Prostate Volume Reduction Research Articles

Endocrine, prostatic vascular, and proapoptotic changes in dogs with benign prostatic hyperplasia treated medically or surgically

Benign prostatic hyperplasia (BPH) is a disorder related to hormone imbalance, local angiogenesis, and prostate growth, which can be treated surgically (orchiectomy) or medically (most commonly with finasteride). However, finasteride therapy is not completely established in dogs regarding local action and posology. This study aimed to evaluate the effect of different doses of finasteride and orchiectomy on hormonal profile, prostate apoptosis, blood flow, and biometry in dogs with BPH. Dogs were assigned to the following groups: untreated, 0.1 mg, 0.2 mg, and 0.5 mg/kg/d of finasteride and orchiectomy. All dogs were assessed monthly: day 0 (before treatment), day 30, and day 60 and subjected to prostate B-mode and Doppler ultrasonography and hormonal analysis (testosterone and dihydrotestosterone). After 60 d, prostatic biopsy was performed for histology and immunohistochemical evaluation for apoptosis (caspase-3). On day 60, percentage reduction of prostatic volume was greater in orchiectomized dogs than that in finasteride groups, which, conversely, was greater than untreated dogs. On day 60, 0.2-mg finasteride, 0.5-mg finasteride, and orchiectomy groups had higher prostatic blood flow than 0.1-mg finasteride and untreated groups. In addition, both 0.5-mg finasteride and orchiectomy groups had an increase in prostate artery resistance. Orchiectomy significantly decreased androgen concentrations at 30 d onward, differing from the remaining groups. The orchiectomy group had lower caspase-3 immunostaining, however, not different from untreated and 0.5-mg finasteride. In conclusion, 0.5 mg/kg finasteride promoted more effective prostate apoptosis and hemodynamic effects among medical treatments, whereas orchiectomy caused prostate atrophy and sharp endocrine changes in dogs with BPH.

A Proof-of-Concept Study on the Use of Prostate Artery Embolization Before Definitive Radiation Therapy in Prostate Cancer

PurposeProstatic artery embolization (PAE) is an effective therapy for alleviating lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia; however, is not well studied in patients with concurrent prostate cancer (PCa). We demonstrate a proof of concept for PAE before definitive radiation therapy (RT) in patients with PCa. Methods and MaterialsFrom December 2017 to July 2019, 9 patients with PCa underwent PAE for the indication of LUTS from benign prostatic hyperplasia with concurrent PCa. Five received radiation and all follow-ups at our institution and were therefore included in the analysis. Median follow-up was 18 months from the time of PAE. Side effects during radiation were quantified using the Common Terminology Criteria for Adverse Events scoring system. Pre- and post-PAE plans were compared in the 5 patients by performing an isovolumetric expansion of the post-PAE plan (treated plan) equivalent to the measured volume reduction after PAE. Patient 1 (PT-01) and PT-02 had prostate RT alone whereas PT-03, PT-04, and PT-05 had prostate with elective nodal coverage RT. Mean doses to organs at risk were compared between the 2 plans. ResultsThe mean International Prostate Symptom Score reduction after PAE was 13.8 (5.0-30.0; P = .02). The mean prostatic volume reduction after PAE was 23.1% (7.2%-47.7%). There were no Common Terminology Criteria for Adverse Events grade 3 (severe) or higher during radiation. Post-PAE plans in PT-01 and PT-02 had on average 23.2%, 39.8%, and 22.9% decrease in mean dose across the bladder, rectum, and penile bulb, respectively, compared with the pre-PAE plans. There were no appreciable differences in dosimetry in PT03, PT-04, and PT-05 who had nodal coverage. There was no biochemical failure in any of the patients. ConclusionsWe demonstrate a proof of concept that PAE is a clinically significant adjunctive therapy for alleviating LUTS and achieving significant volume reduction before RT, resulting in decreased radiation-related toxicity from RT for PCa.

The effect of vitamin D supplementation on the progression of benign prostatic hyperplasia: A randomized controlled trial

Inflammation and proliferation are the cause of benign prostatic hyperplasia (BPH) and are the key components of its mechanism of action. In this study we sought to determine the role of 25-hydroxyvitamin D in BPH, because of its anti-inflammatory activities, and its effect on prostate volume and BPH symptoms. This randomized clinical trial (RCT) was conducted on 108 participants >50 years of age who had either asymptomatic or mild BPH symptoms according to the International Prostate Symptom Score (IPSS) questionnaire. Patients were randomly divided into two groups, intervention and control. The intervention group received 50000 units of vitamin D3 and the control group received a placebo every two weeks for six months. Prostate ultrasound, routine clinical examinations, toucher rectal (TR), and laboratory tests were performed for all patients. After six months, the patients underwent another ultrasound evaluation, measurement of prostate-specific antigen (PSA) levels and completed the IPSS. Results of the evaluations before and after the intervention were compared between the groups using the chi-square, t-test, and logistic regression analysis. Repeated measure analysis was used to evaluate the effect of vitamin D intervention on the changes in the IPSS score. The mean age of the participants was 56±9 years. In the control group, the mean prostate volume was higher compared to the intervention group (p<0.001). The control group had a higher mean PSA level than the intervention group (p<0.001). Although the IPSS score decreased over time in both groups, analysis of variance showed that the amount of change or decrease in IPSS score in the intervention group was significantly more than the control group (p<0.001). The results of our study support the effect of vitamin D in reducing prostate volume and PSA levels, and in improving BPH symptoms. Further studies are needed to confirm these findings to verify the use of vitamin D as a treatment for BPH.

Urtica dioica in the Management of Benign Prostate Hyperplasia (BPH)

Background:: Benign Prostatic hyperplasia (BPH) is known as a disease prevalent in men after the age of 50 years old. Ninety percent of men with the age of 80 years and over have BPH. BPH is associated with functional problems like dysuria, nocturia, polyuria, urinary incontinence and recurrent urinary tract infections. Urtica dioica or nettle is a popular medicinal plant for management of BPH in men. Objective:: This article evaluates the efficacy and safety of nettle and its related possible mechanisms in the management of BPH. Methods:: For the preparation of this manuscript, all the information was gathered from accessible and inaccessible resources (Web, Books, Thesis, etc.). Results:: The results of preclinical and clinical studies confirmed the efficacy of nettle roots extracts (methanol, ethanol, and petroleum ether) in the improvement of BPH in term of IPSS score, and patient's life quality. An increase in mean and maximum urinary flow rates and a reduction in prostate volume and residual urine level were observed after treatment with nettle extract. Nettle roots should be used for 6-12 months as its use is possible for a long time without any serious adverse effects. Conclusion:: Designing the clinical trials to compare the efficacy of different extracts from roots or leaves and investigation of molecular mechanisms of action could be the approaches for future.

Reproductive and endocrinological effects of Benign Prostatic Hyperplasia and finasteride therapy in dogs

Benign prostatic hyperplasia (BPH) is one of the most important reproductive disorders in aging dogs. Therapeutic measures include orchiectomy and pharmacological treatment, leading to reduction of prostate volume and clinical signs. One of the most common drugs used in BPH treatment is finasteride, but data regarding its possible side effects are scarce. Thus, the aim of this study was to evaluate the effects of BPH and short-term (2 months) finasteride therapy on clinical, endocrinological, and reproductive parameters in dogs. Dogs were allocated into four experimental groups: Non-affected (n = 5), BPH (n = 5), Non-Affected-Finasteride (n = 5) and BPH-Finasteride (n = 5) groups. Dogs were evaluated monthly during 2 months by a complete breeding soundness examination, B-mode ultrasound and Doppler ultrasonography of the testicular artery, hormonal profile (testosterone, estrogen and dihydrotestosterone) and oxidative profile of the prostatic fluid. After 2 months, dogs were gonadectomized and testicles were subjected to histologic analysis. Finasteride treatment reduced dihydrotestosterone concentrations, without negative influence on semen quality and also reverted testicular hemodynamics changes of BPH. On the other hand, BPH was accompanied by significant changes in testosterone and estrogen concentrations and semen quality, mainly related to sperm kinetics alterations. In conclusion, BPH dogs have important hormonal and sperm alterations, however, short-term finasteride treatment (2 months) was able to reduce overall effects of BPH, thus representing a method of therapy for BPH treatment.

Prostatic artery embolization with polyethylene glycol microspheres: evaluation in a canine spontaneous benign prostatic hyperplasia model

BackgroundProstatic artery embolization (PAE) is a minimally invasive technique for the management of symptomatic benign prostatic hyperplasia (BPH) relieving the lower urinary tract symptoms in patients. Various embolic agents have been tested in animal models and subsequently used in human patients. The purpose of this study was to evaluate the technical feasibility, effectiveness, and safety of PAE with polyethylene glycol microspheres in a canine spontaneous BPH model.ResultsFive adult male Beagle dogs (4.78 ± 1.11 years) were diagnosed by tranrectal ultrasonography of spontaneous BPH (prostate volume > 18 ml) and underwent PAE with polyethylene glycol microspheres (400 ± 75 μm). PAE procedures were performed successfully in all dogs. After PAE, all dogs were inspected for potential procedure-related complications during 1 month of follow-up. No major complications were observed any animal. Follow-up angiography was performed in each animal at 1 month of follow-up. Recanalization was demonstrated in all the embolized prostatic arteries or main branches at the end of the study. Magnetic Resonance Imaging (MRI) evaluations were performed immediately before PAE as baseline data, and 1 week, 2 weeks and 1 month after PAE. MRI study showed that the prostate shrank substantially with ischemic necrosis in each dog. There was a significant reduction in the mean prostate volume at 2 weeks and 1 month compared with the baseline data, from 19.95 ± 1.89 mL to 13.14 ± 2.33 and 9.35 ± 2.69 mL (p < 0.001), respectively. Histopathological study was conducted after 1-month follow-up angiography and confirmed the therapeutic responses with diffuse glandular atrophy and interstitial fibrosis.ConclusionsThe findings of the present study support that PAE with the use of polyethylene glycol microspheres is a safe and feasible procedure that may induce a significant shrinkage of prostate due to the local ischemia and secondary glandular atrophy. Early recanalization of target arteries remains to be further addressed in both laboratory investigation and clinical practice.

Paying the price for standing tall: Fluid mechanics of prostate pathology.

BackgroundAge‐dependent increase in the incidence of benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are both related to cell proliferation and survival controlled by intraprostatic free testosterone (FT) concentration. Paradoxically, BPH and PCa occur as circulating testosterone levels decrease, so any possible relationship between testosterone levels and development of BPH and PCa remains obscure.ResultsIn BPH the enlarging prostate is exposed to high testosterone levels arriving directly from the testes at concentrations about hundredfold higher than systemic FT. This occurs because venous blood from the testes is diverted into the prostate due to the elevated hydrostatic pressure of blood in the internal spermatic veins (ISVs). Elevated pressure is caused by the destruction of one‐way valves (clinically detected as varicocele), a unique phenomenon related to human erect posture. While standing, human males are ISVs vertically oriented, resulting in high intraluminal hydrostatic pressures—a phenomenon not found in quadrupeds. In this communication, we demonstrate the fluid mechanics' phenomena at the basis of varicocele leading to prostate pathology.ConclusionsSo far, varicocele has been studied mostly for its etiologic role in male infertility and, thus, for its effects on the testes. It is becoming clear that varicocele is a major etiologic factor in BPH and likely also in PCa. Restoring normal testicular venous pressure by treatment of the abnormal ISV's in varicocele has been shown to avert the flow from the prostate with the effect of reducing prostate volume, alleviating symptoms of BPH, and increasing concentrations of circulating FT.

Low reduction of prostate volume is a significant predictor of prostate cancer at subsequent biopsy in patients with dutasteride: A retrospective study.

Appropriate decision of prostate biopsy in men with 5α‐reductase inhibitor (5AR inhibitor) is still unclear to avoid unnecessary biopsy. We retrospectively investigated patients with initial PSA 4.0 ng/ml or more and underwent subsequent prostate biopsy following dutasteride treatment. From September 2009 to August 2018, 399 cases of benign prostate hyperplasia (BPH) were treated with dutasteride in our department. Of the total, 36 cases with elevated pre‐treatment PSA (4.0 ng/ml or more) and underwent subsequent prostate biopsy were included into this study. We evaluated PSA kinetics and changing prostate volumes (PV), and detection of prostate cancer. Overall, average PSA reduced by half at 6 months from dosing. Pre‐treatment biopsy was performed in 17 of 36 cases, and all were diagnosed as having no malignancy. After treatment, prostate cancer was detected in 15 cases by subsequent biopsy. Fourteen of 15 cases were clinically significant cancer (Gleason score 7 or more). Logistic regression analysis detected a nominal association between prostate cancer detection and three variants, PSAD, PV reduction (1–Before/After PV) and abnormal MRI findings. In addition to abnormal MRI findings and pre‐treatment of high PSAD, the case with low reduction of PV after treatment should consider performing prostate biopsy.

Clinical predictive factors in prostatic artery embolization for symptomatic benign prostatic hyperplasia: a comprehensive review.

Prostatic artery embolization (PAE) has been established as a routine treatment for symptomatic benign prostatic hyperplasia (BPH) all over the world. With increasing clinical experience in the last decade, investigators have sufficient data to assess predictive factors with the purpose to guide patient selection and counseling for PAE or to individualize therapeutic plans after PAE. This paper is a comprehensive review to introduce the concept of clinical predictors and give a systemic classification of various predictive factors in PAE. The authors review each individual factor and its predictive capability and discuss the possible reasons for the inconsistent or conflicting findings in the literature. Based on current evidence, the baseline prostate volume, in particular the transition zone volume and transition zone index; 24 h post-PAE prostate-specific antigen (PSA) level; and prostate infarction and prostate volume reduction at 1–3 months have potential in prediction of treatment outcomes. Patients with Adenomatous-dominant BPH or with indwelling bladder catheter before PAE may have more benefits from PAE. Baseline intravesical prostatic protrusion (IPP), C-reactive protein (CRP) level at 48 h and early detection of prostate infarct at 1 day and 1 week after PAE need further investigating.

Prostatic Artery Embolization for Treatment of Symptomatic Benign Prostatic Hyperplasia Patients: Short- and Intermediate- term Outcome

Background: Benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men and is the most common cause of lower urinary tract symptoms (LUTS). There are several treatment options for benign prostatic hyperplasia. Aim: This study aims to evaluate the effectiveness, safety, morbidity and short- and intermediate-term results of prostatic artery embolization (PAE) for symptomatic BPH patients with moderate to severe LUTS. Methods: A prospective cohort study was carried out on 33 BPH patients, with moderate to severe LUTS. PAE was performed for patients and they were followed up at 3, 6 and 12 months post-procedural. Results and conclusion: Post-embolization follow-up results revealed significant reduction in the mean prostatic volume, post-voiding residual urine volume, severity of symptoms , total prostate specific antigen (PSA) level as well as significant improvement in patients’ quality of life (QoL). Meanwhile, no statistically significant changes were found in the erectile function post-procedural. Future researchers are recommended to replicate this study with longer follow-up periods, especially multi-center randomized controlled trials, using different types of embolic agents.

Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes.

This study aimed to assess the midterm outcomes and safety of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH). A single-center, retrospective review of PAE performed for BPH was performed. Validated International Prostate Symptom Score (IPSS), quality of life (QoL) index, and International Index for Erectile Function (IIEF-5) questionnaires were completed at baseline and at least 12 months post-procedure. Prostate imaging was performed preprocedure as well as 3 months and 12 months post-procedure to assess prostate volume (PV). Uroflowmetry was also performed at baseline and 12 months post-procedure to assess urine flow rate (Qmax) and post-void residual (PVR) volume. Adverse events were graded according to Society of Interventional Radiology (SIR) guidelines. Eighty male patients underwent the PAE procedure (mean age 69 years). Prostate volume decreased significantly from a mean volume 156 to 107 mL after 12 months post-procedure, commensurate with a mean reduction of 27.5% (P < .05). Significant improvements were seen in IPSS (21.8 vs 10.5) and QoL (4.5 vs 2.0) from baseline to 12 months post-procedure (P < .05). There was no significant change in IIEF-5 score. There was a significant reduction in PVR (202 vs 105 mL) and improvement in Qmax (5.9 vs 10.0 mL/s) between baseline and 12 months post-procedure (P < .05). No major complications occurred; 4 minor complications occurred (SIR grade A or B). Prostate artery embolization achieved a clinically and statistically significant prostate volume reduction, symptom and QoL improvement, and enhanced uroflowmetry parameters in patients with BPH.

Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: 10 Years' Experience.

Background Long-term experience with prostatic artery embolization (PAE) for benign prostatic hyperplasia remains limited. Purpose To evaluate the efficacy, safety, and long-term results of PAE for benign prostatic hyperplasia. Materials and Methods This retrospective single-center study was conducted from June 2008 to June 2018 in patients with moderate to severe benign prostatic hyperplasia-related symptoms. International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, postvoid residual volume, prostate-specific antigen (PSA), and prostate volume were assessed. PAE was performed with 100-500-μm embolic microspheres. Mixed-model analysis of variance and Kaplan-Meyer method was accessed, as appropriate. Results A total of 317 consecutive men (mean age ± standard deviation, 65 years ± 8) were treated. Follow-up ranged from 3 months to 96 months (mean, 27 months). Bilateral and unilateral PAE was performed in 298 (94%) and 19 (6%) men, respectively. Early clinical failure occurred in six (1.9%) and symptom recurrence in 72 (23%) men at a median follow-up of 72 months. Mean maximum improvement was as follows: IPSS, 16 points ± 7; quality-of-life score, 4 points ± 1; prostatic volume reduction, 39 cm3 ± 39 (39% ± 29); maximum urinary flow rate, 6 mL/sec ± 10 (155% ± 293); and postvoid residual volume, 70 mL ± 121 (48% ± 81) (P < .05 for all). Unilateral PAE was associated with higher recurrence (42% vs 21%; P = .04). Baseline PSA was inversely related with recurrence (hazard ratio, 0.9 per nanograms per milliliter of PSA; 95% confidence interval [CI], 0.8, 0.9; P < .001). Embolization with combined particle sizes (100-500 μm) did not relate to symptom recurrence (hazard ratio, 0.4; 95% CI: 0.2, 1.1 for 100-500-μm group vs 300-500-μm group and hazard ratio, 0.4; 95% CI: 0.1, 1.5 for 100-500-μm group vs 100-300-μm group; P = .19).None of the patients presented with urinary incontinence or erectile dysfunction. Conclusion Prostatic artery embolization was a safe and effective procedure for benign prostatic hyperplasia with good long-term results for lower urinary tract symptoms. © RSNA, 2020 Online supplemental material is available for this article.

Water-stable and finasteride-loaded polyvinyl alcohol nanofibrous particles with sustained drug release for improved prostatic artery embolization - In vitro and in vivo evaluation.

Prostatic artery embolization (PAE) has been a well-established treatment for benign prostatic hyperplasia (BPH). To enhance the therapeutic efficacy, a strategy is to use embolic agent preloaded with 5α-reductase inhibitors for localized drug delivery. In this study, finasteride (FNS) was encapsulated into the polyvinyl alcohol (PVA) nanofibers via co-electrospinning technique, followed by heat treatment and cryogenic grinding to convert them into nanofibrous particles as a drug-loaded embolic agent. The FNS was found to be distributed uniformly in PVA nanofibers, and the processed FNS/PVA nanofibrous particles were 272μm in mean particle size. Besides, the studies on the composition, thermal properties, swelling ratio, and water stability of the nanofibers and drug showed that the FNS remained its crystalline state in PVA nanofibers. The heat treatment increased the crystallinity of nanofibers and rendered them water stability. Both FNS and PVA possessed excellent thermal stability at high temperature (150°C). In addition, in vitro drug release studies suggested the FNS followed a favorable sustained release up to 744h. Furthermore, the cell viability and hemocompatibility assays indicated the nanofibers possessed excellent cytocompatibility and with no evidence of hemolysis. More importantly, the in vivo PAE procedures on beagles demonstrated the crosslinked FNS/PVA nanofibrous particles exhibited higher embolization efficacy with more obvious prostate volume (PV) reduction compared to crosslinked PVA nanofibrous particles after embolization for 1, 3, and 6months (P<0.05). Therefore, such drug-loaded PVA nanofibrous particles combined physical embolization and localized medical therapy together, which offer great potential to be used as an effective embolic agent for BPH therapy.

Use of 70- to 150-μm Radiopaque Spherical Embolics for Prostatic Artery Embolization

This retrospective report describes treatment of 21 patients who underwent prostatic artery embolization using 70- to 150-μm radiopaque microspheres for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Seventeen patients (81%) received successful bilateral prostatic artery embolization. At a mean follow-up of 42 days (range, 25–59 days), patients showed improvement in International Prostate Symptom Score (n = 11; mean = 10.6; P = .001), quality of life score (n = 17; mean = 2.0; P = .02), and International Index of Erectile Function (n = 17; mean = 9.3; P = .01). The mean prostate volume reduction was 28 mL (16.2%; P = .003). Nontarget embolization occurred twice, resulting in 1 minor adverse event of hematospermia.

Prostatic artery embolization versus transurethral resection of the prostate in management of benign prostatic hyperplasia.

BackgroundTransurethral resection of the prostate (TURP) is considered the gold standard surgical intervention for prostate size less than 80 g. Prostatic artery embolization (PAE) has been suggested as a minimally invasive interventional radiological procedure in the management of benign prostatic hyperplasia (BPH), especially by using the PErFecTED technique. We aim through our study to evaluate the efficacy and safety of PAE compared with those of monopolar transurethral resection of prostate (M-TURP) and bipolar transurethral resection of prostate (B-TURP) in treating lower urinary tract symptoms (LUTSs) secondary to BPH.MethodsWe randomized 60 patients into 3 equal groups representing M-TURP, B-TURP, and PAE. Patients were followed up at 1 and 6 months postoperatively with regard to the International prostate symptom score (IPSS) score; uroflowmetry; prostate volume by transrectal ultrasound; and postvoid residual urine.ResultsThe mean operative time was 59, 68, and 89 minutes for the M-TURP group, the B-TURP group, and the PAE group, respectively; only one patient, who represented 5% of the M-TURP group and 1.7% of the whole study population, developed transurethral resection syndrome. Four patients of the PAE group complained of postembolization syndrome, which represented 20% of the cases. Only two patients in our study, both belonging to the PAE group, developed acute urinary retention after catheter removal, representing 10% of the PAE group and 3.33% of the whole study population. The improvement in the IPSS score, the average uroflowmetry (Q-average) score, postvoid residual urine, and prostate volume reduction was noted in all groups, with more statistically significant improvement in each of the M-TURP and the B-TURP groups than in the PAE group.ConclusionPErFecTED technique is a novel way of embolization, with statistically significant improvement for patients complaining of LUTSs due to BPH in terms of improvement of IPSS, uroflowmetry, prostate size, and amount of postvoid residual urine, yet these results are still not comparable with either the results of M-TURP or B-TURP that still show more effective improvement.

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Bleomycin-Eluting versus Bland Microspheres in a Canine Model

PurposeTo prospectively assess safety and efficacy of prostatic artery embolization (PAE) with bleomycin-eluting microspheres for benign prostatic hyperplasia (BPH) in a canine model. Materials and MethodsTwelve adult male beagles (mean age, 1.6 y ± 0.2; range, 1.2–2.0 y) were randomly assigned to group A (n = 6; PAE with bleomycin-eluting 30–60-μm HepaSphere microspheres) and group B (n = 6; PAE with bland 30–60-μm HepaSphere microspheres) between April 2017 and November 2018. Plasma bleomycin concentration in group A was measured within 7 days. Prostate volume (PV) and ischemic volume after PAE were measured by magnetic resonance imaging. Prostates and adjacent organs were harvested after the last magnetic resonance study and histopathologically examined. ResultsPlasma bleomycin concentration peaked at 10 minutes at 2,055.0 ng/mL ± 606.1 and lasted for 1,440 min at low levels after PAE. PV reduction percentage was greater in group A than in group B at 1 month (74.1% ± 4.3 vs 63.7% ± 3.5; P = .006) and 3 months (61.5% ± 6.7 vs 46.1% ± 3.8; P = .001) after PAE. Proportion of prostate ischemic volume was greater in group A than in group B (75.3% ± 3.0 vs 62.0% ± 7.1; P = .006) at 1 month after PAE. Proportion of prostate ischemic volume at 1 month positively correlated with PV percentage reduction at 3 months in group A (r = 0.840, P = .036) and group B (r = 0.844, P = .035). There were no complications or nontarget embolization to surrounding organs after the procedures. ConclusionsIn a canine model, PAE with bleomycin-eluting microspheres was feasible and well tolerated and caused ischemic necrosis and reduction in PV.

Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia

PurposeTo compare clinical and functional outcomes of prostatic artery embolization (PAE) with those of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Materials and MethodsNoninferiority randomized trial was conducted involving men over 60 years of age with LUTS secondary to BPH. From November 2014 to January 2017, 45 patients were randomized to PAE (n = 23) or to TURP (n = 22). PAE was performed with 300- to 500-μm microspheres with the patient under local anesthesia, whereas bipolar TURP was performed with the patients under spinal or general anesthesia. Primary outcomes were changes in peak urinary flow (Qmax) and international prostate symptoms score (IPSS) from baseline to 12 months. Quality of life (QoL), and prostate volume (PV) changes from baseline to 12 month were secondary outcomes. Adverse events were compared using the Clavien classification. ResultsMean Qmax increased from 6.1 mL/s in the PAE group and from 9.6 mL/s in the TURP patients (P = .862 for noninferiority), and mean IPSS reduction was 21.0 points for PAE and 18.2 points for TURP subjects (P = .080) at 12 months. A greater QoL improvement was reported in the PAE group (3.78 points for PAE and 3.09 points for TURP; P = .002). Mean PV reduction was 20.5 cm³ (34.2%) for PAE subjects and 44.7 cm³ (71.2%) for TURP subjects (P < .001). There were fewer adverse events reported in the PAE group than in the TURP group (n = 15 vs n = 47; P < .001). ConclusionsReduction of LUTS in the PAE group was similar to that in the TURP group at 12 months, with fewer complications secondary to PAE. Long-term follow-up is needed to compare the durability of the symptomatic improvement from each procedure.

Therapeutic use of pulsed electromagnetic field therapy reduces prostate volume and lower urinary tract symptoms in benign prostatic hyperplasia.

BackgroundBenign prostatic hyperplasia (BPH) etiology remains poorly understood, but chronic low‐grade inflammation plays a role. Pulsed electromagnetic field therapy (PEMF) (1‐50 Hz) is effective in reducing tissue inflammation.ObjectivesWe designed a pilot study to evaluate the effects of PEMF on prostate volume (PV) in BPH.Materials and MethodsThis is a prospective interventional trial on 27 naive patients with BPH and lower urinary tract symptoms (LUTS). At baseline (V0), all patients had blood tests, transrectal ultrasound, and questionnaires (IPSS, IIEF‐15) and received a perineal PEMF device (Magcell®Microcirc, Physiomed Elektromedizin). PEMF was delivered on perineal area 5 minutes twice daily for 28 days, then (V1) all baseline evaluations were repeated. Afterward, nine patients continued therapy for 3 more months (PT group) and 15 discontinued (FU group). A 4‐month evaluation (V2) was performed in both groups.ResultsA reduction was observed both at V1 and at V2 in PV: PVV0 44.5 mL (38.0;61.6) vs PVV1 42.1 mL (33.7;61.5, P = .039) vs PVV2 41.7mL (32.7;62.8, P = .045). IPSS was reduced both at V1 and at V2: IPSSV0 11 (5.7;23.2) vs IPSSV1 10 (6;16, P = .045) vs IPSSV2 9 (6;14, P = .015). Baseline IPSS was related to IPSS reduction both at V1 (rs = 0.313;P = .003) and at V2 (rs = 0.664;P < .001). PV reduction in patients without metabolic syndrome (ΔPVV1nMetS −4.7 mL, 95%CI −7.3;‐2.0) was greater than in affected patients (ΔPVV1MetS 1.7 mL, 95%CI −2.69;6.1)(P = .017, Relative RiskMetS = 6). No changes were found in gonadal hormones or sexual function.DiscussionPEMF was able to reduce PV after 28 days of therapy. Symptoms improved in a short time, with high compliance and no effects on hormonal and sexual function or any side effects. Patients with moderate‐severe LUTS and without MetS seem to benefit more from this treatment.ConclusionPEMF reduces PV and improves LUTS in a relative short time, in BPH patients. These benefits seem greater in those patients with moderate‐severe LUTS but without MetS.

Surgical blood loss during holmium laser enucleation of the prostate (HoLEP) is not affected by short-term pretreatment with dutasteride: a double-blind placebo-controlled trial on prostate vascularity.

Five α-reductase inhibitors (5ARIs) are able to reduce prostate volume and are a useful treatment for reducing perioperative bleeding during prostate surgery. Holmium laser enucleation of the prostate (HoLEP) is an effective surgical technique for the definitive cure of benign prostate enlargement.We investigated whether pretreatment with dutasteride before HoLEP could reduce intraoperative bleeding. A total of 402 patients were included in this double-blind placebo-controlled trial to receive daily 0.5 mg of dutasteride or placebo over 8 weeks before HoLEP. Vascular endothelial growth factor (VEGF) and microvascular density (MVD) were evaluated. Analysis was also stratified according to prostate volume (<70 mL vs ≥70 mL).Hemoglobin and hematocrit values before and after surgery were not statistically different between the two groups. MVD and VEGF index in smaller prostates were 23.35±1.96 and 4.06±0.76 in the treatment group and 19.04±0.96 and 2.55±0.55 in placebo (p<0.05); in patients with larger prostates MVD and VEGF were 26.83±2.812 and 8.54±1.18 in the treatment group and 20.76±0.79 and 3.21±0.54 in placebo (p<0.05).Vascularization of the prostate was affected by 5ARIs therapy. HoLEP is less burdened in perioperative bleeding and for this reason we did not find any difference in hemoglobin/hematocrit values pre- and post- surgery.

BIPOLAR PLASMA VAPORIZATION VERSUS QUARTZ HEAD LASER ABLATION OF THE PROSTATE FOR THE TREATMENT OF BENIGN PROSTATEHYPERPLASIA: A COMPARATIVE STUDY OF OUTCOME AND COMPLICATIONS

Background: Benign prostatic hyperplasia (BPH) is considered one of the most common causes of lower urinary tract symptoms (LUTS), urinary obstruction and urinary retention which usually occurs above age of 40 years. Aim of the Work: to compare the short term effectiveness and complications of bipolar plasma versus laser vaporization of prostateover 6 months duration of follow up post-operative. Patients and Methods: This prospective comparative clinical study (double armed) included 128 patients with prostates less than 80 gm operated upon and followed up in the Urology Department of Ain shams University hospitals in the period from September 2015 to January 2018. The patients were divided into 2 groups: Group A 64 patients who underwent Plasma vaporization. Group B 64 Patients who underwent Quartz Laser Ablation of prostate (QLAP). Results: There were statistically significant differences between both groups as regards prostate volume reduction, PSA reduction and decrease in postvoiding residual urine more in the laser group. While IPSS and QOL reduction and uroflowmetry improvement showed higher improvement in the plasma group.Conclusion: both techniques whether laser vaporization or plasma vaporization are considered safe, effective minimally invasive procedure in managing prostatic enlargement indicated for surgery. Both techniques are similar in the outcome and both lead to improvement of all parameters of prostatic symptoms. Laser vaporization looks to be faster, has stronger power to vaporize more tissues than plasma. No serious complications occurred in both groups. Nevertheless complications are more frequent in the plasma group.