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World Journal of Urology Jul 2019Though clinical benign prostatic hyperplasia (BPH) is a common disease worldwide, there is still much confusion in the literature and the many clinical guidelines as to... (Review)
Review
INTRODUCTION
Though clinical benign prostatic hyperplasia (BPH) is a common disease worldwide, there is still much confusion in the literature and the many clinical guidelines as to its definition. Often the disease is associated with lower urinary tract symptoms (LUTS) and managed according to only symptoms. This leads to undertreatment in some patients with severe bladder outlet obstruction (BOO) with no symptoms, and overtreatment in patients with LUTS but no clinical BPH.
DEFINITION OF A DISEASE
Fundamentally, a disease can be defined as an abnormal structure or function or a condition which may cause harm to the organism.
DEFINITION OF CLINICAL BPH
Thus, clinical BPH can be defined as prostate adenoma/adenomata, causing a varying degree of BOO, which may eventually cause harm to the patients. With this definition, we are then able to differentiate the disease clinical BPH from the many other less common causes of LUTS, and then treat it according to its severity.
DIAGNOSING CLINICAL BPH
Clinical BPH can be diagnosed with non-invasive ultrasound in the clinic, grading it according to the shape (intravesical prostatic protrusion) and size of the prostate.
CLINICAL SIGNIFICANCE
Treatment can then be planned according to the disease severity using our staging system that classifies severity according to the presence or absence of significant obstruction and bothersomeness of symptoms.
CONCLUSION
This would lead to better individualised and cost-effective management of the disease clinical BPH.
Topics: Humans; Lower Urinary Tract Symptoms; Male; Organ Size; Prostate; Prostatic Hyperplasia; Ultrasonography; Urinary Bladder Neck Obstruction
PubMed: 30805683
DOI: 10.1007/s00345-019-02691-0 -
American Family Physician Mar 2008Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as... (Review)
Review
Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alphaadrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and complete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheterization may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments.
Topics: Adult; Diagnostic Techniques, Urological; Female; Humans; Male; Severity of Illness Index; Treatment Outcome; Urinary Catheterization; Urinary Retention
PubMed: 18350762
DOI: No ID Found -
European Urology Jul 2021Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under... (Randomized Controlled Trial)
Randomized Controlled Trial
Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: 2-yr Outcomes of a Randomised, Open-label, Single-centre Trial.
BACKGROUND
Prostatic artery embolisation (PAE) for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction (LUTS/BPO) still remains under investigation.
OBJECTIVE
To compare the efficacy and safety of PAE and transurethral resection of the prostate (TURP) in the treatment of LUTS/BPO at 2 yr of follow-up.
DESIGN, SETTING, AND PARTICIPANTS
A randomised, open-label trial was conducted. There were 103 participants aged ≥40 yr with refractory LUTS/BPO.
INTERVENTION
PAE versus TURP.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
International Prostate Symptoms Score (IPSS) and other questionnaires, functional measures, prostate volume, and adverse events were evaluated. Changes from baseline to 2 yr were tested for differences between the two interventions with standard two-sided tests.
RESULTS AND LIMITATIONS
The mean reduction in IPSS after 2 yr was 9.21 points after PAE and 12.09 points after TURP (difference of 2.88 [95% confidence interval 0.04-5.72]; p = 0.047). Superiority of TURP was also found for most other patient-reported outcomes except for erectile function. PAE was less effective than TURP regarding the improvement of maximum urinary flow rate (3.9 vs 10.23 ml/s, difference of -6.33 [-10.12 to -2.54]; p < 0.001), reduction of postvoid residual urine (62.1 vs 204.0 ml; 141.91 [43.31-240.51]; p = 0.005), and reduction of prostate volume (10.66 vs 30.20 ml; 19.54 [7.70-31.38]; p = 0.005). Adverse events were less frequent after PAE than after TURP (total occurrence n = 43 vs 78, p = 0.005), but the distribution among severity classes was similar. Ten patients (21%) who initially underwent PAE required TURP within 2 yr due to unsatisfying clinical outcomes, which prevented further assessment of their outcomes and, therefore, represents a limitation of the study.
CONCLUSIONS
Inferior improvements in LUTS/BPO and a relevant re-treatment rate are found 2 yr after PAE compared with TURP. PAE is associated with fewer complications than TURP. The disadvantages of PAE regarding functional outcomes should be considered for patient selection and counselling.
PATIENT SUMMARY
Prostatic artery embolisation is safe and effective. However, compared with transurethral resection of the prostate, its disadvantages regarding subjective and objective outcomes should be considered for individual treatment choices.
Topics: Arteries; Embolization, Therapeutic; Humans; Lower Urinary Tract Symptoms; Male; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 33612376
DOI: 10.1016/j.eururo.2021.02.008 -
World Journal of Urology Jul 2021
Topics: Humans; Male; Prostatic Hyperplasia; Transurethral Resection of Prostate; Urinary Bladder Neck Obstruction
PubMed: 34283282
DOI: 10.1007/s00345-021-03780-9 -
The Canadian Journal of Urology Jun 2017To report the five year results of a prospective, multi-center, randomized, blinded sham control trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
To report the five year results of a prospective, multi-center, randomized, blinded sham control trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).
MATERIALS AND METHODS
At 19 centers in North America and Australia, 206 subjects ≥ 50 years old with International Prostate Symptom Score (IPSS ) > 12, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume 30 cc-80 cc were randomized 2:1 to the PUL procedure or blinded sham control. In PUL permanent UroLift implants are placed to hold open the lateral lobes of the prostate to reduce urinary obstruction. After randomized comparison at 3 months and the only opportunity to add more PUL implants, PUL patients were followed to 5 years. LUTS severity (IPSS), quality of life (QOL), BPH Impact Index (BPHII), Qmax, sexual function, and adverse events were assessed throughout follow up.
RESULTS
IPSS improvement after PUL was 88% greater than that of sham at 3 months. LUTS and QOL were significantly improved by 2 weeks with return to preoperative physical activity within 8.6 days. Improvement in IPSS, QOL, BPHII, and Qmax were durable through 5 years with improvements of 36%, 50%, 52%, and 44% respectively. No difference was seen between Intent to Treat and Per Protocol populations. Surgical retreatment was 13.6% over 5 years. Adverse events were mild to moderate and transient. Sexual function was stable over 5 years with no de novo, sustained erectile or ejaculatory dysfunction.
CONCLUSIONS
PUL offers rapid improvement in symptoms, QOL and flow rate that is durable to 5 years. These improvements were achieved with minimal use of a postoperative urinary catheter, rapid return to normal, and preservation of both erectile and ejaculatory function. Symptom improvement was commensurate with patient satisfaction. PUL offers a minimally invasive option in the treatment of LUTS due to BPH.
Topics: Double-Blind Method; Ejaculation; Follow-Up Studies; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Penile Erection; Prospective Studies; Prostatic Hyperplasia; Prostatism; Prostheses and Implants; Quality of Life; Reoperation; Severity of Illness Index; Sexuality; Treatment Outcome; Urodynamics
PubMed: 28646935
DOI: No ID Found -
The Canadian Journal of Urology Oct 2020INTRODUCTION To characterize procedure variables and outcome data from men undergoing the Aquablation Therapy of the prostate procedure for lower urinary tract symptoms...
UNLABELLED
INTRODUCTION To characterize procedure variables and outcome data from men undergoing the Aquablation Therapy of the prostate procedure for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). We evaluated the safety and efficacy of robotically guided waterjet-based prostate resection in the first study of all-comers in a single-center, commercial setting in the United States.
MATERIALS AND METHODS
The analysis was a retrospective review of prospectively collected data.
RESULTS
Fifty-five men underwent the Aquablation of the prostate between July 2018 and December 2019. Mean prostate volume was 100 cc, and 85% had a prominent, obstructing middle lobe. Operative time averaged 59 minutes, and the mean hemoglobin drop was 1 g/dL. A substantial improvement of 80% (17 points) was seen in BPH symptoms scores. By uroflowmetry, Qmax improved by 182% (14 mL/sec). Men with prostate volume > 100 cc had similar hospital length of stay, BPH symptom reduction, and Qmax improvement compared to those with volume < 100 cc.
CONCLUSION
In the setting of a community private urology practice, Aquablation Therapy was safe and effective for the treatment of men with BPH regardless of prostate shape or prostate size.
Topics: Ablation Techniques; Aged; Aged, 80 and over; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Water
PubMed: 33049190
DOI: No ID Found -
The World Journal of Men's Health Jan 2018Prostatic calculi often occur in middle-aged and old men. Prostatic calculi are usually classified as primary/endogenous stones or secondary/extrinsic stones. Endogenous... (Review)
Review
Prostatic calculi often occur in middle-aged and old men. Prostatic calculi are usually classified as primary/endogenous stones or secondary/extrinsic stones. Endogenous stones are commonly caused by obstruction of the prostatic ducts around the enlarged prostate by benign prostatic hyperplasia (BPH) or by chronic inflammation. Extrinsic stones occur mainly around the urethra, because they are caused by urine reflux. The exact prevalence of prostatic calculi is not known, and it has been reported to vary widely, from 7% to 70%. Most cases of prostatic calculi are not accompanied by symptoms. Therefore, most cases are found incidentally during the diagnosis of BPH using transrectal ultrasonography (TRUS). However, prostatic calculi associated with chronic prostatitis may be accompanied by chronic pelvic pain. Rare cases have been reported in which extrinsic prostatic calculi caused by urine reflux have led to voiding difficulty due to their size. More than 80% of prostatic calculi are composed of calcium phosphate. Prostatic calculi can be easily diagnosed using TRUS or computed tomography. Treatment is often unnecessary, but if an individual experiences difficulty in urination or chronic pain, prostatic calculi can be easily removed using a transurethral electroresection loop or holmium laser.
PubMed: 29076299
DOI: 10.5534/wjmh.17018 -
The Journal of Pathology Apr 2022Benign prostatic hyperplasia (BPH) is a feature of ageing males. Up to half demonstrate bladder outlet obstruction (BOO) with associated lower urinary tract symptoms...
Benign prostatic hyperplasia (BPH) is a feature of ageing males. Up to half demonstrate bladder outlet obstruction (BOO) with associated lower urinary tract symptoms (LUTS) including bladder overactivity. Current therapies to reduce obstruction, such as α1-adrenoceptor antagonists and 5α-reductase inhibitors, are not effective in all patients. The phosphodiesterase-5 inhibitor (PDE5I) tadalafil is also approved to treat BPH and LUTS, suggesting a role for nitric oxide (NO ), soluble guanylate cyclase (sGC), and cGMP signalling pathways. However, PDE5I refractoriness can develop for reasons including nitrergic nerve damage and decreased NO production, or inflammation-related oxidation of the sGC haem group, normally maintained in a reduced state by the cofactor cytochrome-b5-reductase 3 (CYB5R3). sGC activators, such as cinaciguat (BAY 58-2667), have been developed to enhance sGC activity in the absence of NO or when sGC is oxidised. Accordingly, their effects on the prostate and LUT function of aged mice were evaluated. Aged mice (≥24 months) demonstrated a functional BPH/BOO phenotype, compared with adult animals (2-12 months), with low, delayed voiding responses and elevated intravesical pressures as measured by telemetric cystometry. This was consistent with outflow tract histological and molecular data that showed urethral constriction, increased prostate weight, greater collagen deposition, and cellular hyperplasia. All changes in aged animals were attenuated by daily oral treatment with cinaciguat for 2 weeks, without effect on serum testosterone levels. Cinaciguat had only transient (1 h) cardiovascular effects with oral gavage, suggesting a positive safety profile. The benefit of cinaciguat was suggested by its reversal of an overactive cystometric profile in CYB5R3 smooth muscle knockout mice that mirrors a profile of oxidative dysfunction where PDE5I may not be effective. Thus, the aged male mouse is a suitable model for BPH-induced BOO and cinaciguat has a demonstrated ability to reduce prostate-induced obstruction and consequent effects on bladder function. © 2021 The Pathological Society of Great Britain and Ireland.
Topics: Animals; Humans; Male; Mice; Nitric Oxide; Oxidoreductases; Prostate; Prostatic Hyperplasia; Soluble Guanylyl Cyclase
PubMed: 34936088
DOI: 10.1002/path.5859