Diagnosis Of Benign Prostatic Hyperplasia Research Articles

Association of CYP3A4*1B, CYP3A4*22 and CYP3A5*3 polymorphisms carriage with efficacy and safety of tamsulosin in patients with benign prostatic hyperplasia

Tamsulosin is a first-line drug in the treatment of lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). Despite high estimates of its efficacy and safety, it rates may vary due to genetic polymorphisms of genes for the enzymes involved in the drugs metabolism.The aim of the work was to evaluate the carriage influence of genes polymorphisms of the CYP3A enzymes group of tamsulosin metabolizers on the efficacy and safety of therapy in patients with LUTS in BPH.Materials and methods. A total of 142 patients with LUTS, with an established BPH diagnosis (N40 according to ICD-10) were included in the study and underwent all stages. All patients received monotherapy with tamsulosin 0.4 mg/day for at least 8 weeks. An IPSS questionnaire with the definition of quality of life, a prostate ultrasound with the determination of the prostate volume and residual urine, as well as uroflowmetry, were used to evaluate the results of the treatment. Controls were performed at 2, 4 and 8 weeks from the start of the therapy. The carriage of polymorphic markers CYP3A4 (*1B, *22) and CYP3A5*3 was determined in patients; HPLC was used to determine drug concentrations in blood plasma and levels of cortisol and its metabolite 6-beta-hydroxycortisol in urine to assess the phenotypic activity of CYP3A.Results. No statistically significant associations between CYP3A phenotype (defined by CYP3A4 and CYP3A5 genotypes) and clinical parameters of the tamsulosin therapy efficacy and the safety assessment in the studied sample of patients were found (p >0.05). Similar data were obtained for individual variants of CYP3A4*1B, CYP3A4*22, CYP3A5*3 (p >0.05). The comparison of the tamsulosin residual equilibrium concentration values in patients in the study sample with respect to the carriers of CYP3A4 and CYP3A5 gene variants did not reveal the presence of significant differences in either CYP3A phenotypes and carriers and non-carriers of individual CYP3A4*1B (p=0.57), CYP3A4*22 (p=0.37) and CYP3A5*3 (p=0.76) variants. No association was found between the metabolic ratio of 6-beta-hydroxycortisol / cortisol in urine and the CYP3A phenotype encoded by a combination of genotypes of CYP3A4 and CYP3A5 gene variants (p >0.05).Conclusion. A possible association between the carriage of CYP3A4*1B, CYP3A4*22, CYP3A5*3 variants, a CYP3A activity assessed by the content of an endogenous substrate of this isoenzyme and its metabolite in urine, the level of plasma concentration of the drug, and the efficacy and safety of tamsulosin, has not been confirmed. The contribution of CYP3A4 and CYP3A5 genetic polymorphisms to clinical parameters of the tamsulosin therapy requires a further study.

Correction of nocturia in patients with benign prostatic hyperplasia. Mini-review and analysis of clinical observations

Aim. To outline the importance of nocturia in benign prostatic hyperplasia (BPH) and justify the feasibility and clinical need for antidiuretic therapy in these patients. Materials and methods. This article is a literature review. PubMed, Embase, and eLibrary databases were used for the search. Relevant publications were included in the literature review. The pilot study included 20 male patients aged 58–75 years with a confirmed diagnosis of BPH. Patients were divided into two groups: standard therapy (Tamsulosin Canon) and combined therapy (Tamsulosin Canon + Nourem). Diurnal diuresis was assessed based on the results of the Zimnitsky test and the nocturnal bladder volume index before and after treatment. Results. During standard therapy, patients had a decrease in the severity of obstructive and irritative symptoms and an improvement in the QoL index (p0.05). However, there was no significant improvement in nocturia. In the combined therapy group, the severity of symptoms significantly decreased by 53.3%, and the QoL index improved by 62.5%. On average, the sleep duration increased by 1.5 hours with almost unchanged rates of daily diuresis. Conclusion. The study showed that in 65% of patients, nocturia was caused not by anatomical and functional changes in the prostate and lower urinary tract but by nocturnal polyuria. Its management has a major role in nocturia treatment. The only pathogenesis-based treatment is the antidiuretic therapy (desmopressin) added to the α1-blocker.

Targeting genomic receptors in voided urine for confirmation of benign prostatic hyperplasia

AbstractObjectivesThe objective of this study is to validate a hypothesis that a non‐invasive optical imaging assay targeting genomic VPAC receptors on malignant cells shed in voided urine will represent either benign prostatic hyperplasia (BPH) or prostatic cancer (PCa). Risk for BPH in men 50–70 years old is 50–70% and PCa is 17%. BPH and PCa can coexist in 20% of men with BPH. Most commonly practiced methods to diagnose BPH do not distinguish BPH from PCa.Patients (or Materials) and MethodsMales with BPH (N = 97, 60.8 ± 6.3 years, prostate‐specific antigen 0.7 ± 0.4 ng/mL) and without oncologic disease (N = 35, 63.4 ± 5.8 years, prostate‐specific antigen < 1.5 ng/mL) signed informed consent form and provided voided urine. Urine was cytocentrifuged, cells collected on glass slide, fixed, treated with VPAC specific fluorophore TP4303 (Kd 3.1 × 10−8M), washed, incubated with DAPI and observed using a fluorescence microscope. Cells with no VPAC did not fluoresce (BPH) and those with VPAC had red‐orange fluorescence (PCa). Real‐time polymerase chain reaction analyses for VPAC and NKX3.1 assay for cell origin were performed.ResultsEighty‐seven subjects were negative for VPAC expression. Positive VPAC expression was noted in 10 subjects. Patient chart review for clinical data on these 10 VPAC positive subjects showed five had nephrolithiasis, three had renal cysts, one had prostatitis and one was being treated with finasteride. Real‐time polymerase chain reaction analysis‐VPAC expressions for 7 normal and 12 BPH subjects were 1.31 ± 1.26 and 0.94 ± 0.89, respectively (P = 0.46). NKX3.1 showed cells of prostate origin for finasteride‐treated patient. Specificity for VPAC urine assay for excluding prostate cancer in this BPH cohort was 88.5%, positive predictive value 0.00% and negative predictive value 100%.ConclusionVPAC assay may contribute extensively for BPH diagnosis and warrant continued investigation.

Case-based presentation of the S2e guideline on the diagnosis and treatment of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the most common disease of the lower urinary tract in men. The prevalence increases continuously with increasing age and achronic progressive course is to be expected. In order to reduce the morbidity of affected patients and to improve their quality of life, the expert panel Benign Prostatic Hyperplasia (BPH) of the German Society of Urology (DGU) has written anew version of the evidence-based "S2e guideline on the diagnosis and treatment of BPH". Using acurrent patient case, the contents of the new S2e guideline are illustrated, from diagnosis to the decision-making process for asuitable treatment choice. The case presented here shows the possible complexity and difficulty that can arise in the diagnosis of BPH, the need for further diagnostic steps and the finding of asuitable therapy in order to fulfill the patient's wishes, if possible.

Nursing diagnoses in patients undergoing prostatectomy at the central hospital of Nampula, 1st semester of 2019

Introduction: The nursing diagnosis is a clinical assessment of a human response to health conditions/life processes, or a vulnerability to that response, by an individual, family, group or community. The research aims to describe the main nursing diagnoses in patients undergoing prostatectomy admitted to Surgery II at the Hospital Central de Nampula. Objectives: This is a descriptive study with a quantitative approach, involving patients admitted to surgery II undergoing prostatectomy. All patients with the medical diagnosis of benign prostatic hyperplasia or prostate cancer who underwent prostate surgery were included, thus all patients who underwent prostate surgery but who had other chronic diseases were excluded. Data were analyzed with SPSS statistical package to obtain descriptive analysis, percentage and use of the following Q-square statistical test of independence. Results: the study involved 33 patients undergoing prostatectomy, 54.5% of these patients had primary schooling and the most predominant age group was 66-75 years old (39.4%). A total of 461 nursing diagnoses were found, and the most frequent were: Impaired walking 5.4%, Constipation 4.8, Risk of infection 6.9, Risk of vascular trauma 7.4%, Acute pain 5.4% and Deficit in self-care for bathing 6.7%. The following diagnoses were associated with the nursing diagnosis: impaired walking p value 0.000, dentition p value 0.006, constipation (p value 0.001), risk of electrolyte imbalance p value 0.000) and risk of falls (p value 0.000). Conclusion: the use of the nursing process by nurses facilitates the survey of health problems in sick patients in order to intervene in care using real nursing diagnoses, risk and health promotion.

Association between chronic prostatitis and the subsequent benign prostatic hyperplasia: a population-based national cohort study.

To explore the association between chronic prostatitis (CP) and the subsequent development of benign prostatic hyperplasia (BPH). Data analyzed were medical claims of Taiwan's National Health Insurance program. From 2010 to 2017, 3571 patients ≧20years with CP diagnosed by certified urologists were enrolled. Patients with past BPH diagnosis and diagnosis of prostate cancer, inguinal hernia, interstitial cystitis, and urethritis in the past and within one year after the first CP diagnosis were excluded. Age-matched controls were randomly selected from all non-CP individuals of the same exclusion criteria in the study period with a CP/non-CP ratio of 1:4. The follow-up was made from the first CPdiagnosis to death or the end of 2018. The endpoint was the newly diagnosed BPH. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of BPH in association with CP. Over a maximum of 8years of follow-up, 287 (8.03%) and 258 (0.43%) BPH events were noted for the CP and non-CP group, respectively, representing a covariate adjusted HR (aHR) of 4.30 (95% CI, 3.61-5.13). Younger patients tended to suffer from higher aHRs, especially those aged 20-39years (aHR: 11.45, 95% CI, 5.12-25.64). The Taiwan national health database indicated that CP patients had a significantly higher risk of developing BPH later than non-CP patients. Interestingly, the younger the CP is diagnosed (under 40), the greater the risk.

Primary diffuse large B-cell lymphoma of the prostate: Histopathological diagnosis of a rare entity in the prostate.

Lymphoma of the prostate is rare whether it is primary extranodal lymphoma or secondary involvement of the prostate by primary lymphoma elsewhere. Of all the lymphomas of the prostate, primary lymphomas of the prostrate are very rare. Although less frequent, it should be a differential diagnosis when evaluating prostate tumors. Here, we report a case of a 61-year-old man who presented with hematuria with clot retention. A cystoscopy with clot removal and transurethral resection of the prostate (TURP) was performed. This biopsy was sent for histopathological examination at an external center, where a diagnosis of benign prostatic hyperplasia was given. Fifteen days later, the patient presented with hematuria again. On examination, clots were present in the bladder. There was significant prostatomegaly. A re-resection of the prostate was performed and sent for another review to us. The biopsy was reported as high-grade round cell neoplasm, most likely lymphoma. Immunohistochemistry (IHC) was recommended for confirmation. Tumor cells showed immunoreactivity for CD20, B-cell Lymphoma (BCL)-2, BCL-6, Myelocytomatosis (c-Myc), and multiple myeloma 1 (MUM1). Cluster Differentiation (CD)10 was negative. Kiel-67 was high. A final diagnosis of double-expressor diffuse large B-cell lymphoma (DLBCL) of non-germinal center type was made. We share this case to emphasize the fact that primary lymphoma of the prostate is primarily a histopathological diagnosis as the clinical presentation is not unique. Owing to its rarity, the clinical and histopathological suspicion is low. Hence, keeping the differential in mind while evaluating prostate biopsy is beneficial in a timely diagnosis of the entity as the management of prostatic carcinoma and lymphoma is different.

Spinal Anestesi Pada Tindakan Transuretral Resection Of Prostat (TURP)

Spinal anesthesia is the choice for Transurethral Resection of Prostate (TURP) procedures. TURP is a surgical procedure performed for patients with prostatic hyperplasia. When a TURP procedure is performed, excessive fluid absorption will occur because during the procedure the injured area causes the vein to open and irrigation fluid will be absorbed. The position of the surgical procedure in the lithotomy position makes the situation worse. Spinal anesthesia helps peripheral blood collection and reduces circulatory overload, early detection of TURP syndrome and bladder perforation. In this case, the procedure was carried out on a 67 year old man with a diagnosis of benign prostate hyperplasia (BPH) with a TURP surgical procedure. The patient was composmentis, ASA III. The patient underwent spinal anesthesia with a sub arachnoid block using Bupivacaine. During TURP procedures, TURP syndrome can occur which is influenced by the use of fluid as irrigation to widen the operator's field of view. Saline fluid should be used, but because it is expensive, H2O is often used as irrigation fluid. A complication of the TURP procedure is TURP syndrome

Erectile Dysfunction after Transuretheral Resection of the Prostate in Patients with Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia (BPH) is commonly associated with lower urinary tract symptoms (LUTS) in aging men, which can significantly impact their quality of life. Transurethral resection of the prostate (TURP) is a standard treatment for BPH, yet its effects on erectile function remain controversial. Objective: To assess the impact of TURP on erectile function in patients with BPH and to evaluate the potential relationship between the relief of obstructive urinary symptoms and changes in erectile function postoperatively. Methods: This single-center, non-randomized study enrolled 177 male patients aged 50 to 80 years with a clinical diagnosis of BPH and an International Prostate Symptom Score (IPSS) greater than 8. Participants underwent monopolar TURP and were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire one month post-surgery. Data were analyzed using SPSS version 21 with Chi-square tests applied to examine the influence of age and IPSS scores on erectile function, considering a p-value ≤0.05 as significant. Results: The mean age of participants was 57.53 ± 6.96 years, and the mean resected prostate tissue weight was 122.82 ± 12.05 grams. Post-TURP, 44.6% of patients were found to have some degree of erectile dysfunction. However, no significant changes in erectile function were observed one month following TURP (p=0.602 for age, p=0.878 for IPSS score). Conclusion: TURP did not significantly affect erectile function one month postoperatively in BPH patients with severe urinary symptoms. While some improvement in erectile function was noted, the results suggest that the benefits of TURP on erectile function may not be immediate. Further longitudinal studies with larger sample sizes are required to provide more definitive conclusions.

Evaluation of Private Payer and Patient Out-of-Pocket Costs Associated With the Surgical Management of Benign Prostatic Hyperplasia

ObjectivesTo evaulate and compare the financial burden of various surgical interventions for the management of benign prostatic hyperplasia (BPH). MethodsWe identified commercially insured men with a diagnosis of BPH who underwent a procedure of interest (SP, TURP, HoLEP, PVP, PUL, or WVTT) between 2015-2021 with the OptumLabs Data Warehouse. Primary outcome was total healthcare costs (THC) which included both patient out-of-pocket (OOP) and health plan paid (HPP) costs for the index procedure and combined follow-up years 1-5. A generalized linear model was used to estimate adjusted costs controlling for demographic and clinical characteristics. Patients undergoing WVTT were excluded from extended follow-up analyses due to limited data. ResultsAmong 25,407 patients with BPH, 10,117 (40%) underwent TURP, 6,353 (25%) underwent PUL, 5,411 (21%) underwent PVP, 1,319 (5%) underwent SP, 1,243 (5%) underwent WVTT, and 964 (4%) underwent HoLEP. Index procedure costs varied significantly with WVTT being the least costly [THC: $2,637 (95% CI: $2,513 – $2,761)], and SP being the costliest [THC: $14,423 (95% CI: $12,772 – $16,075)]. For aggregate index and 5-year follow-up costs, HoLEP ($31,926 [95% CI: $29,704–$34,148]) was the least costly and PUL ($36,596 [95% CI: $35,369-37,823]) was the costliest. ConclusionsBPH surgical treatment is associated with significant system-level healthcare costs. The level of impact varies between procedures. Minimally invasive options, such as WVTT, may offer initial cost reductions; however, HoLEP and SP are associated with lower follow-up costs.

Use of phosphodiesterase 5 inhibitors is not associated with ocular adverse events.

Phosphodiesterase 5 inhibitor (PDE5i) use has been linked to a number of ocular side effects, such as serous retinal detachment (SRD), retinal vascular occlusion (RVO), and ischemic optic neuropathy (ION). We investigated the risk for SRD, RVO, and ION in patients using PDE5is. We utilized the IBM MarketScan (2007-2021) Commercial and Medicare Supplemental Databases (version 2.0) for this analysis. To estimate overall events risk, Cox proportional hazard models were applied to calculate the hazard ratios (HRs) for erectile dysfunction (ED) diagnosis and the different treatments, adjusting for region, median age, obesity, diabetes mellitus, hyperlipidemia, smoking, hypertension, coronary artery disease, and sleep apnea. Additionally, the same analyses were performed to calculate the HRs for benign prostatic hyperplasia (BPH) diagnosis and the different treatments. HRs for SRD, RVO, and ION. In total, 1 938 262 men with an ED diagnosis were observed during the study period. Among them, 615 838 (31.8%) were treated with PDE5is. In total, 2 175 439 men with a BPH diagnosis were observed during the study period. Among them, 175 725 (8.1%) were treated with PDE5is. On adjusted Cox regression analysis, PDE5i use was not associated with SRD, RVO, ION, and any ocular event when compared with ED diagnosis and other ED treatments. Importantly, as the intensity of ED treatment increased, so did the risk of ocular events. In addition, PDE5i use was not associated with SRD and ION when compared with BPH diagnosis and other BPH treatments. In contrast, in patients with BPH, PDE5i use was associated with RVO (HR, 1.14; 95% CI, 1.06-1.23). Importantly, patients with BPH receiving other medical treatment (ie, 5a reductase/alpha blocker; HR, 1.11; 95% CI, 1.06-1.16) or surgical treatment (HR, 1.10; 95% CI, 1.02-1.19) had a higher risk of RVO. We did not observe any consistent association between PDE5i use and any ocular adverse events (SRD, RVO, and ION). Because we did not have access to the patients' medical records, we recorded outcome definitions using ICD-9 and ICD-10 coding. Patients using PDE5is for ED or BPH indications did not have an increased risk of ocular events, even when compared with other treatments for ED or BPH.

CHRDL1, NEFH, TAGLN and SYNM as novel diagnostic biomarkers of benign prostatic hyperplasia and prostate cancer.

Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are common male diseases whose incidence rates gradually increase with age. They seriously affect men's physical health and quality of life. This study aimed to identify new biomarkers for the diagnosis of BPH and PCa. Two datasets, GSE28204 and GSE134051 (including human PCa and BPH), were downloaded from the GEO database. The batch effect was removed for merging, and then differential gene expression analysis was conducted to identify BPH and PCa cases. The diagnostic biomarkers of BPH and PCa were further screened using machine learning and bioinformatics. ROC curves were drawn to evaluate the diagnostic accuracy of the selected biomarkers. An online website and qPCR were used to preliminarily explore the expression levels of PCa biomarkers. The correlations between the expression of biomarkers and the tumor microenvironment, tumor mutation load and immunotherapy drugs were evaluated. We identified fifteen genes (CHRDL1, DES, FLNC, GSTP1, MYL9, TGFB3, NEFH, TAGLN, SPARCL1, SYNM, TRPM8, HPN, PLA2G7, ENTPD5 and GPR160) as critical diagnostic biomarkers. After reviewing the literature on all selected biomarkers, we found few studies on the four genes CHRDL1, NEFH, TAGLN and SYNM in BPH or PCa. We defined these four genes as new potential diagnostic biomarkers (NPDBs) of BPH and PCa. All NPDBs were downregulated in PCa patients and PCa cell lines and upregulated in BPH patients and cell lines. When the immune landscape and mutation frequencies were analyzed, the results showed that the tumor microenvironment (TME), immune landscape, tumor mutation burden, and drug response were significantly correlated with NPDB expressions. We found four new diagnostic markers of BPH and PCa, which may facilitate the early diagnosis, treatment, and immunotherapeutic responses assessment and may be of major value in guiding clinical practice.

5-alpha reductase inhibitors (5-ARi) with or without alpha-blockers (α-B) for Benign Prostatic Hyperplasia do NOT lower the risk of incident Bladder Cancer: United States insurance claims data.

Chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer (BCa) risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results. We sought to examine the effect of 5-ARi on new BCa diagnoses in a large US database. Men ≥ 50 y/o with a prescription for 5-ARi after BPH diagnosis were identified in the IBM® Marketscan® Research de-identified Databases between 2007 and 2016 and matched with paired controls. Incident BCa diagnoses were identified after BPH diagnosis and/or pharmacologic treatment. Multivariable regression modeling adjusting for relevant factors was implemented. Sub-group analyses by exposure risk were performed to explore the association between 5-ARi and BCa over time. Administration of alpha-blockers (α-B) w/o 5-ARi was also examined. In total, n = 24,036 men on 5-ARi, n = 107,086 on 5-ARi plus alpha-blockers, and n = 894,275 without medical therapy for BPH were identified. The percentage of men diagnosed with BCa was 0.8% for the 5-ARi, 1.4% for the 5-ARi + α-B, and 0.6% for the untreated BPH group of incident BCa (adjusted hazard ratio [aHR], 0.90, 95% confidence interval [CI] 0.56 - 1.47), and 1.08, 95%CI 0.89 - 1.30, respectively). This was also true at both shorter (≤ 2yr) and longer-term (> 2yr) follow up. In addition, α-B alone had no change in BCa risk (HR 1.06, 0.86-1.30). We did not find any diminished risk of new BCa in men treated with 5-ARi (i.e., chemoprotective effect). The current report suggests that 5-ARi do not change a man's bladder cancer risk.

The effect of acute urinary retention on the results of transurethral resection of the prostate.

Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.

Five-alpha reductase inhibitors and risk of prostate cancer among men with benign prostatic hyperplasia: A historical cohort study using primary care data

Background: Five-alpha reductase inhibitors (5ARIs) are used in the management of benign prostatic hyperplasia (BPH). 5ARIs prevent the conversion of testosterone to dihydrotestosterone, which is important in prostate development. It has been suggested that 5ARIs can be used a chemopreventative agent for prostate cancer. The aim of this study was to assess the risk of prostate cancer associated with 5ARI use among men with BPH. Methods: Using Clinical Practice Research Datalink (CPRD) from 1992 to 2011 in UK, prostate cancer risk was retrospectively compared in men with a new diagnosis of BPH, with no history of prostate cancer who were treated with 5ARIs, to men treated with alpha blockers (ABs) and those given no pharmacological treatment. Incidence rate of prostate cancer was calculated by treatment group; the association between BPH treatment group and prostate cancer was estimated by a multivariate Cox model. Results: 77,494 men with newly diagnosed BPH were included. The crude incidence rate of prostate cancer was 892.4 cases per 100,000 person-years amongst those treated with 5ARIs, compared with 1209.0 and 1542.9 in those treated with ABs and untreated individuals, respectively. The HR adjusted for potential confounders was 0.79 (0.72-0.86) for 5ARI vs ABs and 0.72 (0.66-0.79) for 5ARI vs untreated. After excluding the first year after BPH diagnosis, adjusted HRs attenuated to 0.87 (0.79-0.97) for 5ARI vs ABs and 0.97 (0.87-1.08) for 5ARI vs untreated. Conclusion: Among men diagnosed with BPH, we found evidence of lower risks of subsequent prostate cancer in those treated with 5ARIs, but this appeared to be driven by cases diagnosed within a year of BPH, possibly reflecting prevalent prostate cancers that were initially misdiagnosed. After excluding the first year after BPH diagnosis, there was little evidence of a reduced prostate cancer risk in those taking 5ARIs.

Effect of the GnRH stimulation test on Canine Prostatic-Specific Esterase (CPSE).

The gonadotropin-releasing hormone (GnRH) stimulation test is used to investigate testicular production of testosterone (T) when performing a breeding soundness examination. In male dogs with fertility problems, the prostate should also be investigated as prostatic conditions may frequently lower semen quality. Serum concentrations of canine prostatic-specific esterase (CPSE) increase in dogs with benign prostatic hyperplasia (BPH). When performing a breeding soundness examination in a male dog, GnRH administration is frequently done at the beginning of the process and then both T and CPSE are assayed on the same serum sample collected 1 h following the GnRH injection. The aim of this study was to assess whether or not the administration of GnRH may alter CPSE concentrations in dogs with a healthy prostate. Twenty-eight client-owned intact adult male dogs were included in the study. Following a 7-day sexual rest all male dogs underwent a clinical examination and an ultrasonographic examination of the prostatic gland. Prostatic size and parenchyma of every tested dog were evaluated by ultrasonography to assess prostatic conditions. Two different GnRH stimulation protocols were used, A = gonadorelin 50μg/dog SC (n = 15) and B = buserelin 0.12 μg/kg IV (n = 13). T and CPSE concentrations were measured before and 1 h after GnRH administration by a laser-induced fluorescence analysis. Buserelin and gonadorelin were equally effective in causing a significant increase in serum T concentrations in the post GnRH sample. When considering the 28 dogs together, CPSE concentrations did not change following the stimulation test with either GnRH compound; however, in 4/28 cases, the post GnRH value was markedly increased to values compatible with a diagnosis of BPH. There was no difference in the action of buserelin or gonadorelin in causing an increase in serum T concentrations. CPSE secretion was increased in approximately 15% of dogs treated with either buserelin or gonadorelin. Therefore, whenever performing diagnostic testing in intact male dogs, CPSE should not be assayed on a post-GnRH serum sample.

(338) Factors Associated with Sexual Inactivity in Patients Diagnosed with Benign Prostatic Hyperplasia

Abstract Introduction Benign prostatic hyperplasia is a common pathology in patients over 40 years of age, with an important role in male sexual health due to its association with sexual dysfunction, with an elevated proportion of patients with sexual inactivity. Objective The objective of this study is to evaluate the factors associated with sexual activity in patients over 40 years of age with a diagnosis of benign prostatic hyperplasia Methods A retrospective cross-sectional study of 331 patients with a confirmed diagnosis of benign prostatic hyperplasia between January 2021 and November 2021. Both sociodemographic and clinical data were evaluated to associate them to the IIEF questionnaire15 Results Of the 331 patients diagnosed with BPH, 68.5% had erectile dysfunction: severe ED 119 (36%) moderate ED 14.2%, Mild/moderate ED 10.6% andMild in 7.9%. Of the 226 patients with ED, only 50 patients (22.1%) treated their erectile dysfunction. In addition, 33.2% had low sexual desire and the overall prevalence of sexual inactivity in more than 1 month was 43%. Sexual inactivity was classified: in 1-3 months: 29, 5%, 3-6 months 15.4%, 12% more than 6 months and 42.9% more than 12 months. The independent predictors related variables of sexual inactivity were: age over 60 years (PR 1.5), not having a sexual partner (PR 3.2), IEEF-15 (Erectile dysfunction RP 9.2) dissatisfaction with the partner (PR 4.9), low sexual desire (PR 2.9), and lack of confidence (PR 2.5), Severity of IPSS (RP 1.7) and urethral catheter carrier (RP 2.4) Conclusions Sexual inactivity is common in patients diagnosed with BPH and is associated with age and sexual desire. Independently lack of confidence, erectile dysfunction, not having a sexual partner or dissatisfaction with the partner. Of the specific variables related to prostatic hyperplasia, the only ones related were being a carrier of urethral catheter and IPSS severity, the latter associated with decreased sexual frequency and erectile dysfunction. Cardiovascular risk factors had no independent association unlike what was found in other studies. Disclosure No

(065) The Impact of Testosterone-Replacement Therapy (TRT) on Benign Prostatic Hyperplasia (BPH) Incidence and Need for Interventions in Hypogonadal Men

Abstract Introduction Investigations on the application of testosterone-replacement therapy (TRT) in hypogonadal men with benign prostatic hyperplasia (BPH) show contrasting results. While some studies reported increased prostate-related events with TRT, recent evidence suggested that TRT can alleviate BPH symptoms in hypogonadal men. Objective Our main objective was to determine the impact of TRT on BPH incidence in a large cohort of hypogonadal men. We also evaluated the relationship between TRT in hypogonadal men and the need for BPH interventions. Methods This retrospective case-control study used the 2011-2020 IBM MarketScan database to identify males above 18 years old with a hypogonadism diagnosis, and determine if they received TRT. We used ICD-9, -10, CPT, HCPCS, and NDC codes to identify diagnoses, interventions, and medications. We excluded individuals who were diagnosed with congenital genetic disorders (e.g. chromosomal abnormalities), hypothalamic-pituitary disorders, or prostatic adenocarcinoma. BPH diagnosis was the primary outcome of this study, and BPH treatment was the secondary outcome. We ran cox proportional hazard (CPH) models from initial hypogonadism diagnosis to BPH occurrence to investigate the effect of TRT on the development of BPH. We also used CPH models from time of BPH diagnosis to first intervention, to evaluate the impact of TRT on BPH interventions. In all models we controlled for age, geographic region, population density, and comorbidities. We included TRT within the last 6 as a time-varying covariate in the models. For BPH occurrence there was non-proportionality in the effect of TRT. Thus, we ran two CPH models for BPH occurrence, one from first hypogonadism diagnosis to 912 days (2.5 years), and one from 2.5 years to the end of enrollment. Results In our total cohort of 882570 hypogonadal men, 157185 (17.8%) were diagnosed with BPH. Hyperlipidemia was the most common comorbidity detected in 84% and 68% of hypogonadal men with and without BPH respectively. For the first 2.5 years after hypogonadism diagnosis, there was no significant difference for development of BPH between patients on TRT and those who were not on TRT (HR 1.00, 95%CI 0.98-1.01, p=0.66). However, from 2.5 years onward, men who were on TRT had a 32% greater chance for development of BPH (HR 1.32, 95%CI 1.28-1.36, p&amp;lt;0.001). Hypogonadal men with BPH who received TRT showed no significant difference for BPH interventions compared to those who were not on TRT (HR 0.95, 95%CI 0.89-1, p=0.08). Conclusions In the long term, TRT can increase the risk of development of BPH in hypogonadal men. On the other hand, TRT in hypogonadal men with BPH does not change the need for BPH interventions. Our findings indicate that TRT should be used with caution in hypogonadal men who are at risk of developing BPH but further work is needed to clarify this relationship. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Educational/Research grant: Acerus, Coloplast, Endo, Boston Scientific; Consultant: Turtle Health; Hold equity: StreamDx, FirmTech, Maximus.

Preferred methods of Diagnosis and Treatment of Benign Prostatic Hyperplasia adopted by Ayurveda practitioners - A Survey Study

Introduction: Benign Prostatic Hyperplasia (BPH) refers to the nonmalignant growth of prostate gland. In Ayurveda, it can be correlated with Mutraaghata or Mutradosha. Currently used common oral medications such as 5α-reductase inhibitors, α1-Blockers as well as surgical treatment methods such as Transurethral Resection of the Prostate (TURP) have well-known side effects. Ayurveda case studies on BPH show evidence of a potential alternative to these current methods. Objectives: To conduct a survey to know the diagnostic methods and treatment modalities used by different Ayurveda Practitioners in BPH treatment. Materials &amp; Methods: A survey comprising 7 questions in the form of multiple-choice questions on the diagnosis and treatment methods of BPH adopted by Ayurveda Physicians was done. The answers were recorded and interpreted in the form of graphs and pie charts. Results: A total of 57 different Ayurveda practitioners participated in the survey. Prevalence of BPH was seen more in the age group of 60-70 years. Ultrasonography (USG) and Prostate Specific Antigen (PSA) were among the most commonly used diagnostic methods for BPH. Most common symptoms observed were increased frequency of urine, urine incontinence and urine urgency. Uttara Basti (administration of medicine through the urethra) was the most recommended type of treatment procedure preferred, followed by Matra Basti (enema). Avagaha Swedana (Sitz bath) was recommended by most practitioners. The course duration of treatment is advised to be around half to one month. Around 40-60% relief was claimed in patients with BPH by the participants. Conclusion: BPH is a condition that is currently being treated by various Ayurveda practitioners using classical treatment methods such as Uttara Basti, Matra Basti etc. with claimed relief of about 40-60% by the participants.

MP24-12 ASSOCIATION OF RARE MONOGENIC VARIANTS WITH DIAGNOSIS OF BPH USING WHOLE EXOME SEQUENCING IN THE UK BIOBANK

You have accessJournal of UrologyCME1 Apr 2023MP24-12 ASSOCIATION OF RARE MONOGENIC VARIANTS WITH DIAGNOSIS OF BPH USING WHOLE EXOME SEQUENCING IN THE UK BIOBANK Clark Judge, David Nusbaum, Jun Wei, Zhuqing Shi, Andrew Rifkin, S. Lilly Zheng, Brian Helfand, Alexander Glaser, and Jianfeng Xu Clark JudgeClark Judge More articles by this author , David NusbaumDavid Nusbaum More articles by this author , Jun WeiJun Wei More articles by this author , Zhuqing ShiZhuqing Shi More articles by this author , Andrew RifkinAndrew Rifkin More articles by this author , S. Lilly ZhengS. Lilly Zheng More articles by this author , Brian HelfandBrian Helfand More articles by this author , Alexander GlaserAlexander Glaser More articles by this author , and Jianfeng XuJianfeng Xu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003249.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is a common condition that leads to bothersome lower urinary tract symptoms. Polygenic heritability of BPH has been demonstrated using genetic risk scores derived from common single nucleotide polymorphisms, but rare monogenic gene mutations associated with BPH have not been well described. The objective of this study was to determine the impact of rare monogenic variants on the development of BPH. METHODS: A total of 83,631 men from the UK Biobank (UKB) with whole exome sequencing data were included and categorized based on ICD10 diagnosis of BPH (N40). Of men with BPH, 9,697 were further characterized as undergoing transurethral resection of prostate (TURP). The robust SKAT-O, a novel gene-based analysis of pathogenic/likely pathogenic mutations that properly controls for type I error rates due to unbalanced case-control ratio, was used for association tests adjusting for age at recruitment and genetic background. RESULTS: Nineteen candidate genes were identified as associated with BPH in 9,697 cases compared to 73,934 controls at p<0.001 using SKAT-O (Table). However, none of these associations was significant after adjusting for multiple testing (FDR<0.05). For most of these genes, higher carrier rates in patients undergoing TURP was also found. CONCLUSIONS: In this large study of nearly 84,000 men, several candidate genes were identified. Confirmation in independent study populations is required. Identification of monogenic gene mutations associated with BPH may advance our understanding of disease etiology and identify potential therapeutic targets. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e322 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clark Judge More articles by this author David Nusbaum More articles by this author Jun Wei More articles by this author Zhuqing Shi More articles by this author Andrew Rifkin More articles by this author S. Lilly Zheng More articles by this author Brian Helfand More articles by this author Alexander Glaser More articles by this author Jianfeng Xu More articles by this author Expand All Advertisement PDF downloadLoading ...