Improvement In Maximum Flow Rate Research Articles

Sustained beneficial effects of intraprostatic botulinum toxin type A on lower urinary tract symptoms and quality of life in men with benign prostatic hyperplasia

To present a comprehensive experience with intraprostatic botulinum toxin-type A (BoNT-A) injection in men with symptomatic benign prostatic hyperplasia (BPH) and to assess the efficacy on lower urinary tract symptoms (LUTS) and quality of life (QoL). In all, 41 men (mean age 69.1 years, sd 7.1 ) with an International Prostate Symptom Score of > or = 8, peak flow rate of < 12 mL/s, and who were refractory to medical treatment were injected with BoNT-A (Botox, Allergan, Inc., CA, USA) at 100 U (21 men, for prostate volume < 30 mL) or 200 U (20, for prostate volume > 30 mL) into the prostate transperineally under transrectal ultrasonography guidance. Study exclusion criteria were confirmed or suspected malignancy, previous pelvic surgery or trauma and previous invasive treatment for BPH. The clinical effects were evaluated at baseline and at 1, 3 and 6 months after treatment. There were no significant local or systemic side-effects in any men. LUTS and QoL indices improved by > 30% in 31 of the 41 men (76%), and four of five men with urinary retention for > 1 month could void spontaneously at 1 week to 1 month after the BoNT-A injection. In 12 of 41 men (29%) there was no change in prostate volume, yet seven of these men still had a > 30% improvement in maximum flow rate, LUTS and QoL. The efficacy was sustained at 12 months. BoNT-A injected into the prostate is safe and effective for men with symptomatic BPH. The mechanisms of relief of symptoms might not depend totally on the volume shrinkage; the inhibitory effect on the smooth muscle tone and aberrant sensory function might also be important.

Transurethral Needle Ablation of the Prostate: An Alternative Minimally Invasive Therapeutic Concept in the Treatment of Benign Prostate Hyperplasia

Alternative minimally invasive methods treating benign prostate hyperplasia (BPH) have become more and more important. Transurethral needle ablation (TUNA^TM) has been demonstrated to be effective in both canine and the human prostate. The goal of our study was to prove the safety, feasibility and tolerance of this new procedure. In this prospective nonrandomized study, 33 patients underwent TUNA^TM-treatment. One, 3 and 6 months postoperatively, follow-up examinations were carried out assessing urodynamic parameters such as urinary flow rates, residual urine levels, and IPSS-scores. During the last visit additional cystomanometry and urethrocystoscopy were done. Six months postoperatively IPSS-score and residual urine volumes were decreased by 50% (range: 1–72%) and 75% (range: 12–97%). Improvement in maximum flow rate was 63% (range: 5–125%). No serious postoperative complications occurred. After a short ‘learning period’ most of the treatments where performed as an out-patient-procedure so the patients could leave the hospital without the need for indwelling catheters. The TUNA^TM appears to be a minimally invasive and safe out-patient procedure for the treatment of selected cases of BPH.

Long-term Effects of Finasteride on Invasive Urodynamics and Symptoms in Treatment of Patients with Bladder Outflow Obstruction Due to Benign Prostatic Hyperplasia

Purpose We assess the long-term effects of finasteride on bladder outlet obstruction and symptoms in the treatment of patients with benign prostatic hyperplasia. Materials and Methods Of the original 36 patients assigned to treatment with 5 mg. finasteride daily (group 1) or placebo (group 2) for 6 months 27 completed an open extension study of 5 mg. finasteride for 4 more years. The possible relief of bladder outlet obstruction was monitored with repeated pressure-flow studies at baseline, 6 months and 4.5 years. Results The treatment resulted in a further slight decrease in detrusor pressure at maximum flow rate in group 1 and a significant decrease in group 2 during the 4-year period, whereas improvement in maximum flow rate did not achieve statistical significance. Concomitantly, there was a significant improvement in obstructive and irritative symptoms. Conclusions Finasteride decreases bladder outlet obstruction moderately and only occasionally relieves it completely. However, the decrease in obstruction achieved in many patients is sufficient to improve the symptoms significantly. The beneficial effect is long-lasting.

Doxazosin in benign prostatic hyperplasia: Effects on blood pressure and urinary flow in normotensive and hypertensive men

Objectives To assess the effects of doxazosin, a selective α 1 adrenoceptor inhibitor, on blood pressure and urinary flow in normotensive and hypertensive (sitting diastolic blood pressure more than 90 mm Hg) men with benign prostatic hyperplasia (BPH). Methods Patients (n = 232) with bladder outflow obstruction due to BPH, classified as normotensive or hypertensive, were enrolled into two, double-blind, placebo-controlled studies. After a washout period of at least 1 week, patients were randomized to doxazosin or placebo, and treatment was continued for 9 to 12 weeks. In addition to measures of standing and sitting blood pressures, the patients' response to treatment was also assessed with regard to urinary flow. Although the protocols differed, they were consistent enough to permit pooling of a number of variables. Results Results from the two studies demonstrated that doxazosin produced a clinically significant reduction in blood pressure only in hypertensive patients (systolic blood pressure/diastolic blood pressure: baseline 162/99 mm Hg, endpoint 143/89 mm Hg); little or no reduction was evident in normotensive patients (systolic blood pressure/diastolic blood pressure: baseline 139/82 mm Hg, endpoint 134/78 mm Hg). Similar effects in terms of uroflow were seen in hypertensive and normotensive patients. The maximum flow rate in hypertensive patients treated with doxazosin increased from 8.82 to 10.84 mL/s (+ 23%) and in normotensive patients treated with doxazosin from 8.52 to 10.90 mL/s (+ 28%). A greater than 30% improvement in maximum flow rate was achieved in 46 of 97 (47.4%) patients in the doxazosin group and 26 of 98 (26.5%) patients in the placebo group. Treatment with doxazosin was effective and generally well tolerated. The majority of side effects were mild or moderate, only slightly higher in the active treatment group compared with placebo, and similar in hypertensive and normotensive patients. Conclusions Treatment with doxazosin is effective and well tolerated in the treatment of BPH. It appears to be a particularly appropriate therapy for men with both BPH and hypertension but can be safely administered to normotensive men without causing significant blood pressure reduction. The beneficial effects on urinary flow are similar, irrespective of blood pressure.

The use of a metallic stent in 32 patients with benign prostatic hypertrophy. Preliminary results and 3 months of follow-up

A prospective noncontrolled study of the safety and potential efficacy of the metallic stent was performed on 32 patients with benign prostatic hypertrophy. Mean age was 76.6 years (range, 56-98 years), and mean prostatic volume was 24.2 cm3. The patients were selected on the basis of a quantitative symptom score (QSS), uroflowmetry measurements, and residual urine volume (RU). Nineteen patients had urinary retention and remaining 13 patients had moderate symptoms and signs of prostatism. Placing the stent was successfully done in 31 patients (97%). It took 15 minutes to place the stent using transabdominal and/or endorectal sonography. After 3 months, 27 patients (87%) showed improved QSS. In patients with dysuria, maximum flow rate (MFR) and RU before treatment were 6.9 +/- 1.7 ml/sec and 112.3 +/- 61.8 ml, respectively. After treatment, they improved to 12.3 +/- 2.7 ml/sec and 12.7 +/- 6.7 ml, respectively. On the other hand, all patients who had urinary retention were able to urinate just after treatment, and MFR and RU were 12.9 +/- 3.6 ml/sec and 24.4 +/- 43.3 ml, respectively. Evaluation on the basis of improvement in MFR and reduction in RU showed that the stent was effective in 71% of total patients (22 out of 31 patients), 94% of the patients with urinary retention (17 out of 18 patients). The overall clinical efficacy of this stent was 68% (21 patients). There were no major complications such as urge incontinence and urinary tract infection during follow-up. Although proximal migration of the stent was observed in 6 patients, the stent could be taken out and replaced in 4 patients. From the above results, we conclude that the metallic stent is useful for the treatment of prostatism and urinary retention.

Evolution of urinary flow rate with prostatectomy

Urinary flow rate was studied before and after transurethral prostatectomy in 53 patients. An average of 43.8 per cent improvement in maximum flow rate after transurethral prostatectomy was observed in this series. Improvement of maximum flow rate occurred in 71 per cent of patients. Half of the cases in which flow rate did not improve were chronic prostatitis. Uroflowmetry cannot be utilized as a quality index of a transurethral prostatic resection as long as the degree of detrusor deterioration is not assessed. There is a relationship between the degree of preoperative symptoms and the degree of postoperative urinary flow improvement. The degree of preoperative symptoms and urinary flow deviation are not related which suggests that uroflowmetry adds to the assessment of symptoms in the determination of the degree of obstruction. Patients presenting difficulty of urination have a greater chance to demonstrate urinary flow improvement after surgery than patients complaining of urinary frequency.