Complications Of Benign Prostatic Hyperplasia Research Articles

17β-Estradiol, through activating the G protein-coupled estrogen receptor, exacerbates the complication of benign prostatic hyperplasia in type 2 diabetes mellitus patients by inducing prostate proliferation

Benign prostatic hyperplasia (BPH) is one of the major chronic complications of type 2 diabetes mellitus (T2DM), and sex steroid hormones are common risk factors for the occurrence of T2DM and BPH. The profiles of sex steroid hormones are simultaneously quantified by LC–MS/MS in the clinical serum of patients, including simple BPH patients, newly diagnosed T2DM patients, T2DM complicated with BPH patients and matched healthy individuals. The G protein-coupled estrogen receptor (GPER) inhibitor G15, GPER knockdown lentivirus, the YAP1 inhibitor verteporfin, YAP1 knockdown/overexpression lentivirus, targeted metabolomics analysis, and Co-IP assays are used to investigate the molecular mechanisms of the disrupted sex steroid hormones homeostasis in the pathological process of T2DM complicated with BPH. The homeostasis of sex steroid hormone is disrupted in the serum of patients, accompanying with the proliferated prostatic epithelial cells (PECs). The sex steroid hormone metabolic profiles of T2DM patients complicated with BPH have the greatest degrees of separation from those of healthy individuals. Elevated 17β-estradiol (E2) is the key contributor to the disrupted sex steroid hormone homeostasis, and is significantly positively related to the clinical characteristics of T2DM patients complicated with BPH. Activating GPER by E2 via Hippo-YAP1 signaling exacerbates high glucose (HG)-induced PECs proliferation through the formation of the YAP1-TEAD4 heterodimer. Knockdown or inhibition of GPER-mediated Hippo-YAP1 signaling suppresses PECs proliferation in HG and E2 co-treated BPH-1 cells. The anti-proliferative effects of verteporfin, an inhibitor of YAP1, are blocked by YAP1 overexpression in HG and E2 co-treated BPH-1 cells. Inactivating E2/GPER/Hippo/YAP1 signaling may be effective at delaying the progression of T2DM complicated with BPH by inhibiting PECs proliferation.

SARS-CoV-2 infection correlates with male benign prostatic hyperplasia deterioration.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) affects extra-respiratory systems, with small-scale studies showing worsened male lower urinary tract symptoms (LUTS) after coronavirus disease 2019 (COVID-19). This study explores the correlation between SARS-CoV-2 infection and male benign prostatic hyperplasia (BPH) complications using large-scale real world data. All male patients attending the public healthcare system in Hong Kong receiving alpha-blocker monotherapy for LUTS from 2021 to 2022 were included in this study. Patients with and without positive polymerase chain reaction (PCR) test for SARS-CoV-2 are selected as the exposure group and control group, respectively. Baseline characteristics are retrieved, with propensity score matching performed to ensure balance of covariates between the two groups. BPH complications were then compared and subgroup analyses were performed. After propensity score matching, 17,986 patients were included for analysis, among which half had PCR-confirmed SARS-CoV-2 infection (n=8993). When compared to controls, the SARS-CoV-2 group demonstrated statistically significant higher incidence of retention of urine (4.55% vs. 0.86%, p<0.001), haematuria (1.36% vs. 0.41%, p<0.001), clinical urinary tract infection (UTI) (4.31% vs. 1.49%, p<0.001), culture-proven bacteriuria (9.02% vs. 1.97%, p<0.001) and addition of 5ARI (0.50% vs. 0.02%, p<0.001). Subgroup analysis demonstrated similar differences across different age groups. There are no statistically significance differences in incidence of retention, haematuria, or addition of 5ARI across different COVID-19 severities. SARS-CoV-2 infection is associated with increased incidence of urinary retention, haematuria, UTI and the addition of combination therapy in the short term, regardless of COVID-19 severity. This is the largest study demonstrating the detrimental urological effects of SARS-CoV-2 infection.

Correlation between Initial International Prostate Symptom Score (IPSS) and Complications of Benign Prostatic Hyperplasia

Objective: Benign prostatic hyperplasia (BPH) is a common disease in elderly men, and some of them are suffering from its complications. Early detection and management of complications of BPH will lead to optimal results of treatment. The International Prostate Symptom Score (IPSS) is a disease and symptom-specific scoring system used for initial evaluations of BPH patients. This study aims to determine the correlation between initial IPSS and complications resulting from BPH. Material and Methods: This hospital-based cross-sectional study enrolled all male patients, aged 60 years and above having complained of lower urinary tract symptoms (LUTS), at the outpatient clinic. Patients’ demographic data (age), IPSS, and history of complications from BPH; including urinary tract infection (UTI), hematuria, urinary retention and prostate related surgery were collected. Results: In total, 301 patients were recruited in this study, with a mean age of 70.1 years old. There was significant correlation between age and IPSS (p-value 0.034), by using correlation coefficients. Sub-group analysis demonstrates a significant correlation of IPSS (both mean and severity group classifications) and complications from BPH (UTI, hematuria, urinary retention, and prostate surgery due to BPH) (p-value&lt;0.001). Conclusion: The rate of complications, due to BPH including UTI, hematuria, urinary retention, and BPH-related surgery, correlate with higher initial IPSS.

Is COVID-19 a risk factor for progression of benign prostatic hyperplasia and exacerbation of its related symptoms?: a systematic review.

BackgroundTo explore the potential mechanisms of SARS-CoV-2 in targeting the prostate gland, leading to exacerbation of benign prostatic hyperplasia (BPH) symptoms and greater risks of BPH complications such as acute urinary retention.MethodsA categorized and comprehensive search in the literature has been conducted by 10 April 2021 using international databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library in line with the PRISMA guidelines recommendations. PICO strategy was used to formulate the research question. The following terms were used: urology, COVID-19, coronavirus, BPH, inflammation, androgen receptors, LUTS, IPSS, PSA, and SARS-CoV-2 or a combination of them. Studies with irrelevant purposes and duplicates were excluded. The selected studies were performed on humans and published in English.ResultsThe research revealed 89 articles. After title screening and considering exclusion criteria, 52 papers were included for the systematic review. BPH is a common condition affecting older men. SARS-CoV-2 infects the host cell by binding to angiotensin converting enzyme 2 (ACE2). A hyperactivated RAS system during infection with SARS-CoV-2 may lead to activation of pro-inflammatory pathways and increased cytokine release. Thus, this virus can lead to exacerbation of lower urinary tract symptoms (LUTS) and trigger inflammatory processes in the prostate gland. Since androgen receptors (AR) play an important role in the BPH pathophysiology and infection with SARS-CoV-2 may be androgen-mediated, BPH progression and its related symptoms can be a complication of COVID-19 through AR involvement and metabolic disturbances.ConclusionsBased on the current findings, SARS-CoV-2 can possibly damage the prostate and worsen BPH and its related LUTS through ACE2 signaling, AR-related mechanisms, inflammation, and metabolic derangement. We encourage future studies to investigate the possible role of COVID-19 in the progression of BPH-related LUTS and examine the prostatic status in susceptible patients with relevant available questionnaires (e.g., IPSS) and serum biomarkers (e.g., PSA).

Serum interleukin 6 and acute urinary retention in elderly men with benign prostatic hyperplasia in China: a cross-sectional study.

BackgroundWhile acute urinary retention (AUR) is a severe complication of benign prostatic hyperplasia (BPH), it can also indicate the progression of this common disease in aging men. This study aimed at exploring the possible relationship between serum interleukin 6 (sIL-6) and AUR in BPH patients.MethodsA cross-sectional study was conducted based on 256 elderly men with BPH in China. The association between the sIL-6 level and the occurrence of AUR was evaluated by univariate and multivariable logistic regressions. The receiver operating characteristic (ROC) curve was utilized to determine the discriminant validity of the sIL-6 level and the optimal cut-off value.ResultsThe concentration of sIL-6 was significantly elevated in the AUR group (P<0.001). A positive correlation was observed between the sIL-6 level and AUR in BPH patients [odds ratio (OR) =1.365, 95% confidence interval (CI): 1.174–1.586, P<0.001]. Based on the ROC curve analysis for sIL-6, the optimal cut-off point of 4.475 pg/mL was set to identify the occurrence of AUR in these patients [area under the curve (AUC) =0.7596, 95% CI: 0.6976–0.8216, P<0.001]. A high sIL-6 level (≥4.475 pg/mL) had a significantly stronger correlation with AUR (OR =9.666, 95% CI: 4.347–21.491, P<0.001).ConclusionsThere was a positive correlation between the sIL-6 level and the occurrence of AUR in elderly Chinese patients with BPH. This study provides potential strategies for the screening of BPH individuals with a possible risk of AUR, which may contribute to the early implementation of effective interventions to improve the quality of life and prognosis. Long-term prospective studies are still required to further illustrate the causal relationship.

The role of Rezūm ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review

Objectives Acute urinary retention (AUR) is one of the most significant complication of benign prostatic hyperplasia (BPH). The gold standard surgical treatment for BPH, transurethral resection of the prostate (TURP), is not without significant side effects and a prolonged hospital stay. The aim of this study is to evaluate the role of Rezūm ™ steam ablation in the treatment of patients with AUR secondary to BPH. Methods Patients who developed AUR and failed their trial without a catheter (TWOC) were recruited. They were counselled about the procedure and offered the treatment. Pre-operative, intraoperative and post operate data were collected. Results All patients were followed up for a mean period of 7.2 months. 100% of patients passed their TWOC and stopped taking any BPH medications after. There was an average of 43.8% decrease in TRUS volume and a fall of 52.5% in PSA value after intervention. The mean operation time was 8.8 min and mean duration in hospital was 5.8 h. No deterioration in sexual function was reported. Conclusions Rezūm ™ steam ablation of the prostate is safe, fast and effective day case procedure in treating patients with AUR secondary to BPH. All patients were satisfied with the functional outcomes.

Retrospective analysis of the changes in the surgical treatment of benign prostatic hyperplasia during an 11-year period: a single-center experience.

The present study aimed to determine whether the number of patients with symptomatic benign prostatic hyperplasia (BPH) who preferred surgery decreased during the past 11 years at our center (West China Hospital, Chengdu, China), and whether this change affected the timing of surgery and the physical condition of surgical patients. This retrospective study included 57 557 patients with BPH treated from January 2008 to December 2018. Of these, 5427 patients were treated surgically. Surgical patients were divided into two groups based on the time of treatment (groups 8–13 and groups 13–18). The collected data comprised the percentage of all patients with BPH who underwent surgery, baseline characteristics of surgical patients, rehabilitation time, adverse events, and hospitalization costs. The surgery rates in groups 8–13 and groups 13–18 were 10.5% and 8.5% (P < 0.001), respectively. The two groups did not clinically differ regarding patient age and prostate volume. The rates of acute urinary retention and renal failure decreased from 15.0% to 10.6% (P < 0.001) and from 5.2% to 3.1% (P < 0.001), respectively. In groups 8–13 and groups 13–18, the mean catheterization times were 4.0 ± 1.7 days and 3.3 ± 1.6 days (P < 0.001), respectively, and the mean postoperative hospitalization times were 5.1 ± 2.4 days and 4.2 ± 1.8 days (P < 0.001), respectively. The incidences of unplanned second surgery and death reduced during the study period. The surgery rate decreased over time, which suggests that medication was chosen over surgery. However, the percentage of late complications of BPH also decreased over time, which indicates that the timing of surgery was not delayed.

Choosing the method of urine derivation in patients with acute urinary retention: current status of the problem

Acute urinary retention (AUR) is an acute inability to empty the bladder, despite its overflow with urine and the urge to urinate. According to the literature data, about 10% of men over 70 years old and about 30% of men over 80 years old suffer this disorder. At the same time, almost 90% of men over 45 years have symptoms of the lower urinary tract disorders and can be included into the risk group for developing of AUR in future. The risk of developing of AUR in middle-aged men is approximately 6.8 cases per 1000 men and increases to 34.7 cases in men over 70 years. Urinary retention remains a common cause of emergency hospitalization of patients to urological departments, as well as the most common complication of benign prostatic hyperplasia (BPH). According to epidemiological studies, 10% of men aged 60-70 years suffer acute urinary retention within 5 years, and their proportion increases up to 30% within 10 years of observation. The main risk factors for the development of AUR in men are old age, the severity of lower urinary tract symptoms (LUTS), and prostate volume.

A study on acute urinary retention in patients with benign prostatic hyperplasia at a rural setup

Background: Acute urinary retention (AUR) is one of the most significant complications of benign prostatic hyperplasia (BPH). Aim was to discuss the management of AUR in BPH in a rural setup.Methods: It was a prospective study, at PESIMSR, Kuppam, on 100 BPH patients who presented to the ER or OPD with AUR from November 2016 to June 2018. All were catheterized initially. Patient clinical characteristics, prostate size, type of AUR and management one (type of catheterization, hospitalization, trial without catheterisation (TWOC), use of medication, immediate and elective surgery) were recorded.Results: Mean age was 68.33±9.1. Most patients (74 %) had spontaneous AUR and rest had precipitating factors. A per-urethral catheter (PUC) was inserted in most cases (96%), rest had supra-pubic cystostomy (SPC). Patients with prostate volume of &lt;30 ml (n=8) were started on alpha-blocker (AB) alone and those with &gt;30 ml were given AB with 5 alpha-reductase inhibitor (ARI) combination. TWOC had an overall success rate of 72% (n=72), of them 38 opted for elective surgery. TWOC failed in 28 patients who were re-catheterized and underwent transurethral resection of prostate (TURP) on an elective basis. 66 out of 100 patients underwent TURP in the course of management of AUR in BPH.Conclusions: Management of AUR in BPH patients in real-life practice in a rural setup hospital has been evaluated. It shows that urethral catheterization, medication, TWOC and finally continuing medical management or planning TURP based has become standard practice.

Comparison of meloxicam, tamsulosin and combination of both drugs with 16 Fr and 20 Fr catheter on trial without catheter successfulness in patients with benign prostatic hyperplasia

Background: Acute urinary retention, is one of the main complications of Benign Prostatic Hyperplasia (BPH) in elderly patients. Trial Without Catheter (TWOC) is a way to evaluate whether a patient can urinate spontaneously after an episode of urinary retention. Objective: To prove that the combination of meloxicam 15 mg and tamsulosin 0.4 mg orally once daily for three weeks with 20 Fr catheter is more effective in the TWOC successfulness in BPH patients than meloxicam 15 mg or tamsulosin 0.4 mg alone with 16 Fr catheter. Methods: Patients BPH who had the first episode of urinary retention and fulfil the inclusion criteria were randomised. There were six treatment groups (n=6). The treatment group are meloxicam 15 mg + catheter 16 Fr (K1), combination of meloxicam 15 mg and tamsulosin 0.4 mg + catheter 16 Fr (K2), tamsulosin 0.4 mg + catheter 16 Fr (K3), meloxicam 15 mg + catheter 20 Fr (K4), combination of meloxicam 15 mg and tamsulosin 0.4 mg + catheter 20 Fr (K5), tamsulosin 0.4 mg + catheter 20 Fr (K6). For each group, drugs were given orally once daily for seven days. Efficacy of TWOC was assessed by the ability of spontaneous urinary after the first 24 hour post urethral catheter treatment, with Q-max result on uroflowmetry = 5 cc/sec and PVR = 100 cc. Result: All subjects from K1 and K4 experience a recurrent episode of urinary retention (100%), 83.3% in K3 and 66.7% in K6. In the combination group, K2 had 50% incidence of repeat urinary retention, while K5 had16.7%. From the whole group, a statistically significant difference with p <0.05 only can be found in K1 and K5 (p = 0.02). Conclusion: The combination of meloxicam 15 mg and tamsulosin 0.4 mg + 20 Fr catheter had a better effect in TWOC efficacy compared with the meloxicam 15 mg + catheter 16 Fr group.

Effectiveness of the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia: A randomized clinical trial.

Acute urinary retention is one of the most significant complications of benign prostatic hyperplasia. Until now, standard treatments include catheterization and use of α-blockers. Tadalafil has been recently seen to also play a role in the treatment of urinary symptoms caused by benign prostatic hyperplasia. The aim of this study was to survey the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. This is a randomized, double-blind placebo-controlled clinical trial. In all, 80 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department of the hospital were divided into two groups of 40 each and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus 10 mg tadalafil daily for 7 days. At the same first visit, the catheter was removed and the ability to void in 24 h and 1 week later was assessed in each group. The differences in age, urine retention volume, history of drug use, lower urinary tract symptoms, and previous acute urinary retention were not significant between the two groups ( p = 0.619, 0.149, 0.501, 0.284, and 0.371, respectively). After catheter removal, 23 (57.5%) patients in the placebo group and 26 (65%) in the tadalafil group voided successfully at 24 h ( p = 0.491). After 1 week, 29 (72.5%) patients taking placebo and 26 (65%) taking tadalafil could void, yet indicating no significant difference ( p = 0.469). Addition of tadalafil to α-blockers has no significant advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone.

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate (HoLEP).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the quality of life. BPH includes 2 major treatments: medication and surgery. Surgical treatment is often the most effective and final intervention. Holmium laser enucleation of the prostate (HoLEP), one of the most efficient surgical procedures for BPH, is conducted transurethrally. During surgery, the most important and most difficult part is to locate the surgical capsule of the prostate, which is consistent to the idea of anatomic surgery. Different skills may be needed in treating different parts of the prostate. HoLEP tends to be efficient and safe with good hemostatic properties, and able to treat bladder calculus, which may be the complications of BPH. The technique is particularly suitable for prostate of varying volumes and sizes. Indeed, HoLEP also presents certain disadvantages, such as a long learning curve and costly equipment. Regardless, this method may be the "new standard" and the excellent method for the surgical treatment of BPH.

Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era.

We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post-antibiotic era, focusing on how patient risk factors and the emergence of multidrug-resistant organisms influence management of the condition. A MEDLINE search for "prostate abscess" or "prostatic abscess" was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug-resistant organisms, such as extended-spectrum β-lactamase-producing enterobacteriaceae and methicillin-resistant Staphylococcus aureus. As many as 75% of infections are resistant to first-generation antibiotics, necessitating aggressive therapy with broad-spectrum parenteral antibiotics, such as third-generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the post-antibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug-resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage.

Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review.

Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL.

Complications graves et inattendues de la chirurgie de l’hyperplasie bénigne de prostate : résultats de l’enquête du CTMH auprès des urologues de l’AFU

Rare and severe complications of benign prostatic hyperplasia (BPH) surgery are poorly documented in the literature. Our purpose was to make an inventory of severe and unexpected complications of BPH faced by urologists of the French Association of Urology (AFU). A declarative 13-question survey was sent by e-mail 2 months before the 108th French Congress of Urology to the urologist's members of the AFU. Complications were split in complications due to material and complications directly related to the surgery. Overall, 216 (16.2%) urologists surveyed but only 85 forms were usable. Complications related to the material was divided into: excessive temperature of the serum irrigation leading to urethral and bladder burns (n=5), material default leading to interruption of the procedure (n=1) or incomplete hemostasis (n=2) and endoscope rupture (n=1). Peroperative complications related to surgery were divided into surgical complications: haemorrhage (n=7), urethral wounds (n=6), perforation and/or explosion (n=16), rectal wounds (n=11), obstructive renal failure (n=1); and medical complications: TURP syndrome (n=2), cardiovascular (n=5) and septic shock (n=6). This is the first French declarative study having allowed the identification of severe and unexpected complications of BPH surgery. The recorded occurred complications were very eclectic and secondary to all types of techniques used.

Estrogen Receptor-α is a Key Mediator and Therapeutic Target for Bladder Complications of Benign Prostatic Hyperplasia

Estrogens are important in prostate growth and have a role in benign prostatic hyperplasia. However, to our knowledge no current therapy directly targets estrogen action. Estrogens act primarily via estrogen receptors α and β. In a mouse model we evaluated the relative contribution of these receptors to bladder complications of benign prostatic hyperplasia. We also evaluated the prevention of these bladder complications using the selective estrogen receptor modulators raloxifene and tamoxifen (estrogen receptor-α selective antagonists), and R,R-THC (estrogen receptor-β selective antagonist). Adult male C57bl/6 mice received implants of 25 mg testosterone and 2.5 mg 17β-estradiol slow release pellets. Untreated controls underwent sham surgery. We evaluated the contributions of the estrogen receptor subtypes in ERαKO and ERβKO mice compared to their respective wild-type litter mates. Wild-type mice treated with testosterone plus 17β-estradiol were compared to mice treated with testosterone plus 17β-estradiol and 25 mg selective estrogen receptor modulators to evaluate the prevention of benign prostatic hyperplasia complications by selective estrogen receptor modulators. Large bladders with urinary retention developed in ERαWT and ERβWT litter mates treated with testosterone plus 17β-estradiol but such bladders did not develop in ERαKO mice treated with testosterone plus 17β-estradiol. ERβKO mice treated with testosterone plus 17β-estradiol had large bladders with urinary retention and increased bladder mass. Cotreatment with the estrogen receptor-α antagonist raloxifene resulted in decreased bladder mass compared to that in wild-type mice treated with testosterone plus 17β-estradiol. Bladders in mice treated with the estrogen receptor-β antagonist R,R-THC were similar to those in testosterone plus 17β-estradiol treated mice. Estrogen receptor-α but not β is a key mediator of bladder complications of benign prostatic hyperplasia and a potential target for future therapies.

Histomorphology of trabeculated urinary bladder – A cadaveric report

IntroductionTrabeculation of urinary bladder is a common complication of benign prostatic hyperplasia, a predominant cause of bladder outlet obstruction in elderly males. The musculature of the urinary bladder, known as the detrusor urinae muscle, is hypertrophied so as to overcome the bladder outlet obstruction giving rise to trabeculated appearance of the urinary bladder. MethodsIn the present case study, trabeculation of the urinary bladder was observed in one of the cadavers, an elderly male aged 79 years, during routine dissection of pelvis by the students in the department of anatomy. Small pieces of the bladder were excised from its walls. Seven μm thick paraffin sections were stained with Masson's trichrome stain and examined under light microscope. ResultsThe urinary bladder was big in size weighing 240 g. Well developed large trabeculae were seen criss-crossing the walls of the bladder on its inner surface. Smooth muscle hypertrophy and abundant deposition of collagen fibres between smooth muscle fibres were the main histological features. Stained sections of the median lobe of prostate gland showed large prostatic follicles with epithelial hyperplasia and inflamed fibrous stroma suggestive of benign prostatic hyperplasia. DiscussionBenign prostatic hyperplasia commonly affects elderly men above 50 years of age presenting with symptoms of bladder outlet obstruction. In the present case study, we report the histological findings of the trabeculated urinary bladder observed in an elderly male cadaver during routine dissection.

Two-micrometer thulium laser resection of the prostate-tangerine technique for patients with acute urinary retention

Two-micrometer thulium laser resection of the prostate-tangerine technique (TmLRP-TT) has been introduced as a minimally invasive treatment for benign prostatic hyperplasia (BPH). Acute urinary retention (AUR) is a common and serious complication of BPH. The study was undertaken to assess the clinical efficacy and safety of TmLRP-TT in the treatment of patients with AUR secondary to BPH. A prospective evaluation of 52 patients undergoing TmLRP-TT from December 2011 to November 2012 was carried out. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at 1 and 6 months. Mean age was 70.3 ± 7.8 years old. Mean prostate volume was 69.6 ± 31.6 ml, and mean residual volume with retention was 274.5 ± 150.7 ml. Mean operative time was 64.1 ± 30.4 min. Mean catheterization duration was 5.4 ± 1.1 days. The mean International Prostate Symptom Score, quality of life score, and postvoid residual urine volume decreased significantly at 6-month follow-up (21.6 ± 6.8 vs. 6.8 ± 3.2, 4.4 ± 1.2 vs. 0.9 ± 0.8, 274.5 ± 150.7 vs. 40.6 ± 22.5 ml). The mean maximum urinary flow rate was 18.7 ± 6.9 ml/s postoperative. Two (3.8 %) of the patients required blood transfusion in operation. Five (9.6 %) of the patients had transient hematuria postoperative, and two (3.8 %) of them received 3 days recatheterization due to clot retention. The early clinical results suggest that the TmLRP-TT is a promising safe, effective, and minimally invasive treatment for patients with AUR secondary to BPH. The incidence of complications was low.

1117 WHITE'S OPERATION: THE HISTORY OF 19TH CENTURY ATTEMPTS TO TREAT PROSTATE DISEASE WITH ORCHIECTOMY

You have accessJournal of UrologyHistory of Urology Forum1 Apr 20131117 WHITE'S OPERATION: THE HISTORY OF 19TH CENTURY ATTEMPTS TO TREAT PROSTATE DISEASE WITH ORCHIECTOMY Tristan Nicholson, Sara Best, and William Ricke Tristan NicholsonTristan Nicholson Madison, WI More articles by this author , Sara BestSara Best Madison, WI More articles by this author , and William RickeWilliam Ricke Madison, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.709AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contemporary medical therapies for benign prostatic hyperplasia (BPH) rely on the basic knowledge that the prostate depends on testicular androgens. While the complications of BPH have been known since ancient times, the first elucidation of its hormonal etiology occurred in the late 19th century. Some fifty years before the hormonal regulation of prostate cancer was understood, American surgeons performed surgical castration and relieved the suffering of some BPH patients. METHODS We reviewed primary literature available in PUBMED and papers from the University of Pennsylvania archives. RESULTS Dr. J. William White, MD, PhD (1850-1916) was a prominent American surgeon at the University of Pennsylvania. Among White's contemporaries, theories of BPH development were numerous and included arterial sclerosis, prostate growth compensatory to bladder changes, prolonged ungratified sexual excitement, and second marriages late in life. Dr. White believed a systemic, chemical influence of the testicles drove prostatic hypertrophy. He further extended this idea to suggest that castration would be followed by prostatic atrophy, which he demonstrated in a canine model. In 1893, he presented his experience with patients suffering from end-stage BPH who improved following bilateral orchiectomy. Dr. White followed this with a detailed case series of 111 patients, showing an improvement in urination in 87%. Regarding one patient he reported, “the patient is practically cured.” He was meticulous in reporting clinical courses, as well as ensuing complications. Among his initial cohort, there was an 18% mortality rate following surgery, although some patients were moribund prior to surgery and succumbed to sepsis; excluding these, his mortality rate was 7%. White's operation was adopted by many of his colleagues, although his approach spurred spirited discussion between advocates for castration and early proponents of prostatectomy. The approach pioneered by Dr. White and his colleagues, targeting androgenic maintenance of the prostate, remains today as a mainstay of medical therapy for BPH. CONCLUSIONS The late 19th century was an important time for surgical advances in the treatment of prostate disease. The bold experiments of Dr. White and his contemporaries paved the way for our contemporary understanding of the critical role of sex steroid hormones in BPH. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e457 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tristan Nicholson Madison, WI More articles by this author Sara Best Madison, WI More articles by this author William Ricke Madison, WI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Non‐steroidal anti‐inflammatory drugs for lower urinary tract symptoms in benign prostatic hyperplasia: systematic review and meta‐analysis of randomized controlled trials

To assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in men with benign prostatic hyperplasia (BPH) using systematic review and meta-analysis of clinical trials. Men treated with NSAIDs in comparison with placebo or other BPH medications. All aspects of the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. Trials were eligible for inclusion provided they (i) randomized men with BPH to receive NSAIDs in comparison with placebo or other BPH medications, and (ii) included clinical outcomes such as urological symptom scales, symptoms or urodynamic measurements. Data analysis was performed using REVIEW MANAGER Version 5.0 software. Study weight was calculated by the inverse variances of the study effect estimates. In all, 183 men from three randomized, placebo-controlled trials (lasting 4-24 weeks) were assessed. NSAIDs improved urinary symptom scores and flow measures. The weighted mean difference for the International Prostate Symptom Score (IPSS) was -2.89 IPSS points (95% CI -3.84 to -1.95, P < 0.001, n = 3 studies). The weighted mean difference for peak urine flow was 0.89 mL/s (95% CI 0.21-1.58, P = 0.01, n = 3 studies) and for reported adverse effects was 1.51 (95% CI 0.66-3.43, P = 0.32, n = 3 studies,). All patients assigned to NSAIDs continued the treatment. There were no serious adverse effects and there were no withdrawals or losses to follow-up. The evidence suggests that NSAIDs improve urinary symptoms and flow measures. Their long-term effectiveness, safety and ability to prevent BPH complications are not known.