Surgical Benign Prostatic Hyperplasia Research Articles

Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety.

Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. Data from 3627 patients who underwent GL-PVP with the XPS-180W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. At baseline, median age, prostate volume, PSA, and IPSS were 70years (interquartile range 64-77), 64 (47-90), 3.1ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62min (46-85), respectively. Median energy use was 250.0kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2days. All-cause mortality within 30days was 0.3%. Median PSA reduction at 3months and 60months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.

Prostatic osteopontin expression is associated with symptomatic benign prostatic hyperplasia.

Male lower urinary tract symptoms (LUTS) occur in more than half of men above 50 years of age. LUTS were traditionally attributed to benign prostatic hyperplasia (BPH) and therefore the clinical terminology often uses LUTS and BPH interchangeably. More recently, LUTS were also linked to fibrogenic and inflammatory processes. We tested whether osteopontin (OPN), a proinflammatory and profibrotic molecule, is increased in symptomatic BPH. We also tested whether prostate epithelial and stromal cells secrete OPN in response to proinflammatory stimuli and identified downstream targets of OPN in prostate stromal cells. Immunohistochemistry was performed on prostate sections obtained from the transition zone of patients who underwent surgery (Holmium laser enucleation of the prostate) to relieve LUTS (surgical BPH, S-BPH) or patients who underwent radical prostatectomy to remove low-grade prostate cancer (incidental BPH, I-BPH). Images of stained tissue sections were captured with a Nuance Multispectral Imaging System and histoscore, as a measure of OPN staining intensity, was determined with inForm software. OPN protein abundance was determined by Western blot analysis. The ability of prostate cells to secrete osteopontin in response to IL-1β and TGF-β1 was determined in stromal (BHPrS-1) and epithelial (NHPrE-1 and BHPrE-1) cells by enzyme-linked immunosorbent assay. Quantitative polymerase chain reaction was used to measure gene expression changes in these cells in response to OPN. OPN immunostaining and protein levels were more abundant in S-BPH than I-BPH. Staining was distributed across all cell types with the highest levels in epithelial cells. Multiple OPN protein variants were identified in immortalized prostate stromal and epithelial cells. TGF-β1 stimulated OPN secretion by NHPrE-1 cells and both IL-1β and TGF-β1 stimulated OPN secretion by BHPrS-1 cells. Interestingly, recombinant OPN increased the mRNA expression of CXCL1, CXCL2, CXCL8, PTGS2, and IL6 in BHPrS-1, but not in epithelial cell lines. OPN is more abundant in prostates of men with S-BPH compared to men with I-BPH. OPN secretion is stimulated by proinflammatory cytokines, and OPN acts directly on stromal cells to drive the synthesis of proinflammatory mRNAs. Pharmacological manipulation of prostatic OPN may have the potential to reduce LUTS by inhibiting both inflammatory and fibrotic pathways.

Contemporary Review of BPH Medical and Surgical Treatments on Sexual Function

Contemporary urologists have myriad options to offer patients when discussing treatments for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). While the primary goal of managing BPH is to improve LUTS, many treatments cause adverse effects on sexual function including erectile and ejaculatory function and libido. In the past 5 years, new literature has continued to evaluate the impact that medical, minimally invasive, and surgical BPH therapies have on sexual function. Research on medical treatment continues to show high rates of erectile and ejaculatory dysfunction in addition to low libido. Minimally invasive procedures had the lowest risk of developing both ejaculatory and erectile dysfunction. Invasive procedures such as transurethral resection of the prostate (TURP) caused significant ejaculatory dysfunction, while holmium laser enucleation of the prostate (HoLEP) caused significant erectile dysfunction. Not all existing studies are comprehensive in their analysis of sexual function with impacts on libido being the least reported. Sexual function remains at a high level of patient concern and can be a significant source of procedural dissatisfaction. Appropriate preoperative counseling and further comparison studies are of paramount importance.

Multicenter international experience of 532nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100cc).

To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100cc at 4 years of follow-up in a large, multicenter experience. 438 men with pre-operative transrectal ultrasound (TRUS) PV > 100cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months. Median PV and PSA were 121cc and 6.3ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90min, 55min, and 422kJ, respectively. Median energy delivery was 3.4kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02). PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.

PD24-11 MULTICENTER INTERNATIONAL EXPERIENCE OF 180W LBO LASER PHOTO-VAPORIZATION IN MEN WITH LARGE PROSTATES (PROSTATE VOLUME>100CC): LONG-TERM OUTCOMES OF 434 PATIENTS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2016PD24-11 MULTICENTER INTERNATIONAL EXPERIENCE OF 180W LBO LASER PHOTO-VAPORIZATION IN MEN WITH LARGE PROSTATES (PROSTATE VOLUME>100CC): LONG-TERM OUTCOMES OF 434 PATIENTS Pierre-Alain Hueber, Malek Meskawi, Roger Valdivieso, Tristan Martel, Mounsif Azizi, Franck Bruyère, Vincent Misrai, Georges Fournier, Ravi Munver, Ganesh Sivarajan, Matthew Rutman, Alexis Te, Bilal Chughtai, Dean Elterman, and Kevin Zorn Pierre-Alain HueberPierre-Alain Hueber More articles by this author , Malek MeskawiMalek Meskawi More articles by this author , Roger ValdiviesoRoger Valdivieso More articles by this author , Tristan MartelTristan Martel More articles by this author , Mounsif AziziMounsif Azizi More articles by this author , Franck BruyèreFranck Bruyère More articles by this author , Vincent MisraiVincent Misrai More articles by this author , Georges FournierGeorges Fournier More articles by this author , Ravi MunverRavi Munver More articles by this author , Ganesh SivarajanGanesh Sivarajan More articles by this author , Matthew RutmanMatthew Rutman More articles by this author , Alexis TeAlexis Te More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Dean EltermanDean Elterman More articles by this author , and Kevin ZornKevin Zorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1776AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate volume (PV) >100cc remains challenging for endoscopic BPH management. Although PVP using XPS-180 system is feasible for patients with large PV, long-term outcome data supporting its use is still lacking. The aim was to evaluate the outcomes and durability at 4 years in a large, multi-center experience. METHODS This is a retrospective study of 434 men with pre-operative TRUS PV>100cc that were treated in 8 centers in North-America (Canada, USA) and in Europe (France) with the Greenlight-XPS laser using PVP for the treatment LUTS associated with BPH. To assess efficacy, IPSS, Qmax, prostate volume (PV), postvoid residual (PVR) and PSA were measured at 6, 12, 36 and 48 months. Durability was evaluated using re-treatment rate at 24, 36 and 48 months. RESULTS Median prostate size and PSA were 121cc (IQR 108-150) and 6.3ng/mL. 42.3% of men had an indwelling catheter at the time of surgery. Median operative time and energy applied were 60min (IQR: 40-74) and 424kJ, with ≥2 fibers used in 40% of the cases. Median energy delivery was 3.4kJ/cc per case. Median length of stay was 24h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months (fig.1). Surgical BPH retreatment was 5.3% at 24 months which rose to 11.9% at 36 months. Interestingly, characteristics of re-treated men include energy delivery that was 2.4kJ (vs 3.4kJ) and PSA reduction at 12 months of 29% (vs46%). CONCLUSIONS PVP treatment using Greenlight XPS-180W can potentially provide durable improvements with regards to functional outcomes including IPSS at 4 years. However retreatment rate rising after 3 years is a concern. This data highlights the need of utilizing a standardized technique with an operative endpoint of an enucleation-like-defect (down to the surgical capsule). Other than encouraging the use of transrectal imaging preoperatively, benchmark perioperative parameters of energy use (KJ/cc), 12-month PSA reduction and rising PSA during followup may serve as a surrogate markers for predicting durability. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e515-e516 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Pierre-Alain Hueber More articles by this author Malek Meskawi More articles by this author Roger Valdivieso More articles by this author Tristan Martel More articles by this author Mounsif Azizi More articles by this author Franck Bruyère More articles by this author Vincent Misrai More articles by this author Georges Fournier More articles by this author Ravi Munver More articles by this author Ganesh Sivarajan More articles by this author Matthew Rutman More articles by this author Alexis Te More articles by this author Bilal Chughtai More articles by this author Dean Elterman More articles by this author Kevin Zorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD39-11 PEAK URINE FLOW PREDICTS DEVELOPMENT OF SYMPTOMATIC BPH IN MEN WITH MILD TO NO URINARY SYMPTOMS: RESULTS FROM REDUCE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History1 Apr 2015PD39-11 PEAK URINE FLOW PREDICTS DEVELOPMENT OF SYMPTOMATIC BPH IN MEN WITH MILD TO NO URINARY SYMPTOMS: RESULTS FROM REDUCE Ross Simon, Lauren Howard, Daniel Moreira, Stephen Freedland, Claus Roehrborn, and Adriana Vidal Ross SimonRoss Simon More articles by this author , Lauren HowardLauren Howard More articles by this author , Daniel MoreiraDaniel Moreira More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , and Adriana VidalAdriana Vidal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Decreased peak urinary flow (Qmax) is a well-established consequence of symptomatic benign prostatic hyperplasia (BPH). The clinical relevance of Qmax in men with mild to no urinary symptoms is unclear. We assessed the link between Qmax and incident symptomatic BPH in men with mild to no BPH symptoms. METHODS We performed an analysis of REDUCE to test the link between Qmax and incident symptomatic BPH. REDUCE was a multicenter, randomized, double-blind, placebo-controlled trial of prostate cancer risk reduction with daily dutasteride 0.5 mg or placebo. Eligible men were aged 50-75 yrs, with a PSA 2.5-10 ng/mL and prostate volume ≤80 mL. Men were followed for 4 years with International Prostate Symptom Scores (IPSS) at baseline and every 6 months. We defined incident symptomatic BPH as two consecutive IPSS ≥12, one IPSS ≥14, or receiving medical or surgical BPH treatment. We included 3,109 men with IPSS <8 (mild to no symptoms) who were not taking 5 alpha-reductase inhibitors or alpha blockers at baseline. We tested the association of Qmax with incident symptomatic BPH using multivariable Cox models adjusting for age (continuous), white race (vs. non-white), prostate volume (continuous), baseline PSA (continuous, logarithmically transformed), and baseline IPSS (continuous). As the association between Qmax and incident symptomatic BPH was similar in men on dutasteride or placebo (p-interaction=0.636), analysis included all men. RESULTS During the 4-year study, 366 (12%) had incident symptomatic BPH progression. Median Qmax was 14.1 mL/s. As a continuous variable, the negative log of Qmax predicted incident symptomatic BPH (HR 1.40, p=0.005). In other words, men with lower Qmax were at higher risk of incident symptomatic BPH. When categorized, men with Qmax <15mL/s had a 28% increased risk of incident symptomatic BPH (HR 1.28, p=0.024). CONCLUSIONS In REDUCE, a Qmax <15mL/s in men with an IPSS<8 predicted onset of symptomatic BPH. If confirmed in other studies, these findings suggest men with no to mild urinary symptoms but low Qmax, are at increased risk for incident symptomatic BPH over the next 4 years and these men may merit closer observation. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e834 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ross Simon More articles by this author Lauren Howard More articles by this author Daniel Moreira More articles by this author Stephen Freedland More articles by this author Claus Roehrborn More articles by this author Adriana Vidal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

FRII-12 HISTORY OF THE TRANSURETHRAL RESECTION OF THE PROSTATE: THE GOLD STANDARD AND ITS ROLE IN THE 21ST CENTURY

You have accessJournal of UrologyHistory of Urology Forum II1 Apr 2015FRII-12 HISTORY OF THE TRANSURETHRAL RESECTION OF THE PROSTATE: THE GOLD STANDARD AND ITS ROLE IN THE 21ST CENTURY Marcus Austenfeld and Ajay Nangia Marcus AustenfeldMarcus Austenfeld More articles by this author and Ajay NangiaAjay Nangia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.503AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 1989 Dr. Winston Mebust, the chairman of the department of Urology at the University of Kansas and future president of the AUA, published the most influential case series on transurethral resection of the prostate (TURP). It has now been 25 years since that landmark paper. This inspired us to examine the history of the TURP. METHODS A search through both bibliographic and digital resources. RESULTS Transurethral resection of the prostate begins with Hugh Hampton Young, often labeled the “Father of American Urology.” Previous methods of resecting the prostate through the urethra relied on blind passage of sounds with concealed blades, which sprung open to incise the bladder neck. In 1909 Young used a tubular sheath with an opening at the distal shaft; one could advance a bite of prostate into the outer sheath and then use a sharpened inner sheath to create a “punch” prostatectomy. Later addition of electrical energy to the inner sheath allowed some level of hemostasis. Maximilian Stern invented the modern resectoscope in 1926 when he added an electrified tungsten loop to scoop out prostatic fragments. By 1931 Joseph McCarthy improved the lens to provide a wider field of view and added a gear system to drive the loop across the prostate through an insulating Bakelite sheath; later that decade Reed Nesbit created the “pistol grip” system more commonly found today. In the 1970s and 1980s further improvement of the lens, the addition of fiber optic lighting and closed circuit video completed the development of the modern resectoscope. Mebust and others solidified the monopolar TURP's position as the gold standard of surgical BPH management in the early 1990s, but options available to the contemporary urologist—bipolar cautery, holmium laser, photoselective vaporization, and even pharmacotherapy—may signal the beginning of the end for the traditional electric loop resection of the prostate. CONCLUSIONS Transurethral resection of the prostate using the resectoscope became a safe and effective option for managing benign prostatic hypertrophy in the 20th century. In the 25 years since Dr. Mebust's paper a wider variety of tools for surgically managing prostatic obstruction are available, but as in 1989, monopolar TURP remains an excellent tool in the hands of a skilled endourologist. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e592-e593 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcus Austenfeld More articles by this author Ajay Nangia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Increased population use of medications for male lower urinary tract symptoms/benign prostatic hyperplasia correlates with changes in indications for transurethral resection of the prostate

Objective. The aim of this study was to determine whether there are correlations between medication use for lower urinary tract symptoms/benign prostate hypertrophy (LUTS/BPH) and alteration in incidence and indications for transurethral resection of the prostate (TURP). Material and methods. The number of TURP patients between 1984 and 2008 in Iceland was obtained from hospital registries. The number of defined daily doses (DDDs) of 5-alpha-reductase inhibitors (5aRIs) and alpha-blockers (ABs) sold was obtained from the Icelandic Medicines Control Agency. Charts of all surgical BPH patients in Iceland from 1998 to 2008 were retrospectively reviewed. The main outcomes measures were: DDDs sold of 5aRIs and ABs, total numbers of TURP, indications for TURP and complications. Results. After the introduction of ABs and 5aRIs, sales increased annually at a near linear rate. TURP rates peaked in 1992, then declined. In 2008, 81 and 3.4 of 1000 men over the age of 50 used LUTS/BPH medications or underwent TURP, respectively. There was an inverse correlation between LUTS/BPH medication use and (i) overall TURP (R2 = 0.85), (ii) TURP done for absolute indications (R2 = 0.91), and (iii) LUTS with (R2 = 0.77) and (iv) without previous medical therapy (R2 = 0.75). As medication use rose, fewer TURPs were performed for previous history of urinary retention, and more for recurrent urinary tract infections. Conclusion. Increased use of ABs and 5aRIs in the Icelandic population correlated with decreasing incidences of TURP procedures for both LUTS and absolute indications. The sequelae of BPH and indications for TURP are changing as medication use increases, although a clear causative link is hard to establish.

2165 THE HOLEP EFFECT: CHANGING PRACTICE PATTERNS AND RESIDENT EDUCATION AT A TERTIARY CARE CENTER

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132165 THE HOLEP EFFECT: CHANGING PRACTICE PATTERNS AND RESIDENT EDUCATION AT A TERTIARY CARE CENTER Gwen Grimsby and Mitchell Humphreys Gwen GrimsbyGwen Grimsby Phoenix, AZ More articles by this author and Mitchell HumphreysMitchell Humphreys Phoenix, AZ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2074AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The development of new surgical techniques encourage the evolution of surgeons in order to meet the demands of patients and improve outcomes. One such procedure, holmium laser enucleation of the prostate (HoLEP), raises the fear that implementation will impact traditional procedural training. This poses a concern for teaching institutions were transurethral resection of the prostate (TURP) provides essential resident education. The objective of this study was to analyze the patterns of surgical BPH interventions and the changing demographics of patients at a tertiary care institution after adoption of HoLEP. METHODS After IRB approval, a retrospective review was performed of all men who underwent TURP or HoLEP at our institution between 2007 and 2011. Data reflects a stable practice of five urologists. Each procedure was compared and further stratified according to permanent address. The percentage of patients from outside versus within the state was also compared over time. RESULTS A total of 425 TURPs (53%) and 374 HoLEPS (47%) were performed. The ability to offer HoLEP accounted for a 109% increase in the number of surgeries while the number of TURPs remained relatively constant. Stratifying patients by permanent address revealed an increase in HoLEP patients coming from outside of the state while the number of TURP patients from outside the state remained stable at 15-20%, Table 1. For every year examined, the percent of HoLEP patients coming from outside the state was double that of TURP patients independent of the total number of procedures performed. CONCLUSIONS The hypothesis that the implementation of HoLEP would alter surgical practice and decrease the number of TURPs performed at our institution was not correct. Incorporating HoLEP into the practice actually resulted in new surgical patients that sought out HoLEP and increased the overall number of annual surgical procedures performed, leading to better opportunities for resident training. The increased geographical distribution of our HoLEP population may reflect the increasing medical sophistication of patients seeking out new treatments and technologies. Table 1. Comparison of TURP and HoLEP Demographics between 2007 and 2011 2007 2008 2009 2010 2011 TURP AZ 83 (85%) 72 (85%) 61 (80%) 50 (81%) 94 (82%) Other 15 (15%) 13 (15%) 15 (20%) 12 (19%) 20 (18%) Total 98 85 76 62 91 HoLEP AZ 12 (70%) 56 (66%) 56 (63%) 54 (55%) 54 (59%) Other 5 (30%) 29 (34%) 26 (37%) 45 (45%) 37 (41%) Total 17 85 82 99 91 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e887 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gwen Grimsby Phoenix, AZ More articles by this author Mitchell Humphreys Phoenix, AZ More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

THE PROGNOSTIC VALUE OF IMPAIREDDETRUSOR CONTRACTILITY ATTHE OPERATIVE TREATMENT OF THE PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

Impaired detrusor contractility may be the cause of disorders of urination in patients with benign prostatic hyperplasia (BPH). Meanwhile, there is still no single point of view on the clinical value of determination of the detrusor contractility at the examination of BPH patients. The review discusses the results of the research devoted to determine the prognostic value impaired detrusor contractility for determining the indications for the surgical BPH treatment and prevention of its poor results

Management of Lower Urinary Tract Symptoms of Eldery Men in Austria

Objectives: The aim of this nation–wide study was to determine the current management of elderly men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and benign prostatic enlargement (BPE) in Austria, and to assess changes over a 4–year study period from 1995 to 1998. Methods: The annual figures of prostatectomies performed in Austria from 1995 to 1998 were collected from the Austrian Institute for Health Affairs. Sales figures for finasteride, α₁–receptor blockers and plant extracts were obtained from IMS market sales and Austrian regional compulsory insurance companies. These data were correlated with the number of males living in Austria during the study period and to the estimated numbers of elderly men with moderate and severe LUTS in this country. Results: The annual number of transurethral resections of the prostate (TURPs) decreased from 6,302 in 1995 to 5,297 in 1998 (–16%), and the number of open prostatectomies from 506 to 469 (–7%). Extrapolation of these data to 100,000 men aged ≧55 years revealed that 0.76% underwent TURP in 1995, this figure decreased to 0.59% in 1998. Market sales of α₁–receptor blockers increased by 497% during the study period and those of finasteride by 1.6%, while plant extract market sales declined by 18.2%. In 1998, plant extracts comprised 43.3% of the total BPH market, α₁–receptor blockers 41.5% and finasteride 15.2%. Conclusions: During the years 1995–1998, significant changes in medical and surgical BPH therapy were observed in Austria. These data provide the basis for a comparison to the situation in other countries and serve as a baseline investigation for future studies in this country.

Epoxycholesterols in secretions and tissues of normal, benign, and cancerous human prostate glands

Extracts of prostatic secretions taken from 25 control subjects, twenty-three to seventy-five years of age, were analyzed by gas-liquid chromatography (GLC) for cholesterol and possible epoxycholesterol content. Only subjects fifty-three years or older exhibited any signs of prostatic enlargement. Whereas cholesterol (893 ± 133 kg/ml) was found in all prostatic secretions, the carcinogenic epoxycholesterols (22.6 ± 3.3 /cg/ml) were detected only in one third of the specimens examined. Prostatic secretion collected from 29 surgical patients prior to primary (20) and secondary (9) prostatectomies revealed cholesterol contents of 1,182 ± 148 and 1,134 ± 1571-μg/ml, respectively. The epoxycholesterols were essentially present at concentrations of 33.7.± 7.9 and 24.0:± 10.3 μg/ml, respectively. Tissue extracts of the different prostatic lobes taken from 40 surgical BPH patients at the time of primary (26) and secondary (14) prostatectomy were examined by capillary GLC. Of these patients 8 had prostatic carcinoma. The cholesterol content of all tissues was essentially double that of normal prostates. The epoxycholesterols were present in all tissues. The mean cholesterol 5α, 6α-epoxide and cholesterol 5β, 6β-epoxide contents of all tissue were 120± 23.4 and 9.9 ± 5.2 μkg/Gm dry tissue, respectively. There were no apparent differences between the lobes nor between BPH and cancers. No epoxycholesterol could be detected in 8 seminal vesicles obtained at autopsy.