Prostatic Hypertrophy Research Articles

Correlation between the International Prostate Symptom Score, Ultrasound Features and Maximum Flow Rate in Cameroonian Patients with Benign Prostatic Hypertrophy

Background: Benign prostatic hypertrophy is the non-malignant stromal and epithelial proliferation of the prostate gland, with or without associated anatomical enlargement of the gland and clinical symptoms. Symptomatic Benign prostatic hypertrophy may cause obstructive symptoms, irritative symptoms or both obstructive symptoms include a sensation of incomplete bladder emptying, straining to void, urinary hesitancy and weak stream while irritative symptoms include dysuria, nocturia, urinary frequency and urinary urgency. A quantitative measure of the severity of lower urinary tract symptoms due to benign prostatic hypertrophy can be obtained using the International Prostate Symptoms Score. Ultrasonography is useful for helping to determine bladder and prostate size in patients with urinary lower urinary tract symptoms. Uroflowmetry is a non-invasive test that assesses voiding function. It provides valuable data on the voided volume, time is taken to reach maximum flow rate and average flow rate. The goal of this study was to improve the follow up of patients with benign prostatic hypertrophy by providing simple, available, affordable and non-invasive that best predict bladder outlet obstruction and the quality of life in these patients. Method: This was a cross-sectional analytic study carried out over a period of five months from May 2020 to September 2020 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, which is a tertiary hospital in Cameroon. Were included in the study, adult males who presented with lower urinary tract symptoms and prostatic enlargement suggestive of benign prostatic hypertrophy taking into account clinical, uroflowmetry and ultrasound findings. Results: A study population of 103 participants was recruited. The mean age of patients was 63.17 ± 10.26 years. Concerning the International Prostate Symptoms Score, the mean total, voiding (obstructive) and storage (irritative) scores were 14.6 ± 6.2, 8.5 ± 4.1 and 6.05 ± 2.7 respectively. The mean maximum flow rate was 13.44 ± 3.88 mL/s. The mean prostate volume was 53.71 ± 16.46 ml. A majority of patients have an enlarged prostate 1.5 to 2 times (46 to 60 mL) the upper limit for normal value. The intravesical prostatic protrusion was present in eighty-three (80.58%) and absent in 20 (19.42%). Above a prostate volume of 60 mL, 91% to 100% of our patients had intravesical prostatic protrusion. There was strong evidence (p < 0.001) that a change from no intravesical prostatic protrusion to intravesical prostatic protrusion grade 1 increased the chances of having a low maximum flow rate with a crude odds ratio of 7.98. The adjusted odds ratio after multivariate analysis was 5.26 and this remained statistically significant (p = 0.03). Conclusion: the measure of intravesical prostatic protrusion is superior to the prostate volume in the assessment of maximum flow rate and thus the follow up of patients with benign prostatic hypertrophy. This measure which is non-invasive, easy to measure, easily accessible, and cost effective may be a useful tool in predicting voiding dysfunction and acute urinary retention.

SARS-CoV-2 and Clinical Urology: There is no Dragon in this Story

Covid-19 disease is caused by the coronavirus of severe acute respiratory syndrome 2. The disease has evolved into a global pandemic that continues to this day. Coronavirus basically causes acute respiratory illness, the symptoms of which may remain milder even three months after the onset of this acute infection. Many patients also experience cardiological, gastrointestinal, and neurological symptoms that last for at least two months. Some patients report worsening of certain urinary symptoms. In this paper, we review the current knowledge about the relationship between SARS-CoV-2 and urinary system. A database and a manual search were conducted in the MEDLINE database of the National Library of Medicine, PubMed, Embase, the Cochrane Library, and other libraries using the keywords “SARS-CoV-2,” “COVID-19,” and “pandemic,” in various combinations with the terms “kidney,” “bladder” “prostate,” “testicles,” “LUTS,” “pain,” and “infection.” A considerable number of articles investigate the possible interaction between SARS-CoV-2 and the urinary system. In addition, to the well-documented involvement of the kidneys, testicle, and penile involvement seems to be possible. There are also studies investigating the development of benign prostatic hypertrophy (BPH) as a complication of SARS-CoV-2 infection and some studies examining the impact of COVID-19 disease on LUTS. In conclusion, the studies published so far do not provide conclusive evidence about a strong association between SARS-CoV-2 and the genitourinary system. Further investigation is warranted to better understand the nature of COVID-19 disease.

Role of Multiparametric Magnetic Resonance Imaging in the Evaluation of Prostatic Pathologies on 3 Tesla Machine

Background and objectives Prostate diseases with an overall incidence of 9% are the leading cause affecting millions of males worldwide, with prostate cancer being the primary cause of death in males owing to benign prostatic hypertrophy being the primary cause of morbidity in the older age group. In light of this, we aimed to evaluate the utility of Magnetic Resonance Imaging in evaluating and characterization prostatic pathologies and grading prostatic cancer using PIRADS v2. Methods This was a study carried out on 50 patients with the age group ranging from 50 to 90 years with clinical suspicion or ultrasonographically demonstrable prostatic pathology and correlation of multiparametric MRI findings on various sequences with clinical features and histopathological findings and classification into groups of benign and malignant prostatic lesions and according to the PIRADS v2 scoring. Results Out of our study group, 4 cases were diagnosed with prostatitis and prostatic abscess, and 46 cases were categorized into PI-RADS, out of which most cases were classified into PI-RADS category V, followed by PI-RADS II and III. These were then evaluated with MR spectroscopy, of which 30 cases showed choline peak, and 16 cases showed citrate peak. The sensitivity and specificity for multiparametric MRI sequences combination detect the carcinoma of the prostate was calculated, and the Positive Predictive Value (PPV) &amp; Negative Predictive Value (NPV) was found as 76% and 92%, respectively. Conclusion Based on our findings, we found out that the multiparametric MRI approach gives a wealth of practical information that has dramatically enhanced the detection and characterization of prostatic lesions. We also found out that morphological and functional sequencing improves the sensitivity and specificity of the lesions' identification and characterization.

Pseudo Tumor of the Bladder Simulating Cancer: Pseudotumoral Glandular Cystitis

Intestinal metaplasia of the bladder is a rare pathology, estimated at less than 1% of bladder pathologies. Some forms, including pseudo tumor glandular cystitis, can mimic cancer. We report a rare case of this pathology, little studied in our context, treated in Senegal and we underline the epidemiologicalclinical and anatomopathological particularities. Observation: Mr. MN, 26 years old, non-smoking, known epileptic, with psychomotor delay since birth (under Tegretil and Gardenal), presented with a hip’s trauma, not operated on in 2012, then a left leg fracture following a traffic accident in August 2019. He consulted for recurrent terminal hematuria without urination burn, dysuria and pelvic pain. The clinical examination revealed a motor deficit, a normal prostate on rectal examination. Cystoscopy showed a solid, vegetative, ulcerated tumor lesion of the bladder, of trigonal location and of the right lateral wall without invasion sign, with ureteral meatus and permeable ureters. The rest of the devices and biological assessments examination are unremarkable. Abdomino-pelvic ultrasound revealed a semi-replete bladder with a non-significant post-void residue and 39.78 cc prostatic hypertrophy without repercussions on the upper urinary system. The patient underwent a complete and deep bladder’s transurethral resection which, after histological examination, showed a pseudotumoral glandular cystitis of the bladder. Conclusion: The bladder should be taken into account in adult patients, often males, with irritative and obstructive urinary signs. It can occur without previous bladder infection. This pathology can simulate bladder cancer from which the interest of the pathological examination which makes it possible to make the formal diagnosis.

Comparative Efficacy of Tamsulosin Versus Tamsulosin Plus Finasteride in Patients with Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hypertrophy, a Randomized Open Label Parallel Group Study

Background: Benign prostatic hypertrophy (BPH) is a common entity among elderly men and is responsible for significant disability. Medical treatment for BPH has played a major role in improving the symptoms associated with bladder outlet obstruction. Recent guidelines recommend the combination of an alpha-1 blocker and a 5-ARI as first-line treatment of men with moderate-to-severe LUTS. There is limited study data to support which is the effective therapy for BPH/LUTS in a tertiary care hospital in India. Methods: A randomized, open labelled, double blind, active control parallel group study comparing the safety and efficacy of tamsulosin versus tamsulosin+finasteride in subjects with lower urinary tract symptoms secondary to benign prostatic hypertrophy. The subjects were randomized after obtaining written informed consent. The subjects were recruited from the patient population that was attending the Out-Patient department of Urology, Sri Ramachandra Medical College &amp; Research Institute, Sri Ramachandra University. Results: A total sample of 60 subjects, 30 into each group was enrolled. In the tamsulosin group, according to IPSS score, 11 patients who had moderate symptoms (36.7%) became mild, and among 19 patients who had severe symptoms (63.3%), 12 patients became mild (40%) and 7 patients became moderate (23.3%) with a p value of 0.021 which is statistically significant. In the tamsulosin+ finasteride group, according to IPSS score, 10 patients who had moderate symptoms (33.3%) became mild, and among 20 patients who had severe symptoms (66.7%), 12 patients became mild (40%) and 8 patients became moderate (26.7%) with a p value of 0.020 which is statistically significant. When comparing between the two groups, 76.7% attained mild symptoms in group 1 and 73.3% patients attained mild symptoms in group 2 with a p value of 0.766 which is statistically not significant. Conclusion: To conclude tamsulosin 0.4mg is as effective as the combination therapy of tamsulosin 0.4mg and finasteride 5mg in the treatment of lower urinary tract symptoms secondary to Benign prostatic hypertrophy.

Correlation between Prostate Specific Antigen (PSA) Level and Various Prostatic Diseases on Biopsies: A Retrospective Study

Introduction: The prostate is a pear-shaped glandular organ that adds part of fluid to semen. The prostate consists of stromal and glandular components. Prostate needle biopsy is performed either transrectal ultrasound (TRUS) guided or transurethral routes. PSA is a glycoprotein produced by secretory cells. Normally the PSA levels are less than 4.0ng/ml.&#x0D; Aim: The main aim of the study is to find out the correlation between various pathological lesions occur in the prostate and serum Prostate Specific Antigen (PSA) level.&#x0D; Study Design: A retrospective study.&#x0D; Place and Duration of Study: Department of Pathology,Saveetha Medical college and Hospital, between January 2019 and December 2019.&#x0D; Methodology: A retrospective study of 84 prostatic biopsies for a period of 1 year in the year 2019 was carried out. All specimens subjected for histopathological examination and the relevant clinical data and Serum PSA values correlation was done.&#x0D; Results: Commonest age group being 61-70 years. Difficulty in micturition was the most common presentation .Most common lesion found was Benign Prostatic Hypertrophy(BPH) constituting 67 cases (71.42%) followed by BPH with prostatitis 17 cases (20.23%), adenocarcinoma 6 cases (7.14%) and 1 case of Prostatic Intraepithelial Neoplasia (PIN) (1.19%). BPH patients, had S.PSA levels in the range of 4.1-15 ng/ml. Three cases of adenocarcinoma showed very high levels of S.PSA (&gt;100 ng/ml) with the Gleason score of 9(5+4).&#x0D; Conclusion: Both benign and malignant pathologies can cause an increase in serum PSA levels, but the chances of finding malignancy increases with rising values of PSA. But in the management of prostatic cancer the histopathological diagnosis and grading plays a definitive role.

Robotic Urethral Reconstruction Outcomes in Men With Posterior Urethral Stenosis

To evaluate surgical outcomes stratified by posterior urethral obstruction (PUO) etiology in men undergoing definitive robotic posterior urethral reconstruction. A retrospective, single surgeon, review of men undergoing robotic posterior urethral reconstruction between 2018 and 2020 was performed. Differences in complications, reconstructive success (no further intervention), and urinary continence by PUO etiology were assessed. Robotic posterior urethral reconstruction was performed in 21 men. PUO etiology included benign prostatic hypertrophy treatment in 5 (24%), prostatectomy in 10 (48%), radiation in 5 (24%), and trauma in 1 (5%). Median number of prior endoscopic treatments was 3 (benign prostatic hypertrophy), 3 (prostatectomy), and 2 (radiation) with an average time between obstruction and reconstruction of 9, 12, and 15 months (P = .52). Median length of stay after reconstruction was 2, 1, and 2 days (P = .45). Thirty-day complications occurred in 0%, 20%, 40% (P = .19). Post-reconstruction re-intervention was necessary in 0%, 10%, 80% (P = .004). Ultimately, anatomic success was achieved in 100%, 90%, 80% (P = .63), with functional success rates of 100%, 100%, 60% (P = .035). Median postoperative pad/day usage was 0,0, 10.5 (P <.001), and ultimately 0%, 30%, 80% (P = .013) underwent artificial urinary sphincter placement. Endoscopic treatment of posterior urethral obstruction (PUO) secondary to benign and malignant prostate conditions is associated with a high incidence of treatment failure. Robotic posterior urethral reconstruction is a safe and effective surgical solution for men with PUO in the absence of pelvic radiation. Men with pelvic radiation appear to be at increased risk of complications, PUO recurrence, and clinically significant stress urinary incontinence.

Rare coding variants in DNA damage repair genes associated with timing of natural menopause.

SummaryThe age of menopause is associated with fertility and disease risk, and its genetic control is of great interest. We use whole-exome sequences from 132,370 women in the UK Biobank to test for associations between rare damaging variants and age at natural menopause. Rare damaging variants in five genes are significantly associated with menopause: CHEK2 (p = 3.3 × 10−51), DCLRE1A (p = 8.4 × 10−13), and HELB (p = 5.7 × 10−7) with later menopause and TOP3A (p = 7.6 × 10−8) and CLPB (p = 8.1 × 10−7) with earlier menopause. Two additional genes are suggestive: RAD54L (p = 2.4 × 10−6) with later menopause and HROB (p = 2.9 × 10−6) with earlier menopause. In a follow-up analysis of repeated questionnaires in women who were initially premenopausal, CHEK2, TOP3A, and RAD54L genotypes are associated with subsequent menopause. Consistent with previous genome-wide association studies (GWASs), six of the seven genes are involved in the DNA damage repair pathway. Phenome-wide scans across 398,569 men and women revealed that in addition to known associations with cancers and blood cell counts, rare variants in CHEK2 are also associated with increased risk for uterine fibroids, polycystic ovary syndrome, and prostate hypertrophy; these associations are not shared with higher-penetrance breast cancer genes. Causal mediation analysis suggests that approximately 8% of the breast cancer risk conferred by CHEK2 pathogenic variants after menopause is mediated through delayed menopause.

COMPARATIVE ASSESSMENT OF EFFICACY OF TADALAFIL AND TAMSULOSIN ALONE AND IN COMBINATION AMONG MEN WITH BENIGN PROSTATIC HYPERPLASIA

Background: Men in 5th and 6th decade of life experience a fall in the quality of life owing to Lower Urinary tract symptoms arising out of benign prostatic hypertrophy. The medical management protocol involves either monotherapy or combination. The present study was done to comparatively evaluate the efficacy of monotherapy as well as combination therapy in treatment of such patients using two drugs, namely Tadalafil and Tamsulosin. Methodology: The study comprised of 90 subjects divided equally in three groups. Group A and B were subjected to monotherapy using Tadalafil and Tamsulosin respectively, while Group C was provided a combination. Observations: There was statistically significant difference in subjects having Tamsulosin alone or in combination therapy as compared to subjects given Tadalafil alone. Conclusion: Tamsulosin alone or in combination therapy has shown a better outcome in the selected study subjects.&#x0D; Keywords: BPH, LUTS, Tamsulosin, Tadalafil

Flavonoids in Benign Prostate Hypertrophy: Identification in Herbal Preparations and Molecular Docking Approach

The benefits of phytotherapy in Benign prostatic hyperplasia (BPH) are of interest where they may lack side effects at long-term therapy. Through plant-derived preparations are Saw palmetto and Pumpkin seed oil. Evidence suggests that fatty acids, phytosterols, tocopherols, and flavonoids are the active components responsible for alleviating BPH symptoms. Flavonoids are reported to inhibit BPH through different mechanisms. Reducing inflammation and lowering reactive oxygen species are amongst the proposed mechanisms. In vitro studies highlighted the role of flavonoids in 5-alpha reductase II (5ARII) inhibitory activity. In this study, herbal preparations known to treat BPH were subjected to LC/MS/MS analysis integrated with multiple reaction monitoring (MRM) to identify the content of flavonoids. A molecular docking study was conducted on the assigned flavonoids to predict the binding mode and interaction with the targeted 3D- crystal structure of the human 5ARII enzyme. Results showed the existence of seven flavonoids and a polyphenol compound. Sakuranetin, Isorhamnetin, and Chlorogenic acid were not reported before. Molecular docking outcomes revealed that Astragalin, Isoquercitrin, Quercetin, and Chlorogenic acid have similar binding affinity to the reference Finasteride compound. These findings suggest flavonoids as potent potential inhibitors of 5ARII and could proceed to in vitro investigations.

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&lt;.05). Furthermore, NF-kb and COX-2 mRNA expression were significantly increased in prostate tissue (p&lt;.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&lt;.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.

Macroglossia reveals multiple myeloma

We present an eighty-year old man with a one year history of progressive macroglossia, dysphagia and loss of weight. He had a medical history of arterial hypertension and prostatic hypertrophy which he had under good therapeutic control. The entire tongue was swollen, had hard solidity and was slightly painful upon palpation. A tongue biopsy revealed an amyloid deposition as it coloured bright orange-red on Congo Red staining and lead us subsequently to the diagnosis of amyloidosis; then a bone marrow biopsy confirmed the diagnosis of multiple myeloma. The case was further evaluated by a multidisciplinary team who considered it appropriate to start a lowdose melphalan treatment combined with supportive care. When macroglossia in the tongue is confirmed to be amyloidosis the differential diagnosis should include systemic amyloidosis deposition and multiple myeloma.

Understanding the needs of low-income countries: how urologists can help.

Delivering urological humanitarian aid to countries with greater need has been provided by urologists associated with British Association of Urological Surgeons (BAUS) Urolink over the last 30 years. Urolink has realised the need to understand where that need is geographically, what tangible help is required, and how assistance can be delivered in the most ethically appropriate way. The World Bank stratification of countries by per capita gross national income has helped in the identification of low-come countries or lower-middle-income countries (LMICs), the vast majority of which are in sub-Saharan Africa. The medical and socioeconomic needs of those country's populations, which constitute 17% of the global community, are substantially different from that required in higher income countries. More than 40% of sub-Saharan Africa's population is aged <14 years, it has a substantially reduced life expectancy, which influences the type of pathologies seen, and perinatal complications are a major cause of morbidity for both mother and child. There is a significant problem with the availability of medical care in these countries and almost a third of global deaths have been attributed to the lack of access to emergency and elective surgery. Urologically, the main conditions demanding the attention of the very few available urologists are congenital anomalies, benign prostatic hypertrophy, urolithiasis, urethral stricture, and pelvic cancer. The management of these conditions is often substantially different from that in the UK, being limited by a lack of personnel, equipment, and access to geographically relevant guidelines appropriate to the healthcare environment. Assisting LMICs to develop sustainable urological services can be helped by understanding the local needs of linked institutions, establishing trusting and durable relationships with partner centres and by providing appropriate education that can be perpetuated, and disseminated, across a region of need.

How routine pharmacovigilance failed to identify finasteride's persistent sexual side effects.

How routine pharmacovigilance failed to identify finasteride's persistent sexual side effects.

Study on Estimation of Serum Prostate Specific Antigen Level and Prostate Volume with Trans-Abdominal Ultrasonography Finding in Benign Prostate Hypertrophy at Tertiary Care Hospital : A Cross Sectional Descriptive Study

Introduction: The periurethral and transition zones of the prostatic gland develop benign prostatic hyperplasia and represent an inevitable phenomenon for the ageing male population. Prostatic specific antigen, is a serine protease, level rises in the blood if the barrier between thelining epithelium and the blood stream is damaged. Benign prostatic hyperplasia, prostatic carcinoma and prostatitis are three common diseases where PSA in the serum is raised. Prostate volume also increases according to age, which can be estimated by trans-abdominal ultrasonography.&#x0D; Objective: The aim of the study is to estimate the PSA level in blood and its relationship with prostate volume in benign prostatic hyperplasia patients.&#x0D; Methodology: It is a descriptive cross-sectional study which was carried out between a periods of 1st April 2018 to 31st March 2019 at Birat Medical College Teaching Hospital. All the patients diagnosed with benign prostate hyperplasia at the department of urology were included in the study. Blood samples of patients were analyzed for Prostate specific antigen level estimation by chemiluminescence immunosorbent assay. Prostatic volume of the patients was measured by Transabdominal ultrasound technique. Data were entered and analyzed in Microsoft Excel.&#x0D; Results: A total of 68 patients were diagnosed with benign prostate hyperplasia. The mean age of the patients was 61.8±12.3 years. The maximum number 23 of patients with BPH was there in age group 51-60. The maximum no of patients 38 were having their PSA level between the range of 4.0-10.0 ng/ml. The maximum no of patients 28 was having Prostate volume in the range of 40-60 gm. The maximum number of patients 31 was having diabetes mellitus as a co-morbid association. The maximum mean PSA level and prostate volume in the patients were observed in age group &gt;80 years,which was 20.1±8.6 ng/ml and &gt;80 gm respectively.&#x0D; Conclusion: The prostate specific antigen level and prostate volume both increase in advance age group of patients suffering with benign prostate hyperplasia.

Learning of self-catheterization: For whom? Why? How?

Since the 1970s, self-catheterization is the preferred method of urine drainage in case of urinary retention of neurological etiology (paraplegia, multiple sclerosis…) and non-neurological cause (benign prostatic hypertrophy, acontractile bladder of the elderly subject…). The main objective is to allow the physiological alternation of filling and complete emptying phases, in order to preserve the renal function and prevent urinary infections. The learning of self-catheterization is simple but requires a therapeutic education session with trained personnel, at home or in a specialized center. Cognitive disorders, poor vision, lack of dexterity or lack of knowledge of urogenital anatomy are the main limitations to their implementation. Their success depends on the frequency of catheterization (every 4h), which is performed in a clean but non-sterile manner. The benefit/risk ratio is largely in favor of using them to replace the indwelling probe whenever possible.

Prostate Artery Embolization-Review of Indications, Patient Selection, Techniques and Results.

Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.

A STUDY ON CORRELATION OF SERUM PROSTATE SPECIFIC ANTIGEN WITH CLINICAL AND PATHOLOGICAL VARIABLES IN PATIENTS OF PROSTATOMEGALY

Background: In clinical practice, biopsies are generally performed only when the results ofprostate specific antigen (PSA) test or digital rectal examination (DRE) are abnormal. This leads to misdiagnosis of most small prostatic cancers present in many older men. Patients with lower urinary tract infection (LUTS) who have serum PSA levels higher than 4ng/ml are primarily advised to undergo prostate biopsy to rule out cancer. However, PSA is organ specific not disease specific, so the presence of other prostate diseases such as benign prostatic hyperplasia (BPH) and prostatitis may influence its effectiveness for cancer detection. Hence, the PSA based prostate cancer detection is fraught with high false positive rate.&#x0D; Aim:To evaluate the utility of PSA assay as a method of investigation in diagnosis of prostatic lesion.&#x0D; Objectives: The use of Serum PSA levels for the early detection of prostate cancer and evaluate its role with other modalities for diagnosis of prostate cancer and to diagnose different diseases of prostate, i.e. prostatitis, BPH in prostatomegaly, and its correlation with Serum PSA levels.&#x0D; Materials and Methods: This prospective descriptive study was conducted in Index Medical College, Hospital &amp; Research Centre, Indore, M.P,India in the period of August 2019 to July 2021. The patients were selected from the outdoor Department of General Surgery.&#x0D; Results: A total of 80 male patients presenting with LUTS were included. Their mean age was 68.66 years. The majority i.e. 41 of the study group were in the age group of 61-70 years. 42 of patients had Serum PSA &lt; 4ng/ml. Biopsy proven adenocarcinoma cases 34% of the cases are in the age group of 61-70 years. Out of the biopsy proven adenocarcinoma cases, DRE was suspicious of malignancy in 89%.&#x0D; Conclusion: Serum PSA levels have a significant correlation with the age group, with the increase in age there is rise in Serum PSA levels. Transabdominal ultrasound, DRE and Serum PSA has high sensitivity in diagnosis of prostatomegaly but it was found that none of the screening tool has got much efficacy in differentiating carcinoma prostate from benign hypertrophy, but the combination of DRE and Serum total PSA or DRE, Serum total PSA and ultrasound abdomen showed higher efficacy in diagnosis of carcinoma prostate. Increase in Serum PSA is directly related to carcinoma, but there is no absolute cut-off for Serum PSAfor diagnosis of carcinoma.&#x0D; Key-Words: Prostate specific antigen, Prostatomegaly, Benign Prostatic Hypertrophy, Digital Rectal Examination, International Prostate Severity Score, Carcinoma Prostate.

The differential presence of human polyomaviruses, JCPyV and BKPyV, in prostate cancer and benign prostate hypertrophy tissues

BackgroundStudies have shown that human polyomavirus infection may be associated with various human cancers. We investigated the potential relationship between the prevalence of JCPyVor BKPyV and prostate cancer (PC) in patients from Taiwan.MethodsPatients with PC and benign prostate hypertrophy (BPH; 76 and 30 patients, respectively) were recruited for this study. Paraffin-embedded tissues and clinical information of the patients were obtained. The tissue sections were used for viral DNA detection and immunohistochemistry analysis was performed for examining viral large T (LT) and VP1 proteins. Regression analysis was used to evaluate the relationship between the clinical characteristics of the patients and the risk of JCPyV/BKPyV infection.ResultsThe prevalence of JCPyV/BKPyV DNA was different in PC and BPH tissues (27/76 [35.52%] and 2/30 [6.7%], respectively, p = 0.003)]. The LT and VP1 proteins were detected in 27 (35.52%) and 29 PC (38.2%) specimens, respectively, but neither protein was detected in BPH samples (p < 0.001). PC cells were more susceptible to JCPyV infection than BPH tissues [odds ratio (OR) 7.71, 95% CI: 1.71–34.09, p = 0.003). Patients with PC showing high levels of prostate-specific antigen and high Gleason scores were associated with a high risk of viral infection (ORs 1.1, 95% CI 1.000–1.003; p = 0.045 and ORs 6.18, 95% CI 1.26–30.33, p = 0.025, respectively). The expression of LT protein associated with the risk of PC increased 2923.39-fold (95% CI 51.19–166,963.62, p < 0.001).ConclusionsThe findings indicate that JCPyV infection in PC cells may be associated with prostate cancer progression and prognosis.Graphical abstract