Treatment Of Symptomatic Benign Prostatic Hyperplasia Research Articles

Significant relationship between parameters measured by transrectal color Doppler ultrasound and sexual dysfunction in patients with BPH 12 months after TURP

BackgroundA link between sexual dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) has been noticed. Transurethral resection of the prostate (TURP) remains the standard treatment for symptomatic BPH, whether TURP causes sexual dysfunction is still uncertain. In this retrospective study, we investigated the relationship between parameters measured by color Doppler ultrasound (CDU) and sexual dysfunction in patients with BPH 12 months after TURP.MethodsThe parameters include presumed circle area ratio (PCAR), maximal horizontal area of seminal vesicles (MHA), resistive index of the prostate (RIP), and peak systolic velocity in the flaccid penis (PSV). The international prostate symptom score was used to evaluate the lower urinary tract symptoms and the five-item version of the International Index of Erectile Function was used to evaluate sexual function before and after TURP.ResultsOf the 103 patients without sexual dysfunction before TURP, 11 (10.7%) had erectile dysfunction (ED) after TURP. These 11 patients had significantly lower PCAR, RIP, PSV and MHA than those without ED. The patients with retrograde ejaculation after TURP had significantly lower PCAR than those without retrograde ejaculation, and the patients with premature ejaculation after TURP had significantly lower MHA than those without premature ejaculation. Comparing the parameters between baseline and after TURP, PCAR, RIP, and MHA decreased significantly in the patients with sexual dysfunction, but no significant differences were noted in the patients without sexual dysfunction after TURP.ConclusionsMore extended TURP can lead to a higher incidence of ED and retrograde ejaculation in BPH patients without sexual dysfunction before TURP. Patients with a lower volume of seminal vesicles after TURP may have a higher incidence of premature ejaculation.

Prostatic Artery Embolization (PAE) As Treatment for Lower Urinary Tract Obstruction Due To Benign Prostatic Hyperplasia: An Update of the Literature

Prostate artery embolization (PAE) as treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) was first undertaken in 2000 and since then utilization of PAE for the treatment of symptomatic BPH associated with failure of medical therapy or patients not being fit to undergo general anaesthesia or spinal anaesthesia for surgical treatment of the prostate gland has continued to be undertaken by well trained interventional radiologists in various well equipped interventional radiology units globally especially in the developed countries. PAE is a technically demanding procedure which is only undertaken by well trained interventional radiologists. PAE is undertaken under radiology imaging control via the left or right femoral artery or the radial artery under local anaesthesia. Super-selective catheterization of the small prostatic artery is undertaken with the use of fine microcatheters that traverse the pelvic arteries / internal pudendal arteries. The PAE procedure does involve introduction of microparticles to completely block the prostate arteries. The embolization agents include polyvinyl alcohol (PVA) and other synthetic materials including microspheres. Successful PAE does lead to necrosis and shrinkage of the prostate gland. With regard to the technical details of PAE, the interventional radiologist does obtain access into the arterial system by piercing the femoral artery or the radial artery under radiology imaging control including ultrasound scan with utilization of a trocar which is hollow. A guide-wire is threaded through the trocar and trocar is then removed. A cannula is passed over the guide-wire and once the cannula is in place the guide-wire is removed. The cannula does allow a sheath to be inserted into the artery. Contrast material is injected through the sheath under radiology imaging / fluoroscopic control which does allow the anatomy of the pelvic blood vessels to be illustrated including the anatomy of the internal pudendal artery as well as if the anatomy is normal or there is a variation in the anatomy of the pelvic vessels including whether or not there is tortuosity of the pelvic vessels or atherosclerosis of the vessels. The contrast angiography is utilized to guide the interventional radiologist to identify the prostate artery in order to advance the catheter to the ostium of the prostatic artery and this then enables the radiologist to inject polyvinyl alcohol or microspheres into the prostatic artery. The anatomy of the pelvic vessels does vary which is well known by all interventional radiologists. Successful PAE does refer to complete bilateral embolization of the prostatic arteries but at times the radiologist is only able to undertake unilateral embolization of a prostatic artery due to a variant anatomy of the pelvic vessel or tortuosity of the vessel or atherosclerosis. Over the past 18 years various case reports, case series, and studies of PAE either alone or in comparison with trans-urethral resection of the prostate have been reported in various journals. These publications have mostly shown that PAE is safe and efficacious in improving upon the IPSS, QoL, Q-max, Post -void residual urine volume, as well as reduction in the volume of the prostate. Some of the studies have shown almost equivalent in the IPSS improvement in comparison with the IPSS improvement pursuant to TURP. Nevertheless, some of the reported improvements in other functional outcomes have not been as good as that obtained following TURP. Additionally the studies had been reported with short and medium term-follow-up only hence generally one cannot confidently state what the overall long-term outcome of PAE would be. Nevertheless, PAE has be associated with minor complications mainly and not with major complications including major bleeding. TURP tends to be associated with higher incidence of retrograde ejaculation and erectile dysfunction in comparison with PAE in which the sexual function tends to remain stable. PAE tends to be associated with retention of urine / long period of urethral catheterization in comparison with TURP. The overall cost of PAE tends to be much cheaper in comparison with TURP because of the fact that PAE tends to be undertaken as an outpatient procedure without any hospitalization cost. Specific complications which could occur include non-target embolization that could lead to transient rectitis, or penile ulcer, urinary tract infection, and dysuria. PAE may be associated with pelvic and urethral pain of more than 1 to 3 days but PAE is not associated with dilutional hyponatraemia which occasionally occurs following TURP. There is need for more studies to be undertaken on PAE and to be reported with long-term follow-up to enable a consensus opinion to be made about the long term outcome of PAE. Meanwhile PAE could be undertaken on individuals who have failed medical therapy who are not fit to undergo surgery or who do not want to undergo surgery.

03:00 PM Abstract No. 122 Economics of embolization: the competitive advantage of prostatic artery embolization in value-based care

To compare the cost-effectiveness of prostatic artery embolization (PAE) to surgical alternatives for symptomatic benign prostatic hyperplasia (BPH) and provide interventional radiologists (IR) with data for discussions with patients, referring physicians, and payers. Cost and efficacy data for PAE, transurethral resection of the prostate (TURP), UroLift, holium laser enucleation (HoLEP), convective radiofrequency (RF) (Rezum), conductive RF (Protista), and photoselective vaporization of the prostate (PVP) were identified by literature review. Total cost included the direct hospital cost plus the estimated cost of complications (reported incidence multiplied by management cost) during a 12-month period. Efficacy was defined by the decrease in International Prostate Symptom Score (IPSS) over a 12-month period. The cost (dollars) per unit decrease in IPSS and the incremental cost-effectiveness ratio (ICER) was calculated for each procedure. PAE had the lowest cost at $1720.34 and a reported 14.44 point 12-month decrease in IPSS. TURP had a cost of $5181 and 16.79 decrease in IPSS. UroLift had the highest cost at $6386 and a 10.65 point IPSS decrease. HoLEP had the highest 12-month decrease in IPSS at 19.74 at a reported cost of $3856. Rezum, Protista, and UroLift were all dominated by PAE (higher reported cost and lower efficacy than PAE); thus, ICER was not calculated. The ICER for TURP, HoLEP, and PVP was $1472.62, $402.95, and $5279.16, respectively. See Table 1 for additional data. PAE shows promise as a cost-effective minimally invasive procedure in the treatment of symptomatic BPH. The reduced hospitalization requirement, low complication rate, and reduced cost are key aspects that can be marketed to patients, referring physicians, and payers as we transition to value-based care.Table 1ICERs and Cost/Unit IPSS Decrease*ProcedureICERCost/IPSSPAEN/A$119.14TURP$1472.62$308.58RezumDominated$221.63ProstivaDominated$254.00UroLiftDominated$599.62HoLEP$402.95$195.34PVP$5279.16$338.13*Dominated indicates higher cost and lower IPSS decrease compared with PAE. Open table in a new tab

82] Efficacy of bipolar photovaporisation of prostate median lobe enlargement using the transurethral resection in saline (TURis) system

ObjectiveTo evaluate the efficiency of a vaporisation-resection of prostate median lobe enlargement in benign prostatic hyperplasia (BPH) using the transurethral resection in saline (TURis) system. Bipolar photovaporisation of the prostate has proven to be effective in the treatment of BPH symptoms with maximum safety and without increasing the complication rate or length of stay.

Экстракты Serenoa repens в лечении доброкачественной гиперплазии предстательной железы и симптомов нижних мочевыводящих путей

This literature review focuses on the use of Serenoa repens extracts in the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Extracts of Serenoa repens produce marked anti-inflammatory, anti-androgenic and antiproliferative effects. Various extracts differ in their activity depending on the concentration of free fatty acids and the method of extract preparation. Extracts of Serenoa Repens from different manufacturers vary considerably in composition, effectiveness and supporting evidence. Evaluation of the effectiveness of Serenoa Repens extracts should be carried out for each extract separately, depending on the method of preparation and brand. The most studied and clinically effective is the hexane lipidosterol extract of Serenoa Repens Permixon. This assessment is supported by a report on Serenoa Repens, issued by the European Medicines Agency. In this report, only Serenoa repens hexanic extract Permixon is considered to be a well-established medical use product for the symptomatic treatment of BPH.

An introduction to genetic and epigenetic changes in prostate gland – implications in efficacy of phytotherapy of benign prostatic hyperplasia and prostate cancer

The usage of classical pharmacological treatment of prostate diseases causes the risk of a number of side effects therefore the researchers are looking for new pharmacologically active molecules, including those contained in the plant extracts. The most widely studied is the lipido-sterolic extract from Serenoa repens (saw palmetto), water extract from Camellia sinensis (green tea) and several cruciferous vegetables. The molecular mechanisms underlying of the development and the progression of prostate disorders, especially benign prostatic hyperplasia (BPH) and prostate cancer (PC), remain still poorly understood. The development of pathologically changed prostate cells proliferation involves many factors, including genetic alterations, such as mutations, and epigenetic changes, appear to contribute to the transformation and progression of prostate cancer. In this paper we suggest that the knowledge of epigenetic modifications presented in this paper introduces the new point of view concerning the possibility of action of plant substances used in prevention and symptomatic treatment of BPH and prostate cancer. Thus, identification of the epigenetic modifications involved on the one hand in the development and progression of BPH / PC, on the other influencing the efficacy and safety of potential phytotherapeutics will be helpful in identifying its novel therapeutic strategy.

IJU this issue

This issue contains three Review Articles, 12 Original Articles, one case report and two Letters to the Editor. Wieczorek et al. (Lodz, Poland) reviewed polymorphisms in the matrix metalloproteinase (MMP) genes, and their association with bladder cancer risk and recurrence. MMP are well known to play crucial roles in tumor invasion and metastasis in several human cancers. Many papers reported an association between increased expression or activation of MMP and the invasiveness or progression of bladder cancer. In contrast, polymorphisms of genes are associated with their protein expression or activation. Therefore, it is important to clarify the association between polymorphisms of MMP genes and the risk of recurrence or metastasis. The authors reviewed articles reporting polymorphisms in MMP genes in bladder cancer. This review gives us up-to-date knowledge on polymorphisms in MMP genes for bladder cancer. The genetic polymorphism of the MMP1 gene (rs1799750) was most widely studied, and interestingly, the results suggested that the 2G2G genotype might show increased susceptibility for bladder cancer, particularly among smokers. However, further large studies are necessary to confirm these results. Improvement of the effect of systemic therapy for metastatic renal cell carcinoma (mRCC) by cytoreductive nephrectomy (CN) before systemic therapy has been reported in the era of cytokines therapy. However, CN has decreased in the era of targeted therapy. It is important to clarify the benefit and risk of CN for treatment of mRCC in the era of molecular targeted therapy. Takagi et al. (Tokyo, Japan) investigated perioperative outcomes of CN in patients with mRCC. The authors used the Japanese Diagnosis Procedure Combination database from 2007 to 2012 to evaluate in-hospital mortality, complications, blood transfusion, anesthesia time and so on. A total of 1074 patients including 270 with T1, 215 with T2, 479 with T3 and 110 with T4 were investigated. Minimally-invasive surgeries were carried out more frequently in low T stage (44.1% for T1, 26.5% for T2, 12.1% for T3, 9.1% for T4). Multivariate analysis showed that increasing T stage was significantly associated with unfavorable perioperative outcomes, except in-hospital mortality. Clinical N stage was the only significant predictor for in-hospital mortality. This article provides helpful information for treatment strategy to mRCC in the era of molecular targeted therapy. α-1 blockers have been used as first-line therapy for symptomatic benign prostatic hyperplasia (BPH). 5-α reductase inhibitors are also used for BPH mainly as combination therapy with α-1 blockers. Two articles reported the effect of dutasteride. Matsukawa et al. (Nagoya, Japan) evaluated the effects of dutasteride monotherapy for untreated patients with BPH. A total of 105 patients were enrolled and 97 patients were evaluated. Symptom parameters including storage and voiding International Prostate Symptom Score improved significantly after 2 months, and progressively improved until after 12 months. Significant improvement of objective parameters including first desire volume and maximum flow rate were observed after 6 months, and further improvements were obtained after 12 months. Araki et al. (Chiba, Japan) evaluated the early additional effect of dutasteride on α-1 blockers for BPH. A total of 88 patients were enrolled, and 74 patients were analyzed early effects. Lower urinary tract symptoms were improved at 1 month after dutasteride administration. These effects continued for at least 6 months. These articles give us useful information on treatment of symptomatic BPH. Interferon-alpha (IFN-α) is a candidate for the first-line treatment of mRCC, particularly clear cell RCC with lung metastasis. Yamamoto et al. (Sapporo, Japan) reported a 70-year-old man treated with IFN-α after unsuccessful molecular targeted therapies. Nephrectomy was carried out before systemic therapy, and the pathological diagnosis was clear cell RCC. Lung metastasis was 30 mm in diameter. The patient was treated by axitinib as first-line treatment and at 8 weeks. Computed tomography showed enlargement of the lung tumor and multiple new lesions in the lung. Everolimus was used for second-line treatment; however, it was discontinued because of interstitial lung disease, and was followed by sorefenib for third-line treatment. Sorafenib was also stopped and discontinued because of thrombocytopenia, proteinuria and nephrotic syndrome. Then, IFN-α was started, and a partial response was shown at 8 week. However, IFN-α was stopped, because the patient was diagnosed with depression after maintenance of 2 years. The residual tumor was resected, and no viable cells were observed. None declared.

Association of breast cancer in men with exposure to 5-α reductase inhibitors: A RADAR report.

2532 Background: Breast cancers in men (BCM) account for <1% of all breast cancers. Dihydrotestosterone (DHT) inhibits proliferation of normal and neoplastic mammary tissue and constrains the effect of estrogens. Finasteride (F) and dutasteride (D) are 5-α reductase inhibitors (5-αRIs) that reduce systemic and local dihydrotestosterone and cause gynecomastia in 1–3% of men. The package inserts for F and D state, “the relationship between long-term use of (finasteride/dutasteride) and male breast neoplasia is currently unknown.” F and D are marketed for treatment of symptomatic benign-prostatic hyperplasia. F is marketed for treatment of androgenetic alopecia. Methods: To detect disproportionality in the FDA MedWatch dataset, we calculated the empiric Bayes geometric mean (EBGM) for association of BCM with F or D. We also calculated the attributable risk of BCM exposed to F or D among men at an urban academic hospital (Northwestern Memorial Hospital) and at a rural healthcare system (Marshfield Clinic). Results: In the MedWatch dataset, we identified 33 reports of F-associated BCM and 5 reports of D-associated BCM. For F–associated BCM, the EBGM was 58.95 (95% CI 24.47-81.76; p=0.0001). For D-associated BCM, the EBGM was 15.79 (95% CI 4.57-35.49; p=0.0001). The mean age for BCM after 5-αRI exposure was 70±11 years; 11/38 (29%) had gynecomastia. There were 38 cases of BCM associated with 5-αRI in the combined Northwestern and Marshfield cohort (see table below). Conclusions: We found a highly significant association between BCM and 5-αRI exposure in each of 6 separate analyses (3 sources X 2 drugs), with an estimated 1 extra BCM per 564 men exposed to 5-αRIs. We now plan to assess BRCA status and other risk factors. Given that 5-αRIs are marketed for control of lower urinary tract symptoms or for cosmetic purposes, it is not immediately obvious that use of finasteride or dutasteride for their labeled indications would provide any net benefit. [Table: see text]

Combination Pharmacological Therapies for the Management of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a highly prevalent condition of older men caused by unregulated growth of the prostate gland. Clinical trials of medical therapy for BPH have consistently demonstrated that combined therapy with an α(1)-adrenergic receptor (AR) antagonist and a 5α-reductase inhibitor is superior to either agent alone. The addition of anticholinergic therapy to a treatment regimen could effectively improve symptoms in men with persistent storage lower urinary tract symptoms (LUTS) who have not seen a benefit with an α(1)-AR antagonist or 5α-reductase inhibitor. Among α(1)-AR antagonists, doxazosin, terazosin, tamsulosin, and alfuzosin, although with slight differences in adverse event profiles, are equivalent in effectiveness and efficacy. No data in the form of direct comparator trials exist to suggest a difference in clinical efficacy of finasteride and dutasteride, the two 5α-reductase inhibitors currently available. Current American Urological Association guidelines do not recommend phytotherapy or dietary supplements in any combination for the medical management of BPH. The current literature supports the safety and efficacy of the combination of an α(1)-AR antagonist and a 5α-reductase inhibitor in the treatment of symptomatic BPH and, in select patients, the use of an α(1)-AR antagonist and anticholinergic medication in the treatment of LUTS suggestive of BPH.

Transurethral Ethanol Ablation of the Prostate for Symptomatic Benign Prostatic Hyperplasia: Long-Term Follow-Up

Over the past decade, a variety of new minimally invasive therapies (MIT) have been developed for the treatment of patients with bladder outflow obstruction from benign prostatic hyperplasia (BPH). Transurethral ethanol ablation of the prostate (TEAP) has been introduced as a minimally invasive alternative treatment for patients with BPH. In this study, we present our experience and results of long-term follow-up of 54 months after treatment of symptomatic BPH with TEAP. Fifty-six men with symptomatic BPH were enrolled in our study; all patients were medically high-risk patients with multiple comorbidities. Procedures were performed under intravenous sedation combined with local urethral instillation of lidocaine jelly and a transrectal ultrasonography (TRUS)-guided periprostatic block. Dehydrated ethanol in a concentration of 95% to 98% was injected transurethrally by means of the Postaject Ethanol Injection System using a rigid cystoscope. The following data were collected: International Prostate Symptom Score, prostate-specific antigen level, prostate volume using TRUS, maximum urine flow rate, and postvoid residual. There was sufficient response in 73% of our patients, while the remaining 23% showed an insufficient response and needed alternative treatment. TEAP is an effective minimally invasive treatment option for medically high-risk symptomatic patients with BPH that can be performed as an outpatient procedure under regional anesthesia. The procedure is easy, available, inexpensive, safe, and rapid. Further larger-scale, long-term multi-institutional trials are needed.

Ultra violet spectrophotometric method: Not possible for the simultaneous estimation of alpha one adrenoreceptor blockers

Background: Although initially introduced for the management of hypertension, al-adrenergic-receptor antagonists (a 1 blockers) have become the standard of care for the medical management of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). Alpha-blockers (alfuzosin, tamsulosin, doxazosin, prazosin, and terazosin) relax the smooth muscles in the prostate and are indicated for the symptomatic treatment of BPH, due to evidence of their positive and rapid effect on LUTS. Objective: Our objective was to develop and validate a method for simultaneous estimation of these drugs. Our aim was to develop a UV spectrophotometric method because of the simplicity and economical advantage of this technique. Materials and Methods: All these drugs were dissolved in the same solvent (methanol) and scanned under a ShimadzuUV spectrophotomer, under full UV (ultraviolet) range (200 - 400 nm). Result: After some experiments we found that this is impossible. This was evident from our study that UV spectra were overlapping each other, except in the case of tamsulosin. Conclusion: Same class of drugs may have almost the same functional groups, and gradient Reverse-Phase Liquid Chromatography(RPLC) will be more useful to separate such complicated mixtures. Therefore, we propose to develop a gradient High-Performance Liquid Chromatography(HPLC) method as it may be a more suitable method for the simultaneous estimation of these drugs.

Editorial Comment

The clinical observations that LUTS in men with BPH is relieved by α-blockers, 5-α-reductase (5AR) inhibitors, and phosphodiesterase (PDE) inhibitors imply that α-adrenoceptors and the downstream products of 5AR and PDE are involved in the pathophysiology of these symptoms. The specific targets mediating the effectiveness of these 3 classes of drugs remain poorly understood. Over the past 30 years, we have learned how to effectively treat LUTS secondary to BPH without unraveling the underlying pathophysiology of LUTS/BPH. 1 Shapiro E. Lepor H. Pathophysiology of clinical benign prostatic hyperplasia. Urol Clin North Am. 1995; 22: 285 PubMed Google Scholar Dose-ranging Study of the Luteinizing Hormone-releasing Hormone Receptor Antagonist Cetrorelix Pamoate in the Treatment of Patients With Symptomatic Benign Prostatic HyperplasiaUrologyVol. 76Issue 4PreviewTo compare the efficacy of 4 dosage regimens of cetrorelix pamoate, a sustained release formulation that allows for more convenient dosing, in patients with symptomatic benign prostatic hyperplasia (BPH). Repeated dosing with cetrorelix acetate was shown to be active in the treatment of BPH symptoms. Full-Text PDF

Dose-ranging Study of the Luteinizing Hormone-releasing Hormone Receptor Antagonist Cetrorelix Pamoate in the Treatment of Patients With Symptomatic Benign Prostatic Hyperplasia

To compare the efficacy of 4 dosage regimens of cetrorelix pamoate, a sustained release formulation that allows for more convenient dosing, in patients with symptomatic benign prostatic hyperplasia (BPH). Repeated dosing with cetrorelix acetate was shown to be active in the treatment of BPH symptoms. Double-blind, randomized, multicenter study was undertaken among patients with International Prostate Symptom Score (IPSS) ≥ 13. After a single-blind placebo run-in phase of 4 weeks, treatment was administered at 2-week intervals as follows: 30 + 30 mg, 30 + 30 + 30 mg, 60 + 30, 60 + 60 mg cetrorelix pamoate, or matching placebo. Patients were followed-up for 28 weeks after randomization. A statistically significant overall difference was found with respect to the primary variable, the IPSS (P ≤ .001). Optimal results, a 4-point improvement in IPSS in excess of the changes observed in the placebo group, were achieved with a starting dose of 60 mg cetrorelix pamoate followed by a dose of 30 mg 2 weeks later. In all dosage groups, the symptomatic improvement was paralleled by an increase in uroflow. There was a marked dissociation between only moderate and transient testosterone suppression and the persisting effects on BPH signs and symptoms. Tolerability was good at all cetrorelix dosages. Intramuscular injections of 60 and 30 mg of cetrorelix pamoate within 2 weeks provide rapid symptomatic improvements of BPH that are sustained for the following 6 months.

Combined medical treatment using dutasteride and tamsulosin for lower urinary tract symptoms suggestive of benign prostatic hyperplasia

Importance of the field: Benign prostatic hyperplasia (BPH) is the fourth most commonly diagnosed medical condition in the elderly. Selective α-blockers (tamsulosin) and dual 5α-reductase inhibitors (dutasteride) have an important role in the medical treatment of symptomatic BPH. Safety and efficacy of combination therapy with dutasteride and tamsulosin as well as long-term benefit on prevention of disease progression have been widely studied in recent trials.Areas covered in this review: The present article summarizes the pharmacologic properties of both dutasteride and tamsulosin. Clinical efficacy of combination therapy in different trials has also been reported. Major randomized trials on this concept published between 2000 and 2010 have been covered in this article.What the reader will gain: Long-term efficacy and safety of combination therapy and its beneficial effect on quality of life and risk reduction of need for BPH-related surgeries have been discussed.Take home message: Combination therapy with dutasteride and tamsulosin is a highly efficacious medical treatment in patients with moderate-to-severe lower urinary tract symptoms due to benign prostatic enlargement, which could be safely tolerated and administrated for ≥ 4 years.

Large scale multi-centre randomized placebo controlled clinical study proves the efficacy of pumpkin seed in symptomatic benign prostatic hyperplasia (BPH) – G.R.A.N.U. study

Of all known herbal drugs in the therapy of BPH, pumpkin seed has the longest tradition. The high level of unique delta-7 sterols is discussed as the active principle. This is supported by a former study where prostate tissue of patients taking pumpkin sterols contained much less dihydrotestosterone, compared to the control group [1]. The aim in the treatment of symptomatic BPH is to improve lower urinary tract symptoms (LUTS) and patient's quality of life (QoL) [2]. This study was carried out to confirm the efficacy of pumpkin seed in a design referring to the recommendations of the International Consultation on BPH and WHO criteria. Method: three treatment groups. 1. pumpkin seed extract (2×500mg capsule per day, PROSTA FINK® FORTE), 2. placebo capsule. 3. pumpkin seed (2×5g per day), The pumpkin is a special variety: GRANU FINK® medicinal pumpkin. Treatment period: 12 months. 1431 patients were randomised. A noticeable decrease in the international prostate symptom score (IPSS) by 3 to 4 points was observed after 3 months followed by gradually continuous decrease until month 12. The QoL improved continuously over time with the remarkable improvement by 36% in the pumpkin seed group. Treatment with pumpkin seed results a strong improvement of micturition complaints. Level of IPSS improvement (%) over 12 months is comparable to most prescription medicines in this indication [3]. The symptom relief is accompanied by a clinically significant improvement of Quality-of-Life by 36%. Pumpkin seed is an effective and safe option for the long-term therapy in men with LUTS due to BPH.

Pre-Clinical Evaluation of Direct Current Ablation for the Treatment of Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia (BPH) is a non-cancerous growth of the prostate gland affecting about 50% of the men over age 50. As men age, the prostate continues to grow leading to increased prostate volume, which may cause lower urinary tract symptoms (LUTS). These symptoms can include the inability to completely empty the bladder, urine retention, and a profound sensation of urgency. Direct Current (DC) ablation may be applied to treat these symptoms as a minimally-invasive alternative to surgery, medication, or thermal ablation, by causing tissue necrosis within the lateral lobes of the prostate. The objective of this study was to evaluate the effects of DC ablation in canine prostates by investigating how the resulting necrosis would change the macrostructure of the prostate for the potential treatment of symptomatic BPH. DC ablation is achieved by passing direct current through two electrodes in tissue, causing the formation of hydrogen ions at the anode and hydroxyl ions at the cathode. These ions diffuse through the tissue causing a pH of ∼1 at the anode, and ∼13 at the cathode. The extreme anti-physiological pH regions cause cellular necrosis and form in a predictable manner that is directly proportional to the charge delivered. The controlled shape and size of the lesions allow for predictable necrotic zones and enable treatment optimization. Treatment was performed on 6 acute and 8 chronic canine subject by performing a laparotomy and inserting electrodes through the prostate capsule. Acute subjects were sacrificed before recovery, while chronic subjects were sacrificed after 1, 3, 20, 40, and 60 days to investigate the healing cascade of the prostate after treatment. The chronic subjects were monitored for changes in urination or defecation patterns. Urine and blood samples were collected to evaluate the subjects' health throughout the study. Both macro-visual and pathological analyses were done to evaluate tissue response all acute and chronic subjects. Cellular necrosis within the prostate was significant and exhibited a dose response within the range of 0.07 to 0.10 cm3/coulomb for each electrode pair. The does response is defined as the ratio of necrotic tissue created, to charge delivered. Necrotic prostate cells resulted in voids with minimal scar tissue and a visible reduction in prostate mass. The treatment followed tissue planes constraining necrotic zones to the region between the prostate capsule and prostatic urethra. Both normal and hyperplastic tissues were treated and exhibited necrosis. No necrosis was observed outside the prostate. DC ablation has been demonstrated to create well-defined, predictable, and repeatable regions of cellular necrosis and structural changes in canine prostates. This technology may offer promise for the treatment of symptomatic BPH with an appropriately designed delivery system. Other potential applications include other benign and malignant tumors within the body.

Revue de la littérature sur l’utilisation des lasers pour le traitement de l’HBP symptomatique

Even if transurethral resection of the prostate (TURP) today remains the referential surgery in the treatment of symptomatic benign prostatic hyperplasia (BPH), the last decade has seen the emergence of considerable improvements in light amplification by stimulated emission of radiation (LASER) technology. Better understanding of the interaction between the different wavelengths of these lasers and tissue has enabled the development of new and promising types of treatment. This article, through a review of published literature, attempts first of all to retrace the history of this technique in the treatment of symptomatic BPH and then goes on to give an update on results and new aspects of the different types of laser used.

5-α-reductase inhibitor monotherapy for lower urinary tract symptoms following combination therapy with α-blockers: When is one medication enough?

Benign prostatic hyperplasia (BPH) and its related lower urinary tract symptoms are common conditions in elderly men that may involve serious complications requiring surgical intervention. Drug therapy, the first-line of treatment for symptomatic BPH, includes α-blockers and 5-α-reductase inhibitors (5ARIs). The landmark Medical Therapy of Prostatic Symptoms (MTOPS) trial demonstrated that combination therapy with 5ARIs and α-blockers was more effective than either drug class alone. Several studies have demonstrated that α-blockers could be discontinued following the initial period of combination therapy without significantly worsening symptoms. After 6 to 9 months of combination therapy, the 5ARI alone maintained symptom improvement, with the advantage of reducing cost and side effects. This article reviews the medical treatment of symptomatic BPH and discusses the rationale, outcome, and withdrawal time of initial α-blockers following combination therapy.

Laser prostatic surgery: An update

This review presents an overview of the current state of the art of laser prostatic surgery. Several types of lasers have been used in the treatment of benign prostatic hyperplasia (BPH) over the past 15 years. Vaporization techniques have recently gained popularity and have been widely accepted by many urologists. Short-term results show that vaporization of a prostatic adenoma with higher-power potassium titanyl phosphate and holmium lasers is safe and effective in the treatment of symptomatic BPH. However, well designed randomized comparative trials with long-term follow-up are still needed. Holmium laser is a multi-purpose surgical tool and has multiple applications in urology. In the treatment of symptomatic BPH, holmium laser can be used in ablation, resection and enucleation of the prostate. Holmium laser enucleation of the prostate (HoLEP) is the most investigated laser procedure used in the treatment of symptomatic BPH. Several randomized controlled trails confirmed the safety, efficacy, and durability of HoLEP regardless of the prostate size.

The Efficacy and Safety of KTP Photoselective Vaporization of the Prostate for the Treatment of Benign Prostatic Hyperplasia: The 2-year Results

Purpose: This study was conducted to evaluate, with using the 2-year follow-up data, the clinical efficacy and safety of performing photoselective vaporization of the prostate (PVP) for the treatment of symptomatic benign prostatic hyperplasia (BPH). Materials and Methods: We analyzed the clinical data of 104 men with symptomatic BPH and who had undergone PVP. The efficacy parameters were the changes from baseline of the International Prostate Symptom Score (IPSS), the quality of life (QoL) score, the maximum urinary flow rate (Qmax) and the postvoid residual volume (PVR). The patients were evaluated preoperatively and then at post-operative 1, 3, 6, 12 and 24 months. Their complications were also evaluated. Results: The mean prostate volume was 45.6ml. The mean lasing time was 44.9 minutes and there was no significant blood loss or fluid absorption during or immediately after PVP. Significant improvements in the IPSS, the QoL score, the Qmax and the PVR were noted as early as 1 month after PVP treatment. After 24-month follow-up, the mean IPSS decreased from 22.4 to 9.9 (p<0.0001) and the QoL score decreased from 4.4 to 2.3 (p<0.0001), while the mean Qmax changed from 8.3 to 14.4ml/sec (p< 0.0001). The PVR decreased from 82.0 to 49.9ml (p=0.033). The complications were retrograde ejaculation (26.9%), transient catheterization (6.7%), transient dysuria (2.9%), bladder neck contracture (1.9%), urethral stricture (0.9%) and meatal stenosis (0.9%). 1 patient was diagnosed with prostate cancer 32 months after operation. Conclusions: Significant improvements of the subjective and objective voiding parameters were achieved and these were sustainable for at least 2-year, with minimal complications, after PVP. PVP seems to be a safe and effective treatment for symptomatic BPH. (Korean J Urol 2008;49: 831-836) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏