Clinical Benign Prostatic Hyperplasia Research Articles

Evaluation of the Accuracy of the Use of Intravesical Prostatic Protrusion Degree as the Predictor of Benign Prostatic Hyperplasia Management

Managing symptoms of benign prostatic hyperplasia (BPH) is important but preventing the progression of the disease is also necessary. Medical therapy is commonly used to treat BPH as initial therapy. However, not every medical therapy is effective for treating BPH. Intravesical prostatic protrusion (IPP), a manifestation of BPH is used to evaluate BPH progression thus helping clinicians in choosing the effective treatment option. Patients with higher IPP degrees may experience more severe bladder outlet obstruction (BOO). They may not respond well to medical therapies, suggesting that IPP measurement can guide treatment decisions for BPH patients. This study evaluates the accuracy of using IPP degree as a predictor of BPH management by reviewing relevant literature. A comprehensive approach was undertaken, including the selection and filtering of articles from reputable databases and scholarly repositories using specific keywords related to the study's objectives. By measuring IPP degrees, the severity of clinical BPH can be categorized, allowing clinicians to choose effective treatment options and predict treatment outcomes.

Effect of Preoperative Administration of Dutasteride on Reducing Blood Loss in Perioperative Period of Transurethral Resection of Prostate

Background and Objective: Clinical benign prostatic hyperplasia (BPH), a condition that commonly occurs in aging men. It is characterized by the development of lower urinary tract symptoms (LUTS), which can lead to impairment of bladder function and potential renal complications. TURP is the gold standard surgical treatment of BPH. Dutasteride is a 5-reductase and is used for medical management. This study was planned to ascertain the effect of pre-treatment dutasteride in reducing blood loss in patients undergoing transurethral resection of prostate (TURP).Methods: It was a randomized clinical trial carried out at Department of Urology, Jinnah Hospital Lahore in which the total study sample was divided in two groups. One group received dutasteride and the second group was the control group. The study variables were Haemoglobin and Hematocrit values, clotting profile PT and INR, serum Ca levels and uric acid, BMI, prostate volume, residual volume of urine and hospital stay. Results were presented as mean ± SD or frequency (%). The main study outcome variable was mean blood loss (calculated by change in hemoglobin and hematocrit level).Results: 6 (10.3 %) patients needed blood transfusion in dutasteride group and 7 (12 %) in control group (p=0.14). Post-surgery change in haemoglobin and HCT levels were less in dutasteride groups as compared to the control group (ΔHb 1.94±1.27 g/dL vs. 2.16±0.73 g/dL, respectively, p=0.02; ΔHct 5.68 % ± 2.56% vs. 6.52 % ± 2.39 %, respectively, p = 0.04).Conclusion: The present research suggests that administering Dutasteride four weeks prior to the TURPprocedure results in a decrease in blood loss during the peri-operative period, ultimately leading to improved patient outcomes.Key words: Benign Prostatic Hyperplasia (BPH). Transurethral resection of Prostate (TURP), 5 Alpha Reductase Inhibitor (5-ARI)

Evaluation of bi-directional causal association between periodontitis and benign prostatic hyperplasia: epidemiological studies and two-sample mendelian randomization analysis.

Background: Periodontitis and benign prostatic hyperplasia (BPH) are all common chronic diseases with higher incidence in middle-aged and old men. Several studies have indicated a potential association between periodontitis and BPH, although the findings remain inconclusive. However, there is no mendelian randomization (MR) studies to assess this association. Methods: The 40 men who had received health check-ups were included in an epidemiological study. Genetic data of BPH (13118 cases and 72799 controls) and periodontitis (3046 cases and 195395 controls) from FinnGen project was used to perform two-sample MR analysis. The inverse-variance weighted (IVW) model was identified as the primary analytical method, with MR Egger, weighted median, simple mode, and weighted mode serving as additional approaches. Results: The epidemiological analysis demonstrated a lack of statistically significant differences in the prevalence of clinical BPH between severe periodontitis group and non-severe periodontitis group. Similarly, no statistically significant differences were found in the prevalence of severe periodontitis among individuals with clinical BPH compared to those without. Additionally, Among the five models utilized in MR analysis, including the IVW model, no evidence of a causal link between periodontitis and BPH was observed. Conclusion: The findings from our epidemiological investigation and MR analysis do not provide support for a causal relationship between periodontitis and BPH.

Influence of Early Apical Release on Outcomes in Endoscopic Enucleation of the Prostate: Results From a Multicenter Series of 4392 Patients

ObjectiveTo evaluate outcomes after laser Endoscopic enucleation of the prostate (EEP) stratified by whether early apical release (EAR) was performed or not. MethodsWe retrospectively reviewed patients with clinical benign prostatic hyperplasia who underwent EEP with holmium or thulium fiber laser in 8 centers (January 2020-January 2022). Exclusion criteria: previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, concomitant lower urinary tract surgery. One-to-one propensity score-matching was performed between patients with EAR versus no EAR, with covariates including age, prostate volume, diabetes mellitus, hypertension, preoperative indwelling catheter, IPSS, Qmax, enucleation and laser types. Multivariable logistic regression analyses were performed to evaluate independent predictors of 30-day postoperative complications and urinary incontinence. ResultsEAR was performed in 2094 of 4392 included patients. The matched cohort consisted of 787 patients per arm. Total operation time was significantly longer in the EAR group (median 75 vs 67 minutes, p=0.004). Early complications were higher in the EAR group (18.6% vs 12.5%, p=0.001), while postoperative incontinence rates were similar (14.1% vs 13.1%, p=0.61). Multivariable regression analysis showed that 3-lobe enucleation and operation time were significant predictors of postoperative complications; preoperative indwelling catheterization, higher prostate volume, and en-bloc enucleation were associated with higher odds of postoperative incontinence. Limitation: retrospective nature. ConclusionsPerforming EAR during EEP is associated with a greater incidence of early complications, which was mainly driven by higher rates of postoperative hematuria and perioperative transfusion. The risk of postoperative incontinence and its duration are not affected by EAR.

Correlation of Prostate Volume, Uroflowmetry Variables and BMI in Patients Having Clinical Benign Prostatic Hyperplasia.

Background: Benign Prostatic Hyperplasia (BPH) causing urinary obstruction is a common entity in a man over 40 years old. Enlarge prostate causes compression of the prostatic part of the urethra leading to bladder outflow obstruction, causes LUTs (lower urinary tract symptoms) of BPH and decreases quality of life.Objectives: To find out the correlation of prostate volume, and BMI with Uroflowmetry variables, of patients having BPH symptoms.Materials and Methods: A total of 44 patients having BPH symptoms, ages ranging from 48 to 85 years, who underwent transabdominal ultrasound and uroflowmetry in a standing position, were included in this study. The patients were divided into 4 age groups and 4 grades of prostate size for comparison. Height in cm and weight in Kg were recorded for BMI calculation.Results: Among the patients, the mean age was 66.25, with a mean prostate size of 39.73 g, with a Qmax of 14.45 ml/sec, Qave 5.96 ml/sec, mean voided volume 327.14 ml and PVR 57.91 ml with mean flow time 61 sec.In age group l, there were 3 patients, ages ranged 40 to 50 years. In age group ll, there were 11 patients, age range 51 to 60 years. In age group lll, there were 17 patients, ages ranged 61 to 70 years. In age group lV, there were 13 patients, age range 71 to 84 years. In grade l of prostate size (prostate <30 g), there were 13 patients. In grade ll prostate size (prostate 30-<50 g ), there were 25 patients. In grade lll, prostate size (50- <85 g), there were 4 patients. In grade lV (prostate size is >85 g), there were 2 patients. No significant difference was found among 4 age groups and 4 grades of prostate volume. However, there was a weak correlation between prostate size and uroflowmetry variables without a significant difference.Conclusion: There was a correlation between prostate volume and different uroflowmetry variables of age-related groups and grades of the prostate but the correlation was weak. KYAMC Journal Volume: 14, No: 03, October 2023: 138-144.

Current Evidence on Surgical Management for Benign Prostatic Hyperplasia in Renal Transplant Recipients: A Systematic Review.

Background: Patients who have undergone renal transplant may have a concomitant benign prostatic hyperplasia (BPH), a condition that can potentially hinder the recovery of the renal graft and necessitate surgical intervention. However, endoscopic treatment of BPH should be performed carefully because of the associated perioperative risks. We aimed to systematically assess the factors affecting surgical indications and perioperative outcomes of BPH surgical treatment in renal transplantation (RT) recipients. Methods: A systematic literature search was performed on January 28, 2023, using Scopus, PubMed, and EMBASE with no date limit. Preclinical and animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Results: Eighteen articles were accepted and included. Clinical BPH has a high incidence rate after RT, particularly in elderly men. Secondary events associated with BPH, such as acute urinary retention and urinary tract infections, can lead to a gradual decline of renal graft function and patient survival. BPH procedure can prevent these events and guarantee improvements in serum creatinine levels, voiding parameters, and lower urinary tract symptoms. When the urine culture is negative, the endoscopic procedure of the prostate may be performed within 1 month of the initial procedure, particularly in older patients, more prone to develop voiding dysfunction. Alternatively, a transurethral incision of the prostate may be recommended for patients with smaller prostates who wish to preserve ejaculatory function. Data on comparative BPH surgical procedures are lacking. Conclusions: BPH procedure should be offered in RT recipients who develop bladder outlet obstruction owing to BPH. Endoscopic treatment should be performed after a few weeks from RT to avoid further graft deterioration.

Abstract 4720: Chromatin conformation alterations in prostate cancer progression and formation of castration resistance

Abstract Introduction: Prostate cancer (PC) is the most common cancer in men and second in cancer related deaths. Aggressive prostate cancer is typically treated with androgen depletion therapy which often results in the formation of castration resistant prostate cancer (CRPC). Androgen receptor (AR) is a transcription factor that regulates hundreds of target genes and is responsible for the differentiation and function of normal prostate epithelial cells. In addition to AR, multiple other TFs that bind to distal enhancers have been implicated in PC, such as FOXA1, MYC and HOXB13. Understanding the role of these distal regulators is paramount in PC. Methods: To study the changes in chromatin conformation in prostate cancer progression, we have sequenced clinical benign prostatic hyperplasia (BPH), PC and CRPC samples using Hi-C sequencing. From each group 6 samples were sequenced with a total of 18 samples in the cohort. In addition, we have combined a multi omics cohort consisting of chromatin accessibility, transcriptome and methylome sequencing data from matching samples. Together these data types allow us to map out the regulatory networks in PC and CRPC by probing the distal active regulatory sites and their interactions. To account for artifacts caused by genomic aberrations in cancer samples we have established a pipeline for normalizing these effects in HiC-data. Results: Overall topologically associated domains (TADs) and A/B-compartments remain stable between the groups. However, local changes of compartments in loci of key genes, such as AKR1C3 and FOXA1 correlate with their gene expression. We detect differential loops between sample groups and these changes are associated with gene expression alterations in PCs. Distal enhancers of PC up-regulated genes are enriched for FOXA1 and HOXB13. Interestingly, up-regulated loops in CRPC are enriched for FOXA1 and HOXB13, while no systematic effect on gene expression is seen on a genome wide scale, apart from genes such as AR and CENPE whose expression correlates strongly with their association to distal enhancers. We also detect enhancer hijacking events in driver genes. One example is the recurrent ETV1-MIPOL1 fusion, where promoter of ETV1 forms contacts with FOXA1 enhancer regions. Conclusions: Alterations in loop structures are strongly associated with regulatory programs that have been previously implicated in PC, including regulation by FOXA1, HOXB13 and other transcription factors. This highlights the importance of chromatin conformation in facilitating the effects of regulatory programs that rely on distal enhancers in PC. These changes appear more systematic in untreated PCs, whilst CRPCs exhibit more heterogeneity in chromatin conformation across the samples. Citation Format: Tuomo Virtanen, Ebrahim Afyounian, Riikka Nurminen, Teuvo Tammela, Tapio Visakorpi, Juha Kesseli, Kirsi Rautajoki, Matti Nykter. Chromatin conformation alterations in prostate cancer progression and formation of castration resistance. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4720.

Assessment of the utility of platelet indices to diagnose clinical benign prostatic hyperplasia in dogs.

Platelet indices changes in severely ill people and in dogs with inflammation are compatible findings. This study aimed to compare platelet indices between dogs with clinical benign prostatic hyperplasia (BPH) and healthy controls. Additionally, to determine whether there is a correlation between the relative prostatic size (S rel) and the platelet indices in BPH dogs. Thirty-five adult intact male dogs of different breeds were allocated to the experimental groups: dogs with clinical BPH (groups A; n = 24; median age of 6 years; the median weight of 8.50 kg) and healthy dogs (group B; n = 11; median age 5.50 years; the median weight of 7.00 kg) based on physical examination, clinical signs, and S rel detected by ultrasonographic findings. The individual prostatic volume (IPV) was divided by the expected prostatic volume (EPV) to determine the relative prostatic size in dogs over 4 years old. Platelet indices were compared between the two groups, and a correlation between S rel and these indices was calculated. The median S rel of dogs in group A was significantly higher (P = 0.001), and the mean plateletcrit (PCT) was significantly lower (P = 0.003) compared with those in group B. S rel showed a significant negative correlation with PLT and PCT (r = -0.388; P = 0.02 and r = -0.402; P = 0.01). Receiver operating characteristic (ROC) analysis showed PLT and PCT thresholds for estimating S rel > 1 with 75% and 87.5% sensitivity and 71.82 and 63.64% specificity. The findings of this study support the use of platelet indices like PLT and PCT to detect clinical BPH in dogs. However, more research is needed to confirm their utility in conjunction with other previously described diagnostic factors.

MP04-06 INCIDENCE OF URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROSPECTIVE, RANDOMIZED TRIALS

You have accessJournal of UrologyCME1 May 2022MP04-06 INCIDENCE OF URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROSPECTIVE, RANDOMIZED TRIALS Ee Jean Lim, Vineet Gauhar, Giacomo Maria Pirola, Emanuele Rubilotta, Marcelo Langer Wroclawski, Dong Le Quy, Marilena Gubbiotti, Vinson Wai, Shun Chan, Mariela Corrales, Esther Garcia Rojo, Thomas R.W. Herrman, Jeremy Yuen, Chun Teoh, Hong Kong, and Daniele Castellani Ee Jean LimEe Jean Lim More articles by this author , Vineet GauharVineet Gauhar More articles by this author , Giacomo Maria PirolaGiacomo Maria Pirola More articles by this author , Emanuele RubilottaEmanuele Rubilotta More articles by this author , Marcelo Langer WroclawskiMarcelo Langer Wroclawski More articles by this author , Dong Le QuyDong Le Quy More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Vinson WaiVinson Wai More articles by this author , Shun ChanShun Chan More articles by this author , Mariela CorralesMariela Corrales More articles by this author , Esther Garcia RojoEsther Garcia Rojo More articles by this author , Thomas R.W. HerrmanThomas R.W. Herrman More articles by this author , Jeremy YuenJeremy Yuen More articles by this author , Chun TeohChun Teoh More articles by this author , Hong KongHong Kong More articles by this author , and Daniele CastellaniDaniele Castellani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture (US) is a well-known long-term complication of endoscopic procedures for benign prostatic hyperplasia (BPH). This systematic review aims to evaluate the incidence and influencing factors of US in relation to different surgical endoscopic techniques for treating clinical BPH. METHODS: We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The PICOS (Patient Intervention Comparison Outcome Study type) model was used to frame and answer the clinical question. The incidence of urethral stricture was estimated by comparing the results of the studies that used different endoscopic techniques. Patients were assigned in groups according to the type of surgery and regardless of energy used (enucleation, ablation and resection group). The incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. Analyses were two-tailed, and the significance was set at p <0.05 and a 95% CI. Study heterogeneity was assessed utilizing the I2 value. Substantial heterogeneity was defined as an I2 value >50% or a Chi2 p-value <0.10. RESULTS: A total of 80 studies were included for meta-analysis. There was no significant heterogeneity among the studies, with an I2 0%, Chi2 16.98, p=0.88 for Enucleation vs TURP studies and I2 0%, Chi2 27.71, p=0.99 for the Ablation vs TURP ones. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p=0.004). US incidence was lower for Ablation procedures than after TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p=0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p=0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p=0.004). The mean postoperative catheterization was significantly shorter in laser treatments than in TURP also potentially influencing US incidence. CONCLUSIONS: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e59 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ee Jean Lim More articles by this author Vineet Gauhar More articles by this author Giacomo Maria Pirola More articles by this author Emanuele Rubilotta More articles by this author Marcelo Langer Wroclawski More articles by this author Dong Le Quy More articles by this author Marilena Gubbiotti More articles by this author Vinson Wai More articles by this author Shun Chan More articles by this author Mariela Corrales More articles by this author Esther Garcia Rojo More articles by this author Thomas R.W. Herrman More articles by this author Jeremy Yuen More articles by this author Chun Teoh More articles by this author Hong Kong More articles by this author Daniele Castellani More articles by this author Expand All Advertisement PDF DownloadLoading ...

Clinical Significance of Intravesical Prostatic Protrusion Index in Patients with Clinical Diagnosis of Benign Prostatic Hyperplasia

Background: To investigate the clinical significance of the intravesical prostatic protrusion (IPP) index in benign prostatic hyperplasia (BPH) patients to clarify its diagnostic value in predicting the clinical and structural abnormalities of the prostate. Methods: In this descriptive and analytical cross-sectional study, every man older than 50 years with lower urinary tract symptoms (LUTS), predominantly voiding or obstructive, suggestive of BPH were included. The patients were evaluated to determine the following indices: International Prostate Symptom Score (IPSS) index, quality of life (QoL), prostate volume (PV) and postvoid residual urine (PVR), serum PSA level, and the maximum urinary flow rate (Qmax) obtained by uroflowmetry. Subsequently, the assessment of the IPP index was conducted by transabdominal ultrasonography. The categorization of the IPP index was done into 3 grades: Grade one (below 5 mm), grade two (between 5 and 10 mm), and grade three (greater than 10 mm). Results: A significant direct correlation between the IPP and IPSS, QoL, PV, PVR, and serum PSA, as well as inversely with the Qmax, was detected before and after medical treatment. Also, the need for surgical intervention increased significantly with the IPP index. Conclusions: The IPP can be used to evaluate and predict the severity of symptoms and outcomes in patients with clinical BPH.

Haematocrit Patterns following Transurethral Resection of Prostate for Benign Prostatic Hyperplasia among Jehovah’s Witnesses

Background: Transurethral resection of the prostate (TURP) is a gold standard surgical intervention for managing symptomatic benign prostatic hyperplasia (BPH) due to its minimal blood loss benefit, especially when dealing with patients that do not consent to blood transfusion. However, there is still a dilemma on the efficacy of this procedure as a preferable choice in minimising blood loss. This study aimed to highlight the pattern of haematocrit levels of Jehovah’s Witnesses’ subjects with BPH following TURP. Methodology: This is a retrospective study of sixty-seven Jehovah’s Witnesses patients with BPH who underwent TURP at the University of Port Harcourt Teaching Hospital and a private hospital from January 2009 to January 2021. Their venous pre-operative haematocrit levels were measured a day before TURP and on a postoperative day 3. Overall blood loss was estimated by subtracting the post-operative packed cell volume (post-ops PCV) from Pre-operative Packed cell volume (Pre-ops PCV) [Overall Blood Loss (%)= post-ops PCV – Pre-ops PCV]. Estimated Blood Loss (ml) = Overall Blood Loss (%) divided by 3% multiplied by 450 ml. Results: Mean age of the study population who underwent TURP was 68.05±8.4 years, while the mean pre-and post-operative haematocrit levels were 35.65±6.5% and 31.44±4.3 %, respectively. There was an age-independent significant association between the pre-and post-operative haematocrit levels (P=0.0004). The pre-operative haematocrit levels significantly reduced with age and increased in the younger age group, while the post-operative haematocrit level did not change significantly with age (P=0.019 and P=0.19 respectively). The net blood loss of BPH patients below their sixties was considerably higher than the amount lost in their BPH counterparts above their sixties (P=0.014). Conclusion: Although TURP is a preferable choice in the surgical management of clinical BPH, bleeding is still one of the possible complications. The younger age group (those below their sixties) are more prone to blood loss using this intervention. Hence, it is a more preferable choice for managing BPH in the elderly. A subsequent study will provide a more robust population size and working variables for validation and generalization of the results.

Association of Frailty Index with Clinical BPH Progression and Serious Adverse Events: the MTOPS Trial

Lower urinary tract symptoms due to suspected benign prostatic hyperplasia (BPH) are increasingly treated with medications targeting obstruction among older men, but frailty may represent a novel risk factor for this condition. Our objective was to assess the associations between frailty and clinical BPH progression or serious adverse events (SAE) among 3047 men, age 50-89 years, enrolled in the Medical Therapy of Prostatic Symptoms Study, a placebo-controlled RCT of doxazosin, finasteride, or combination therapy on clinical BPH progression. We created a frailty index using 69 items collected at baseline and categorized men as fit (0-0.1), less fit (0.1-<0.25), or frail (0.25-1.0). The primary outcomes were time to 1) first composite event of clinical BPH progression, and 2) SAE requiring hospitalization. Cox proportional hazards models were adjusted for demographics, intervention, BPH surrogates, and comorbidities. At baseline, 28% men were fit, 58% were less fit, and 14% were frail. During follow-up (mean 4.5 years), the incidence rate of clinical BPH progression was 2.2/100p-y among fit, 3.0/100p-y among less fit (HR =1.28, 95% CI 0.98, 1.67), and 4.1/100p-y among frail men (HR=1.60, 95% CI 1.13, 2.26). Among men randomized to combination therapy, the SAE incidence rate was 3.4/100p-y for fit men versus 12.7/100p-y for frail men (HR=5.98, 95% CI 3.76, 9.52). In conclusion, frailty is independently associated with greater risk of both clinical BPH progression and SAE. The decision to initiate medical therapy for BPH among frail men should therefore include a discussion of both benefits and risks via shared decision making.

Assessment of Frailty and Association With Progression of Benign Prostatic Hyperplasia Symptoms and Serious Adverse Events Among Men Using Drug Therapy

Benign prostatic hyperplasia (BPH) in older men can cause lower urinary tract symptoms (LUTS), which are increasingly managed with medications. Frailty may contribute to both symptom progression and serious adverse events (SAEs), shifting the balance of benefits and harms of drug therapy. To assess the association between a deficit accumulation frailty index and clinical BPH progression or SAE. This cohort study used data from the Medical Therapy of Prostatic Symptoms trial, which compared placebo, doxazosin, finasteride, and combination therapy in men with moderate-to-severe LUTS, reduced urinary flow rate, and no prior BPH interventions, hypotension, or elevated prostate-specific antigen. Enrollment was from 1995 to 1998, and follow-up was through 2001. Data were assessed in February 2021. A frailty index (score range, 0-1) using 68 potential deficits collected at baseline was used to categorized men as robust (score ≤0.1), prefrail (score 0.1 to <0.25), or frail (score ≥0.25). Primary outcomes were time to clinical BPH progression and time to SAE, as defined in the parent trial. Adjusted hazard ratios (AHRs) were estimated using Cox proportional hazards regressions adjusted for demographic variables, treatment group, measures of obstruction, and comorbidities. Among 3047 men (mean [SD] age, 62.6 [7.3] years; range, 50-89 years) in this analysis, 745 (24%) were robust, 1824 (60%) were prefrail, and 478 (16%) were frail at baseline. Compared with robust men, frail men were older (age ≥75 years, 12 men [2%] vs 62 men [13%]), less likely to be White (646 men [87%] vs 344 men [72%]), less likely to be married (599 men [80%] vs 342 men [72%]), and less likely to have 16 years or more of education (471 men [63%] vs 150 men [31%]). During mean (SD) follow-up of 4.0 (1.5) years, the incidence rate of clinical BPH progression was 2.2 events per 100 person-years among robust men, 2.9 events per 100 person-years among prefrail men (AHR, 1.36; 95% CI, 1.02-1.83), and 4.0 events per 100 person-years among frail men (AHR, 1.82; 95% CI, 1.24-2.67; linear P = .005). Larger point estimates were seen among men who received doxazosin or combination therapy, although the test for interaction between frailty index and treatment group did not reach statistical significance (P for interaction = .06). Risk of SAE was higher among prefrail and frail men (prefrail vs robust AHR, 1.81; 95% CI, 1.48-2.23; frail vs robust AHR, 2.86; 95% CI, 2.21-3.69; linear P < .001); this association was similar across treatment groups (P for interaction = .76). These findings suggest that frailty is independently associated with greater risk of both clinical BPH progression and SAEs. Older frail men with BPH considering initiation of drug therapy should be counseled regarding their higher risk of progression despite combination therapy and their likelihood of experiencing SAEs regardless of treatment choice.

Efficacy of a polyherbal formulation in the management of benign prostatic hyperplasia: a randomized, controlled trial

Background: Benign prostatic hyperplasia (BPH) affects a significant number of men beyond the age of 40 years with its incidence reaching up to 90% in 80’s. Despite multiple treatment innovations, BPH still remains a nightmare for ageing men, mostly due to its distressing lower urinary tract symptoms (LUTS) and sexual dysfunction. The severity of LUTS is graded by international prostate symptom score or American urological association symptom index (AUA-SI) along with impact on quality of life (QOL). The objective of this study was to evaluate the efficacy of an Unani polyherbal formulation, Habb-i-muqil, in improving the AUA-SI and QOL in patients with BPH.Methods:In an open, standard controlled study, 76 men, diagnosed with clinical BPH, aged between 40 and 80 years were randomly allocated for treatment for duration of 90 days with Habb-i-muqil (test drug) or Tamsulosin (standard control) after ethical approval. AUA-SI and QOL were assessed at baseline (0 day) and days 15, 30, 45, 60, 75 and 90.Results: Analysis of 60 men showed that after 90 days of treatment the percentage changes in the AUA-SI from baseline were 59.4 and 49.4% by Habb-i-muqil and tamsulosin, respectively. The test drug produced statistically significant improvement (p&lt;0.001) in overall AUA-SI and QOL compared with standard control.Conclusions:The Unani polyherbal formulation, Habb-i-muqil, was effective in improving AUA-SI and QOL in men with BPH in comparison to tamsulosin. Both the treatments were generally well tolerated.

Clinical profile and outcomes of patients with clinical benign prostate hyperplasia treated by trans urethral resection of prostate at Bugando Medical Centre, Mwanza, Tanzania

Introduction: Benign Prostate Hyperplasia (BPH) is the most common prostatic pathology in elderly men with Trans Urethral Resection of the Prostate (TURP) still being considered as the gold standard surgical management. TURP is the commonest endoscopic surgery performed for BPH in developing countries including Tanzania, however its outcome in this part of the world has not been documented. Therefore, the study aimed to determine the clinical profile, outcome as well as predictors of outcome in patients with clinical BPH undergoing TURP at Bugando Medical Centre (BMC), a tertiary hospital in Mwanza, Tanzania. Methods: This was a cross sectional longitudinal hospital based study to evaluate the clinical profile as well as the outcome of patients with clinical BPH treated by TURP at BMC from November 2018 to April 2019. All participants scheduled for TURP for the diagnosis of clinical BPH who signed informed consent for the study were included, their international prostate symptom score (IPSS) with the 8th question for quality of life (QoL) was scored, social demographic data and clinical profile information were obtained from their files. Participants were followed in the theatre to document any intraoperative complications and other necessary data required by this study. Progress in the ward was recorded and following discharge, patient was scheduled for follow up at 6 and 12 weeks. During follow up, IPSS and QoL scores as well as complication was recorded. Results: A total of 210 participants met the eligibility criteria. The median age was 69 (IQR 63-75) years. Prostate size ranged from 15 – 200 grams with median size of 77 (IQR 51-107) grams. Acute urine retention was the most common indication 69 (33%), followed by lower urinary tract symptoms 52 (25%). Urologist operated most of the patient 122 (58.1%) with the rest operated by either resident alone or finished up by urologist, and the median weight resected was 20 (IQR 13.5 –28.3) grams. About 66 (31.4%) developed perioperative complication with majority having clot retention. During follow up, the median IPSS score was 9 (IQR 7 – 12) and 2 (IQR 0 – 6) and median QoL score of 3 (IQR 1 – 3) and 0 (IQR 0 – 1) with improvement of 93 (45.4%) and 184 (89.8%) on 1st and 2nd follow up visits respectively. There were a total of 9 (4.3%) patients whom developed Trans urethral resection (TUR) syndrome, with overall mortality of 3 (1.4%). Conclusion: BPH is common from 6th decade of life onwards. Though most participants were operated because of either acute urine retention or severe lower urinary tract symptoms (LUTS), some presents late already with renal insufficiency. Despite the fact that most of the participants had severe symptoms and their quality of life was poor at presentation, TURP improved symptoms in most of the participants. The improvement is even better in the hands of experienced surgeon, for the participants with small prostate and in absence of UTI prior to surgery.

Clinical profile and outcomes of patients with clinical benign prostate hyperplasia treated by trans urethral resection of prostate at Bugando Medical Centre, Mwanza, Tanzania

Clinical profile and outcomes of patients with clinical benign prostate hyperplasia treated by trans urethral resection of prostate at Bugando Medical Centre, Mwanza, Tanzania

Association of TERT gene polymorphisms with clinical benign prostatic hyperplasia in a Chinese Han population of the Northwest region.

BackgroundTo investigate the association between single nucleotide polymorphisms (rs10078761, rs12696304, rs2853669, rs16847897, rs2736100, rs10069690) of telomerase gene (TERT) and the risk clinical benign prostatic hyperplasia (BPH) in a Chinese Han population of the Northwest region.MethodsA total of 150 BPH patients and 150 healthy older males from the northwest Chinese Han population were included in this study. The sample size for this unmatched case-control study was estimated by the look-up table method. Meanwhile, the general information and disease data of patients were collected. Age was only collected in healthy control subjects for statistical correction. Genotypes were detected using a multiplex PCR + ligase detection reaction (LDR). Typing results and clinical data were statistically analyzed using multiple linear regression and logistic regression. Pearson correlation was used for Hardy-Weinberg equilibrium.ResultsThe included population is in Hardy-Weinberg equilibrium. There was no significant association between SNP and the risk of BPH by correlation analysis. However, 4 haplotypes (TCTGGT, TCTGTC, TGCCTC, and TGTGTC) were identified as risk factors of BPH by haplotype analysis. The SNP rs2853669 is an independent risk factor for smooth muscle type of hyperplasia. Besides, rs2736100, rs10078761, and rs10069690 which are in linkage disequilibrium are associated with the severity of BPH.ConclusionsPolymorphism of the TERT gene determines the different disease development and pathological manifestations of BPH in the Chinese Han population the Northwest region.

Tight junction protein claudin-1 is downregulated by TGF-β1 via MEK signaling in benign prostatic epithelial cells.

Benign prostatic hyperplasia (BPH) is arguably the most common disease in aging men. Although the etiology is not well understood, chronic prostatic inflammation is thought to play an important role in BPH initiation and progression. Our recent studies suggest that the prostatic epithelial barrier is compromised in glandular BPH tissues. The proinflammatory cytokine transforming growth factor beta 1 (TGF-β1) impacts tight junction formation, enhances epithelial barrier permeability, and suppresses claudin-1 messenger RNA expression in prostatic epithelial cells. However, the role of claudin-1 in the prostatic epithelial barrier and its regulation by TGF-β1 in prostatic epithelial cells are not clear. The expression of claudin-1 was analyzed in 22 clinical BPH specimens by immunohistochemistry. Human benign prostate epithelial cell lines BPH-1 and BHPrE1 were treated with TGF-β1 and transfected with small interfering RNAs specific to claudin-1. Epithelial monolayer permeability changes in the treated cells were measured using trans-epithelial electrical resistance (TEER). The expression of claudin-1, E-cadherin, N-cadherin, snail, slug, and activation of mitogen-activated proteins kinases (MAPKs) and AKT was assessed following TGF-β1 treatment using Western blot analysis. Claudin-1 expression was decreased in glandular BPH tissue compared with adjacent normal prostatic tissue in patient specimens. TGF-β1 treatment or claudin-1 knockdown in prostatic epithelial cell lines increased monolayer permeability. TGF-β1 decreased levels of claudin-1 and increased levels of snail and slug as well as increased phosphorylation of the MAPK extracellular signal-regulated kinase-1/2 (ERK-1/2) in both BPH-1 and BHPrE1 cells. Overexpression of snail or slug had no effect on claudin-1 expression. In contrast, PD98059 and U0126, inhibitors of the upstream activator of ERK-1/2 (ie, MEK-1/2) restored claudin-1 expression level as well as the epithelial barrier. Our findings suggest that downregulation of claudin-1 by TGF-β1 acting through the noncanonical MEK-1/2/ERK-1/2 pathway triggers increased prostatic epithelial monolayer permeability in vitro. These findings also suggest that elevated TGF-β1 may contribute to claudin-1 downregulation and compromised epithelial barrier in clinical BPH specimens.

The Alken stages-a German-French affair

Anatomy and pathophysiology of the prostate have gained increasing attention of anatomists and surgeons at the beginning of the 19thcentury. It was only around 1900 that French and German authors discussed staging of clinical benign prostatic hyperplasia (BPH) in order to group therapy. From 1970 to the 1990s, staging of the clinical course of BPH was associated with the name of Carl-Erich Alken, aleading figure within the German urological society at that time, although Alken never researched or focused on disease staging. He only presented the three traditional clinical stages originally described in 1888 by Jean Casimir Felix Guyon in ashort and often edited and translated student's textbook (1955).

A Prospective Study of Subjective Symptoms-Ipss and Uroflowmetry Before and after Turp of BPH Patients

Background- Benign Prostatic Hyperplasia(BPH) is a common condition in older men. BPH refers to a proliferative process of cellular elements of prostate. It is estimated that close to 90% of men will develop histologic evidence of BPH by age of 80. Uroflowmetry and IPSS(International Prostate Symptom Score) can predict the presence of obstruction. TURP(Transurethral Resection of Prostate) is one of the most frequently performed surgery by the urologists. Aims &amp; Objectives- The objective of the study is to evaluate the changes in IPSS &amp; Uroflowmetry before and after TURP. Materials and Method- Evaluation was done on 30 patients of clinical BPH in Surgery Department, SVBP Hospital, Meerut from September 2018 to September 2019. Case records containing variables on IPSS before and after TURP, maximum flow rate before and after TURP, their subjective evaluation were recorded for each patient. Observations &amp; Results- The subjective response was significant, as analysed on the basis of changes in IPSS and maximum flow rate as 13.53 in IPSS and 8.688 in maximum flow rate. There was a weak correlation between pre and post operative maximum flow rates but a strong correlation between pre and postoperative IPSS. Conclusion- TURP has been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia. IPSS is a good parameter for using as an indication of TURP and medical therapy and should be used in pretreatment evaluation of all patients who come with symptoms suggestive of BPH and their treatment modality defined on the basis of result of IPSS.