Home About us Contact
|
Home About us Contact | ||
|
|
||
Prostate Size (prostate + size)
Selected AbstractsProstate size influences the outcome after presenting with acute urinary retentionBJU INTERNATIONAL, Issue 6 2005Alan McNeill No abstract is available for this article. [source] A prospective study of conservatively managed acute urinary retention: prostate size mattersBJU INTERNATIONAL, Issue 7 2000V. Kumar Objective To evaluate in a prospective study the medium- to long-term outcome of a policy of conservatively managing acute urinary retention (AUR), arising solely by bladder outlet obstruction caused by benign prostatic enlargement (BPE), and to identify the factors favouring a positive outcome of a trial without catheter (TWOC). Patients and methods All men admitted as an emergency with primary AUR caused by BPE (from August 1997 to March 2000) underwent a TWOC. The following variables were recorded; the nature and duration of any preceding lower urinary tract symptoms, previous episodes of retention, concomitant anticholinergic medication, coexisting constipation, alcohol as a precipitating cause of AUR, previous prostatectomy, confirmed urinary tract infection, residual urine drained on catheterization and prostate size, as determined by a digital rectal examination (DRE) carried out by one consultant urologist in all patients. Those voiding successfully were followed up prospectively using the International Prostate Symptom Score (IPSS), quality-of-life score, urinary flow rate measurement and ultrasonographic measurement of the postvoid residual (PVR). Results Of the 40 men with AUR, 22 (55%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 12.2 mL/s and mean PVRs of 69.6 mL over a follow-up of 8,24 months. These patients remained asymptomatic, with a mean IPSS of 5.2 and quality-of-life score of 0.9. These men had a mean prostatic size of 15.9 g and a mean catheterized residual volume of 814 mL, while in those who had an unsuccessful TWOC the mean prostate size was 27.5 g (P = 0.006) and a mean catheterized residual volume of 1062 mL (P = 0.09). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of a TWOC. Conclusion A TWOC is justified in the long-term for men presenting with AUR caused by BPE. Prostate size is the most important factor for predicting the outcome of such a trial. [source] Transurethral needle ablation of the prostate: An initial Japanese clinical trialINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2001Masaru Murai Abstract Objectives: Transurethral needle ablation of the prostate is a new alternative endoscopic thermal therapy that uses a low-energy radio frequency delivered into the prostatic adenoma. Herein is reported the initial clinical experience by multiple institutes in Japan of transurethral needle ablation of the prostate for the treatment of symptomatic benign prostatic hyperplasia. Methods: A total of 93 patients were treated with this technique. Transurethral needle ablation of the prostate was generally performed under low-spinal anesthesia. Before and after the procedure, international symptom score (IPSS), quality of life (QOL) score, peak urinary flow rate (Qmax), postvoid residual urine volume and prostate size were evaluated. Results: There was a reduction of IPSS of more than 50% when compared with that of pretreatment, being 51.3% (57/93 patients) and 60.2% (56/93 patients) at 3 months and 6 months after the procedure, respectively. Sixty-seven patients who were available for a 12-month follow-up period demonstrated a markedly decreased mean IPSS when compared with that measured before the treatment for a statistically significant difference (P < 0.01). Fifty-eight patients who were available for uroflowmetric study at 12 months exhibited a notably increased mean Qmax of 11.2 ± 4.5 mL/s, which was a statistically significant increase when compared with that found before treatment (P < 0.05). Although all patients suffered some degree of gross hematuria after the procedure, none of them required any specific treatment for complications. Conclusion: Transurethral needle ablation technique for the treatment of symptomatic benign prostatic hyperplasia is safe and effective. However, a much longer follow-up study is essential for fully evaluating the extended effectiveness of this technique. [source] Data from frequency-volume charts versus maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility grade in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 5 2002Ger E.P.M. van Venrooij Abstract Aims To examine associations of data from frequency-volume charts with maximum free flow rate, residual volume, and voiding cystometric estimated urethral obstruction grade and detrusor contractility in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). Methods The 160 men included in the study met the criteria of the International Scientific Committee on BPH, i.e., they voided more than 150 mL during uroflowmetry, their residual volume and prostate size were estimated, and they completed frequency-volume charts correctly. From the frequency-volume charts, voiding habits and fluid intake were evaluated. Pressure-flow studies were performed as well. Results Increasing residual volume was related to a decrease of maximum voided volume and to a decrease of maximum free flow rate. Cystometric capacity was little affected by residual volume. Low contractility did not result in high residual volume. A marked decrease in voided volumes with increasing obstruction grade was observed, due to a decrease of cystometric capacity and an increase of residual volume. Detrusor contractility was little associated with voided volumes. A higher voiding frequency was related to a higher fluid intake. However, increased standardized frequency (number of voidings per 1,000 mL) was associated with a substantial reduction of fluid intake. Conclusions Infravesical obstruction is the most important factor influencing voided volumes, cystometric capacity, and residual urine volume. Frequency of voiding was not influenced significantly because patients with small voided volumes minimized their fluid intake. Neurourol. Urodynam. 21:450,456, 2002. © Wiley-Liss, Inc. [source] Data from frequency-volume charts versus filling cystometric estimated capacities and prevalence of instability in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 2 2002Ger E.P.M. van Venrooij Abstract The aim was to examine associations of filling cystometric estimated compliance, capacities, and prevalence of bladder instability with data from frequency-volume charts in a well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Men with LUTS suggestive of BPH were included if they met the criteria of the International Consensus Committee on BPH, i.e., they voided more than 150 mL during uroflowmetry, their residual volume and prostate size were estimated, and they completed frequency-volume charts correctly. From the frequency-volume charts, voiding habits, and fluid intake in the daytime and at night were evaluated. Filling cystometric studies were performed in these men as well. Decreased compliance was an exceptional finding. Cystometric capacity and especially effective capacity (cystometric capacity minus residual volume) corresponded significantly with the maximum voided volume on the frequency-volume charts. Effective capacity was almost twice as high as the average voided volume. Minimum voided volume on frequency-volume charts was not related to filling cystometric data. The presence of instability in the supine or sitting position or in both positions was not significantly associated with smaller voided volumes, higher nocturia, or diuria. Filling cystometric capacities were strongly associated with maximal and mean voided volumes derived from frequency-volume charts. The presence of detrusor instability during filling cystometry did not significantly affect voided volumes, diuria, or nocturia. Neurourol. Urodynam. 21:106,111, 2002. © 2002 Wiley-Liss, Inc. [source] Interactions between prostate volume, filling cystometric estimated parameters, and data from pressure-flow studies in 565 men with lower urinary tract symptoms suggestive of benign prostatic hyperplasiaNEUROUROLOGY AND URODYNAMICS, Issue 5 2001Mardy D. Eckhardt Abstract The aim of this study was to establish the characteristics and to investigate the interactions between prostate volume, degree of obstruction, bladder contractility, the prevalence of residual volume, bladder compliance, bladder capacities, and the prevalence of instability in a large, well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). The 565 consecutive men included in this study met the criteria of the International Consensus Committee on BPH and voided more than 150 mL during uroflowmetry. Their residual urine volume and prostate size were estimated, and filling cystometry and pressure-flow studies were performed. Fifty-three percent of the men appeared to have obstruction. We found a positive correlation between prostate volume and Schäfer's obstruction grade, except that mean prostate volume decreased at Schäfer's grades 5 and 6. Significant negative correlations existed between Schäfer's grade and cystometric bladder capacity and effective capacity. Bladder outlet obstruction results in incomplete emptying. Of all men, 26% had a significant residual volume (,>,20% of cystometric capacity). Thirty-nine percent did not have residual volume. Of the 565 men, 46% had an unstable bladder. In particular, patients with an unstable bladder in the sitting and lying positions have a significantly higher Schäfer's grade and contractility grade and a significantly lower cystometric and effective bladder capacity compared with patients without instability. Patients with a residual volume or instability were significantly older. We conclude that in men with LUTS suggestive of BPH, abnormalities of bladder and bladder outlet function vary greatly and have complex mutual interactions. Neurourol. Urodynam. 20:579,590, 2001. © 2001 Wiley-Liss, Inc. [source] Vascular endothelial growth factor and angiopoietin are required for prostate regenerationTHE PROSTATE, Issue 5 2007Gui-min Wang Abstract BACKGROUND The regulation of the prostate size by androgens may be partly the result of androgen effects on the prostatic vasculature. We examined the effect of changes in androgen levels on the expression of a variety of angiogenic factors in the mouse prostate and determined if vascular endothelial growth factor (VEGF)-A and the angiopoietins are involved in the vascular response to androgens. METHODS Expression of angiogenic factors in prostate was quantitated using real-time PCR at different times after castration and after administration of testosterone to castrated mice. Angiopoietins were localized in prostate by immunohistochemistry and in situ hybridization. The roles of VEGF and the angiopoietins in regeneration of the prostate were examined in mice inoculated with cells expressing soluble VEGF receptor-2 or soluble Tie-2. RESULTS Castration resulted in a decrease in VEGF-A, VEGF-B, VEGF-C, placenta growth factor, FGF-2, and FGF-8 expression after 1 day. In contrast, VEGF-D mRNA levels increased. No changes in angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), hepatocyte growth factor, VEGF receptor-1, VEGF receptor-2, or tie-2 mRNA levels were observed. Administration of testosterone to castrated mice had the opposite effect on expression of these angiogenic factors. Ang-2 was expressed predominately in prostate epithelial cells whereas Ang-1 was expressed in epithelium and smooth muscle. Inoculation of mice with cells expressing soluble VEGF receptor-2 or Tie-2 blocked the increase in vascular density normally observed after administration of testosterone to castrated mice. The soluble receptors also blocked the increase in prostate weight and proliferation of prostatic epithelial cells. CONCLUSION VEGF-A and angiopoietins are required for the vascular response to androgens and for the ability of the prostate to regenerate in response to androgens. Prostate 67: 485,499, 2007. © 2007 Wiley-Liss, Inc. [source] Concurrent improvement of the metabolic syndrome and lower urinary tract symptoms upon normalisation of plasma testosterone levels in hypogonadal elderly menANDROLOGIA, Issue 1 2009A. Haider Summary Central obesity in adulthood, the metabolic syndrome, erectile failure and lower urinary tract symptoms (LUTS) are all associated with lower-than-normal testosterone levels, although the relationship between testosterone and LUTS appears weak. The metabolic syndrome is associated with an overactivity of the autonomic nervous system. Alternatively, the metabolic syndrome is associated with markers of inflammation, such as C-reactive protein (CRP), maybe signalling intraprostatic inflammation. A large cohort of 95 middle-aged to elderly hypogonadal men (T levels 5.9,12.1 nmol l,1) were treated with parenteral testosterone undecanoate and its effects on the metabolic syndrome {waist circumference, cholesterol, CRP and LUTS [residual bladder volume (RBV), International Prostate Symptoms Score (IPSS), prostate volume, prostate-specific antigen (PSA)]} were evaluated. Along with the improvements of the metabolic syndrome, there was a significant decline of the values of the IPSS, RBV and CRP. There was a (low) level of correlation between the decline of waist circumference and residual volume of urine but not with IPSS and prostate size. Along with the improvement of the metabolic syndrome upon testosterone administration, there was also an improvement of the IPSS and of RBV of urine and CRP. The mechanism remains to be elucidated. [source] Performance and functional outcome of endoscopic extraperitoneal radical prostatectomy in relation to obesity: an assessment of 500 patientsBJU INTERNATIONAL, Issue 6 2008Evangelos Liatsikos OBJECTIVE To investigate the impact of obesity on the performance and functional outcome of endoscopic extraperitoneal radical prostatectomy (EERPE). PATIENTS AND METHODS We retrospectively examined 500 patients treated with EERPE; they were categorized into three groups according to the World Health Organization classification of obesity: normal weight (body mass index, BMI, <25.0 kg/m2), overweight (25.0,29.9 kg/m2) and obese (30.0 kg/m2). The database of our institution was reviewed and perioperative data evaluated. The functional data were collected through questionnaires before and after EERPE and analysed statistically. RESULTS The age, prostate size and preoperative PSA level were similar in all three groups. The mean (sd) BMI was 27 (3.3) kg/m2, with 26.8%, 56.6% and 16.6% of the patients classed as normal, overweight and obese, respectively. A pelvic lymph node dissection and nerve-sparing was done in 218 and 123 patients, respectively. There was no statistically significance difference in the number of patients in each group who had previous procedures. Obese patients had a significantly higher American Society of Anesthesiologists score. The mean operative duration for all patients was 149 min; there was a statistically significant difference in duration among the three groups, with EERPE or nerve-sparing EERPE requiring a mean of 20 min more in obese patients. There was no conversion to open surgery. The estimated mean blood loss was 200 mL; four patients, none of them in the obese group, received a blood transfusion. At 3 months after EERPE there was a trend to worse continence in obese patients, but it was not statistically significant, and was not apparent at 6 months. There was no difference in transfusion rate and duration of catheterization. CONCLUSION EERPE seems to be a feasible and reproducible surgical technique in obese patients, although the operation takes longer. [source] The impact of targeted training, a dedicated protocol and on-site training material in reducing observer variability of prostate and transition zone dimensions measured by transrectal ultrasonography, in multicentre multinational clinical trials of men with symptomatic benign prostatic enlargementBJU INTERNATIONAL, Issue 1 2007Philip S. Murphy OBJECTIVE To assess the variability of a standardized protocol of transrectal ultrasonography (TRUS), with targeted training, and compare it to the variability in other multicentre clinical trials, as TRUS-estimated total prostate volume (TPV) and transition zone volume (TZV) are considered important efficacy endpoints in assessing new drug therapies for benign prostatic enlargement (BPE), but standardizing TRUS remains a challenge in such studies. PATIENTS AND METHODS In all, 174 patients with BPE in the placebo arm of a 30-centre clinical trial were analysed at baseline, 13 and 26 weeks with TRUS, to extract TPV and TZV values. All TRUS operators received training in the standardized methods, which was supplemented at the outset by a compact disc-based video. RESULTS The mean (sd) changes from baseline in TPV at 13 and 26 weeks were ,,2.9 (8.9) and ,1.9 (8.5) mL, respectively; the respective mean changes from baseline in TZV were ,1.2 (6.4) and +,0.7 (7.8) mL. For TPV, 80% of the measurements had differences of +,5.2 to ,13.4 mL at 13 weeks, and +,8.0 to ,,10.9 mL at 26 weeks. For TZV, 80% of the differences were +,5.8 to ,,7.4 at 13 weeks, and +,9.3 to ,6.5 mL at 26 weeks. CONCLUSION The performance of TRUS compared favourably with similar published multicentre studies, which we suggest relates in part to the careful implementation of the protocol. We showed that diligent implementation of a detailed protocol, supplemented by targeted training of investigators and provision of on-site training material, promoted consistent acquisition and successful derivation of key clinical trial endpoints. Quantifying the variability of such endpoints will enable us to track deployment quality for future clinical trials, and will ensure that trials are sufficiently powered to define small changes in prostate size. [source] Cardiovascular risk factors correlate with prostate size in men with bladder outlet obstructionBJU INTERNATIONAL, Issue 1 2003L. Sandfeldt OBJECTIVE To study whether the risk profile for cardiovascular disease correlates with prostate size in elderly men seeking medical attention for lower urinary tract symptoms (LUTS), by assessing physiological, biochemical and personality traits. PATIENTS AND METHODS Fifty-two men (mean age 68 years, range 52,85) with bladder outlet obstruction, as verified by urodynamic testing, had their prostate size measured by transrectal ultrasonography. Their blood and urine was also examined, and their personality and heart rate variability tested. The measured variables were assessed statistically in relation to whether the prostate volume was smaller (22 men) or larger (30 men) than 50 mL. RESULTS Patients with a large prostate (mean 104 mL) had a higher mean arterial pressure (105 vs 95 mmHg, P < 0.01), and serum glucose (5.3 vs 4.8 mmol/L, P < 0.01) and serum cortisol (423 vs 362 nmol/L, P = 0.06) concentrations than those with a small gland (mean 31 mL). The personality test showed that they were also less assertive than the others (P < 0.03). The components of the heart rate variability indicated that men with a large prostate had increased sympathetic activity. CONCLUSION Men with LUTS caused by a very large prostate have more risk factors for cardiovascular disease than those with a smaller gland. [source] Rotoresect for bloodless transurethral resection of the prostate: a 4-year follow-upBJU INTERNATIONAL, Issue 1 2003M.S. Michel OBJECTIVE To report the results and long-term follow-up of transurethral resection of the prostate (TURP) with a new resection device, the Rotoresect (Karl Storz, Tuttlingen, Germany). PATIENTS AND METHODS Most endoscopic resection techniques for benign prostatic tissue aim for high ablation rates and minimal bleeding. Available resection electrodes are effective, but cause high blood loss (loop electrode), or less bleeding but poorer ablation rates (electrovaporization). To resolve these conflicts the Rotoresect was developed in 1995; it consists of a specially designed rotating resection electrode, driven by a micromotor, and a high-frequency current to enable simultaneous coagulation, vaporization and mechanical tissue removal during resection. To date, 84 patients with benign prostatic hyperplasia have had their prostate resected with this device (mean prostate size 46.0, sd 18.4 mL) and have been assessed for up to 4 years. RESULTS During resection there was very little bleeding, with no significant changes in haemoglobin or sodium levels. The mean (sd) duration of catheterization was 1.4 (1.1) days; the urinary peak flow rate was improved from 9.7 (3.2) to 24.2 (8.23) mL/s and the residual urine volume reduced from 187.3 (109.6) to 22.7 (19.5) mL. The International Prostate Symptom Score and quality-of-life index were both improved, from 24.0 (7.5) to 4.1 (2.7), and 4.2 (3.2) to 0.8 (0.9), respectively. Overall the results were stable during the 4 years of follow-up. CONCLUSION The Rotoresect combines the advantages of standard resection (high ablation rate) by actively rotating the resection electrode, and the haemostatic effect of electrovaporization (minimal blood loss) by simultaneous tissue coagulation and vaporization. [source] A prospective study of conservatively managed acute urinary retention: prostate size mattersBJU INTERNATIONAL, Issue 7 2000V. Kumar Objective To evaluate in a prospective study the medium- to long-term outcome of a policy of conservatively managing acute urinary retention (AUR), arising solely by bladder outlet obstruction caused by benign prostatic enlargement (BPE), and to identify the factors favouring a positive outcome of a trial without catheter (TWOC). Patients and methods All men admitted as an emergency with primary AUR caused by BPE (from August 1997 to March 2000) underwent a TWOC. The following variables were recorded; the nature and duration of any preceding lower urinary tract symptoms, previous episodes of retention, concomitant anticholinergic medication, coexisting constipation, alcohol as a precipitating cause of AUR, previous prostatectomy, confirmed urinary tract infection, residual urine drained on catheterization and prostate size, as determined by a digital rectal examination (DRE) carried out by one consultant urologist in all patients. Those voiding successfully were followed up prospectively using the International Prostate Symptom Score (IPSS), quality-of-life score, urinary flow rate measurement and ultrasonographic measurement of the postvoid residual (PVR). Results Of the 40 men with AUR, 22 (55%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 12.2 mL/s and mean PVRs of 69.6 mL over a follow-up of 8,24 months. These patients remained asymptomatic, with a mean IPSS of 5.2 and quality-of-life score of 0.9. These men had a mean prostatic size of 15.9 g and a mean catheterized residual volume of 814 mL, while in those who had an unsuccessful TWOC the mean prostate size was 27.5 g (P = 0.006) and a mean catheterized residual volume of 1062 mL (P = 0.09). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of a TWOC. Conclusion A TWOC is justified in the long-term for men presenting with AUR caused by BPE. Prostate size is the most important factor for predicting the outcome of such a trial. [source] | ||||||||||