Treatment Of Prostatic Hyperplasia Research Articles

The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis

PurposeThe aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.MethodsThe literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle–Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.ResultsThe study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.ConclusionTheoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.

The efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) in the preservation of the urethral ridge in the treatment of prostatic hyperplasia in patients aged 75 years or less

The efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) in the preservation of the urethral ridge in the treatment of prostatic hyperplasia in patients aged 75 years or less

Chemical composition and toxicity of extracts of <i>Fouquieria splendens</i> against <i>Artemia salina</i>

<abstract> <p>Ocotillo (<italic>Fouquieria splendens</italic>) has been used in Mexican traditional medicine for the treatment of blood circulation problems, swelling, and prostatic hyperplasia, among others. The objective of this study was to use different extraction methods (soxhlet, hydrodistillation and ultrasound) and solvents with different polarities (hexane, methyl chloride, ethyl acetate, acetone and methanol) to determine volatile compounds contained in ocotillo stems. Solvents used were water in hydrodistillation; hexane, methyl chloride, ethyl acetate, acetone, and methanol in soxhlet; and a solvent mixture of water acidified with methanol, acetone, and 1% acetic acid at a 50:35:15 ratio in the ultrasound method. The major components identified were bis (2-Ethylhexyl) phthalate, bis (2-Ethylhexyl) ester, butyl acetate, palmitic acid, and myristic acid. A toxicity assay on <italic>Artemia salina</italic> was conducted and the median lethal concentration was quantified. The bioassay showed that extracts isolated by non-polar solvents are extremely toxic because they were lethal at concentrations lower than 100 ppm, while polar extracts were innocuous. However, in polar extracts were found compounds that suggest their use in traditional medicine, the most relevant being 2-butoxyethanol, pentadecanol, and undecanal.</p> </abstract>

Spirometric Assessment Before and After treatment of Prostatic Hyperplasia in Patients with Chronic Obstructive Pulmonary Disease

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) predominantly prevalent in men, is a chronic inflammatory disorder of the airway and lungs. COPD is associated with increased risk of Benign prostatic hyperplasia (BPH). Judging from the association between COPD and BPH in ageing male population, and the samilarities between receptors in airways and the urinary bladder. Objectives the aim of the study was to show the effect of treatment of symptomatic BPH on the airways of COPD patients by spirometric assessment before and after starting treatment of BPH. Patients and Methods The present study was conducted upon 60 subjects during the period from March 2019 to August 2019 in Ain Sham University Hospitals. Type of Study prospective study, there were two groups of patients first group received tamsulosin and the second group received tamsulosin and solifenacin Results By comparison of the two groups, there was non-significant change. as regard percent of change of forced vital capacity (FVC), first group’s median was 7.9% and second group median was 5.6%. as regard percent of change of forced expiratory volume 1 (FEV1), in first group’s median was 5.7% and second group’s median was 7.4%. Conclusion There was significant improvement in spirometric values in each group before and after starting treatment, but by comparison between the two groups, there was insignificant change.

Resveratrol Attenuates the Proliferation of Prostatic Stromal Cells in Benign Prostatic Hyperplasia by Regulating Cell Cycle Progression, Apoptosis, Signaling Pathways, BPH Markers, and NF- κB Activity.

Resveratrol can inhibit cell proliferation and metastasis and induce apoptosis. However, the mechanisms of action through which resveratrol inhibits the abnormal proliferation of prostate stromal cells, causing prostatic hyperplasia, have not been fully elucidated. Here, we evaluated the inhibitory effects of resveratrol on cell proliferation associated with prostatic hyperplasia using WPMY-1 cells. Our results showed that resveratrol inhibited the proliferation of WPMY-1 cells via the induction of G0/G1-phase cell cycle arrest, which was caused by downregulated expression of cyclins and cyclin-dependent kinases regulated by increased p21WAF1 and p27KIP1 expression level. In addition, resveratrol treatment suppressed the phosphorylation of phosphatidylinositol 3-kinase/AKT and extracellular signal-regulated kinase 1/2. The expression levels of molecular markers affecting prostate development were also reduced by treatment with resveratrol. Finally, resveratrol attenuated the binding activity of the transcription factor nuclear factor-κB in WPMY-1 cells, and accelerated apoptotic cell death via intrinsic cascade pathway. These results indicate that resveratrol may be useful for the prevention or treatment of prostatic hyperplasia.

Treatment of beneficial prostate hyperplasia of large sizes: traditional surgical, low-invasive and laser technologies (literature review)

Benign prostatic hyperplasia – one of the most common diseases in older men. The treatment strategy for benign prostatic hyperplasia consists in its drug therapy, or active surgical tactics. The indication for planned surgical treatment of benign prostatic hyperplasia is the progression of symptoms of the lower urinary tract, which are not amenable to drug correction. Men with a large prostate volume of more than 80 m3, with severe symptoms of the lower urinary tract, with a history of acute urinary retention episodes, represent a difficult group of patients in terms of choosing the tactics of surgical treatment. This article discusses the most common operations that are used in the treatment of benign prostatic hyperplasia (especially of large sizes): open adenectomy, transurethral resection of the prostate gland, enucleation of benign prostatic hyperplasia using a holmium laser, embolization of an artery of the prostate gland. Surgical treatment of benign prostatic hyperplasia requires an individual approach to the patient, taking into account his age, concomitant pathology and clinical symptoms.

The protective effect of Sophora japonica on prostatic hypertrophy and inflammation in rat.

The atypical adenomatous hyperplasia (AAH) is invariably an incidental histological change, with no clinical findings specific for its diagnosis, and the mean patient age at diagnosis is 64-70years. The incidence of AAH varies between 1.5 and 19.6% of transurethral resections and in up to 33% of radical prostatectomies. Herbal medicines are becoming a popular option in the treatment of prostatic-related diseases, such as date palm pollen and saw palmetto in the treatment of prostatic hyperplasia. A testosterone/citral-induced AAH in Wistar rat model was used to evaluate the protective effect of Sophora japonica fruit extract (SFE). The present study suggests that SFE has an ameliorating effect on the prostatic hypertrophy and inflammation through its effect on clusterin, IGF, IL-6, IL-8, TNF-α, and TGF-β1 expression. In addition, the administration of SFE ameliorated the inflammatory score, and histopathological changes in AAH-induced rats in a dose-dependent manner. The treatment with SFE reduced the number of prostatic acini in AAH rat model and decreased the production of pro-inflammatory cytokines. The fruit extract of S. japonica was characterized by determination total phenol content (60.3mg of gallic acid equivalent/g of dry extract), total flavonoid content (97.9mg quercetin equivalent/g of dry extract) and the major isoflavonoid sophoricoside (302.9 ± 2.6µg/g of the extract). In conclusion, SFE has an ameliorating effect on the prostatic hypertrophy and inflammation. This effect may be attributed to the ability of SFE to decrease the production of pro-inflammatory cytokines, TNF-α, IL-1β and IGF-1 as well as an increase in TGF-β1.

Aquablation—image-guided robot-assisted water-jet ablation of the prostate: current advance

In recent years robot system has been widely introduced into prostatic hyperplasia treatment. Rather than pay attention to traditional laparoscopic robot, this paper focused on Image-Guided Robot-Assisted Prostate Ablation Using Water Jet-Hydrodissection. This treatment system was very mini-invasive and easy to learn. Therefore, it reduced learning curve, operation time and related complications. This paper summarized current advance on the above fields. Key words: Benign prostatic hyperplasia; Aquablation; Minimally invasive robotic surgery; Water-jet ablation; Transurethral resection of prostate

Value-based care for the treatment and evaluation of benign prostatic hyperplasia: an analysis of a metropolitan service area claims database.

With an aging population, cost containment and improved outcomes will be crucial for a sustainable healthcare ecosystem. Current data demonstrate great variation in payments for procedures and diagnostic workup of benign prostatic hyperplasia (BPH). To help determine the best financial value in BPH care, we sought to analyze the major drivers of total payments in BPH. Commercial and Medicare claims from the Truven Health Analytics Markestscan® database for the Austin, Texas Metropolitan Service Area from 2012 to 2014 were queried for encounters with diagnosis and procedural codes related to BPH. Linear regression was utilized to assess factors related to BPH-related payments. Payments were then compared between surgical patients and patients managed with medication alone. Major drivers of total payments in BPH care were operative, namely transurethral resection of prostate (TURP) [$2778, 95% CI ($2385-$3171), p < 0.001) and photoselective vaporization (PVP) ($3315, 95% CI ($2781-$3849) p < 0.001). Most office procedures were also associated with significantly higher payments, including cystoscopy [$708, 95% CI ($417-$999), p < 0.001], uroflometry [$446, 95% CI ($225-668), p < 0.001], urinalysis [$167, 95% CI ($32-$302), p = 0.02], postvoid residual (PVR) [$245, 95% CI ($83-$407), p < 0.001], and urodynamics [$1251, 95% CI ($405-2097), p < 0.001]. Patients who had surgery had lower payments for their medications compared to patients who had no surgery [$120 (IQR: $0, $550) vs. $532 (IQR: $231, $1852), respectively, p < 0.001]. Surgery and office-based procedures are associated with increased payments for BPH treatment. Although payments for surgery were more in total, surgical patients paid significantly less for BPH medications.

Study on the difference of green laser in the treatment of prostatic hyperplasia

Objective To compare the safety and efficacy of different green laser surgery in the treatment of benign prostatic hyperplasia. Methods A retrospective comparative analysis was made of the data of patients who underwent various green laser prostatectomy(GL-PVP), green laser vaporization of the prostate(GL-PVRP) and green laser enucleation of the prostate(GEL-EP) in our hospital during May 2016 and May 2018. The short-term clinical indexes such as operation time, bleeding volume, bladder irrigation time and indwelling time of urethral catheter after prostatectomy were compared and analyzed.The long-term clinical data, such as urodynamic data, postoperative IPSS score, postoperative QOL score, international erectile function index questionnaire score, postoperative complications were analyzed between groups. Results There was no statistically significant difference between preoperative general data(age, preoperative prostate volume, preoperative PSA, preoperative IPSS score, preoperative QOL score, preoperative maximum urine flow rate, preoperative residual bladder urine, international erectile function index questionnaire score) of patients in GL-PVP group, GL-PVRP group and GEL-EP group(P>0.05). Compared with the preoperative patients in postoperative maximum urinary flow rate, postoperative bladder residual urine, postoperative IPSS score, postoperative QOL scores improved were statistically significant(P<0.01). The mean operative time of PVP, PVRP and EP in BPH treatment, .intraoperative mean blood loss, duration of continuous bladder irrigation and indwelling catheter time were statistically significant(P<0.05). However, there was no statistically significant difference in postoperative IPSS change value, postoperative QOL change value, urinary flow rate change value, and bladder residual urine change value, international erectile function index questionnaire score change value and incidence of postoperative complications. Conclusions Green laser can effectively and safely treat prostatic hyperplasia. Compared with PVRP and GL-EP, PVP has advantages of shorter operative time, less intraoperative blood loss, shorter postoperative bladder rinsing time and shorter time of indwelling urinary catheter. Key words: Prostatic Hyperplasia; Lasers, Solid-State

Comparison of effects of transurethral enucleation of prostate and suprapubic prostatectomy in the treatment of massive prostatic hyperplasia

Objective To compare the clinical effects of transurethral prostatectomy(TUERP) and suprapubic prostatectomy(SP) in the treatment of massive prostatic hyperplasia. Methods The clinical data of 40 patients with benign prostatic hyperplasia(BPH) with a volume range of 80-150 mL from October 2015 to October 2017 in Shengjing Hospital of China Medical University were retrospectively analyzed.They were divided into two groups: TUERP group(20 cases) and SP group(20 cases). The length and distribution of large prostate were measured.The degree of hemoglobin decrease, bladder irrigation time, operation time, indwelling catheter time, maximum urine flow rate(Qmax), international prostate symptom score(IPSS), prostate specific antigen(PSA), residual urine volume(PVR) and the incidence of complications were compared between the two groups before and after operation. Results It was found that the length of the prostatic fossa was less than 5 cm in patients with large prostatic hyperplasia whose volume ranged from 80 to 150 mL.After operation, the degree of hemoglobin decrease, bladder irrigation time, indwelling catheter time and the incidence of complications in the TUERP group were (7.9±2.3)g/L, (42.5±3.6)h, (5.3±1.1)d, 15%(3/20), respectively, while in the SP group were (14.2±4.4)g/L, (62.6±6.0)h, (7.8±0.8)d and 50%(10/20), respectively, there were statistically significant differences between the two groups(t=-5.7, -12.8, -8.6, χ2=5.6, all P 0.05). Conclusion After TUERP treatment of large prostate hyperplasia, the improvement of urination and the decrease of PSA is similar to SP, and the hemostasis effect is good, the complications are less and the recovery is faster. Key words: Prostatic hyperplasia; Prostatectomy; Transurethral resection of prostate; Hemoglobins; Administration, intravesical; Postoperative complications

The application and progress of the thulium laser in the treatment of prostatic hyperplasia

铥激光系统(TLS)是一种新兴的手术工具。其提供的2 μm波长可以将电切范围精确到0.2～0.4 mm的凝固深度，以减少潜在的意外伤害。经过大量试验，TLS的准确性和易操作性已被证实。精准医疗的时代已然到来，这项新兴技术作为先进的介入内窥镜检查和相关疾病的治疗技术，将为医务工作者和患者带来意想不到的益处。本综述意在介绍铥激光在治疗良性前列腺增生中的优势，以供临床医师参考。

The Adverse Effects of Tamsulosin in Men with Benign Prostatic Hyperplasia, a Review of the Literature

In the United States, tamsulosin is the most prescribed drug for benign prostatic hyperplasia (BPH) treatment. However, less is known about the adverse effects and mechanism of action of the drug in the organism. So, the aim of this review is to evaluate the benefits and harms of tamsulosin therapy in patients with BPH. A literature analysis was realized using the database of the National Center for Biotechnology Information (NCBI) MEDLINE®. The data collection was carried out in a retrospective of 10 years from 2008. Thus, we considered some measurements parameters used in different studies for a reliable comparison of the works. Tamsulosin has been characterized as an effective treatment for BPH. However, some studies demonstrate that the epithelial elements remain proliferative even after the administration of the drug and may be involved in the continuous growth of the gland. Also, tamsulosin can directly impact on the ejaculation process, cognitive functions and mental health of men. BPH affects approximately 50% of men between 50 and 60 years old. Beyond that, 90% of men in their eighth decade of life will present anatomical evidence of BPH. Therefore, the treatment with tamsulosin, an α1-adrenergic antagonist that promotes the relaxation of the prostate smooth muscle, is essential to diminish the gland size and restore the urinary flow. However, its administration must be assessed for a better response and lower risk of adverse effects in those patients.

Effect of transurethral split of the prostate for the treatment of prostatic hyperplasia in the elderly

Effect of transurethral split of the prostate for the treatment of prostatic hyperplasia in the elderly

Transurethral balloon dilatation of the Prostate and Transurethral Plasmakinetic resection of the Prostate in the treatment of Prostatic Hyperplasia.

Background & Objective:With the aggravation of global aging, benign prostate hyperplasia tends to have a higher incidence and has been the most common disease in urinary surgery. It is usually treated by surgery. Our objective was to select an effective treatment scheme, the clinical efficacy and relevant indicators of transurethral balloon dilatation of the prostate (TUDP) and transurethral plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostate hyperplasia were emphatically compared.Methods:Ninety-eight patients with benign prostate hyperplasia who were admitted to the hospital of between May 2014 and July 2016 were selected and divided into a TUDP group (n=49) and PKRP (n=49) using random number table. The intraoperative blood loss, duration of surgery, international prostate symptom score (IPSS), quality of life (QOL), post-void residual urine (PVR) and complications of the two groups were observed.Results:The results demonstrated that the postoperative blood loss and duration of surgery of the patients in the PKRP group were significantly higher than those of the TUDP group (P<0.05); the IPSS, QOL and PVR of the patients in the two groups after surgery were much lower than those before surgery (P<0.05); the IPSS, QOL and PVR of the patients in the PKRP group were significantly lower than those in the TUDP group after surgery (P<0.05). The incidence of postoperative complications of the PKRP group was 38.8%, which was apparently higher than 14.3% in the TUDP group (P<0.05).Conclusion:PKRP has better efficacy than TUDP in treating benign prostatic hyperplasia, but QOL was poor and there are many complications. Proper surgical procedure should be selected according to the specific disease condition of patients.

Prostate artery embolization (PAE) : Technique and results

In the treatment of the benign prostatic hyperplasia (BPH) medical and surgical therapies have been established. Prostate artery embolization (PAE) is an innovative endovascular technique that might close the gap between both these procedures. The PAE procedure is safe and has a low incidence of side effects. The efficacy of PAE has been proven for medium sized and large sized glands as well as for intravesical protrusions. The complex mechanism of PAE carries the potential to cure lower urinary tract symptoms as well as to retard the progression of the hyperplasia. Data concerning the long-term efficacy are missing at present.

Survivin and NAIP in Human Benign Prostatic Hyperplasia: Protective Role of the Association of Serenoa repens, Lycopene and Selenium from the Randomized Clinical Study.

Benign prostatic hyperplasia (BPH) treatment includes the apoptosis machinery modulation through the direct inhibition of caspase cascade. We previously demonstrated that Serenoa repens (Ser) with lycopene (Ly) and selenium (Se) reawakened apoptosis by reducing survivin and neuronal apoptosis inhibitory protein (NAIP) levels in rats. The aim of this study was to evaluate the effectiveness of Ser-Se-Ly association on survivin and NAIP expression in BPH patients. Ninety patients with lower urinary tract symptoms (LUTS) due to clinical BPH were included in this randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to receive placebo (Group BPH + placebo, n = 45) or Ser-Se-Ly association (Group BPH + Ser-Se-Ly; n = 45) for 3 months. At time 0, all patients underwent prostatic biopsies. After 3 months of treatment, they underwent prostatic re-biopsy and specimens were collected for molecular, morphological, and immunohistochemical analysis. After 3 months, survivin and NAIP were significantly decreased, while caspase-3 was significantly increased in BPH patients treated with Ser-Se-Ly when compared with the other group. In BPH patients treated with Ser-Se-Ly for 3 months, the glandular epithelium was formed by a single layer of cuboidal cells. PSA showed high immunoexpression in all BPH patients and a focal positivity in Ser-Se-Ly treated patients after 3 months. Evident prostate specific membrane antigen (PSMA) immunoexpression was shown in all BPH patients, while no positivity was present after Ser-Se-Ly administration. Ser-Se-Ly proved to be effective in promoting apoptosis in BPH patients.

Curative effect of plasmakinetic enucleation of prostate in the treatment of large volume prostate

Objectives To evaluate the clinical effect of transurethral plasmakinetic enucleation of the prostate (PKEP) in treatment of large volume benign prostatic hyperplasia(BPH) (>80mL). Methods The clinical date of 80 patients with large volume BPH in the hospital from May 2012 to January 2015 were analyzed retrospectively. All patients were divided into PKEP group(n=37) and transurethral bipolar plasma kinetic prostatectomy (TUPKP group) (n=43) according to surgical ways. Perioperative indices, postoperative follow-up results of two groups were compared and ana- lysed. Results Bladder washing time (20.5 ± 6.7 )min, blood loss (120.5± 44.9 )mL, indwelling catheter time (4.4 ± 1.9)d, postoperative hospitalization (5.2 ±1.8)d in PKEP group were significantly lower than in TUPKP group and resection of the prostate weight (63.2± 21.5) g was significantly higher than TUPKP group (P 0.05). Qmax (22.4±4.7) mL/s in PKEP group was significantly higher than that in TUPKP group (19.5±4.0) mL/s (P 0.05), and the PSA values of the two groups were significantly decreased (P<0.05). The postoperative complication rate (62.16%) in the PKRP group was significantly lower than that in the TUPKP group (86.05%) and the difference was statistically significant (P<0.05). Conclusions PKEP has good clinical effect in the treatment of large volume BPH and TUPKP, it has the advantages of less bleeding, quick recovery and low complications. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate

Benign Prostatic Hyperplasia (BPH) Treatment with Physiotherapeutic Device/Thermobalancing Therapy causes New Challenges in Watchful Waiting

explains the cause of chronic internal diseases. Constriction of capillaries in response to an irritating trigger develops local micro-hypothermia. It is this focus of hypothermia, which in turn becomes a constant irritant maintaining illness, i.e., making a disease chronic. In response to irritation, i.e., a trigger-initiator (cold/ infection/ inflammation) and later focus of hypothermia, and in order to eliminate them, the blood flow increases through the spontaneous expansion of the capillary net locally. The formation of new capillaries is essentially the growth of the excess tissue [5].

779 Efficacy and safety of tamsulosin with and without flavoxate in the treatment of symptomatic benign prostatic hyperplasia

779 Efficacy and safety of tamsulosin with and without flavoxate in the treatment of symptomatic benign prostatic hyperplasia