Clinical Benign Prostatic Hyperplasia Research Articles

Androgen regulated genes in human prostate xenografts in mice: relation to BPH and prostate cancer.

Benign prostatic hyperplasia (BPH) and prostate carcinoma (CaP) are linked to aging and the presence of androgens, suggesting that androgen regulated genes play a major role in these common diseases. Androgen regulation of prostate growth and development depends on the presence of intact epithelial-stromal interactions. Further, the prostatic stroma is implicated in BPH. This suggests that epithelial cell lines are inadequate to identify androgen regulated genes that could contribute to BPH and CaP and which could serve as potential clinical biomarkers. In this study, we used a human prostate xenograft model to define a profile of genes regulated in vivo by androgens, with an emphasis on identifying candidate biomarkers. Benign transition zone (TZ) human prostate tissue from radical prostatectomies was grafted to the sub-renal capsule site of intact or castrated male immunodeficient mice, followed by the removal or addition of androgens, respectively. Microarray analysis of RNA from these tissues was used to identify genes that were; 1) highly expressed in prostate, 2) had significant expression changes in response to androgens, and, 3) encode extracellular proteins. A total of 95 genes meeting these criteria were selected for analysis and validation of expression in patient prostate tissues using quantitative real-time PCR. Expression levels of these genes were measured in pooled RNAs from human prostate tissues with varying severity of BPH pathologic changes and CaP of varying Gleason score. A number of androgen regulated genes were identified. Additionally, a subset of these genes were over-expressed in RNA from clinical BPH tissues, and the levels of many were found to correlate with disease status. Our results demonstrate the feasibility, and some of the problems, of using a mouse xenograft model to characterize the androgen regulated expression profiles of intact human prostate tissues.

Obesity and Benign Prostatic Hyperplasia: Clinical Connections, Emerging Etiological Paradigms and Future Directions

Benign prostatic hyperplasia is a highly prevalent disease in older men with substantial adverse effects on public health. Classic etiological paradigms for benign prostatic hyperplasia focus on nonmodifiable risk factors. However, obesity also potentially promotes benign prostatic hyperplasia. We performed a structured, comprehensive literature review to identify studies of obesity, benign prostatic hyperplasia, lower urinary tract symptoms and physical activity. A preponderance of published evidence suggests strong positive associations of obesity with benign prostatic hyperplasia and lower urinary tract symptoms. This evidence encompasses most established metrics of adiposity, including body mass index, waist circumference and waist-to-hip ratio, and falls under 3 general categories, including prostate volume, clinical benign prostatic hyperplasia and lower urinary tract symptoms. 1) Prior studies consistently showed that increased adiposity is positively associated with radiographically determined prostate volume and enlargement, suggesting that obesity promotes prostate growth. 2) Most studies revealed that obesity increases the risk of clinical benign prostatic hyperplasia by several measures, including the initiation of benign prostatic hyperplasia medical treatment, noncancer prostate surgery, physician diagnosed benign prostatic hyperplasia, histological diagnosis and urinary flow rate. 3) Prior studies demonstrated that obesity increases the risk of lower urinary tract symptoms, as measured by a validated questionnaire. Also, most studies showed that physical activity significantly decreases the risk of benign prostatic hyperplasia. Obesity markedly increases the risk of benign prostatic hyperplasia. Since physical activity decreases the risk of benign prostatic hyperplasia, these observations support the development of novel prevention strategies and treatment targeted toward adiposity, weight loss and lifestyle.

Efficacy and safety of dutasteride in Japanese men with benign prostatic hyperplasia

To assess the efficacy and safety of dutasteride in Japanese men with benign prostatic hyperplasia (BPH). This was a randomized, double-blind, placebo-controlled, parallel-group study. A total of 378 subjects with clinical BPH having an International Prostate Symptom Score (IPSS) of 8 points or greater, a prostate volume of 30 mL or greater, and a maximal urinary flow rate (Qmax) of 15 mL/s or less were randomized to receive placebo or dutasteride once daily for 52 weeks. Subjects were stratified according to tamsulosin use at baseline. The numbers of subjects with and without tamsulosin use were 242 and 136, respectively. IPSS, Qmax, prostate volume and drug safety were evaluated. Continued improvement in IPSS was noted in the dutasteride group, and dutasteride significantly decreased IPSS compared with placebo. At week 52, dutasteride significantly improved Qmax and prostate volume compared with placebo. Drug-related sexual function events in the dutasteride group were infrequent and generally were not treatment limiting. Dutasteride improves urinary symptoms and flow rate and reduces prostate volume. In Japanese men with BPH, it is effective and generally well tolerated during the one-year treatment period.

Rapid Efficacy of the Highly Selective α 1A-Adrenoceptor Antagonist Silodosin in Men With Signs and Symptoms of Benign Prostatic Hyperplasia: Pooled Results of 2 Phase 3 Studies

Rapid Efficacy of the Highly Selective α 1A-Adrenoceptor Antagonist Silodosin in Men With Signs and Symptoms of Benign Prostatic Hyperplasia: Pooled Results of 2 Phase 3 Studies

Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men

The 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24-28, 2005 in Paris, France to review new developments in benign prostatic disease. A series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system. The Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as "clinical benign prostatic hyperplasia" or "the benign prostatic hyperplasia patient" be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. The recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms. The use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in selection for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used.

Current Trend of the Primary Treatment in Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia

－Abstract－Clinical benign prostatic hyperplasia (BPH) is a multifaceted phenomenon that is due to prostatic and bladder influences as well as nonurological causes. It is also important to differentiate between the more common voiding or obstructive symptoms as well as the more bothersome storage or irritative symptoms. Lower urinary tract symptoms (LUTS) and BPH may be two separate conditions with different underlying pathologies. However, they are often treated incorrectly as one entity. Both conditions are very common and they represent chronic conditions of the aging male. They are often associated with a significant reduction in the patients' quality of life. Although these are not new conditions, there have been enormous changes in the methods of assessing and managing the patients with these conditions.This review describes some of the influential studies in this area and the current trends of the primary treatment for LUTS/BPH.KeyWords:Lower urinary tract symptoms, Benign prostatic hyperplasia, Medical treatment서 론하부요로증상(Lower urinary tract symp- toms: LUTS)과 전립선비대증(benign prostatic hyperplasia: BPH)은 서로 다른 병인에 의한 것인지는 알 수 없지만, 종종 하나의 상태로

Relations between Prostatic Calculi and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia

Purpose: Recently as ultrasonography is increasingly used to evaluate lower urinary tract symptoms (LUTS) in the elderly patients, prostatic calculi are more often revealed; however, the mechanism of formation of prostatic calculi is not clearly known, and their impacts on LUTS are controversial. We investigated whether the type and location of prostatic calculi might influence LUTS in benign prostatic hyperplasia (BPH) patients. Materials and Methods: From July 2003 to January 2008, 1,437 consecutive patients underwent transrectal ultrasonography. Of these patients 383 with clinical BPH were retrospectively studied. According to the type (type A: a discrete small reflection; type B: a large mass of multireflection; type M: mixed) and location (periurethral vs. non-periurethral) of prostatic calculi, the serum prostate-specific antigen (PSA) levels, volume of prostate, maximum urinary flow rate and residual urine volume, and International Prostate Symptom Score (IPSS) were compared. Results: Prostatic calcification was found in 70% (268/383), and type A in 38%, type B in 46% and type M in 16%. There was no significant difference according to the presence or types of prostatic calcification, comparing serum PSA levels, volume of prostate, maximum urinary flow rate and residual urine volume. And there was no significant correlation between the types of prostatic calcificaton and each item of IPSS. Periurethral and non-periurethral prostatic calcification failed to show the significant difference in each items of IPSS. Conclusions: There is no significant difference in LUTS according to presence, types, or locations of prostatic calculi in clinical BPH patients. (J Korean Continence Soc 2009;13:30-36)

New Histopathological Experimental Model for Benign Prostatic Hyperplasia: Stromal Hyperplasia in Rats

Histological observations of clinical benign prostatic hyperplasia specimens show that benign prostatic hyperplasia tissue is mainly composed of stromal components, smooth muscle and fibrous tissue, so-called stromal hyperplasia. However, little is understood regarding the pathogenesis of this stromal hyperplasia due to no suitable stromal hyperplasia model to elucidate the pathology of benign prostatic hyperplasia. We created a novel model of benign prostatic hyperplasia accompanied by clinically relevant stromal hyperplasia. The urogenital sinus isolated from male rat 20-day embryos was implanted into pubertal male rat ventral prostates. Two to 8 weeks after the operation the implanted urogenital sinus was isolated, weighed and subjected to histochemical analysis. To distinguish between and characterize the epithelial and stromal components we stained for collagen, smooth muscle components, growth factors and proliferating cell nuclear antigen. In addition, to determine whether the implanted urogenital sinus had differentiated into functional prostate we stained for androgen receptor and dorsolateral prostatic secretory protein. Urogenital sinuses removed from male rat 20-day embryos initially weighed approximately 1 mg. After implantation into host rat ventral prostates they grew in time dependent fashion with no apparent change in the original ventral prostate weight in the host rat. Implanted urogenital sinus weight was more than 100 mg 3 weeks after implantation. Histological observation demonstrated that the ratio of stromal to total area was approximately 70%, which was much higher than that in age matched rat ventral prostates and in a testosterone induced epithelial hyperplasia model (approximately 20% and 15%, respectively). This predominantly stromal tissue composition was maintained up to 8 weeks after implantation. Proliferating cell nuclear antigen staining revealed that the ratio of proliferating cells in stroma was equal to or greater than that in epithelium. In this model the antiandrogen agent chlormadinone acetate (Wako Pure Chemicals Industries, Osaka, Japan) at a dose of 10 mg/kg prevented the increase in implanted urogenital sinus weight (19.1%) but its potency was less than that seen in the testosterone induced epithelial hyperplasia model, that is 93.4% at the 10 mg/kg dose. We have established a new experimental stromal hyperplasia model corresponding to clinical benign prostatic hyperplasia in terms of the composition of stromal components and functional differentiation of the prostate. Furthermore, the localization and time course of growth factor expression were also similar to those in men with benign prostatic hyperplasia.

Risk Factors for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia in a Community Based Population of Healthy Aging Men: The Krimpen Study

We explored risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in the open population. A longitudinal, population based study with a followup of 6.5 years was done in 1,688 men who were 50 to 78 years old. Data were collected on transrectal ultrasound of prostate volume, urinary flow rate, ultrasound estimated post-void residual urine volume, generic and disease specific quality of life, and symptom severity based on the International Prostate Symptom Score. Lower urinary tract symptoms suggestive of benign prostatic hyperplasia were defined as an International Prostate Symptom Score of greater than 7 after a report of a score of less than 7 in the previous round. A multivariate Cox proportional hazard model was constructed to determine risk factors for clinical benign prostatic hyperplasia after correcting for patient age. Total followup was 4,353 person-years. During followup 180 events of attaining an International Prostate Symptoms Score of greater than 7 occurred. Multivariate analysis showed that functional bladder capacity, post-void residual urine volume, treatment for cardiac diseases, education level, antidepressant use, calcium antagonist use, erectile function or dysfunction, prostate specific antigen and a family history of prostate cancer were determinants with a significant HR. In addition to age, we established 9 significant determinants for lower urinary tract symptoms suggestive of benign prostatic hyperplasia. However, not all risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia are accounted for since we can conclude that 1 of 3 men without these risk factors will still be diagnosed with lower urinary tract symptoms suggestive of benign prostatic hyperplasia between ages 50 and 80 years.

Race and Socioeconomic Status are Independently Associated With Benign Prostatic Hyperplasia

Prostate enlargement is common as men age. However, differences in the diagnosis or treatment of clinical benign prostatic hyperplasia between black and white men remain poorly understood. We investigated racial differences in and surgical intervention for benign prostatic hyperplasia in a large and predominantly low income population. Participants included 21,949 men, of whom 79.8% were black and 20.2% were white, recruited from 60 community health centers in the southeastern United States between 2002 and 2007. Benign prostatic hyperplasia, surgical intervention for benign prostatic hyperplasia, and economic and demographic indexes, eg education, household income, health insurance and marital status, were determined by an interview in person. Logistic regression was used to summarize the association between race and benign prostatic hyperplasia while controlling for health care access and socioeconomic status. Black men were approximately half as likely to report a benign prostatic hyperplasia diagnosis compared to white men (4.1% vs 9.9%, age adjusted OR 0.45, 95% CI 0.40, 0.51), a difference that persisted with only small abatement after controlling for age, income, insurance coverage, comorbidity, education and other factors (adjusted OR 0.49, 95% CI 0.43, 0.56)). Of men with benign prostatic hyperplasia surgical intervention for that condition (133 patients) was more prevalent in black vs white men (12.9% vs 9.1%, adjusted OR 1.65, 95% CI 1.10, 2.48). After controlling for economic factors associated with benign prostatic hyperplasia black men were significantly less likely to report a prior benign prostatic hyperplasia diagnosis. In contrast, surgical intervention typically reserved for severe benign prostatic hyperplasia was more common in black men. Our results suggest that race and socioeconomic status are independently associated with benign prostatic hyperplasia.

Epidemiology of Benign Prostatic Hyperplasia and Comorbidities in Racial and Ethnic Minority Populations

In the United States, research into the etiology of benign prostatic hyperplasia (BPH) and the incidence and treatment of lower urinary tract symptoms (LUTS) in racial/ethnic minority patients is just beginning, despite a high incidence of both conditions in these populations. The relative risks for the development of BPH and commonly comorbid conditions in African Americans and Latinos may be increased compared with the white majority population. This heightened risk may be attributable to factors such as autonomic hyperactivity and metabolic abnormalities, which appear at a higher rate in African Americans and Latinos. Differences in genetic factors related to androgen receptor CAG repeats, the androgen signaling pathway, and in the cellular composition of the prostate also contribute to racial/ethnic differences in the incidence of clinical BPH and LUTS. Despite the disproportionately high rates of BPH-associated risk factors and comorbidities associated with the condition, a large proportion of minority patients with BPH and LUTS are undiagnosed and untreated. Expanding the information base on BPH and LUTS in minority patients may help to narrow existing ethnic/racial disparities in treatment and to reduce the impact of LUTS on the quality of life of these patients.

Age and Bladder Outlet Obstruction Are Independently Associated with Detrusor Overactivity in Patients with Benign Prostatic Hyperplasia

BackgroundDetrusor overactivity is one known cause of lower urinary tract symptoms and has been linked to bladder storage symptoms (urgency, frequency, or urge incontinence). ObjectiveTo determine clinical and urodynamic parameters associated with detrusor overactivity in patients with suspected benign prostatic hyperplasia. Design, Setting, and ParticipantsDuring 1993–2003, urodynamic investigations were performed in patients aged 40 yr or older and with lower urinary tract symptoms, benign prostatic enlargement, and/or suspicion of bladder outlet obstruction (maximum flow rate < 15ml/s or postvoid residual urine > 50ml). MeasurementsDetrusor overactivity was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. The Schäfer algorithm was used to determine bladder outlet obstruction. ResultsIn total, 1418 men were investigated (median age: 63 yr) of whom 864 men (60.9%) had detrusor overactivity. In univariate analysis, men with detrusor overactivity were significantly older, more obstructed, had larger prostates, higher irritative International Prostate Symptoms Score subscores, a lower voiding volume at free uroflowmetry, and a lower bladder capacity at cystometry. The prevalence of detrusor overactivity rose continuously with increasing bladder outlet obstruction grade. Multivariate analysis showed that only age and bladder outlet obstruction grade were independently associated with detrusor overactivity. After age adjustment, the odds ratios of detrusor overactivity compared to Schäfer class 0 were 1.2 for class I, 1.4 for class II, 1.9 for class III, 2.5 for class IV, 3.4 for class V, and 4.7 for class VI. ConclusionsIn patients with clinical benign prostatic hyperplasia, detrusor overactivity is independently associated with age and bladder outlet obstruction. The probability of detrusor overactivity rises with increasing age and bladder outlet obstruction grade.

The antibody response to Propionibacterium acnes is an independent predictor of serum prostate‐specific antigen levels in biopsy‐negative men

To investigate whether the serum titres of Propionibacterium acnes antibodies in patients undergoing prostate biopsy are associated with prostate cancer or markers of prostate disease, including serum prostate-specific antigen (PSA) levels. The cell wall-associated proteins from P. acnes types IA, IB and II were extracted and characterized by Western blotting and immunoblotting. We developed an enzyme-linked immunosorbent assay (ELISA) based on extracted proteins to determine the anti-P. acnes antibody titres in the sera of 68 patients undergoing prostate biopsy. Correlations between these titres and multiple markers of prostate disease were investigated. In patients with biopsies negative for cancer, a high anti-P. acnes antibody titre was associated with high serum PSA levels (>or=10.0 ng/mL, P = 0.04), and multiple linear regression analysis identified antibody titre as the predominant independent predictor of serum PSA level (P = 0.03). The titre was positively correlated with patient age, prostate volume and aggressive inflammation, suggesting an involvement with benign prostatic hyperplasia (BPH). However in patients with histologically detected cancer, the volume of cancer in the biopsy cores was the predominant independent predictor of serum PSA (P = 0.01). These results support our hypothesis that P. acnes might be involved in the development of inflammation-related prostate diseases, in particular with BPH. Our ELISA might be valuable for identifying P. acnes infection of the prostate gland in patients with elevated serum PSA levels but a negative biopsy, and might identify men at risk of developing clinical BPH. However, an investigation with more patients is needed to confirm these preliminary findings.

Rising PSA in patients with minor LUTS without evidence of prostatic carcinoma: a missing link?

To determine the role of pressure flowmetry in patients without bothersome lower urinary tract symptoms (LUTS), rising prostate-specific antigen (PSA) levels and diagnosed as having clinical benign prostatic hyperplasia (BPH) after negative (multiple) extended multi-site biopsy. The study enrolled patients with minor LUTS who were referred to our urological practice by their general practitioner because of a rising PSA level (>/=4 ng/ml). After exclusion of clinical prostatic carcinoma by digital rectal examination and transrectal ultrasound, all patients underwent at least one set of extended multi-site biopsies to exclude T1c prostate cancer. Patients with negative biopsies (clinical BPH) were subjected to pressure flowmetry whereafter those with bladder outlet obstruction underwent TURP. The study included 82 patients, with a mean age of 64.8 years (50.2-78.2 years), satisfying the inclusion criteria. Urodynamic analysis showed that all patients had bladder outlet obstruction. After TURP, eight patients (9.8%) were diagnosed as having histologically proven prostate cancer; 74 patients (90.2%) were diagnosed as having BPH. Patients of the BPH group had a mean preoperative PSA level of 8.8 ng/ml (4.3-25.8 ng/ml) and a mean international prostate symptom score of 8.8 (2-18). The mean detrusor pressure at maximum flow in BPH patients was 89.5 cmH(2)O (20-200 cmH(2)O). An increased PSA in patients with minor or no LUTS, clinical BPH and negative extended multi-site prostate biopsy is strongly correlated to bladder outlet obstruction. Therefore, patients with these characteristics should be treated with TURP.

Modifiable Risk Factors for Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms: New Approaches to Old Problems

Benign prostatic hyperplasia is generally not regarded as a preventable disease. However, accumulating evidence suggests that modifiable factors may influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms. A structured, comprehensive literature review was done to identify modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms among observational studies of older men. Outcome measures used to define benign prostatic hyperplasia in clinical studies include histological analysis of prostate tissue, radiographically determined prostate enlargement, acute urinary retention, decreased urinary flow rate, pressure flow studies consistent with bladder outlet obstruction, history of benign prostatic hyperplasia surgery, physician diagnosed benign prostatic hyperplasia and American Urological Association symptom score or International Prostate Symptom Score. Factors that potentially increase the risk of benign prostatic hyperplasia and lower urinary tract symptoms include obesity and diabetes. Factors that potentially decrease the risk include increased physical activity and moderate alcohol consumption. Other candidate factors for which clear risk patterns have not yet emerged are dyslipidemia, hypertension, smoking, diet and environment. Obesity, diabetes, physical activity and alcohol intake may substantially influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms in older men. Further analyses of these and other potential modifiable risk factors may identify novel interventions for the prevention, diagnosis and treatment of these highly prevalent conditions.

Comparisons of Urodynamic Findings and Voiding Habits in Patients with Concomitant Benign Prostatic Hyperplasia and Detrusor Overactivity Presenting with or without the Symptom of Urgency

Aims: The urodynamic findings and voiding habits in patients with concomitant clinical benign prostatic hyperplasia (BPH) and detrusor overactivity (DO) presenting with or without the symptom of urgency were compared. Materials and Methods: 84 BPH patients with an urodynamic diagnosis of DO by conventional cystometry were included in the study. The patients were grouped according to the presence or absence of the symptom of urgency. The urodynamic findings, urinary diary and clinical information were analyzed. Results: Among the 84 BPH-DO patients, 52 reported the symptom of urgency while 32 did not. There were no significant differences in mean age, International Prostate Symptom Score and flow rate between the two groups. Patients without urgency had a higher incidence of terminal DO and abnormal bladder sensation. The occurrence of unfelt phasic DO was also significantly higher in this group. Sphincter electromyography showed conscious and subconscious sphincter contractions associated with DO. The urinary diary showed lower 24-hour urinary output, smaller bladder functional capacity and average voided volume in the BPH-DO patients without urgency. Conclusions: BPH patients with DO may neglect the symptom of urgency due to abnormal bladder sensation, or negate the symptom by subconscious sphincter contraction to abort the overactivity. Some may avoid the symptom by drinking less fluid and emptying the bladder at a smaller volume.

Atherosclerosis as a risk factor for benign prostatic hyperplasia

To evaluate the relationship between clinical benign prostatic hyperplasia (BPH) and atherosclerosis, using colour Doppler ultrasonography (CDUS) and symptom scores. CDUS was used to evaluate prostatic vascularity in four groups of men, comprising young healthy subjects, patients presenting with coronary artery disease (CAD), diabetes mellitus, or peripheral arterial occlusive disease (PAOD). Resistive index (RI) measurements and computer-assisted quantification of colour pixel density (CPD) were used to objectively evaluate perfusion. The International Prostate Symptom Score (IPSS) and the International Index of Erectile Function were used to quantify symptoms. In diabetic patients and men with PAOD, perfusion of the transition zone (TZ) of the prostate was significantly lower (P < 0.001) and the RI of the TZ was significantly higher (P < 0.001) than in healthy controls and men with CAD. In diabetics and men with PAOD, the mean prostate volume was greater than in healthy controls and men with CAD. The IPSS in patients with vascular damage (diabetes, PAOD) was significantly worse than in the control group. The significantly lower CPD and higher RI values of the TZ in patients with vascular disease than in healthy subjects support the hypothesis that an age-related impairment of blood supply to the prostate has a key role in the development of BPH.

Simple case definition of clinical benign prostatic hyperplasia, based on International Prostate Symptom Score, predicts general practitioner consultation rates

Objectives To determine which case-definition of clinical benign prostatic hyperplasia (BPH) has the best predictive value for general practitioner visits for lower urinary tract symptoms (LUTS) suggestive of BPH. The incidence and prevalence rates of general practitioner visits for LUTS were also determined. Methods A longitudinal, population-based study from 1995 to 2003 was conducted among 1688 men aged 50 to 78 years old. Data were collected on physical urologic parameters, quality of life, and symptom severity as determined from the International Prostate Symptom Score. Information on health-care-seeking behavior of all participants was collected from the general practitioner (GP) record using a computerized search engine and an additional manual check of the electronically selected files. Results The incidence and prevalence rate of the men at risk was 19.6% and 14.0%, respectively, and these rates increased with age. For sensitivity and the positive predictive value, the case-definition of clinical BPH as an International Prostate Symptom Score greater than 7 had the best predictive value for GP visits for LUTS within 2 years after baseline. Conclusions Because only marginal improvement (greater specificity but lower sensitivity) in the prediction of GP visits for LUTS was possible by adding information on prostate volume and flow, for the prediction of future GP visits for LUTS suggestive of BPH, we suggest that the International Prostate Symptom Score questionnaire be used and that estimation of the prostate volume and flow is not required.

Response to Daily 10 Mg Alfuzosin Predicts Acute Urinary Retention and Benign Prostatic Hyperplasia Related Surgery in Men With Lower Urinary Tract Symptoms

We analyzed the influence of treatment response on the risk of acute urinary retention and benign prostatic hyperplasia related surgery in 5,792 men complaining of lower urinary tract symptoms who were treated for 6 months with the selective alpha1-blocker alfuzosin at 10 mg once daily. The influence of dynamic variables (International Prostate Symptom Score change and bother during treatment) and baseline variables (patient age, prior acute urinary retention managed conservatively, prostate specific antigen, International Prostate Symptom Score and bother severity) on the risk of acute urinary retention and benign prostatic hyperplasia related surgery was estimated using the Kaplan-Meier method and log rank test. The associated HR and 95% CI were calculated using Cox proportional hazard models. During alfuzosin treatment International Prostate Symptom Score improved by 3 or greater and greater than 6 points in 74.8% and 50.3% of men, respectively. In this unselected population, including 3.8% with prior unoperated acute urinary retention, the rate of acute urinary retention and benign prostatic hyperplasia related surgery events during treatment was low (0.5% and 1.1%, respectively). Men with stable or worsening International Prostate Symptom Score were at increased risk for acute urinary retention or surgery (HR 3.75, 95% CI 1.58 to 8.89, p = 0.003 and HR 4.71, 95% CI 2.69 to 8.24, p <0.001, respectively). Prior acute urinary retention was a strong predictor of acute urinary retention relapse and surgery (HR 10.35, 95% CI 4.29 to 26.08, p <0.001 and HR 3.57, 95% CI 1.59 to 7.98, p = 0.002, respectively). Bother score greater than 3 during treatment was the strongest predictor of surgery (HR 7.61, 95% CI 4.16 to 13.93, p <0.001). Prostate specific antigen had much less predictive value. This 6-month real life practice study shows that alfuzosin is associated with a low incidence of acute urinary retention and benign prostatic hyperplasia related surgery. It also suggests that responder status is the most important predictor of acute urinary retention and benign prostatic hyperplasia related surgery. Thus, first line treatment with alfuzosin may help select patients at risk for benign prostatic hyperplasia progression to optimize treatment.

Comparison of Transurethral Resection and Plasmakinetic Transurethral Resection Applications with Regard to Fluid Absorption Amounts in Benign Prostate Hyperplasia

Introduction: We compare the absorption of irrigant fluid during gyrus plasmakinetic transurethral prostatectomy (PK-TURP) and transurethral resection of the prostate (TURP). Patients and Methods: 42 patients with clinical benign prostatic hyperplasia were randomly assigned to undergo PK-TURP or TURP. In the PK-TURP group 0.9% NaCl was used as an irrigation fluid and 1.5% glycine in the TURP group. By adding ethanol to the irrigation fluids 1% ethanol-containing solutions were formed. All operations were carried out under spinal anesthesia and alcohol concentration of the ventilated air measurements were made just at the beginning of the operation, every 10 min peroperatively and at the end of the operation by using an alcoholmeter. Results: There was no difference in age, prostate volume and the length of operation time in either group. In both groups, the estimated absorbed fluid volume increased with the duration of surgery (p < 0.05). The difference between mean fluid absorption during PK-TURP and during TURP was the statistically significant (p < 0.01). Conclusion: PK-TURP operation causes lesser absorption of the irrigation fluid than the TURP operation. The lesser absorption of irrigation fluid and using saline instead of glycine decreases the risk of TUR syndrome.