Benign Prostatic Obstruction Patients Research Articles

Benign Prostatic Obstruction and Parkinson's Disease—Should Transurethral Resection of the Prostate be Avoided?

According to the literature transurethral resection of the prostate in patients with Parkinson's disease has an increased risk of postoperative urinary incontinence. However, this conclusion might have been reached because some patients with multiple system atrophy incorrectly diagnosed as Parkinson's disease were included in these reports. Therefore, we investigated the outcome of transurethral prostate resection in patients with a secure neurological diagnosis of Parkinson's disease. A total of 23 patients with Parkinson's disease who underwent transurethral prostate resection for benign prostatic obstruction were evaluated retrospectively. Subsequent neurological developments in patients were followed, ensuring that those with multiple system atrophy had not been included in analysis. At transurethral prostate resection median patient age was 73 years, median duration of Parkinson's disease before the resection was 3 years, and median Hoehn and Yahr scale was 2. Of the 14 patients with a preoperative indwelling urinary catheter transurethral prostate resection restored voiding in 9 (64%) and only 5 (36%) required catheterization postoperatively. Of the 10 patients with preoperative urge urinary incontinence, continence was restored in 5 and improved in 3 following transurethral prostate resection. There were no cases of de novo urinary incontinence after transurethral prostate resection. At a median postoperative followup of 3 years transurethral prostate resection was successful in 16 of the 23 patients (70%). Transurethral prostate resection for benign prostatic obstruction in patients with Parkinson's disease may be successful in up to 70% and the risk of de novo urinary incontinence seems minimal. Thus, Parkinson's disease should no longer be considered a contraindication for transurethral prostate resection provided that preoperative investigations including urodynamic assessment indicate prostatic bladder outlet obstruction.

Safety of anticholinergics in patients with benign prostatic hyperplasia

Background: Storage lower urinary tract symptoms (LUTS) or overactive bladder (OAB) often coexist with voiding symptoms in patients with benign prostatic obstruction (BPO). Anticholinergic medications to treat storage LUTS are often withheld in such patients for fear of significantly increasing post-void residual urine volumes or provoking acute urinary retention (AUR). Objective: To assess the clinical validity of concerns regarding urinary safety of anticholinergics in patients with benign prostatic hyperplasia. Methods: Review of indexed literature and congress abstracts. Results/conclusions: Existing urinary and non-urinary safety data on BPO patients administered anticholinergics, either alone or in combination with α-blockers, do not seem to support the above-mentioned concerns. Nevertheless, precise criteria for patient and drug selection to ascertain safe and effective administration are not yet established and need to be investigated in future trials.

Results of Questionnaires Regarding Video Recordings of Benign Prostatic Obstruction by Flexible Cystourethroscopy Responded to by Urologists

Objective: To evaluate the reliability of subjective diagnoses of benign prostatic obstruction (BPO) using flexible cystourethroscopy as compared to the actual degree of bladder outlet obstruction as measured by a pressure-flow study (PFS), and to investigate the difference of subjective diagnoses among different urologists. Methods: A standardized PFS was done in 33 BPO patients. The degree of BPO (0∼VI) was determined by linear PURR. Flexible cystourethroscopy was also performed in order to evaluate the BPO by video recording. Nine urologists, who have served on the Japanese Board of Urology, diagnosed the degree of the BPO (0∼VI) by watching the video recordings. The degree of obstruction revealed by cystourethroscopy was dependent upon the subjective impression of each urologist who wrote their diagnoses on questionnaires. Results: A positive correlation was found between the results of the PFS and the subjective evaluations based on the cystourethroscopy video (p < 0.001), and the trained urologists arrived at a similar obstruction grade in most cases. However, relatively large gaps between linear PURR and cystoscopic finding were found in some cases. We suggest that these gaps could be caused by dynamic obstructions which cannot be detected by cystourethroscopy. Conclusions: Even though it is difficult to establish an objective measurement of the degree of a BPO using cystourethroscopy, our results show that it is a simple and reliable tool for the assessment of BPO in most cases.

Effects of Prazosin and Carbachol in Patients with Benign Prostatic Obstruction

To eight patients with benign prostatic obstruction (BPO), prazosin and placebo were given in a double blind cross-over manner. Prazosin decreased significantly residual urine volume and increased maximum and average flow rates. Neither when treated with prazosin nor with placebo, did the patients improve their ability to empty the bladder after injection of carbachol (0.25 mg) s.c. The only significant effect of carbachol on urodynamic variables was an increase in intravesical premicturition pressure. This was observed both when the patients were treated with prazosin and with placebo. Fourteen patients with BPO were given oral carbachol in maximally tolerated doses (6 or 12 mg/day) during a 2 week period. Despite producing significant systemic side effects in all patients, carbachol did not change any of the urodynamic variables tested. It is concluded that carbachol does not further improve bladder emptying in BPO patients given prazosin. Oral carbachol has no effects on bladder emptying in these patients.