Prostate Bladder Research Articles

The Risk Factors for Increased Post-Voiding Residual Urine Volume after Long-Term Anticholinergic Therapy in Patients with Benign Prostatic Hyperplasia and Overactive Bladder

Purpose: Adding anticholinergics to the treatment regimen of benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) elicits concern about deterioration of obstructive symptoms and the possibility of urine retention. We evaluated the risk factors increasing post-voiding residual (PVR) volume with long-term anticholinergics therapy of over 1 year in patients with BPH and OAB. Materials and Methods: We selected patients with BPH and OAB from 2005 to 2007 who were more than 40 years old, were treated with αblockers, had an International Prostate Symptom Score (IPSS) of 8 or more, and had an IPSS urgency score of 2 or more for OAB. The 98 patients selected were evaluated by age, diabetes mellitus, central nervous system (CNS) disease above the brain stem, prostate volume, uroflowmetry, PVR volume, prostate-specific antigen (PSA) level, and IPSS retrospectively. We evaluated risk factors for increasing PVR volume over 50 ml and 100 ml after treatment and analyzed the risk factors both univariately and multivariately. Results: Age, diabetes mellitus, CNS disease, PSA level, prostate volume, initial PVR volume, peak urine flow rate (≤15 ml/s), use of anticholinergics, and no use of 5-α-reductase inhibitor, which were regarded as risk factors for increasing PVR volume, were analyzed for their relation with PVR volume over 50 ml and 100 ml, respectively. Age, initial PVR volume, CNS disease, and use of anticholinergics were significantly associated with an increased PVR volume over 100 ml in the univariate analysis. In multivariate analysis, age, initial PVR volume, CNS disease, and use of anticholinergics remained significantly associated with an increased PVR volume over 100 ml. Conclusions: Age (≥65 years), initial PVR (≥50 ml), long-term therapy with anticholinergics of over 1 year, and CNS disease appear to be risk factors for increasing PVR volume over 100 ml in patients with BPH and OAB. (Korean J Urol 2009;50:982-988) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Engineering Oncolytic Vaccinia Viruses for Non-Invasive Optical Imaging of Tumors

Attenuated vaccinia viruses (VV) selectively replicate in malignant cells and confer oncolytic effect in vivo. Here we demonstrate that oncolytic VV may also be used as a diagnostic agent for tumor-bearing mice. A series of recombinant vaccinia viruses has been constructed expressing optical reporters to mediate emission of bioluminescent and fluorescent light which can be visualized. Data show that following systemic virus delivery the developing tumors can be non-invasively visualized in mice in vivo. Renilla luciferase and Aquoria GFP have been effective in imaging xenografted PC-3 prostate and orthotopic MB-49 bladder tumors. Brighter reporters, Gaussia luciferase and Renilla GFP have been used for imaging TRAMP prostate cancer and C6 subcutaneous model of glioma. The C6 imaging data have been corroborated by traditional MRI. We are also developing a VV-mediated system for tumor detection in far red or near infra red fluorescent light. Results suggest that VV-mediated imaging is a promising alternative for early diagnosis of various human cancers.

Crataeva nurvala: A Valuable Medicinal Plant

Crataeva nurvala Buch. Ham. (Capparaceae) is a high-value medicinal tree that grows almost all over India, especially in the semiarid regions. Medicinal usage has been reported in traditional systems of medicine, such as Ayurveda and Unani, wherein the plant is frequently preferred in the treatment of urinary disorders that reoccur owing to development of antibiotic resistance by the infecting organism. C. nurvala has also been used in the treatment of prostate enlargement and bladder sensitivity. The plant is known to relieve, prevent, and promote the discharge of kidney stones. Lupeol, a pentacyclic triterpene isolated from the root bark, has been shown to significantly minimize the deposition of stone-forming constituents in kidneys. Investigations have also indicated the plant has anti-arthritic, hepatoprotective, and cardio-protective actions. These multiple uses of C. nurvala along with erratic seed germination, destructive harvesting, and habitat loss from deforestation have endangered survival of the plant. As a result of this endangerment, in India the plant has been categorized as rare or vulnerable in the natural environment, making conservation of this plant crucial. This review briefly examines the biological activities, pharmacological actions, clinical studies, and medicinal applications of C. nurvala to provide direction for further research.

T03-O-04 Emotional impact on International Index of Erectile Function administration

Objectives To evaluate the sexual life of the male patients, using the International Index of Erectile Function (IIEF) questionnaire in our urological ambulatory patients. Design and method Between 1st of October 2006 and 1st of May 2007 we asked the ambulatory urological patients (who have not presented for erectile dysfunction) to complete the IIEF questionnaire. From a total of 336 sexual active patients 47 (14%) didn’t want to read the questionnaire and 67 (30%) red it but didn’t want to answer from different reasons. 32 (48%) from them didn’t have sexual life in the last period. 222 answered (66%): 38% were under 35 years old, 29% between 36 and 50, 21% between 51 and 65 and 22% were over 65 years old. Results We analysed for each group of age the erectile function, the satisfaction with intercourse and the overall satisfaction correlating them with the disease, urban/rural background, BMI, marital status, education, alcohol behaviour and smoking. The most common affections were BPH (18%), urolithiasis (15%), bladder tumours (10%) and urinary tract infections (7%). Conclusions Comparing with general population the urological patients have an increased percent of sexual dysfunction, with bigger values for those with benign prostatic hyperplasia and bladder tumours. There was an important emotional impact at the administration of IIEF.

Radiologische Beckendiagnostik

Prostate cancer, bladder cancer, and pelvic floor weakness are among the most common diseases of the pelvis. Cardinal symptoms include painless macrohematuria in bladder cancer and urinary and fecal incontinence in pelvic floor weakness. Suspicion of prostate cancer currently is most frequently raised when the serum concentration of prostate-specific antigen is pathologically elevated. Besides extensive clinical and invasive diagnosis, clinical imaging is frequently applied for the localization, locoregional staging, and diagnosis of recurrence of prostate cancer and invasive bladder cancer, and in clinically difficult cases of cystocele, enterocele, rectocele, descensus or prolapse of vagina, uterus, and rectum, and rectal intussusception. Magnetic resonance imaging with T2-weighted TSE or FSE images in several planes combined with either axial, T1-weighted images and MR spectroscopy for the prostate, dynamic contrast-enhanced T1-weighted images for the urinary bladder, or dynamic T2-weighted functional images for pelvic floor incontinence are particularly well suited as clinical imaging methods.

Laser Fibre Deterioration and Loss of Power Output During Photo-Selective 80-W Potassium-Titanyl-Phosphate Laser Vaporisation of the Prostate

BackgroundThe potassium-titanyl-phosphate (KTP) laser technique for photo-selective vaporisation of the prostate (PVP) has been regularly improved over the last decade. Nonetheless, decreasing efficiency of tissue vaporisation during the course of the operation and macroscopic alterations of the laser fibre's tip are regularly observed and seem to affect the outcome of this procedure. ObjectiveTo investigate the course of power output and to determine the type and extent of fibre deterioration during PVP. Design, Setting, and ParticipantsForty laser fibres were investigated during PVP in 35 consecutive patients with prostatic bladder outflow obstruction between January 2007 and August 2007 in a university hospital. InterventionAll patients underwent PVP performed by three different surgeons using the 80-W KTP laser. MeasurementsPower output was measured at the beginning and regularly throughout PVP and throughout in vitro vaporisation without fibre–tissue contact. Microscopic documentation of the fibre tip was performed after the procedure. Results and LimitationsCarbonisation and melting of the fibre tip was regularly visible and appeared to be more pronounced as more energy was applied. Additionally, 90% of the fibres showed a significant decrease of power output during PVP, resulting in an end-of-lifespan (ie, 275-kilojoule) median power output of 20% of the initial value. Final median power output after in vitro vaporisation was 83% of the starting value. The extent of the structural and functional changes might only be valid for the operative technique performed in this investigation. ConclusionsFibre deterioration caused significant reduction of power output during PVP. This finding is an explanation for the often observed decreasing efficiency of tissue ablation and may also be responsible for some of the typical drawbacks and complications of PVP. Hence, improvements in fibre quality are necessary to advance the efficiency of this technique.

Endourological Treatment of Benign Prostatic Hyperplasia and Bladder Calculi(Report of 16 cases)

目的 探讨腔内泌尿外科技术治疗前列腺增生症伴膀胱结石的治疗效果.方法 对16例前列腺增生症伴膀胱结石的患者采用经电切镜外鞘输尿管镜气压弹道碎石联合前列腺汽化电切术(TUVP)进行治疗.结果 所有患者均一次性治疗成功,无膀胱穿孔或发生TUR综合症,未见结石复发,未出现严重并发症.结论 同期进行经尿道前列腺电切除和气压弹道碎石术是治疗前列腺增生并膀胱结石的一种高效、安全、并发症少的手术方法。

1725: Early Reinstitution of Aspirin after Prostate and Transurethral Bladder Surgeries is not associated with Increased Incidence of Postoperative Bleeding - A Prospective Randomized Trial

1725: Early Reinstitution of Aspirin after Prostate and Transurethral Bladder Surgeries is not associated with Increased Incidence of Postoperative Bleeding - A Prospective Randomized Trial

Eosinophil infiltration in posttransurethral resection prostatitis and cystitis with special reference to sequential changes of eosinophilia

Post-transurethral resection (TUR) status in the prostate and urinary bladder has been infrequently documented. Furthermore, sequential changes in eosinophil count in peripheral blood (PB) after TUR have not been investigated in detail. In the present study, eosinophil counts and changes in eosinophils in PB were examined before to after TUR of the prostate (P) in 20 patients with benign prostatic hyperplasia. Among them, 14 patients exhibited increased numbers of eosinophils, the greatest increase being 17%. After TUR to treat bladder tumor (BT), massive infiltration of eosinophils into the resected areas, peaking 1 month later, was also detected in 8 of 15 cases of post-TUR cystitis. The PB eosinophil counts increased by more than 5% in two of five cases of post-TUR cystitis in which eosinophil counts were obtained before and after surgery. Most infiltrating eosinophils reacted positively to antibodies to eosinophil cationic proteins. These results indicated that, in patients with post-TUR prostatitis, the number of eosinophils in PB increased, and peaked 1 month later, with infiltration by eosinophils observed. Pathologists and urologists should be aware of the potential for increase in eosinophils not only in regions of TUR but also in PB.

Urinothorax: an unexpected cause of severe dyspnea

Dear Editor: Recently, Tortora et al. [1] reported on a case of urinothorax with severe dyspnea. This description is of interest because urinothorax is rarely recognized. To date, less than 60 cases have been reported [2, 3]. However, to diagnose urinothorax is very important; in a patient with obstructive uropathy and pleural effusion, if the effusion is a urinothorax, no further diagnostic tests are necessary because it disappears after the resolution of the obstruction. To consider this possible diagnosis is of interest especially in patients whose obstruction is caused by a malignant disease. Due to this importance, we consider it to be of interest to present some clinical, radiological, and biochemical data that could help in its diagnosis. Reviewing the literature, we have found two groups of urinothorax: those associated with bilateral obstruction (prostate disease or bladder cancer, for instance) and those associated with a traumatic cause (including surgical injury or blunt trauma) [3]. In most cases, urinothorax do not produce respiratory symptoms, but cases with severe dyspnea have been described [1, 2]. In cases of unilateral lesion, the effusion tends to be ipsilateral to this side. Urinothorax resolves without treatment after the resolution of a urinary problem. Therefore, establishing the diagnosis is necessary to perform a thoracocentesis. The fluid looks and smells like urine and it is a transudate with a creatinine concentration higher in pleural fluid than in serum, as in the case reported by Tortora et al. [1]. Probably, urinothorax is more frequent than is recognized, but the scarcity of reported cases might be due to the low index of suspicion (it would not always be suspected) and because it occurs in a clinical scenario where urological problem predominates and rapidly resolves. The publication by Tortora et al. [1] demonstrates the contribution of emergency radiologists in the suspicion and the detection of this rare entity.

Controversial issues and optimal management of stage T1G3 bladder cancer

The management of T1G3 bladder cancer is controversial. Diagnostic methods, such as bladder mapping or second-look transurethral resection are recommended to assess risk. Bacillus Calmette–Guérin intravesical therapy with a maintenance regimen is recommended for solitary T1G3 tumors. The timing of radical cystectomy for these patients is controversial, but early recurrence during intravesical therapy is an indication for radical cystectomy. Multifocal disease, concomitant carcinoma in situ and disease in the prostatic urethra and bladder neck also suggest aggressive disease and cystectomy should be considered in these patients.

TU-D-224C-04: A Monte Carlo Post-Implant Prostate Dosimetry Study : Interseed Attenuation, Tissue Composition, and Calcification

Purpose: To use an automated Monte Carlo (MC) code to perform a clinical dosimetry study that includes 18 post‐implant prostate brachytherapy cases. The interseed attenuation and the impact of tissue compositions are specifically investigated. Method and Materials: A MC technique is used to simulate the post‐implant dosimetry for voxelized patients. For a typical patient, 200,000 voxels are stacked to generate the realistic anatomy. For each voxel, the density is set by the Hounsfield Units (HU) from the computed tomography data and the elemental composition is set according to the radiation oncologist's contours. Between 180 and 320 different materials (prostate tissue,muscle, rectum tissue, bladder tissue, calcification, adipose tissue, and various mixtures) are utilized for each patient. Data (HU, seed positions, and contours) is input into the MC program through the DICOM‐RT protocol. Several MC simulations are performed in order to study different elements: interseed attenuation, impact of inter‐organ tissue composition, prostate composition, and specifically calcifications inside the prostate. Results: The interseed attenuation level is 3.9±1.5% for the D90 CTV parameter. The effect on organs at risk is an average decrease of 0.2 cm3 for the V100 parameter in both rectum and bladder. For the 18 clinical cases, the comparison between the TG‐43 based dosimetry and the complete MC simulation leads to average differences of 12±3 Gy for the D90 CTV parameter. If localized and/or diffuse calcifications are incorporated into the prostate tissue, differences of up to 14 Gy are added. Conclusion: The overall difference between the clinically approved TG‐43 based calculations and MC simulations can reach non‐negligible levels. Including the calcifications in the prostate can lead to important dosimetry differences. However, the presence of calcification is difficult to establish with traditional CT data.

Precise Anatomical Location of the Autonomous Nerve from the Pelvic Plexus to the Corpus Cavernosum

Purpose: We wanted to study the precise anatomical location of the branches of the pelvic plexus from the sacral root to the cavernous nerve. Materials and Methods: We performed microdissection on the pelvises from 4 male formalin fixed cadavers under a Zeiss surgical microscope and we traced the location of the branches of the pelvic plexus at a magnification of 6x. Results: The configuration of the pelvic plexus was an irregular diamond shape rather than rectangular. It was located retroperitoneally on the lateral wall of the rectum 8.2 to 11.5cm from the anal verge. Its midpoint was located 2.0 to 2.5cm from the seminal vesicle posterosuperiorly. A prominent neurovascular bundle (NVB) was located on the posterolateral portion of the apex and the mid portion of the prostate. The pelvic splanchnic nerve (PSN) joined the NVB at a point distal and inferior to the bladder-prostate (BP) junction. The PSN components joined the NVB in a spray-like distribution at multiple levels distal to the BP junction. The distance from the membranous urethra to the NVB was 0.5 to 1.2cm. We also found multiple tiny branches on the anterolateral aspect of the prostate apex. Conclusions: In contrast to the usual concept, the NVB was much wider above the mid portion of the prostrate and it supplied multiple tiny branches on the anterolateral aspect of the prostate. The PSN branches arose from the more posteroinferior area of the pelvic plexus. Therefore, we recommend a more anterior dissection of the lateral pelvic fascia for nerve sparing radical prostatectomy. If surgeons plan a nerve graft after radical prostatectomy, they should consider this neuroanatomy for obtaining a successful outcome. (Korean J Urol 2006;47:876-881) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

A retrospective study of the time to clinical endpoints for advanced prostate cancer

To determine the natural history of patients with prostate cancer who start initial androgen-deprivation therapy (ADT) for biochemical failure with no radiographic evidence of disease (D0) or with radiographic metastatic disease (D2), as the history is either not well-defined or is changing, and such data are critical for guiding therapy after prostate cancer recurrence. We retrospectively assessed the time to androgen-independence (AI), defined as the first sustained rise in prostate-specific antigen (PSA) level on ADT, time to metastatic disease and overall survival for 80 patients with metastatic prostate cancer in clinical trials at the National Cancer Institute. ADT was initiated after metastatic disease in 37 patients and before metastatic disease in 43 patients; in these 43 patients, the median time to developing metastatic disease on ADT was 37.8 months. The median time to AI from the initiation of ADT was 19.3 and 13.1 months in D0 and D2 patients, respectively. The median overall survival from the start of ADT was 89.0 and 63.0 months, and the median overall survival from the time of AI was 63.1 and 44.2 months in D0 and D2 patients, respectively. These 80 patients, which included 43 who had no metastatic disease when starting ADT, had a median survival of 54.8 months after AI prostate cancer. We describe the natural history of AI prostate cancer in D0 patients who eventually developed metastasis, and in D2 patients. The results suggest a longer than expected survival with AI prostate cancer, and to our knowledge this is the first study to report the time to metastatic disease for D0 patients from ADT and from AI. These results can be used to help design clinical trials in patients with D0 prostate cancer.

Identification and characterization of DISP3 gene in silico

Lipid-modified soluble proteins Hedgehog (SHH, DHH and IHH) and WNT (WNT1, WNT2, WNT2B, WNT3, etc.) share distantly related mechanisms for ligand modification as well as for signaling through seven-transmembrane protein with Frizzled domain. Hedgehog and WNT signaling pathways network together during embryogenesis and carcinogenesis. Dispatched 1 (DISP1) and Dispatched 2 (DISP2) are human homologs for Drosophila Dispatched implicated in the release of lipid-anchored Hedgehog from producing cells. Here, we identified and characterized Dispatched 3 (DISP3) gene by using bioinformatics. DISP3 complete coding sequence was determined by assembling BU170953 EST and KIAA1337 uncharacterized cDNA. DISP3 gene at human chromosome 1p36.22 was linked to D1S2667 microsatellite maker and TERE1 gene, whose locus is associated with prostate cancer, bladder cancer, and liver cancer. DISP3 mRNA was expressed in human embryonic stem (ES) cells, brain, testis, lung carcinoid, neuroblastoma, retinoblastoma and brain tumor. DISPH1 domain with five transmembrane regions (codon 452-637 of DISP3) and DISPH2 domain with four transmembrane regions (codon 1116-1319 of DISP3) were identified as novel domains conserved between DISP3 (1392 aa) and DISP1. The region around DISPH1 and DISPH2 domains of DISP3 protein was the Patched homologous region conserved among Patched family members and DISP family members. Because DISP3 and DISP1 are multi-span transmembrane proteins with the Patched homologous region, DISP3 is predicted to be implicated in the release of lipid-anchored secreted proteins. This is the first report on identification and characterization of the DISP3 gene.

ANATOMICAL ANALYSIS OF THE NEUROVASCULAR BUNDLE SUPPLYING PENILE CAVERNOUS TISSUE TO ENSURE A RELIABLE NERVE GRAFT AFTER RADICAL PROSTATECTOMY

Urologists and anatomists have disagreed concerning pelvic neurovascular bundle (NVB) structure. Recently interposition nerve grafting has been performed to improve erectile function after radical prostatectomy. To refine this procedure we reviewed NVB structure from the surgical viewpoint. Seven fresh cadavers and serial horizontal sections from 20 formalin fixed cadavers were used for gross dissection and histological examination. Fresh cadaver dissections demonstrated that the pelvic splanchnic nerve (PSN) joined the NVB at a point distal or inferior to the bladder-prostate (BP) junction. Histologically hypogastric nerve fibers were much more dominant than PSN fibers at the BP junction, and the NVB, covered by the lateral pelvic fascia, became evident at levels more than 20 to 30 mm below the BP junction. PSN components joined the NVB in a spray-like distribution at multiple levels more than 20 mm distal to the BP junction. At these low levels nerves tended to be located outside of the NVB at the dorsolateral margin of the prostate. The cranial end of the mimic interposition nerve graft was directed toward the hypogastric nerve rather than the PSN. In contrast to general clinical opinion, the NVB appears to supply few PSN components at the BP junction with caudal PSN branches reaching the dorsolateral prostate more than 20 mm below the BP junction. This anatomy has important implications for a reliable nerve graft.

DOES BLADDER PRESERVATION (AS A SURGICAL PRINCIPLE) LEAD TO RETAINING BLADDER FUNCTION IN BLADDER/PROSTATE RHABDOMYOSARCOMA? RESULTS FROM INTERGROUP RHABDOMYOSARCOMA STUDY IV

We determine patient and tumor characteristics, event-free and overall survival, methods of local control, rate of bladder preservation and proportion with normal bladder function for patients with localized bladder/prostate (BP) rhabdomyosarcoma (RMS) treated on the Fourth Intergroup Rhabdomyosarcoma Study (IRS IV). We reviewed the records of 90 patients with nonmetastatic BP RMS enrolled on IRS IV for presenting characteristics, details of therapy and outcome. Of the 90 records 88 had sufficient information for review. Patient age distribution was less than 1 year for 7 patients, 1 to 9 years for 71 and 10 or greater years for 10. Tumors commonly arose in the bladder (70%), had favorable histology (embryonal or botryoid 80%), large (69% greater than 5 cm), unresectable (84% group III) and invasive (56% T2). Local therapy included radiation in 74 patients, and most patients underwent second-look operations after radiation. All patients received alkylating based chemotherapy. With a median followup of 6.1 years there have been 3 second malignancies, 1 toxic death and 18 relapses, for an event-free survival rate of 77%. Bladders were retained without relapse at last contact in 55 patients. Of those 55 patients 36 and of the entire group 40% had normal function determined by history. Of patients with nonmetastatic BP RMS on IRS IV 82% survived 6 years. Bladder function was preserved in 55% (36/66) of event-free survivors. Of all patients entered on study 40% (36 of 88) survive event-free with apparently normal functioning bladders. More precise long-term evaluation of bladder and sexual function will require application of better tools such as urodynamic studies and validated patient surveys.

V24 Sequential trans-urethral resection of prostate and laparoscopic bladder diverticulectomy under us guidance

V24 Sequential trans-urethral resection of prostate and laparoscopic bladder diverticulectomy under us guidance

Alpha-blockers increase vesical and prostatic blood flow and bladder capacity

Alpha-blockers increase vesical and prostatic blood flow and bladder capacity

Early treatment of benign prostatic hyperplasia: implications for reducing the risk of permanent bladder damage.

A significant change has occurred in the management of symptomatic benign prostatic hyperplasia (BPH) since effective pharmacological treatment became available and led to a significant decrease in the number of surgical procedures in many Western countries. The hypothesis of a causative role of benign prostatic enlargement and bladder outflow obstruction (BOO) in lower urinary tract symptoms (LUTS) was based on the association between prostate growth and symptoms of prostatism in elderly men and on the dramatic reduction of LUTS upon relief of obstruction. Careful investigation into the epidemiology of LUTS and BPH failed to confirm such an association and opened new perspectives in the pathophysiology of lower urinary tract dysfunction and symptoms. The observation that LUTS were equally distributed in male and female cohorts, when matched for age, moved attention away from the prostate and towards the urinary bladder and its aging-related disorders. When BPH surgery was developed, the management of the disease was aimed at preventing death from chronic renal failure, but the picture has changed and modern medical treatment is now aimed at improving the patient's quality of life. The increasing size of elderly populations in the Western world and the consequent financial constraints of national healthcare systems have raised the question of when pharmacological treatment of symptomatic BPH should be initiated. Retrospective and prospective analysis of various BPH populations and clinical studies has clearly defined the capacity of pharmacological treatment to reduce the incidence of complications of BPH, such as acute urinary retention and the need for surgery, but the cost/benefit ratio is unclear. Notwithstanding the limitations inherent in the experimental models, there is evidence from various animal models, investigating the pathophysiology of the urinary bladder in the presence of outflow obstruction, to indicate that a cause and effect relationship between BOO and bladder decompensation has been established and to support the hypothesis that permanent bladder damage may occur when the obstruction is not relieved early enough. Preliminary experimental evidence also suggests that alpha(1)-adrenoceptor antagonists may have a role in reducing the damaging effects of BOO on the urinary bladder. At present, there is no evidence to support the need for early pharmacological treatment of symptomatic BPH with no BOO beyond the obvious target of improving the patient's quality of life. The evidence for early treatment of BOO and the need to preserve bladder function is clear. Further experimental and clinical research is required to identify markers of early bladder damage and decompensation which can be used to select patients for early pharmacological treatment of BPH.