Irritative Lower Urinary Tract Symptoms Research Articles

Serenoa repens for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate, which can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto, or dwarf palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several phytotherapeutic agents available for the treatment of BPH. This systematic review aimed to assess the effects and harms of Serenoa repens in the treatment of men with LUTS consistent with BPH. We searched for trials in general and in specialized databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE®, EMBASE, CINAHL®, Web of Science, SCOPUS, BIOSIS Previews®, LILACS, ClinicalTrials.gov, Controlled-Trials.com, World Health Organization (WHO), and Google Scholar. We also handsearched systematic reviews, references, and clinical practice guidelines. There were no language restrictions. Trials were eligible if they randomized men with symptomatic BPH to receive preparations of SR (alone or in combination) for at least four weeks in comparison with placebo or other interventions, and included clinical outcomes, such as urologic symptom scales, symptoms, and urodynamic measurements. Eligibility was assessed by at least two independent observers (JT, RM). One review author (JT) extracted Information on patients, interventions, and outcomes which was then checked by another review author (RM). The main outcome measure for comparing the effectiveness of SR with active or inert controls was change in urologic symptom-scale scores, with validated scores taking precedence over non validated ones. Secondary outcomes included changes in nocturia and urodynamic measures. The main outcome measure for harms was the number of men reporting side effects. In a meta-analysis of two high quality long-term trials (n = 582), Serenoa repens therapy was not superior to placebo in reducing LUTS based on the AUA (mean difference (MD) 0.25 points, 95% confidence interval (CI) -0.58 to 1.07). A 72 week trial with high quality evidence, using the American Urological Association Symptom Score Index, reported that SR was not superior to placebo at double and triple doses. In the same trial the proportions of clinical responders (≥ three-point improvement) were nearly identical (42.6% and 44.2% for SR and placebo, respectively), and not significant (RR 0.96, 95% CI 0.76 to 1.22).This update, which did not change our previous conclusions, included two new trials with 444 additional men, an 8.5% (5666/5222) increase from our 2009 updated review, and a 28.8% (1988/1544) increase for our main comparison, SR monotherapy versus placebo control (17 trials). Overall, 5666 men were assessed from 32 randomized, controlled trials, with trial lengths from four to 72 weeks. Twenty-seven trials were double blinded and treatment allocation concealment was adequate in 14.In a trial of high quality evidence (N = 369), versus placebo, SR did not significantly decrease nightly urination on the AUA Nocturia scale (range zero to five) at 72 weeks follow-up (one-sided P = 0.19).The three high quality, moderate-to-long term trials found peak urine flow was not improved with Serenoa repens compared with placebo (MD 0.40 mL/s, 95% CI -0.30 to 1.09).Comparing prostate size (mean change from baseline), one high quality 12-month trial (N = 225) reported no significant difference between SR and placebo (MD -1.22 cc, 95% CI -3.91 to 1.47). Serenoa repens, at double and triple doses, did not improve urinary flow measures or prostate size in men with lower urinary tract symptoms consistent with BPH.

Involvement of Rho-Kinase Signaling Pathways in Nerve Evoked and Spontaneous Contractions of the Guinea Pig Prostate

Men with benign prostatic hyperplasia commonly experience irritative lower urinary tract symptoms, which are due at least in part to enhanced prostatic smooth muscle tone. To provide some insight into the changes that occur in prostatic contractility with age, we examined the contribution of rho-kinase dependent Ca(2+) sensitization in neurogenic and spontaneous contractions of young and aging guinea pig prostates. We used conventional tension recording and electrophysiological intracellular microelectrode recording techniques. The Rho-kinase inhibitor Y-27632 (10 and 100 μM) significantly inhibited electrical field stimulated evoked (neurogenic) contractions in the guinea pig prostate in a dose dependent manner. In addition, Y-27632 (1 and 10 μM) similarly suppressed tetrodotoxin insensitive spontaneous contractions in dose dependent fashion. While Y-27632 at 10 μM decreased spontaneous contractions of young and aging guinea pig prostates, as evidenced by a significant decrease in the AUC, there was no significant difference in the degree of inhibition between the 2 age groups. In contrast to contractile activity, Y-27632 did not affect the generation or modulation of spontaneous slow wave electrical activity, which underlies spontaneous contractions. There are strong indicators that Rho-kinase signaling pathways have a significant role in prostatic smooth muscle contractility, most likely independent of cytosolic Ca(2+) levels. Features of the rho-kinase pathway may well represent alternative, novel future therapeutic targets to reduce prostatic contractility, thereby alleviating the lower urinary tract symptoms arising from benign prostatic hyperplasia.

Outcome of midurethral tape continence surgery in patients with and without urodynamically confirmed stress incontinence

To compare the outcomes of midurethral tape continence surgery in patients with urodynamically confirmed stress incontinence (USI) and patients with symptoms of stress urinary incontinence but normal urodynamic studies (NUDS) and a positive 1-h pad test. Analysis of data collected prospectively from 356 women who underwent tension-free vaginal tape (TVT) surgery from June 1998 to September 2009. There were 25 women with NUDS but a positive pad test. Outcome measures in these 25 women were compared with 65 women with urodynamically confirmed stress incontinence. These 65 women were chosen as suitable controls from the group of 331 potential controls. All the women underwent TVT surgery under local or spinal anaesthesia. The outcome measures were: (1) absence of stress urinary incontinence symptoms, (2) new occurrence of lower urinary tract irritative symptoms (LUTS), (3) persistent voiding dysfunction (VD), and (4) recurrent urinary tract infections (UTIs). Following TVT, stress incontinence was absent in 100% and 97% of patients in the NUDS and USI groups respectively. The occurrence of LUTS was 4% and 4.6% in the NUDS and USI groups, while VD was found in 4% and 4.6% and recurrent UTIs in 8% and 6.1% of the groups respectively. There were no significant differences in outcomes following TVT in patients with and without urodynamically confirmed stress urinary incontinence.

617 EROSION OF CALCIFIED MARCROPLASTIQUE: A LATE COMPLICATION FOLLOWING INJECTION FOR VESICO-URETERAL REFLUX

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012617 EROSION OF CALCIFIED MARCROPLASTIQUE: A LATE COMPLICATION FOLLOWING INJECTION FOR VESICO-URETERAL REFLUX Justin Lee, Bryce Weber, Victor Figueroa, Rodrigo Romao, Joao L. Pippi Salle, Darius Bagli, Antoine Khoury, and Armando Lorenzo Justin LeeJustin Lee Toronto, Canada More articles by this author , Bryce WeberBryce Weber Toronto, Canada More articles by this author , Victor FigueroaVictor Figueroa Toronto, Canada More articles by this author , Rodrigo RomaoRodrigo Romao Toronto, Canada More articles by this author , Joao L. Pippi SalleJoao L. Pippi Salle Toronto, Canada More articles by this author , Darius BagliDarius Bagli Toronto, Canada More articles by this author , Antoine KhouryAntoine Khoury Orange, CA More articles by this author , and Armando LorenzoArmando Lorenzo Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.695AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Polydimethylsiloxane (Macroplastique®) gained acceptance in many parts of the world as an injectable bulking agent for correction of vesicoureteral reflux (VUR). Although regarded as safe and effective, the long-term consequences of such intervention remain largely unknown. Herein we report one important complication detected during follow-up in a single institution series. METHODS A total of 274 children underwent subureteric injection between 1998 and 2004, being regularly monitored since. Of these, all patients that have presented with submucosal calcification in the prior area of injection have been prospectively captured. Clinical features and data on patient characteristics were obtained by chart review. RESULTS Four patients ages 10, 13, 13 and 15 developed submucosal bladder calcifications 5, 7, 9, and 10 years following the initial injection for VUR. In all, the intervention was uneventful and no clinical or sonographic abnormalities were detected after the procedure. Patients subsequently presented with worsening hydronephrosis, hematuria and irritative lower urinary tract symptoms. On ultrasonography and X-ray we discovered calcifications at the site of prior injection. At time of surgery the calcified material was extracted endoscopically after unroofing the overlying eroded mucosa or resected along with its adjacent fibrotic pseudo-capsule through cystotomy. To date no recurrences have been detected and none of the patients have undergone ureteral reimplantation. CONCLUSIONS This experience calls attention to a potentially important yet rare complication that can be encountered following endoscopic injection with Macroplastique®. Monitoring of these patients appears warranted as long-term issues with new injectable materials remains largely unknown. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e251 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Lee Toronto, Canada More articles by this author Bryce Weber Toronto, Canada More articles by this author Victor Figueroa Toronto, Canada More articles by this author Rodrigo Romao Toronto, Canada More articles by this author Joao L. Pippi Salle Toronto, Canada More articles by this author Darius Bagli Toronto, Canada More articles by this author Antoine Khoury Orange, CA More articles by this author Armando Lorenzo Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Role of Ultrasound-Estimated Bladder-Wall Thickness In the Prediction of Detrusor Overactivity in Patients with Irritative Lower Urinary Tract Symptoms

The Role of Ultrasound-Estimated Bladder-Wall Thickness In the Prediction of Detrusor Overactivity in Patients with Irritative Lower Urinary Tract Symptoms

Ketamine-associated vesicopathy

An 18-year-old male with a 3-year history of weekly recreational ketamine abuse had developed severe irritative lower urinary tract symptoms (LUTS, including urinary urgency, frequency and dysuria) and suprapubic pain of 6-months duration. He was otherwise well and denied other substance use. Physical examination revealed localized suprapubic tenderness. A urinalysis showed non-bacterial pyuria and was negative for tuberculosis. Results of all the blood tests and urine cytology were normal. An intravenous urogram (IVU) in standing position …

Evaluation of prostate cancer prevalence in Iranian male population with increased PSA level, a one center experience

Purpose:This study was conducted to evaluate the incidence of prostate cancer (PCa) in Iranian male patients with increased prostate-specific antigen (PSA), and normal or abnormal digital rectal examination (DRE) that underwent prostate biopsy.Materials and methods:From March 2006 to April 2009, a total of 346 consecutive males suspected of having PCa due to increased PSA levels underwent transrectal ultrasonography (TRUS)-guided sextant biopsy of the prostate. The total PSA (tPSA), demographic data, incidence of PCa, benign prostate hyperplasia (BPH), and prostatitis were assessed.Results:The patients were divided into two groups according to their PSA values (group A serum tPSA level, 4–10 ng/mL; group B serum tPSA level, 10.1–20.0 ng/mL). Of the 346 biopsied cases, 193 cases (56%) had PCa, 80 cases (23%) had BPH, and 73 cases (21%) had prostatitis. The mean PSA and the age of the carcinoma group were significantly higher than those of the benign group (P < 0.01). The biopsy results were grouped as PCa, BPH, and prostatitis. Incidence of PCa for group A and group B cases were 115 cases (51%), and 78 cases (65%), respectively. In the case of PCa, BPH, and prostatitis, the mean PSAs were 10.02 ng/mL, 8.76 ng/mL, and 8.41 ng/mL, respectively (P < 0.40).Conclusion:TRUS-guided prostate biopsy and interpretation by a skilled team is highly recommended for early detection of PCa or its ruling-out. It seems that a PSA cutoff value of 4 ng/mL may be applied to the Iranian population. Although the chance of PCa is high in the PSA levels of 4–10 ng/mL, the combination of some data, like age and prostate volume, can decrease the rate of unnecessary prostate biopsies. We recommend prostate biopsy when PSA and/or DRE is elevated in symptomatic patients with obstructive and/or irritative lower urinary tract symptoms (LUTS) such as dysuria, frequency, or nocturia. Due to the very high incidence of PCa in the patients with PSA greater than 10 ng/mL, TRUS-guided biopsy is indicated, whatever the findings on DRE and/or LUTS, since the PCa detection rate is high.

WITHDRAWN: Cernilton for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH), nonmalignant enlargement of the prostate, can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH has been growing steadily. Cernilton, prepared from the rye-grass pollen Secale cereale, is one of the several phytotherapeutic agents available for the treatment of BPH. This systematic review aims to assess the effects of Cernilton on urinary symptoms and flow measures in men with benign prostatic hyperplasia (BPH). Trials were searched in computerized general and specialized databases (MEDLINE, EMBASE, Cochrane Library, Phytodok), by checking bibliographies, and by contacting manufacturers and researchers. Trials were eligible if they were: (1) randomized controlled trials or controlled clinical trials comparing Cernilton with placebo or other BPH medications in men with BPH; and (2) included clinical outcomes such as urologic symptom scales, symptoms, or urodynamic measurements. Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. Main outcome measure for comparing the effects of Cernilton with placebo and standard BPH medications were the change in urologic symptoms scales. Secondary outcomes included changes in nocturia as well as urodynamic measures (peak and mean urine flow, residual volume, prostate size). Main outcome measure for side effects was the number of men reporting side effects. Four hundred forty-four men were enrolled in two placebo-controlled and two comparative trials lasting from 12 to 24 weeks. Three studies used a double-blind method although treatment allocation concealment was unclear in all. Cernilton improved "self rated urinary symptoms" (percent reporting satisfactory or improving symptoms) versus placebo and Tadenan. The weighted risk ratio (RR) for self-rated improvement versus placebo was 2.40 (95% CI = 1.21 to 4.75), and the weighted RR versus Tadenan was 1.42 (95% CI = 1.21 to 4.75). Cernilton reduced nocturia compared with placebo and Paraprost. Versus placebo, the weighted RR was 2.05 (95% CI = 1.41 to 3.00), and versus Paraprost, the WMD was -0.40 times per evening (95% CI = -0.73 to -0.07). Cernilton was not more effective than placebo or the comparative study agents in improving urinary flow rates, residual volume or prostate size. Adverse events were rare and mild. The withdrawal rate for Cernilton was 4.8% compared to 2.7% for placebo and 5.2% for Paraprost. The Cernilton trials analyzed were limited by short duration, limited number of enrollees, gaps in reported outcomes, and unknown quality of the preparations utilized. The comparative trials lacked a proven active control. The available evidence suggests Cernilton is well tolerated and modestly improves overall urologic symptoms including nocturia. Additional randomized placebo and active-controlled trials are needed to evaluate the long-term clinical effectiveness and safety of Cernilton.

Intravesical foreign bodies: a case report and a review of the literature

AimWe report a case of intravesical polyvinyl-coated electric wire in the urinary bladder.Case reportA 34-year-old man presented in our clinic with irritative lower urinary tract symptoms. Three weeks earlier he had seen and felt a wire in his urethra of which he was unaware of the origin. Radiologic evaluation revealed an electric wire completely coiled up in the urinary bladder. It was removed through a suprapubic cystotomy.DiscussionPatients are usually too ashamed to admit the cause of an intravesical foreign body, which is often sexual or erotic in origin. Radiologic evaluation usually reveals the nature and size of the foreign body in the bladder of patients evaluated for recurrent urinary tract infection. Open surgery or an endoscopic approach may be used for their extraction.

Medial thigh pain: An unusual presentation of giant calculi in sigmoid neobladder

Calculi in a neobladder usually present with irritative lower urinary tract symptoms, flank pain, and haematuria. We report a case of giant stones in a sigmoid neobladder, who presented with medial thigh pain.

Synthesis and α 1-adrenoceptor antagonist activity of tamsulosin analogues

Tamsulosin (−)- 1 is the most utilized α 1-adrenoceptor antagonist in the benign prostatic hyperplasia therapy owing to its uroselective antagonism and capability in relieving both obstructive and irritative lower urinary tract symptoms. Here we report the synthesis and pharmacological study of the homochiral (−)- 1 analogues (−)- 2–(−)- 5, bearing definite modifications in the 2-substituted phenoxyethylamino group in order to evaluate their influence on the affinity profile for α 1-adrenoceptor subtypes. The benzyl analogue (−)- 3, displaying a preferential antagonist profile for α 1A-than α 1D-and α 1B-adrenoceptors, and a 12-fold higher potency at α 1A-adrenoceptors with respect to the α 1B subtype, may have improved uroselectivity compared to (−)- 1.

Percutaneous Urinary Drainage and Ureteric Stenting in Malignant Disease

Patients with malignant ureteric obstruction often have a poor life expectancy, even if relief of urinary obstruction is achieved. Careful discussion between the patient, their family and all health care professionals involved in the case must be undertaken before any intervention. The goal of treatment in the palliative setting may be to offer symptom relief, avoid complications from renal insufficiency or allow further oncological systemic therapy. The obstruction can be relieved by placement of a percutaneous nephrostomy tube, a ureteric stent or, more rarely, due to the palliative nature of the patients, a more complex open surgical procedure. Nephrostomy tubes offer excellent drainage and can be placed under a local anaesthetic, although they do require and a bag, which can reduce a patient’s quality of life. Bleeding, sepsis, bowel transgression and pleural complications can all be encountered when inserting a nephrostomy. JJ stents in comparison have a higher failure rate due to extrinsic compression and usually require a general anaesthetic for placement, although significant bleeding and other complications are reduced. Quality of life is still affected by irritative lower urinary tract symptoms. Metallic ureteric stents have recently been developed to try and offer better relief of obstruction than polymeric stents with fewer side-effects and increased intervals between changes. Initial data appear encouraging, although further trials are needed. No blueprint for treatment of malignant ureteric obstruction exists and each case must be decided on an individual basis with a fully informed patient.

Development of Macroplastique® Bolus Calcification Detected During Long Term Follow-Up After Injection for Vesico-Ureteral Reflux

Purpose Macroplastique® gained acceptance in many parts of the world as an injectable bulking agent for correction of vesico-ureteral reflux. As with other substances, the long-term consequences of such intervention remain largely unknown. Herein we present one important complication detected during follow-up in a single institution series. Material and Methods A total of 232 children underwent subureteric injection between 1998 and 2004, being regularly monitored since. Of these, all patients that have presented with submucosal stones in the prior area of injection have been prospectively captured. Clinical features and data on patient characteristics were obtained by chart review. Results Three patients ages 10, 13 and 15 developed submucosal bladder calcifications 5, 7 and 9 years following the initial injection for vesicoureteral reflux. In all the intervention was uneventful and no clinical or sonographic abnormalities were detected after the procedure. Patients subsequently presented with worsening hydronephrosis, hematuria and irritative lower urinary tract symptoms. On ultrasound and pelvis X-ray we encountered calcifications at the site of prior injection. At time of surgery the calcified material was extracted after unroofing the overlying eroded mucosa. To date no recurrences have been detected and none of the patients have undergone ureteral reimplantation. Conclusions This experience calls attention to a potentially important complication that can be encountered following endoscopic injection with Macroplastique®. Monitoring of these patients appears warranted as long-term issues with new injectable materials remains largely unknown.

The impact of irritative lower urinary tract symptoms on erectile dysfunction in aging Taiwanese males

Objective. This study assessed the possible associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in aging Taiwanese males and investigated the impact of various aspects of LUTS on ED.Methods. A free health screening for aging males (≥40 years old) was conducted in Kaohsiung Medical University Hospital. All the subjects had completed clinical data and answered questionnaires. ED and LUTS were assessed by validated symptom scales: the International Index of Erectile Function-5 (IIEF-5) and the International Prostate Symptom Score (IPSS).Results. A total of 339 eligible patients enrolled in this study with a mean age of 60.1 years old. In multiple logistic regression analysis, age and IPSS (p < 0.001 and p = 0.013, respectively) were significantly associated with ED after controlling other comorbidities. In a further age-adjusted multiple regression analysis, our results showed that irritative symptoms (p = 0.042) have a more significant association with ED than the obstructive symptoms (p = 0.101).Conclusions. Our results indicate that age and LUTS are the two most independent risk factors for ED. Aging Taiwanese males with LUTS are at increasing risk for ED, especially for those with significant irritative symptoms.

UP-3.073: Dystrophic Calcification of Urinary Bladder Associated with Ketamine Use

The use of Ketamine has been reported to cause ulcerative cystitis leading to irritative lower urinary tract symptoms. Ketamine and its metabolites norketamine and hydroxynorketamine can be measured in high quantities in the urine of patients using ketamine. The evidence in case of Ketamine use came from History and response to cessation of use. We present a case of Dystrophic calcification in the urinary bladder in association with use of Ketamine as a recreational drug.

Associations Between C-Reactive Protein and Benign Prostatic Hyperplasia/Lower Urinary Tract Symptom Outcomes in a Population-based Cohort

Inflammation may play a role in the development of benign prostatic hyperplasia and/or lower urinary tract symptoms (LUTS). Higher levels of C-reactive protein (CRP) may therefore be associated with the development of these outcomes. The authors examined the association of CRP levels measured in 1996 with rapid increases in prostate volume, prostate-specific antigen levels, and LUTS as well as rapid decreases in peak flow rates (through 2005) in a population-based cohort of men residing in Olmsted County, Minnesota. Men with CRP levels of > or =3.0 mg/L were more likely to have rapid increases in irritative LUTS (odds ratio (OR) = 2.14, 95% confidence interval (CI): 1.18, 3.85) and rapid decreases in peak flow rates (OR = 2.54, 95% CI: 1.09, 5.92) compared with men with CRP levels of <3.0 mg/L. CRP levels were not significantly associated with rapid increases in prostate volume, obstructive LUTS, or prostate-specific antigen levels. Associations were attenuated after adjusting for age, body mass index, hypertension, and smoking history (irritative LUTS: OR = 2.00, 95% CI: 1.04, 3.82; peak flow rate: OR = 2.45, 95% CI: 0.73, 8.25). These results suggest that rapid increases in irritative LUTS and rapid decreases in peak flow rates may be due to inflammatory processes.

St. Sauver et al. Respond to "Lower Urinary Tract Symptoms and Inflammation"

We appreciate the opportunity to respond to the erudite commentary by Drs. Freedland and Aronson (1) regarding our manuscript examining associations between C-reactive protein levels and development of lower urinary tract symptoms (LUTS) and other urologic outcomes (2). The authors correctly note that the associations we found of elevated C-reactive protein levels with irritative LUTS and peak fl ow rates were restricted to only the most rapid worsening of these outcomes. Because C-reactive protein is a very nonspecific marker of systemic inflammation, it may be that inflammation in the urogenital tract needs to be substantial before systemic inflammatory markers are affected; consequently, this possibility may be why we saw associations of only elevated C-reactive protein levels with the most rapid increases in irritative LUTS and the most rapid declines in peak flow rates. Therefore, we completely agree with the authors that better markers of inflammation that are more proximal to the urologic system could substantially enhance our understanding of the role of inflammation in the development of LUTS and prostatic enlargement. Additionally, as noted by the authors (1), inflammation found in prostate biopsies has been only weakly associated with either irritative or obstructive symptoms (3). It is clear that LUTS may develop even in the absence of increases in prostate volume, and it is possible that inflammation in other components ofthe urogenital system could play an important role in the development of LUTS. Unfortunately, prostate biopsies are invasive, and the question of how to measure inflammation in the bladder, the bladder neck, or even the urethra remains perplexing. The discovery of inflammatory markers that are tightly linked to inflammation in the urogenital tract but that could be tested from serum or urine would be extremely useful in furthering our understanding of how prostatic versus nonprostatic inflammation might contribute to the development of LUTS. Drs. Freedland and Aronson (1) also note that prospective trials of antiinflammatory medications to treat established LUTS or prostatic enlargement have been disappointing. However, the benefit of antiinflammatory agents might be realized in primary rather than secondary prevention of these conditions. It is possible that inflammation may play a role in the development of LUTS or prostatic enlargement, but, once these conditions are established, antiinflammatory agents might have little effect in alleviating these conditions. Intervening earlier in the pathogenic process might help prevent their development. Indeed, the authors note the recent study in which statins were associated with a reduction in prostate-specific antigen levels in healthy men, suggesting an effect on the prostate (4). Additionally, in our own cohort, we previously found that long-term nonsteroidal antiinflammatory drug use was associated with a decreased likelihood of developing LUTS and an enlarged prostate (5). Future studies could help determine whether inhibiting inflammatory processes before LUTS or prostatic enlargement is established might be useful in preventing these conditions.

Serenoa repens for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate, can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto, or dwarf palm plant, Serenoa repens (also known by its botanical name of Sabal serrulatum), is one of several phytotherapeutic agents available for the treatment of BPH. This systematic review aimed to assess the effects of Serenoa repens in the treatment of LUTS consistent with BPH. Trials were searched in computerized general and specialized databases (MEDLINE, EMBASE, and The Cochrane Library), by checking bibliographies, and by handsearching the relevant literature. Trials were eligible if they (1) randomized men with symptomatic BPH to receive preparations of Serenoa repens (alone or in combination) for at least four weeks in comparison with placebo or other interventions, and (2) included clinical outcomes such as urologic symptom scales, symptoms, and urodynamic measurements. Eligibility was assessed by at least two independent observers. Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The main outcome measure for comparing the effectiveness of Serenoa repens with placebo or other interventions was the change in urologic symptom-scale scores. Secondary outcomes included changes in nocturia and urodynamic measures. The main outcome measure for side effects or adverse events was the number of men reporting side effects. In this update 9 new trials involving 2053 additional men (a 64.8% increase) have been included. For the main comparison - Serenoa repens versus placebo - 3 trials were added with 419 subjects and 3 endpoints (IPSS, peak urine flow, prostate size). Overall, 5222 subjects from 30 randomized trials lasting from 4 to 60 weeks were assessed. Twenty-six trials were double blinded and treatment allocation concealment was adequate in eighteen studies.Serenoa repens was not superior to placebo in improving IPSS urinary symptom scores, (WMD (weighted mean difference) -0.77 points, 95% CI -2.88 to 1.34, P > 0.05; 2 trials), finasteride (MD (mean difference) 0.40 points, 95% CI -0.57 to 1.37, P > 0.05; 1 trial), or tamsulosin (WMD -0.52 points, 95% CI -1.91 to 0.88, P > 0.05; 2 trials).For nocturia, Serenoa repens was significantly better than placebo (WMD -0.78 nocturnal visits, 95% CI -1.34 to -0.22, P < 0.05; 9 trials), but with the caveat of significant heterogeneity (I(2) = 66%). A sensitivity analysis, utilizing higher quality, larger trials (>/= 40 subjects), demonstrated no significant difference (WMD -0.31 nocturnal visits, 95% CI -0.70 to 0.08, P > 0.05; 5 trials) (I(2) = 11%). Serenoa repens was not superior to finasteride (MD -0.05 nocturnal visits, 95% CI -0.49 to 0.39, P > 0.05; 1 trial), or to tamsulosin (per cent improvement) (RR) (risk ratio) 0.91, 95% CI 0.66 to 1.27, P > 0.05; 1 trial).Comparing peak urine flow, Serenoa repens was not superior to placebo at trial endpoint (WMD 1.02 mL/s, 95% CI -0.14 to 2.19, P > 0.05; 10 trials), or by comparing mean change (WMD 0.31 mL/s, 95% CI -0.56 to 1.17, P > 0.05; 2 trials).Comparing prostate size at endpoint, there was no significant difference between Serenoa repens and placebo (MD -1.05 cc, 95% CI -8.84 to 6.75, P > 0.05; 2 trials), or by comparing mean change (MD -1.22 cc, 95% CI -3.91 to 1.47, P > 0.05; 1 trial). Serenoa repens was not more effective than placebo for treatment of urinary symptoms consistent with BPH.

Risk factors for deterioration of erectile function: the Krimpen study

This report from the Krimpen study explored the relationship between the determinants for worsening of erectile function in the open population. In Krimpen aan den IJssel (a municipality near Rotterdam), all men aged 50-75 years, without cancer of the prostate or the bladder and without a history of radical prostatectomy or neurogenic bladder disease, were invited to participate in June 1995. The response rate was 50%. The follow-up was until June 2004. At baseline a visit to a health centre for the measurement of urinalysis, height, weight and blood pressure was part of the ongoing study. During baseline and at the first follow-up, second follow-up and third follow-up, a self-administered booklet consisting of a compilation of validated questionnaires including the International Continence Society male sex questionnaire was completed. At the urology outpatient clinic, a urological workup was measured. All participants were asked to keep a frequency-volume chart for 3 days. A multivariate Cox-proportional hazard model was constructed to find the determinants of worsening of erectile function, correcting for age. Total follow-up time was 4948 person years consisting of 975 men. During follow-up, 441 events of worsening of erectile function occurred. Multivariate Cox-proportional hazard ratio analyses showed that body mass index (BMI), irritative lower urinary tract symptoms, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and sexual inactivity were determinants with significant hazard ratios. In addition to age, determinants for a deterioration of erectile function based on multivariate longitudinal analyses are BMI, diabetes mellitus, COPD, sexual inactivity and irritative IPSS. The mechanism of various determinants is discussed.

Holmium laser treatment of a vesical calculus secondary to TVT procedure

A case of vesical calculus is being presented as a complication of TVT procedure done for severe stress incontinence in an elderly lady. The patient, who presented with obstructive and irritative lower urinary tract symptoms, needed an indwelling catheter. Non-enhanced CT scan of abdomen confirmed an intraluminal calcific density in the anterior wall of urinary bladder just left of midline. On cystoscopy, a blue-colored polypropylene mesh of the TVT was visible at the ends of this calculus, holding it to the anterior vesical wall. Holmium laser was used to disintegrate the ends of the mesh deep in the submucosa of the urinary bladder. To our knowledge, this is a unique case of calculus forming near the dome of bladder over a TVT mesh presenting 3 years post-operatively and treated with holmium laser.