPSS was 2.8, with minimum long-term complications. Conclusions: Holmium laser enucleation of the prostate with TUSTM is a safe and effective alternative to open prostatic surgery for glands >,100 mL. [source] | ||||||||||||||||||||||||||||