Management Of Benign Prostatic Hypertrophy Research Articles

Trends in Prostate Specific Antigen (PSA) testing and prostate cancer incidence and mortality in Australia: A critical analysis

BackgroundPopulation trends in PSA testing and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA testing, prostate cancer incidence and mortality in Australia and factors that influence them. MethodsWe calculated and described standardised time trends in PSA tests, prostate biopsies, treatment of benign prostatic hypertrophy (BPH) and prostate cancer incidence and mortality in Australia in men aged 45–74, 75–84, and 85 + years. ResultsPSA testing increased from its introduction in 1989 to a peak in 2008 before declining in men aged 45–84 years. Prostate biopsies and cancer incidence fell from 1995 to 2000 in parallel with decrease in trans-urethral resections of the prostate (TURP) and, latterly, changes in pharmaceutical management of BPH. After 2000, changes in biopsies and incidence paralleled changes in PSA screening in men 45–84 years, while in men ≥85 years biopsy rates stabilised, and incidence fell. Prostate cancer mortality in men aged 45–74 years remained low throughout. Mortality in men 75–84 years gradually increased until mid 1990s, then gradually decreased. Mortality in men ≥ 85 years increased until mid 1990s, then stabilised. ConclusionAge specific prostate cancer incidence largely mirrors PSA testing rates. Most deviation from this pattern may be explained by less use of TURP in management of BPH and consequent less incidental cancer detection in TURP tissue specimens. Mortality from prostate cancer initially rose and then fell below what it was when PSA testing began. Its initial rise and fall may be explained by a possible initial tendency to over-attribute deaths of uncertain cause in older men with a diagnosis of prostate cancer to prostate cancer. Decreases in mortality rates were many fold smaller than the increases in incidence, suggesting substantial overdiagnosis of prostate cancer after introduction of PSA testing.

Ex Vivo Comparison of Efficiency, Safety, and Surgeon Satisfaction in Four Commercial Morcellators.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the management of benign prostatic hypertrophy. Although advancements in laser technology have led to clinical improvements in the enucleation portion of HoLEP, the morcellation aspect of HoLEP is often the rate-limiting step. We sought to compare efficiency and surgeon satisfaction in four commercial morcellators. Methods: This was an ex vivo study comparing four commercial morcellators: the Wolf Piranha™, the Lumenis VersaCut™, the JenaSurgical MultiCut Solo™, and the Hawk™ Morcellator. Four surgeons with significant experience performing HoLEPs participated. Surgeons tested each device to morcellate two different prostate models (1) morcellating as much microwave-cooked chicken breast in 10 minutes and (2) timed morcellation of bull testicles. Surgeons completed subjective surveys after each morcellator trial. Objective outcomes included the following: morcellation efficiency (g/min morcellated) and aspiration power (time to aspirate 1 L of saline). Means of continuous variables were compared using analysis of variance. Categorical variables were compared using chi-square tests. Statistical analyses were performed using SAS 9.4 (2019). Results: Comparing subjective outcomes, the Piranha™ was chosen as the safest morcellator (p = 0.0058). The least safe morcellator was thought to be the MultiCut by 75% of surgeons (p = 0.046). The Piranha™ was chosen as the most effective morcellator by 75% of surgeons (p = 0.046). Comparing objective parameters between the morcellators, the Piranha™ had the fastest aspiration time (43.50 ± 10.34 seconds, p = 0.0116). There were no significant differences in morcellation efficiency when using chicken breast (p = 0.3096). However, when comparing the morcellation efficiency using bull testicles, the Piranha™ had the highest efficiency at 39.68 ± 3.57 g/min (p = 0.0268). Conclusion: In this ex vivo study comparing four different commercially available morcellators, the Piranha™ had the highest aspiration power. No significant differences were found in morcellation efficiency using microwave-cooked chicken breast. The Piranha™ was felt to be the safest and most effective morcellator.

Effects of Exercise on Serum Inflammatory Markers and NF-kb, COX-2 mRNA Expression in Prostate of BPH-Induced Mice

PURPOSE: Benign prostatic hypertrophy (BPH) is a common finding in older men and a frequent cause of lower urinary tract symptoms. The efficacy of exercise in the management of BPH-related inflammation is not fully understood. Thus, we investigated the effects of exercise on inflammatory markers in a mouse model of BPH.METHODS: A total of 36 male C57BL/6 mice were divided into three groups; CON (sham control, n=12), BPH-CON (received testosterone propionate [TP] control, n=12), and BPH-EXE (TP+aerobic exercise group, n=12). For BPH induction, mice were castrated and testosterone propionate (3 mg/kg/day) was administered by subcutaneous injection. The exercise group was forced to run on a treadmill for 30 minutes 3 times per week for 12 weeks.RESULTS: The BPH-CON group showed significantly increased blood pro-inflammatory cytokines such as interleukin-6, -1β, and TNF-α compared with CON (p<.05). Furthermore, NF-kb and COX-2 mRNA expression were significantly increased in prostate tissue (p<.05). In contrast, the BPH-EXE group exhibited a significant decrease in IL-1β and TNF-α cytokines and NF-kb and COX-2 mRNA, but a significant increase in SOD activity when compared to the BPH-CON group (p<.05).CONCLUSIONS: These results suggest that inflammation may be an important factor for the prevention and management of BPH, and that exercise may contribute to the alleviation of inflammation in the blood and prostate tissues of men with BPH.

PD61-09 LONG-TERM FUNCTIONAL OUTCOMES AND REOPERATIONS IN LARGE PROSTATES (>80CC): A COMPARATIVE BICENTRIC STUDY BETWEEN GREENLIGHT LASER PHOTOSELECTIVE VAPORIZATION AND OPEN SIMPLE PROSTATECTOMY

INTRODUCTION AND OBJECTIVE:Open simple prostatectomy (OSP) is an alternative for the management of benign prostatic hypertrophy (BPH) over 80 cc. The results of photoselective vaporization (PVP) fo...

Micellar enhanced spectrofluorimetric approach for nanogram detection of certain α1 -blocker drugs: Application in pharmaceutical preparations and human plasma.

Alpha1-adrenergic-blocking drugs, namely; alfuzosin hydrochloride (ALF), doxazosin mesylate (DOX) and terazosin hydrochloride (TER) are effective as antihypertensive agents as well as in management of benign prostatic hypertrophy. In this study, a simple, very fast, highly sensitive and cheap technique was optimized for assay of these drugs in pure states and pharmaceutical tablets. The proposed method is dependent on enhancement of the native fluorescence of investigated drugs using the polyoxyethylene 50 stearate (POE50S) micellar system. The method showed excitation at 325, 340 and 250nm for ALF, DOX and TER, respectively and an emission maxima at 382nm. The fluorescence intensity-concentration charts of studied drugs were attained utilizing concentration ranges (2.0-60.0ngmL-1 ) for DOX and (4.0-100.0ngmL-1 ) for ALF and TER with quantitation limits 2.9, 1.6 and 2.5ngmL-1 for ALF, DOX and TER, respectively. The suggested technique was approved according to International Council for Harmonisation (ICH) standards and the United States Food and Drug Administration (US FDA) bioanalytical method validation and has been effectively applied for assay of these medications in their dosage forms as well as for content uniformity test. The developed procedure was also efficiently applied for determination of these drugs in real human plasma with high accuracy.

Prostate artery embolisation: ready for adoption?

Prostatic artery embolisation can be used to block the blood supply in benign prostatic hypertrophy (BPH), leading to a significant reduction in size and improvement in associated lower urinary tract symptoms. In this article the author describes the results of a recently published multicentre registry study and looks at where this technique can fit in the management of BPH.

Évaluation prospective des coûts directs de l’énucléation prostatique par le laser HoLEP® pendant la courbe d’apprentissage

Holmium laser enucleation of the prostate (HoLEP) has been shown to be effective in treating large prostates compared to prostate transurethral resection (TURP). There are no published data evaluating specifically the impact of the learning curve on the direct costs of HoLEP. The objective of this study was to evaluate the direct costs generated by the use of HoLEP laser during the learning curve period. The costs of all medical devices (DM) and drugs used, pre- and post-operative parameters during surgery have been prospectively collected between March and October 2016. A total of 32 patients were included in the study with a mean age of 70.8 years and a mean prostate volume of 68.6 cm3. The mean cost of anesthesia was 39.0 € and that of drugs and DM used for surgery was 257.95 € but could reach 470.76 € in case of conversion to bipolar resection. The mean duration of enucleation and morcellation was 150minutes with a mean weight of enucleated specimens of 40.4g. The total mean duration of patient care was 197minutes at an estimated hourly cost of € 636. Despite some limitations, this study makes it possible to analyze the direct costs of the management of benign prostatic hypertrophy using HoLEP, an innovative surgical technique, and to specify that these costs are more related to bipolar conversion and voluminous adenomas especially during the learning curve. 5.

Transanal total mesorectal excision for a large leiomyosarcoma at the lower rectum: a case report and literature review

BackgroundRectal leiomyosarcoma (LMS) is an extremely rare disease. Previously, LMS was not properly distinguishable from gastrointestinal stromal tumor (GIST) until c-kit, a characteristic marker of GIST, was discovered in 1998. No standard therapeutic strategy for gastrointestinal LMS has been established except for surgical resection because of its rarity. Rectal LMS is often accompanied by symptoms, which can enable detection at a small size. However, when a large LMS is detected at the lower rectum, it is difficult to excise due to the narrow pelvic space.Case presentationWe present the case of an 86-year-old man with a large LMS. The LMS was asymptomatic and incidentally found at the lower rectum when he visited another hospital for management of benign prostatic hypertrophy. An abdominoperineal resection of the rectum was performed with combined resection of both seminal vesicles and a part of the prostate because tumor invasion was suspected. We used the hybrid method of laparoscopic and transanal total mesorectal excision (TaTME) approaches to achieve negative surgical margins. Late-onset urethral injury occurred in the postoperative course, which was successfully treated with a urethral catheter. The patient was discharged and received no adjuvant therapy. Local recurrence did not occur, but multiple lung metastases were detected 4 months later and the patient died 12 months after the surgery.ConclusionsThis is the first report of the hybrid method of laparoscopic and TaTME approaches to remove a large LMS at the lower rectum.

Is combination therapy with an alphablocker and a DHT blocker better than either agent alone for long-term management of benign prostatic hypertrophy (BPH)?

EVIDENCE-BASED ANSWER Combination therapy with an alpha-blocker and dihydrotestosterone (DHT) blocker is superior to either agent alone for reducing clinical progression of BPH and symptom deterioration. Combination therapy is inconsistently better than alpha-blockers for reducing acute urinary retention and in need for invasive therapy, but combination therapy causes a few more adverse events than either monotherapy (SOR: A, 2 RCTs).

AB101. Diversity and choice in the surgical techniques for benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH) is still one of the most diseases that urologists need to deal with every day. Although conservative and medical therapy for BPH is now well established in terms of alpha-blocker and 5-alpha reductase inhibitor treatment, surgical intervention is still finally irreplaceable for many cases. Open prostectomy has more than 200 years of history since Doctor Guthrie first used the perineum incision to enucleate the hyperplastic prostate adenoma in the year of 1834. From then on, surgical techniques have been evolved and improved constantly and Guthrie’s perineum approach was superseded by Freyer’s suprapubic transvesical approach, Millin’s retropubic transcapsular prostectomy, and more recently laparoscopic and robotic-assisted approach. When it comes to surgical treatment options available for BPH, transurethral surgery of prostate (TUSP) have to be mentioned. Monopolar transurethral resection of the prostate (TURP) have been called for many years as the golden standard treatment for the surgical management of BPH. However, TURP rates have declined over the past two decades due to the significant benefits of medical therapy and, to a lesser extent, the proliferation of other transurethral surgical techniques. Transurethral vaporization and vaporesection of the prostate are reported to have the similar results compared to TURP. With the development of the monopolar to bipolar technique and many electrode designs available, TUSP is becoming more and more safety. In recent years, transurethral plasmakinetic resection of the prostate (TUPKRP/PKRP) is the more and more popular technique of TUSP and considered as the new golden standard procedure for surgical treatment of BPH. In the past 5 years, transurethral laser techniques have been used more and more in the surgical management of BPH. There are several types of lasers used for BPH surgery by either coagulating, vaporizing or enucleating the prostate. Laser techniques for treating BPH appears to have equivalent results to TURP and have superiority to TURP in anticoagulated patients where risks of bleeding and the need for post-operative blood transfusion remain low. Transurethral laser treatment of BPH seems to have a tendency to replace the TURP. In fact, surgical treatment options are far more than the above mentioned, for example, UroLift system can illustrate this point as the latest technique and new technology will appear constantly and apply to clinic. However, so many surgical options exist for BPH and indications are well defined, questions remain in this area. How much prostate volume reduction is necessary to relieve BOO or LUTS, how is bladder underactivity and its associated with LUTS after BPH surgery and which procedure is the best choice for each BPH patient. And more, cost effectiveness of any options should be considered, especially in developing country. It is clear that appropriate counseling is necessary in all patients who undergo BPH surgery.

Evaluation and management of post-transurethral resection of the prostate lower urinary tract symptoms.

Transurethral resection of the prostate (TURP) continues to be the most common treatment in the operative management of benign prostatic hypertrophy (BPH). Several other modalities have shown equivalence to TURP. However, even after surgical treatment, up to one third of patients have bothersome lower urinary tract symptoms (LUTS). This review discusses the pathophysiology, evaluation, and management options for patients with LUTS after TURP.

Alpha‐blockers in the treatment of benign prostatic hypertrophy

AbstractSteve Chaplin and Professor Roger Kirby provide an over ‐ view of the properties of alpha‐blockers and how they compare in the management of benign prostatic hypertrophy.

American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy

The purpose of this review is to provide a complete revision of two of the most widely used clinical guidelines in the management of lower urinary tract symptoms induced by benign prostatic hyperplasia and their importance and compliance among urologists. Updates of the American Association of Urology and European Association of Urology clinical practice guidelines (CPGs) were reviewed and analyzed. Literature concerning compliance and application of these two CPGs in the different working scenarios of practicing has been evaluated. Urology has moved to an era in which costs and quality of care are being scrutinized, and compliance to CPGs will be assessed. Practicing urologists do not have the time to keep up to date with the continuous incoming literature and CPGs are a great tool to give the highest quality of care to our patients.

Incontinence Related to Management of Benign Prostatic Hypertrophy

Background: The prevalence of incontinence ranges from 11% to 34% among community-dwelling men aged ≥65 years. Objective: The objective of this analysis was to determine the nature of incontinence diagnosed in men with benign prostatic hypertrophy (BPH), focusing on its incidence, prevalence, diagnostic workup, and management. Methods: A cohort of patients with BPH was identified in the Integrated Healthcare Information Services National Managed Care Benchmark Database (1997-2003). Age and duration in the database after the first diagnosis of BPH were used as matching strata. Therapeutic subgroups consisted of watchful waiting, g-blockers, 5-α-reductase inhibitors (5ARIs), and BPH-related surgery. Results: A total of 411,658 males with BPH were identified from 12,298,027 males (3.3%). Of the BPH cohort, 2.7% (n = 11,172) were identified as having incontinence; of these, 57.8% of patients were ≥65 years of age. Alter applying inclusion/exclusion criteria, the final matched case-control sample included 6346 men as case subjects and 229,154 men as control subjects. The overall incidence of incontinence in this BPH sample was 1835/100,000/year, and the prevalence was 2713/100,000 men. In 48.5% of the incontinent men, the type of incontinence was not specified. Diagnostic testing was performed in 2.9% of men with incontinence. Conditional logistic regression analyses found that BPH-related surgery and g-blocker use increased the adjusted odds ratio for the risk of incontinence 3.1-fold, and 1.1- to 1.7-fold, respectively. The odds ratio of the risk of incontinence was not significantly increased with long-term 5ARI use. Condusions: Use of g-blockers, 5ARIs for the short term (<1 year), and BPH-related surgery were independently, significantly associated with BPH-related incontinence; 5ARI use for >1 year and watchful waiting were not. BPH-related incontinence may be related to progression of BPH or as a postsurgical complication. Patients with BPH should be asked specifically about incontinence, especially after BPH-related surgery, and undergo a full diagnostic workup for the diagnosis of urinary incontinence.

Update on the use of dutasteride in the management of benign prostatic hypertrophy

Benign prostatic hyperplasia (BPH) is a frequent cause of lower urinary symptoms, with a prevalence of 50% by the sixth decade of life. Hyperplasia of stromal and epithelial prostatic elements that surround the urethra cause lower urinary tract symptoms (LUTS), urinary tract infection, and acute urinary retention. Medical treatments of symptomatic BPH include; 1) the 5alpha-reductase inhibitors, 2) the alpha1-adrenergic antagonists, and 3) the combination of a 5alpha-reductase inhibitor and a alpha1-adrenergic antagonist. Selective alpha1-adrenergic antagonists relax the smooth muscle of the prostate and bladder neck without affecting the detrussor muscle of the bladder wall, thus decreasing the resistance to urine flow without compromising bladder contractility. Clinical trials have shown that alpha1-adrenergic antagonists decrease LUTS and increase urinary flow rates in men with symptomatic BPH, but do not reduce the long-term risk of urinary retention or need for surgical intervention. Inhibitors of 5alpha-reductase decrease production of dihydrotestosterone within the prostate resulting in decreased prostate volumes, increased peak urinary flow rates, improvement of symptoms, and decreased risk of acute urinary retention and need for surgical intervention. The combination of a 5alpha-reductase inhibitor and a alpha1-adrenergic antagonist reduces the clinical progression of BPH over either class of drug alone.

Pharmacological Management of Benign Prostatic Hypertrophy and Prostate Cancer in Older Men

Benign prostatic hypertrophy (BPH) and prostate cancer are common conditions affecting older men. Treatment options for these conditions depend on the severity of symptoms, comorbidities and patient choice and include observation, medications and surgery.BPH is an important cause of lower urinary tract symptoms. Alpha‐adrenergic antagonists are useful for mild to moderate symptoms of BPH. Trans‐urethral resection of the prostate is the most effective treatment for the relief of symptoms and is the only treatment recommended for serious complications of the disease.After skin cancers, prostate cancer is the commonest malignancy in older males. Hormonal manipulation with luteinising hormone releasing hormone analogues and antiandrogens form the mainstay of treatment of metastatic prostate cancer.This article will review the use of drugs and their place in the overall management of these disorders.

Future aspects of TUMT treatment of benign prostatic hypertrophy.

The future of conservative non-medical and minimally invasive management of benign prostatic hypertrophy (BPH) lies in the improvement in the technical possibilities of destroying prostatic tissue. After more than ®ve years' experimentation and experience with microwave thermotherapy, it is evident that this form of treatment will play an important role in the management of symptomatic BPH in the future. Patients will increasingly insist on less invasive treatment, especially when drug treatment fails. Apart from TUMT, other forms of destructive energy can be locally introduced into the prostate and such examples are laser therapy, radiofrequency treatment, high intensity focussed ultrasound (HIFU) and cryoablation. Basically, any form of energy can destroy malignant and benign tissue. The destruction itself is not the problem, the diculties lie in the surgical aspects of the equipment and machines developed for these purposes, and in particular in the exact and ecacious focusing of the energy by an acceptable route of administration.

Interstitial and transurethral photodynamic therapy of the canine prostate using meso-tetra-(m-hydroxyphenyl) chlorin.

Photodynamic therapy (PDT) produces localised necrosis with light after prior administration of a photosensitising drug. Although the technique is promising for small tumours of hollow organs, little work has been done on solid organs like the prostate. We studied the tissue biodistribution and photodynamic effects of meso-tetra-(m-hydroxyphenyl) chlorin (mTHPC), a potent second-generation photosensitiser, on normal canine prostate in vivo. Using quantitative fluorescence microscopy, the highest concentration of mTHPC in the prostate was seen 24-72 hr after intravenous administration. For PDT, red light (650 nm) was delivered to the prostate by laser fibres inserted via the transurethral or transperineal route under transrectal ultrasound guidance. PDT lesions up to 40 mm in diameter (using 4 fibre sites) were produced, characterised by swelling, inflammatory response and extensive glandular destruction. There was persistent glandular atrophy at 90 days, but no disruption of the main stroma and no change in the ultimate size or shape of the gland. Urethral damage sometimes caused temporary urinary retention, but this resolved by 7 days, and no animal became incontinent. Occasional small lesions were seen in the rectum, but these healed without sequelae and there were no fistulae. Since cancer and normal prostate are likely to respond similarly, PDT has considerable promise for treating cancer confined to the gland as large areas of glandular tissue can be necrosed with safe healing. Because the structural integrity of the gland is maintained, PDT is unlikely to be of value in the management of benign prostatic hypertrophy.

Interstitial and transurethral photodynamic therapy of the canine prostate using meso‐tetra‐(m‐hydroxyphenyl) chlorin

Photodynamic therapy (PDT) produces localised necrosis with light after prior administration of a photosensitising drug. Although the technique is promising for small tumours of hollow organs, little work has been done on solid organs like the prostate. We studied the tissue biodistribution and photodynamic effects of meso-tetra-(m-hydroxyphenyl) chlorin (mTHPC), a potent second-generation photosensitiser, on normal canine prostate in vivo. Using quantitative fluorescence microscopy, the highest concentration of mTHPC in the prostate was seen 24–72 hr after intravenous administration. For PDT, red light (650 nm) was delivered to the prostate by laser fibres inserted via the transurethral or transperineal route under transrectal ultrasound guidance. PDT lesions up to 40 mm in diameter (using 4 fibre sites) were produced, characterised by swelling, inflammatory response and extensive glandular destruction. There was persistent glandular atrophy at 90 days, but no disruption of the main stroma and no change in the ultimate size or shape of the gland. Urethral damage sometimes caused temporary urinary retention, but this resolved by 7 days, and no animal became incontinent. Occasional small lesions were seen in the rectum, but these healed without sequelae and there were no fistulae. Since cancer and normal prostate are likely to respond similarly, PDT has considerable promise for treating cancer confined to the gland as large areas of glandular tissue can be necrosed with safe healing. Because the structural integrity of the gland is maintained, PDT is unlikely to be of value in the management of benign prostatic hypertrophy. © 1996 Wiley-Liss, Inc.

Placement of the Urethral Stent Made of Shape Memory Alloy in Management of Benign Prostatic Hypertrophy for Debilitated Patients

Placement of the Urethral Stent Made of Shape Memory Alloy in Management of Benign Prostatic Hypertrophy for Debilitated Patients