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Investigative and Clinical Urology Jul 2021The negative correlation between BPH-size and incidence of prostate cancer (PCa) is well-documented in the literature, however the exact mechanism is not...
PURPOSE
The negative correlation between BPH-size and incidence of prostate cancer (PCa) is well-documented in the literature, however the exact mechanism is not well-understood. The present study uses histo-anatomical imaging to study prostate volume in correlation to prostate capsule thickness, and glandular epithelial cell density within the peripheral zone (PZ).
MATERIALS AND METHODS
Specimens were selected from radical prostatectomies ranging from 20 to 160 mL based on ease of anatomical reconstruction by the slides. A total of 60 patients were selected and underwent quantitative measurements of prostate capsule thickness and glandular epithelial density within the PZ using computer-based imaging software. Pearson's correlation and a stepwise multiple linear regression analysis was conducted to determine the relationship between these measured parameters and the clinical characteristic of these patients.
RESULTS
Pearson's correlation analysis revealed a strongly significant, negative correlation between prostate volume and glandular epithelial cell density (r(58)=-0.554, p<0.001), and a strongly significant, positive correlation between prostate volume and average capsule thickness (r(58)=0.462, p<0.001). Results of multiple regression analysis showed that average glandular epithelial cell density added statistically to this prediction (p<0.05).
CONCLUSIONS
The results suggest that growth of the transition zone in BPH causes increased fibrosis of the PZ, leading to atrophy and fibrosis of glandular cells. As 80% of PCa originates from the glandular epithelium within the PZ, this observed phenomenon may explain the inverse correlation between BPH and PCa that is well-documented in the literature.
Topics: Aged; Atrophy; Epithelial Cells; Fibrosis; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Organ Sparing Treatments; Prostate; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms; Retrospective Studies
PubMed: 34085792
DOI: 10.4111/icu.20200605 -
BMC Urology Apr 2023Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Benign prostatic hyperplasia (BPH) is a common chronic condition among men aged 50 or older, causing voiding and obstructive lower urinary tract symptoms. Water vapor thermal therapy (WVTT) using the Rezūm® system is a new minimally invasive surgical technique that is increasingly reported as a treatment for BPH.
METHODS
The protocol was submitted to the PROSPERO registry. We searched PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov up to July 29, 2022. Quality assessment was carried out by a 20-item checklist form prepared by the Institute of Health Economics (IHE). Double arcsine transformation was performed to stabilize the variance of the original ratio. When I > 50%, the random effect model was used to calculate the pooled parameters. Otherwise, the fixed effect model was used. 95% confidence intervals (CIs) were calculated. A leave-one-out sensitivity analysis was performed to evaluate the impact of each study on the pooled outcomes, and finally, Egger's test was used to assess publication bias.
RESULTS
A total of seven single-arm observational studies and one random controlled trial, including 1015 patients, were included. One year after WVTT, the International Prostate Symptom Score decreased by 11.37 (95% CI: -12.53, -10.21), the IPSS Quality of Life scale decreased by 2.59 (95% CI: -2.92, -2.26), the maximum urine flow rate increased by 5.26 ml/s (95% CI: 4.53, 5.99), and the postvoid residual decreased by 13.18 ml (95% CI: -24.32, -2.03). The most common complication was dysuria, with a pooled incidence of 21% (95% CI: 14%, 29%), and the second most common complication was hematuria, with a pooled incidence of 14% (95% CI: 10%, 18%). The pooled incidence of retreatment was 3% (95% CI: 2%, 5%).
CONCLUSIONS
WVTT is an attractive alternative to medication or more invasive surgical procedures and can serve as first-line therapy for men with BPH.
Topics: Male; Humans; Prostatic Hyperplasia; Steam; Prostate; Quality of Life; Hyperplasia; Lower Urinary Tract Symptoms; Treatment Outcome
PubMed: 37118692
DOI: 10.1186/s12894-023-01237-2 -
The Urologic Clinics of North America Feb 2008Prostatitis, a histologic diagnosis, has evolved over the years to describe a clinical syndrome that was believed to be associated with prostatic inflammation.... (Review)
Review
Prostatitis, a histologic diagnosis, has evolved over the years to describe a clinical syndrome that was believed to be associated with prostatic inflammation. Similarly, benign prostatic hyperplasia (BPH), another histologic diagnosis, has evolved to describe a clinical syndrome believed to be associated with prostatic enlargement. Recent explorations of the interrelationships between these prostate-associated histologic and clinical conditions have generated much interest and excitement. This article describes these relationships and their impact on the management of, in particular, BPH.
Topics: Biomarkers; Humans; Male; Prostatic Hyperplasia; Prostatitis
PubMed: 18061029
DOI: 10.1016/j.ucl.2007.09.012 -
The British Journal of General Practice... Apr 1997The clinical syndrome of benign prostatic hyperplasia reflects a complex interplay between benign prostatic enlargement, which will affect almost all men by the age of... (Review)
Review
The clinical syndrome of benign prostatic hyperplasia reflects a complex interplay between benign prostatic enlargement, which will affect almost all men by the age of 80, and the resulting outlet obstruction and lower urinary tract symptoms. The disease is now known to adversely affect the quality of life of around one man in three over the age of 50. New medical treatments and new surgical interventions are challenging the previous standard treatment of transurethral resection of prostate, which continues to have a morbidity of 17% and some mortality. Primary care will be increasingly involved in shared care with particular emphasis on monitoring of patients on watchful waiting medical therapy- and following operative intervention.
Topics: Aged; Aged, 80 and over; Humans; Male; Middle Aged; Morbidity; Prostatectomy; Prostatic Hyperplasia; Quality of Life; Risk Factors; Urodynamics
PubMed: 9196969
DOI: No ID Found -
Clinical Interventions in Aging 2016Prostate artery embolization (PAE) is emerging and is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prostate artery embolization (PAE) is emerging and is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). The purpose of this article was to evaluate the efficacy and safety of PAE on LUTS related to BPH.
MATERIALS AND METHODS
A literature review was performed to identify all published articles of PAE for BPH. The sources included MEDLINE, EMBASE and Cochrane Library from 1980 to 2016. A systematic review and meta-analysis was conducted. The outcome measurements were combined by calculating the mean difference with 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.0.
RESULTS
Twelve studies involving 840 participants were included. Compared with baseline, the International Index of Erectile Function (IIEF-5; International Prostate Symptom Score) scores, the quality of life scores, peak urinary flow rate () and postvoid residual volume all had significant improvements during the 24-month follow-up (all <0.00001). Both prostate volume (PV) and prostate-specific antigen had significant decrease during the 12-month follow-up (<0.00001 and =0.005, respectively), except postoperative 24 months (=0.47 and =0.32, respectively). The IIEF-5 short form scores had significant increase at postoperative 6 months (=0.002) and 12 months (<0.0001), except postoperative 1 month (=0.23) and 24 months (=0.21). For large volume (PV ≥80 mL) BPH, the results were similar. There were no life-threatening complications.
CONCLUSION
PAE is an effective, safe and well-tolerable treatment for LUTS related to BPH, including large volume (PV ≥80 mL) BPH, with a good short-term follow-up. Studies with large number of cases and longer follow-up time are needed to validate our results.
Topics: Embolization, Therapeutic; Humans; Lower Urinary Tract Symptoms; Male; Prostate; Prostatic Hyperplasia
PubMed: 27956827
DOI: 10.2147/CIA.S119241 -
Korean Journal of Radiology Apr 2023
Review
Topics: Male; Humans; Prostate; Embolization, Therapeutic; Prostatic Hyperplasia; Vascular Surgical Procedures; Arteries; Treatment Outcome
PubMed: 36788767
DOI: 10.3348/kjr.2022.0814 -
Urologia Internationalis 2022To critically appraise the methodological rigour of the clinical practice guidelines (CPGs) vis-à-vis BPH surgery as used by specialist research associations in the US,... (Review)
Review
OBJECTIVE
To critically appraise the methodological rigour of the clinical practice guidelines (CPGs) vis-à-vis BPH surgery as used by specialist research associations in the US, Europe and UK, and to compare whether the guidelines cover all or only some of the available treatments.
METHODS
The current guidelines issued by the EUA, AUA and NICE associations have been analyzed by 4 appraisers using the AGREE-II instrument. We also compared the recommendations given in the guidelines for surgical and minimally invasive treatment to find out which of these CPGs include most of the available treatment options.
RESULTS
According to the AGREE II tool, the median scores of domains were: domain 1 scope and purpose 66.7%, domain 2 stakeholder involvement 50.0%, domain 3 rigor of development 65.1%, domain 4 clarity of presentation 80.6%, domain 5 applicability 33.3%, domain 6 editorial independence 72.9%. The overall assessment according to AGREE II is 83.3%. The NICE guideline scored highest on 5 out of 6 domains and the highest overall assessment score (91.6%). The EAU guideline scored lowest on 4 out of 6 domains and has the lowest overall assessment score (79.1%).
CONCLUSIONS
The analyzed CPGs comprehensively highlight the minimally invasive and surgical treatment options for BPH. According to the AGREE II tool, the domains for clarity of presentation and editorial independence received the highest scores. The stakeholder involvement and applicability domains were ranked as the lowest. Improving the CPG in these domains may help to improve the clinical utility and applicability of CPGs.
Topics: Europe; Humans; Male; Minimally Invasive Surgical Procedures; Practice Guidelines as Topic; Prostatic Hyperplasia; Societies, Medical; United Kingdom; United States; Urologic Surgical Procedures, Male
PubMed: 34350885
DOI: 10.1159/000517675 -
Archivos Espanoles de Urologia Nov 2023Benign prostatic hyperplasia (BPH) is a prevalent condition among older men that is characterized by the enlargement of the prostate gland and compression of the... (Review)
Review
Benign prostatic hyperplasia (BPH) is a prevalent condition among older men that is characterized by the enlargement of the prostate gland and compression of the urethra, which often results in lower urinary tract symptoms, such as frequent urination, difficulty in starting urination, and incomplete bladder emptying. The development of BPH is thought to be primarily due to an imbalance between cell proliferation and apoptosis, underlying inflammation, epithelial-to-mesenchymal transition, and local paracrine and autocrine growth factors, although the exact molecular mechanisms are not yet fully understood. Anatomical structures considered natural and benign observations can occasionally present multi-parametric magnetic resonance imaging appearances that resemble prostate cancer (PCa), posing a risk of misinterpretation and generating false-positive outcomes and subsequently, unnecessary interventions. To aid in the diagnosis of BPH, distinguish it from PCa, and assist with treatment and outcome prediction, various Artificial Intelligence (AI)-based algorithms have been proposed to assist clinicians in the medical practice. Here, we explore the results of these new technological advances and discuss their potential to enhance clinicians' cognitive abilities and expertise. There is no doubt that AI holds extensive medical potential, but the cornerstone for secure, efficient, and ethical integration into diverse medical fields still remains well-structured clinical trials.
Topics: Male; Humans; Aged; Prostatic Hyperplasia; Artificial Intelligence; Prostate; Prostatic Neoplasms; Urination
PubMed: 38053419
DOI: 10.56434/j.arch.esp.urol.20237609.79 -
Cleveland Clinic Journal of Medicine Dec 2023Interventions for benign prostatic hyperplasia have evolved from transurethral resection of the prostate and simple prostatectomy to a myriad of office-based and... (Review)
Review
Interventions for benign prostatic hyperplasia have evolved from transurethral resection of the prostate and simple prostatectomy to a myriad of office-based and operating-room procedures. The contemporary approach involves matching the right procedure to the right patient, choosing on the basis of prostate characteristics, patient preference, and urologist expertise. This review details currently available and guideline-backed surgical and procedural treatments.
Topics: Male; Humans; Transurethral Resection of Prostate; Prostatic Hyperplasia; Laser Therapy; Prostatectomy
PubMed: 38040442
DOI: 10.3949/ccjm.90a.23026 -
Journal of Healthcare Engineering 2022Prostatic hyperplasia can cause dysuria, such as frequent urination, urgency of urination, increased nocturia, poor urination, and other symptoms, which seriously affect...
Prostatic hyperplasia can cause dysuria, such as frequent urination, urgency of urination, increased nocturia, poor urination, and other symptoms, which seriously affect the quality of life of old men. We aim to compare and analyze the safety and clinical effect of embolization of the target blood vessels of ruptured prostatic hyperplasia with gelatin sponge particles and embosphere microspheres. . The transcatheter MRI was performed in 422 patients. Among them, 198 patients were treated with gelfoam particles and 224 patients were treated with embosphere microspheres. The clinical effect and adverse reactions were observed and analyzed by biochemical and imaging examination. Four hundred and twenty two cases were hemostasis. In the gelatin sponge group, 34 patients had recurrent bleeding 24-36 hours after embolization, 122 patients had different degrees of elevation of prostatic hyperplasia transaminase (31 cases increased to more than 1000 U/L), 198 patients had different degrees of elevation of bilirubin; in the microsphere group, there was no significant difference in prostatic hyperplasia function indexes between the two groups. . Compared with the gelfoam embolic agent, the embosphere embolic microsphere has a good efficacy and safety in the treatment of prostatic hyperplasia rupture and hemorrhage, with a light adverse reaction, a low probability of recanalization, and little damage to the postoperative prostatic hyperplasia function, which is conducive to the benign recovery of perioperative patients and is worthy of clinical application.
Topics: Acrylic Resins; Arteries; Embolization, Therapeutic; Gelatin; Humans; Male; Microspheres; Prostate; Prostatic Hyperplasia; Quality of Life; Treatment Outcome
PubMed: 35126897
DOI: 10.1155/2022/1424021