Prostatic Enlargement Research Articles

Adreno-Muscarinic Synergy of Contractile Responses From Human Hyperplastic Prostate.

Adreno-muscarinic synergy, a supra-additional contractile response to simultaneous application of α-adrenoreceptor and muscarinic receptor agonists, is a feature of several lower urinary tract regions that have dual sympathetic and parasympathetic innervation. We tested the hypothesis that synergy is also a feature of prostate tissue obtained from men with benign prostatic enlargement. Isolated tissue strips were dissected from prostate 'chips', collected after transurethral prostate resection procedures for in vitro experiments, to measure isometric tension at 36°C. Added separately to the superfusate, phenylephrine and carbachol generated contractions with mean pEC50 (-log10EC50) values of 5.36 and 5.58, respectively, although phenylephrine maximal responses were about six-fold greater. In the presence of carbachol, the mean phenylephrine pEC50 was significantly increased to 5.84 and maximal response increased by 28%; overall, a significant synergistic response was demonstrated. The synergistic response was reduced by muscarinic receptor antagonists, most potently by the M3-selective agent 4-DAMP (1,1-dimethyl-4-diphenylacetoxypiperidinium iodide), and less so by M2 and M1-selective inhibitors gallamine and pirenzepine, but with an overall profile indicating M3/M2 mediation of the synergistic response. The magnitude of the synergistic response was variable between prostate chips that provided isolated preparations suggesting regional heterogenicity, although their zonal origin could not be determined. These experiments show that adreno-muscarinic contractile synergy is a feature of human hyperplastic prostate tissue. This has implications for the use of a combination therapy of α-blockers and anti-muscarinic agent to relieve secondary symptoms associated with benign prostatic hyperplasia, at least in men who can tolerate antimuscarinics without a risk of retention.

The impact of water vapor thermal therapy of the prostate (rezūm) on sexual functions: a narrative review

Background: Senile prostate enlargement is an age-related condition. Many sexually active patients fear formal prostate surgeries owing to their negative impact on sexual performance. Minimally invasive procedures, including prostate water vapor thermal therapy (Rezūm®), were devised to make ends meet. This study aims to present a comprehensive narrative synthesis about the impact of prostate water vapor therapy on sexual functions. Methods: A narrative literature review was performed in May 2023, using MEDLINE, Cochrane Library, Ovid-Embase, Scopus, Science Direct, and Google Scholar; for the MeSH term “rezum AND sexual functions”. Selected reports were published articles from 2018 to date (the last 5 years). Only open-access journals in English were analyzed. Efforts were made to focus on the 2 main domains of sexual functions; erection and ejaculation. Results: As per the concise MeSH term “rezum AND sexual functions”, a score of 207 hits appeared on the initial search. After eliminating duplicate and irrelevant papers, only 7 articles fulfilled the inclusion criteria and were subjected to analysis. The analyzed articles were critically appraised to point out the studies` strengths and limitations. The gathered data were found to be consistent with one another as no outliers were detected. Conclusion: Water vapor thermal therapy of the prostate showed satisfying preservation of erectile function with minimal ejaculatory dysfunction.

Metastatic Superscan in 18F PSMA PET/CT of a Patient with Prostate Carcinoma.

A biopsy-proven patient with prostate carcinoma aged 70 years was referred to the department of nuclear medicine for radionuclide-based therapy. His prostate-specific antigen levels were >1000 ng/mL, and prostatic magnetic resonance imaging showed an enlarged prostate with a heterogeneous signal and size 3.8x3.7x3.5 cm with few small heterogeneous nodular signals in the transition zone. He was scheduled for 18F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scan before therapy. 18F PSMA PET/CT revealed PSMA-expressing prostate lesions (maximum standardized uptake value ~10.2) with extension into the urinary bladder along with bilateral supraclavicular, mediastinal, retrocrural, retroperitoneal, and pelvic lymph nodes and sclerotic lesions in the entire axial and appendicular skeleton.

Gamut of Urological Diseases in a Tertiary Hospital in North Central Nigeria.

Worldwide, urological disorders vary from one topography to another. An in-depth understanding of their distribution in each region could serve as a basis for the distribution of manpower, equipment's alongside determine policy formulation and training. This study enumerates the annual frequency and distribution of urological disorders at the Federal Medical Centre, Keffi. A cross-sectional retrospective study from November 2021 to November 2022 of all new patients who attended the urology outpatient clinic, emergency department as well as those who had surgical interventions at the Federal Medical Centre, Keffi, Nasarawa State. The pertinent records were extracted from the patient's electronic medical records (EMR) and entered into a semistructured questionnaire. Data were analyzed using the SPSS software version 20. A total of 452 new patients were seen over the study period. There were 428 (94.5%) males and 24 (5.3%) females, with a male-to-female ratio of 17.8:1. The median age was 58 years, with the age range of 2-97 years. Urological emergencies were seen in 13.5% patients. Ninety-eight percent of cases were acquired, whereas 1.8% were of congenital etiology. Overall, the most commonly diagnosed urologic diseases among new patients in order of decreasing frequency were benign prostatic enlargement (BPE) (54.7%), urethral stricture disease (11.0%), upper tract urinary calculi (6.3%), prostate adenocarcinoma (5.9%), and male infertility (4.3%). BPE, urethral stricture disease, upper tract urinary calculi, prostate adenocarcinoma, and male infertility are common in our environment. An understanding of the urological disease distribution will enhance policy-making and drive manpower needs inspiring core areas of subspecialization with a view at improving the standard of urological care and promoting collaboration with international organizations and funding agencies.

Electroacupuncture Therapy for Urinary Retention in an Elderly Patient.

Urinary retention is the inability to urinate voluntarily and difficulty in urinating even when the bladder is full. Acute urinary retention is most common in men aged 60-80. In the past 5 years, 10% of men older than age 70 and almost a third of men in their 80s have experienced acute urinary retention. Risk factors include prostate enlargement, increasing age, African-American race, obesity, diabetes mellitus, high alcohol consumption, and lack of physical activity. Treatment for urinary retention is mainly urethral catheterization, but it can be uncomfortable for a patient in the long term. A 68-year-old man was unable to urinate voluntarily for 3 months and was diagnosed with urinary retention caused by a hypotonic bladder and was initially given a catheter. The patient then received manual acupuncture therapy in acupoints ST-28, CV-3, CV-4 and CV-6, and electroacupuncture (EA) therapy in acupoints SP-6, SP-9, BL-23, BL-25, BL-31, BL-32, BL-33, and BL34, with a continuous-wave, at a frequency of 2 Hz. Acupuncture therapy was carried out for 12 sessions, twice per week. After 5 sessions of acupuncture therapy, the patient's urinary retention was resolved. He felt the urge to urinate and was able to urinate voluntarily even after removing the catheter, He also experienced an increase in his quality of life, as shown on an EQ-5D questionnaire with an increased score from 50 to 80. A combination of manual acupuncture and EA in an elderly patient can be a safe choice to reduce or resolve symptoms of urinary retention.

Filamin A Is a Prognostic Serum Biomarker for Differentiating Benign Prostatic Hyperplasia from Prostate Cancer in Caucasian and African American Men.

Prostate cancer represents a significant health risk to aging men, in which diagnostic challenges to the identification of aggressive cancers remain unmet. Prostate cancer screening is driven by the prostate-specific antigen (PSA); however, in men with benign prostatic hyperplasia (BPH) due to an enlarged prostate and elevated PSA, PSA's screening utility is diminished, resulting in many unnecessary biopsies. To address this issue, we previously identified a cleaved fragment of Filamin A (FLNA) protein (as measured with IP-MRM mass spectrometry assessment as a prognostic biomarker for stratifying BPH from prostate cancer and subsequently evaluated its expanded utility in Caucasian (CA) and African American (AA) men. All men had a negative digital rectal examination (DRE) and PSA between 4 and 10 ng/mL and underwent prostate biopsy. In AA men, FLNA serum levels exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.71 AUC and 12.2 OR in 48 men with BPH and 60 men with PCa) and outperformed PSA (0.50 AUC, 2.2 OR). In CA men, FLNA serum levels also exhibited diagnostic utility for stratifying BPH from patients with aggressive prostate cancer (0.74 AUC and 19.4 OR in 191 men with BPH and 109 men with PCa) and outperformed PSA (0.46 AUC, 0.32 OR). Herein, we established FLNA alone as a serum biomarker for stratifying men with BPH vs. those with high Gleason (7-10) prostate cancers compared to the current diagnostic paradigm of using PSA. This approach demonstrates clinical actionability of FLNA alone without the requirement of prostate volume measurement as a test with utility in AA and CA men and represents a significant opportunity to decrease the number of unnecessary biopsies in aggressive prostate cancer diagnoses.

A nomogram model for the occurrence of bladder spasm after TURP in patients with prostate enlargement based on serum prostacyclin and 5-hydroxytryptamine and clinical characteristics.

With the development of analytical methods, mathematical models based on humoral biomarkers have become more widely used in the medical field. This study aims to investigate the risk factors associated with the occurrence of bladder spasm after transurethral resection of the prostate (TURP) in patients with prostate enlargement, and then construct a nomogram model. Two hundred and forty-two patients with prostate enlargement who underwent TURP were included. Patients were divided into Spasm group (n=65) and non-spasm group (n=177) according to whether they had bladder spasm after surgery. Serum prostacyclin (PGI2) and 5-hydroxytryptamine (5-HT) levels were measured by enzyme-linked immunoassay. Univariate and multivariate logistic regression were used to analyze the risk factors. Postoperative serum PGI2 and 5-HT levels were higher in patients in the Spasm group compared with the Non-spasm group (P<0.05). Preoperative anxiety, drainage tube obstruction, and elevated postoperative levels of PGI2 and 5-HT were independent risk factors for bladder spasm after TURP (P<0.05). The C-index of the model was 0.978 (0.959-0.997), with a χ2 = 4.438 (p = 0.816) for Hosmer-Lemeshow goodness-of-fit test. The ROC curve to assess the discrimination of the nomogram model showed an AUC of 0.978 (0.959-0.997). Preoperative anxiety, drainage tube obstruction, and elevated postoperative serum PGI2 and 5-HT levels are independent risk factors for bladder spasm after TURP. The nomogram model based on the aforementioned independent risk factors had good discrimination and predictive abilities, which may provide a high guidance value for predicting the occurrence of bladder spasm in clinical practice.

Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non- en-bloc techniques: a multicenter, real-world experience of 5068 patients.

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62-73] years vs 69 [63-74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52-92] ml in Group 1 vs 70 [54-90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 ( P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 ( P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.

Assessing the Safety and Effectiveness of Bipolar Technology in Transurethral Prostate Resection: A study in a Tertiary Care Private Hospital

Background: Benign enlargement of prostate (BEP) is a common affliction among aging males, predominantly emanating from the transition zone of the prostate, resulting in lower urinary tract symptoms. Despite the availability of diverse treatment modalities, transurethral resection of prostate (TURP) has conventionally served as a benchmark intervention. Recently, there has been a growing interest in bipolar energy techniques, spurred by their potential advantages in mitigating complications such as TUR syndrome and surgical bleeding. Objectives: The main aim of the study to evaluate the safety profile (including serum sodium and hemoglobin reductions, clot retention, TUR syndrome, catheterization duration, and hospital stay) and efficacy (resection rate, maximum flow rate increase, and International Prostate Symptom Score reduction) within the bipolar technique for the TURP. Methods &amp; Materials: A prospective observational study was conducted at the Department of Urology, Square Hospitals Ltd, Dhaka, Bangladesh, spanning December 2020 to November 2021. The study employed comprehensive preoperative assessments, including bipolar transurethral resection of the prostate (B-TURP) using Olympus ESG-400 energy platform. Surgical parameters, postoperative monitoring, and statistical analysis were meticulously executed to evaluate outcomes and complications for symptomatic benign enlargement of prostate. Results: In a sample of 50 individuals undergoing bipolar transurethral resection of the prostate (B-TURP), the distribution of ages revealed 66.97±7.95 years as the bipolar system's average age, ranging from 53-82 years. The majority resided in urban areas (62%), with family income predominantly in the 25000-50000 bracket (42%). Preoperative baseline variables, including IPSS, Qmax, serum hemoglobin, and sodium levels, exhibited similar values between groups. Intraoperatively, the mean resection rate was 0.56±0.16 gm/min. Postoperatively, B-TURP resulted in a slight ......

Evaluation of Tamsulosin 0.4 mg versus 0.8 mg in management of lower urinary tract symptoms due to benign prostatic enlargement

PurposeTo compare the efficacy and the safety of Tamsulosin 0.4 mg/day and 0.8 mg/day in patients suffering from lower urinary tract symptoms due to benign prostatic obstruction.Patients and MethodsA prospective interventional, double-blinded, controlled study was carried out on 93 patients who met the criteria and divided randomly into two groups: group A for Tamsulosin 0.4 mg/day and group B for Tamsulosin 0.8 mg/day. International prostate symptom score, post void residual urine volume, and maximum flow rate of urine were assessed before and after 4 weeks of treatment.ResultsBoth study groups showed a significant reduction in storage sub-score but only frequency was significantly reduced in group B (P < 0.001). On the other hand, Tamsulosin 0.8 mg was superior to Tamsulosin 0.4 mg regarding voiding sub-score except for straining (P = 0.325). Accordingly, the total international prostate symptom score was significantly improved in group B versus group A (P < 0.001). Furthermore, maximum flow rate and post-void residual urine volume were notably improved in Group B as compared to Group A (P < 0.001). Of all adverse events only dizziness was noted to be statistically significant in Group B versus Group A (P < 0.001).ConclusionTamsulosin 0.8 mg has shown better outcomes in treating patients who suffer from lower urinary tract symptoms due to benign prostatic enlargement than Tamsulosin 0.4 mg, and besides that, it is well tolerated.Trial registration numberM S 292/2020, SID: 373, date: 22/4/2020.

Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review.

Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines. We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome. Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System. The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.

Whole-exome sequencing of Nigerian benign prostatic hyperplasia reveals increased alterations in apoptotic pathways.

Through whole-exome sequencing of 60 formalin-fixed paraffin-embedded Nigerian (NGRn) benign prostatic hyperplasia (BPH) samples, we identified germline and somatic alterations in apoptotic pathways impacting BPH development and progression. Prostate enlargement is a common occurrence in male aging; however, this enlargement can lead to lower urinary tract symptoms that negatively impact quality of life. This impact is disproportionately present in men of African ancestry. BPH pathophysiology is poorly understood and studies examining non-European populations are lacking. In this study, NGRn BPH, normal prostate, and prostate cancer (PCa) tumor samples were sequenced and compared to characterize genetic alterations in NGRn BPH. Two hundred and two nonbenign, ClinVar-annotated germline variants were present in NGRn BPH samples. Six genes [BRCA1 (92%), HSD3B1 (85%), TP53 (37%), PMS2 (23%), BARD1 (20%), and BRCA2 (17%)] were altered in at least 10% of samples; however, compared to NGRn normal and tumor, the frequency of alterations in BPH samples showed no significant differences at the gene or variant level. BRCA2_rs11571831 and TP53_rs1042522 germline alterations had a statistically significant co-occurrence interaction in BPH samples. In at least two BPH samples, 173 genes harbored somatic variants known to be clinically actionable. Three genes (COL18A1, KIF16B, and LRP1) showed a statistically significant (p < 0.05) higher frequency in BPH. NGRn BPH also had five gene pairs (PKD1/KIAA0100, PKHD1/PKD1, DNAH9/LRP1B, NWD1/DCHS2, and TCERG1/LMTK2) with statistically significant co-occurring interactions. Two hundred and seventy-nine genes contained novel somatic variants in NGRn BPH. Three genes (CABP1, FKBP1C, and RP11-595B24.2) had a statistically significant (p < 0.05) higher alteration frequency in NGRn BPH and three were significantly higher in NGRn tumor (CACNA1A, DMKN, and CACNA2D2). Pairwise Fisher's exact tests showed 14 gene pairs with statistically significant (p < 0.05) interactions and four interactions approaching significance (p < 0.10). Mutational patterns in NGRn BPH were similar to COSMIC (Catalog of Somatic Mutations in Cancer) signatures associated with aging and dysfunctional DNA damage repair. NGRn BPH contained significant germline alteration interactions (BRCA2_rs11571831 and TP53_rs1042522) and increased somatic alteration frequencies (LMTK2, LRP1, COL18A1, CABP1, and FKBP1C) that impact apoptosis. Normal prostate development is maintained by balancing apoptotic and proliferative activity. Dysfunction in either mechanism can lead to abnormal prostate growth. This work is the first to examine genomic sequencing in NGRn BPH and provides data that fill known gaps in the understanding BPH and how it impacts men of African ancestry.

Efficacy of Prostatic Artery Embolization in Symptomatic Benign Enlargement of Prostate (&gt;100 cc): A Hospital-based Prospective Study in a Tertiary Care Center

Abstract Background: Prostatic artery embolization (PAE) has recently emerged as an effective minimally invasive procedure for the treatment of patients with symptomatic benign enlargement of prostate (BEP). Aim and Objective: The objective of the study was to evaluate the efficacy of PAE in BEP patients. Materials and Methods: A prospective observational clinical study was conducted at tertiary care hospital over 1-year from April 2022 to March 2023. This study included patients with lower urinary tract symptoms indicative of BEP and a prostate volume of 100 cc or more. The primary endpoints of the study were determining the International Prostate Symptom Score (IPSS), Q-max, prostate volume, intraprostatic resistive index, and prostate-specific antigen (PSA). Results: A total of 21 patients, with a mean age of 72 years were included in the study. After a 6-month follow-up, 15 patients were catheter-free, while 6 patients required adjunctive surgical treatment in the form of transurethral resection of prostate or holmium enucleation of prostate. The mean IPSS significantly decreased from 22 to 8 after PAE (P = 0.0394 Mean Q-max significantly increased from 8 mL/s to 16 mL/s (P = 0.05), while prostate volume decreased significantly at 6 months’ follow-up (122.0 cc vs. 58.0 cc, P = 0.0334). Intraprostatic resistive index showed a statistically significant increase after embolization of unilateral/bilateral prostatic arteries. 0.62 versus 1.34, P = 0.0317, and serum PSA values were comparable pre- and post- PAE. Conclusion: PAE effectively treats symptomatic BEP with a prostatic volume of 100cc or more, achieving a success rate of 71.5% with improvements in IPSS, increased Q-max values, and reduced prostate size.

Serenoa repens for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Enlargement: An Updated Cochrane Review.

To assess the effects of Serenoa repens in the treatment of men with lower urinary tract symptoms (LUTS) consistent with benign prostatic hyperplasia (BPH). We performed a comprehensive search using multiple databases up to September 2022 with no language or publication status restrictions. We included parallel-group randomized controlled trials of participants with BPH who were treated with Serenoa repens or placebo/no treatment. We used standard Cochrane methods, including a GRADE assessment of the certainty of the evidence (CoE). We included 27 studies involving a total of 4,656 participants. Serenoa repens results in little to no difference in urologic symptoms at short-term follow-up (International Prostate Symptom Score [IPSS]: mean difference [MD] -0.90, 95% confidence interval [CI] -1.74 to -0.07; I²=68%; 9 studies, 1,681 participants; high CoE). Serenoa repens results in little to no difference in the quality of life at short-term follow-up (high CoE). Serenoa repens probably results in little to no difference in adverse events (moderate CoE). Different phytotherapeutic agents that include Serenoa repens may result in little to no difference in urologic symptoms compared to placebo at short-term follow-up (IPSS: MD -2.41, 95% CI -4.54 to -0.29; I²=67%; 4 studies, 460 participants; low CoE). We are very uncertain about the effects of these agents on quality of life (very low CoE). These agents may result in little to no difference in the occurrence of adverse events (low CoE). Serenoa repens alone provides little to no benefits for men with LUTS due to benign prostatic enlargement. There is more uncertainty about the role of Serenoa repens in combination with other phytotherapeutic agents.

Analysis of risk factors for benign prostate enlargement with prostate calcification

Analysis of risk factors for benign prostate enlargement with prostate calcification

Efficacy and safety of photoselective vaporization of the prostate using the Greenlight XPS 180W laser and simple prostatectomy for high-volume prostate hypertrophy: a comparative analysis.

This study aimed to compare the safety and efficacy of treatment using simple prostatectomy (SP) and using photoselective vaporization of the prostate (PVP) with a 180W GreenLight XPS laser in patients with high-volume prostate hypertrophy. The study included 120 patients with LUTS symptoms caused by prostatic enlargement of more than 80 ml; 79 patients were treated with SP, while 41 were treated with PVP. The analysis included subjective the International Prostate Symptom Score (IPSS) and Quality of Life (QoL), and objective (Qmax), (Qave), and post-void residual volume (PVR) parameters before treatment and at an average of 38 months after surgical treatment. Early and late adverse effects and length of hospitalisation were assessed. Complication reports were performed according to the modified Clavien-Dindo system. The analysis independently showed the effectiveness of both methods. Subjective parameters (IPSS, QoL), showed no significant differences. Patients treated with SP scored slightly better on objective parameters (Qmax, Qave, and PVR). Analysis of adverse effects and hospitalisation time were more favourable after PVP. SP and PVP were found to be comparable and highly effective in treating benign prostatic hyperplasia in terms of IPSS and QoL. Patients treated with the SP method obtained slightly better results of objective parameters such as Qmax, Qave, and PVR. Compared with SP, PVP has a more favourable safety profile.

Role of Alcian Blue Stain in Differentiating Prostatic Adenocarcinoma from Nodular Hyperplasia of Prostate

Objective: Enlargement of prostate is one of the leading cause of morbidity in men. Alcian Blue stain demonstrates that the acidic mucin is present in prostatic adenocarcinoma but absent in nodular hyperplasia of prostste. So this histochemical marker can be used in distinguishing them. This study aims to determine the role of Alcian Blue stain in differentiating prostatic adenocarcinoma from the nodular hyperplasia of prostate. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Rajshahi Medical College, Rajshahi and in the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of March 2018 to February 2020. Specimens were processed routinely for Haematoxilin and Eosin stain. The Alcian Blue stain was performed to demonstrate the presence of acidic mucin and the findings were categorized as positive or negative staining. Statistical analyses was carried out by using the Statistical package for Social Sciences (SPSS) version 20 for Windows. The components of accuracy test were computed by respective formulae for the tests. Result: The study involved a total 60 specimens of prostatic tissue among which 30 were histopathologically diagnosed cases of prostatic adenocarcinoma and another 30 were histopathologically diagnosed cases of nodular hyperplasia. Among the 30 cases of prostatic adenocarcinoma the acidic mucin was positive in 25 (83.3 %) cases and negative in 5 (16.7%) cases but in nodular hyperplasia it was positive in 8 (26.6%) cases and negative in 22 (73.4%) cases. The sensitivity of Alcian Blue stain in favour of malignancy was 83.3% and specificity was 73.3%. The overall diagnostic accuracy of Alcian Blue stain was 78.3% and it showed a statistically significant difference in staining between the cases of adenocarcinoma and nodular hyperplasia, indicated by p&lt;0.05. Conclusion: Alcian Blue stain has a valuable role in differentiating prostatic adenocarcinoma from the nodular hyperplasia. So it can be used in the diagnosis of prostatic adenocarcinoma. TAJ 2023; 36: No-2: 57-63

Comparison of the results of bipolar transurethral enucleation and resection of the prostate with and without morcellation in treatment of benign prostatic hyperplasia

Objective: To compare the result of bipolar transurethral enucleation and resection of the prostate with morcellation (B-TUERP-M) and without morcellation (B-TUERP) in treatment of benign prostatic hyperplasia. Materials and Methods: This was a prospective single centre cohort study of 101 patients with prostate enlargement of more than 60 ml who underwent B-TUERP by a single surgeon between January 2020 and June 2022. Patients were divided into two groups, a B-TUERP group of 49 patients and a second group of 52 patients classed as B-TUERP-M. The perioperative outcomes followed up at 1, 3 and 6 months after surgery were evaluated. Results: There were no significant differences in the preoperative parameters of the two groups. Comparisons between the two groups showed a shorter operative time (63.94 ± 12.01 vs 77.77 ± 11.80 min, p-value 0.000), more resected prostate tissue (65.73 ± 14.67 vs 60.73 ± 5.45 gm, p-value 0.027) and a higher post-operative hematocrit level (35.16 ± 3.97 vs 33.18 ± 3.22%, p-value 0.007) in the patients who underwent B-TUERP with morcellation. At 6 months after the procedure, better results were found in patients who had undergone B-TUERP-M regarding urine flow rate (26.33 ± 5.33 vs 20.66 ± 5.08 ml/sec, p-value 0.000), post-void residual urine volume (24.19 ± 10.93 vs 36.04 ± 16.90 ml, p-value 0.000), post-operative PSA (0.72 ± 0.43 vs 1.22 ± 0.54 mg/ml, p-value 0.000) and International Prostate Symptom Scores (5.01 ± 1.36 vs 5.71 ± 1.33, p-value 0.001). Conclusion: Better outcomes occurred following B-TUERP with morcellation with regard to operative time, resection weight of prostatic adenoma, post-operative urine flow rate, Post-void residual urine volume, PSA and International Prostate Symptom Score than in patients treated with B-TUERP without morcellation.

Autoimmune hemolytic anemia in a preoperative patient: a case report and literature review

Background: In patients undergoing elective surgery, it is known that as many as one-third have preoperative anemia. Preoperative anemia is associated with an almost five-fold increase in the likelihood of postoperative mortality. So, it is essential to know the cause of anemia so that the management is appropriate so that surgery can be performed safely and prevent patients from dying on the operating table or postoperatively. This case report aims to describe the pathogenesis of the laboratory findings in a patient with autoimmune hemolytic anemia (AIHA) who was accidentally diagnosed during preoperative screening and the management performed. Case: A 65-year-old man with an enlarged prostate was scheduled for elective surgery. Preoperative examination revealed anemic right and left conjunctiva, decreased erythrocytes, hemoglobin, hematocrit, and increased MCV, MCH, and MCHC, peripheral blood smear dominated by red cell agglutination and positive direct Coomb's test. The patient was given methylprednisolone 62.5 mg intravenously before transfusion and given a transfusion of 2 units of slow drip packed red cells (PRC) under close supervision. There were no transfusion reactions during and after transfusion. There was an increase in Hb after transfusion so that the patient could be operated on. Conclusion: The patient in this case was diagnosed with AIHA based on preoperative laboratory findings. Laboratory results showed evidence of autoimmune hemolytic anemia with decreased erythrocytes, hemoglobin, hematocrits, spherocytes, and agglutination on peripheral blood smear and positive Coomb's test. Rapid identification and treatment of anemia help improve preoperative conditions.

Causes and prevalence of prenatal and neonatal mortality in the District Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan

Objectives: Perinatal mortality is among the key health, prosperity, and economic status indicators. This retrospective study determines the causes of prenatal (stillbirth) and neonatal mortality during July–December 2021 and their yearly prevalence during 2013–2021 in the Women and Children’s Hospital in the district Dera Ismail Khan. Materials and Methods: The data were extracted from the admission registers maintained by the said hospital and were found not in organized and consolidated form. A month-wise organized/consolidated report for each cause of mortality was prepared. Results: A total of 508 cases of both prenatal and neonatal mortality in the nursery ward indicated hypoxic-ischemic encephalopathy (HIE) showed overall 39.8% mortality in the study area, followed by premature (15.4%), senile prostatic enlargement (10%), low birth weight revealed (9.3%), birth asphyxia (5.3%), neonatal jaundice (4.5%), respiratory distress syndrome (4.3%), non-nutritive sucking (3.5%), congenital heart defects (2.4%), meconium aspiration syndrome (1.8%), and the remaining cases each contributed to ≤0.6% of overall mortality. The isolation ward contributed (48.5%), followed by the labor room (42.4%), the nutrition ward (6.1%), and the Gynae wards (3%) of all 33 cases. The overall highest mortality occurred in 2019 (15.4%) and lowest in 2013 (6.8%). The remaining years showed each &lt;10% mortality. Neonatal mortality was mostly higher than prenatal mortality during 2013–2021 and highest (85.8%) in 2013 and the lowest (19%) in 2014. The highest and lowest prenatal mortality was 81% (2014) and 14.2% (2013), respectively. Conclusion: HIE caused about 40% of perinatal mortality. Neonatal mortality showed higher prevalence than prenatal mortality except in 2014.