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Objective. To evaluate the effect of intraprostatic botulinum toxin type A (BoNTA, Dysport™) injection on lower urinary tract symptoms, prostate-specific antigen (PSA), prostate volume (PV), peak urine flow rate ( Qmax) and postvoiding residue (PVR), and to evaluate the role of PV in the treatment outcome. Material and methods. Seventy-two men with PSA < 4 ng/ml, International Prostate Symptom Score (IPSS) ≥ 8, Qmax < 12 ml/s and PV < 60 ml were enrolled. A total of 300–600 U Dysport was injected transperineally under transrectal ultrasound guidance. Initial IPSS, quality of life (QoL) score, Qmax and PVR were compared with their measures at 1, 6 and 12 months after the injection. Initial PSA and PV were compared with their values after 6 months. Parameters were also compared between patients with PV ≤ 30 ml and those with PV > 30 ml. Results. The mean age of participants was 63.5 years. At follow-up sessions, IPSS and QoL score were significantly decreased ( p < 0.001). PVR reduced significantly and Qmax increased considerably ( p < 0.001). PSA and PV substantially decreased after 6 months ( p < 0.001). No serious complications were reported. Similar to patients with larger prostates, IPSS and QoL score decreased statistically significantly after 12 months in those with PV ≤ 30 ml; however, changes in PV, PSA, PVR and Qmax did not persist during 12 months' follow-up. Conclusions. The procedure is safe and efficacious and the results are comparable to previous experiences with Botox®. It seems that the toxin efficacy depends directly on PV in prostates < 60 ml. [ABSTRACT FROM AUTHOR]

Objective. This study evaluated the 5-year failure rate of naftopidil (NAF) or tamsulosin hydrochloride (TAM) in lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH/LUTS) and compared the prognostic factor of two α1-blockers. Material and methods. A total of 131 patients with International Prostate Symptom Score (IPSS) ≥ 8 or IPSS quality of life (IPSS-QOL) ≥ 3 with BPH/LUTS receiving treatment with α1-blockers had been administered NAF or TAM, and failure rates were calculated for 5 years. Age, prostate volume (PV), acute urinary retention (AUR), overactive bladder (OAB), IPSS, IPSS-QOL and postvoiding residual volume (PVR) were evaluated as prognostic factors. Results. No significant differences in failure rate were observed between the drugs. The failure rate was significantly high for patients with a PV ≥ 35 ml, PVR ≥ 30 ml, a history of AUR or complications of OAB symptoms. The failure rate for patients with a history of AUR was significantly higher than in those without AUR in the NAF group. By contrast, in the TAM group, it was significantly higher in patients who had OAB symptoms than in those without OAB. Conclusions. No significant differences were observed between the drugs for the failure rate. Each treatment had a unique factor for prognosis, such as history of AUR for NAF and complications of OAB for TAM. Therefore, it will be necessary to use the two α1-blockers properly, considering the patient's background. [ABSTRACT FROM AUTHOR]

Objective. To assess the efficacy and safety of propiverine hydrochloride (antimuscarinic), naftopidil (α1-adrenoceptor antagonist) or both in patients with male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia and concomitant overactive bladder (OAB). Material and methods. Men aged at least 50 years who had a total International Prostate Symptom Score (IPSS) of 8 or higher and bladder dairy documenting micturition frequency (more than eight micturitions/24 h) and urgency (more than one episode/24 h), with or without urgency urinary incontinence were randomized into three groups: group N, naftopidil (50 mg once daily) only; group P, propiverine hydrochloride (20 mg once daily); and group NP, naftopidil (50 mg once daily) plus propiverine hydrochloride (20 mg once daily) for a 4-week treatment regimen. Results. A total of 66 men, including 20 in group N, 23 in group P and 23 in group NP, were treated and 58 (87.9%) completed the 4 weeks of treatment. IPSS improved significantly in groups N and NP. Urinary frequency improved significantly in groups P and NP. Postvoid residual urine volume increased significantly in groups P and NP. Significant improvements in urgency episodes were noted in each group. One patient in group P required catheterization owing to acute urinary retention and another stopped medication because of difficulty in voiding. Conclusion. These results suggest that each treatment showed effectiveness for male LUTS with OAB. However, there are some possibilities of adverse effects with propiverine hydrochloride monotherapy. [ABSTRACT FROM AUTHOR]

Objective. The genitourinary tract is considered to be a target for the actions of sex steroid hormones. Decreased ovarian function and lack of estrogen after menopause are associated with lower genitourinary tract symptoms as well as bladder dysfunctions such as incontinence. Estrogen may also affect urothelial cells. The estrogen receptors (ERs) are found in the mucosa of the urinary tract. The purpose of this study was to culture human urothelial cells (HUCs) originating from urothelial tissue biopsies and to use them as a reproducible test platform to evaluate the effect of 17β-estradiol (E2). Material and methods. Urothelial tissue biopsies were obtained from 95 patients undergoing gynaecological open surgery for urinary incontinence, paediatric vesicoureteral reflux or transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. HUCs originating from biopsies were cultured in vitro in the absence or in the presence of 0.1 nmol, 0.01 µmol and 1 µmol of E2. ER expression of the cultured HUCs was examined by Western analysis and immunofluorescence microscopy, which was also used for HUC characterization. The effect of E2 in the proliferation of the HUCs was determined by tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT)-assay. Results. HUCs were cultured successfully in four to six passages but there was variation between samples. The cultured cells showed expression of β4-integrin, E-cadherin and cytokeratins 7, 8, 9 and 19, indicating the epithelial origin of the cells. Both types of ERs, ERα and ERβ, were found in the in vitro cultured HUCs. E2 treatment of HUCs did not affect remarkably the expression of ERα but cell proliferation was induced. However, no concentration-dependent effect was seen. Conclusions. This study indicates that HUCs originating from small tissue biopsies can be cultured in several passages in vitro and could have potential in repairing or restoring urinary tract tissue by tissue engineering therapy. HUCs serve as a good in vitro test platform, as shown by analysing E2-treated HUCs. E2 induced the proliferation of cultured HUCs even though concentration dependency was not observed. The findings of this study may have relevance in determining the mechanisms of estrogen therapy in postmenopausal urinary tract symptoms and in the future development of tissue engineering technology. [ABSTRACT FROM AUTHOR]

Objective. Botulinum toxin A (BoNT-A) injections into the prostate have been reported to be effective and durable in the treatment of small benign prostatic hyperplasia (BPH). This study evaluated the effectiveness of BoNT-A in patients with large BPH with an unsatisfactory response to combined α-blocker and 5-α-reductase inhibitor therapy. Material and methods. Sixty patients with BPH and total prostate volume (TPV) of > 60 ml with unsatisfactory response to combination medical therapy were randomly assigned to receive add-on intraprostatic BoNT-A injection (n=30) or continued medical therapy (control group). Patients in the treatment group received 200-600 U of Botox® injected into the prostate. Outcome parameters including International Prostate Symptom Score (IPSS), quality of life index (QoL-I), TPV, maximum flow rate (Q max) and postvoid residual (PVR) were compared between treatment and control groups at baseline, 6 months and 12 months. Results. Significant decreases in IPSS, QoL-I and TPV, and increase in Q max were observed at 6 months and remained stable at 12 months in the treatment group. Improvements in IPSS and QoL-I were also observed at 6 months and a decrease in TPV at 12 months was noted in the control group. However, no significant changes in any parameters except for QoL-I at 6 and 12 months were noted between the treatment and control groups. Acute urinary retention developed in three patients receiving BoNT-A treatment. Three BoNT-A and two medical treatment patients converted to transurethral surgery at the end of study. Conclusions. This study shows that add-on prostatic BoNT-A medical treatment can reduce prostate volume and improve lower urinary tract symptom score and QoL-I within 6 months in the treatment of large BPH. However, the therapeutic effect at 12 months was similar to combination medical treatment. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate morphological changes in the hyperplastic prostate tissue following transurethral microwave thermotherapy and to investigate the dependence of the treatment outcome on structural and physiological features of the prostate. Material and methods. In this prospective study, 13 patients with chronic urinary retention due to benign prostatic hyperplasia (BPH) underwent Coretherm (ProstaLund, Lund, Sweden) microwave thermotherapy. Prior to the treatment and 1 week and 6 months after, the patients were examined with MRI using morphologic, contrast medium-enhanced perfusion and diffusion-weighted imaging. Such advanced MRI techniques permit an assessment of parameters that have a hypothetical influence on microwave thermotherapy (e.g. prostate blood perfusion, water content and prostate microstructure). Results. Morphologic and perfusion MRI showed a clear prostatic tissue defect in all 13 patients after 1 week and in all 12 patients at 6 months' follow-up. The mean size of the defect was 22.5 cm3 (27%) (range 3.7-47.3 cm3) and 4.1 cm3 (1.1-10.1 cm3) at 1 week and 6 months, respectively. The cell kill volume was estimated to be 20.5±7.4 cm3 and correlated significantly with the size assessed by MRI at 1 week (r=0.8; p=0.002) and 6 months (r=0.69; p=0.05). At 6 months, the mean decrease in prostate volume was 20.1 cm3 (p<0.0001). The microstructure of the prostate expressed as the apparent diffusion coefficient was shown to have a strong influence on the treatment process. All patients (n=12) were catheter-free at 6 months. Another patient experienced persistent obstruction and underwent transurethral resection of the prostate. Conclusions. Coretherm microwave treatment leads to significant intraprostatic necrosis, which is detectable with MRI even 6 months after the treatment. Diffusion-weighted MRI is capable of identifying structural features of the prostate that can predict the length of treatment and the amount of energy needed. [ABSTRACT FROM AUTHOR]

Objective. To determine whether subjective or objective seasonal changes occur in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Material and methods. A total of 31 patients with LUTS were observed for >5 years. Their International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), voided volume (VV) and post-void residual (PVR) were measured every month. Results. Total IPSS, QOL, VV or PVR did not show any seasonal changes between the three seasons: summer (hot season: June to September); winter (cold season: December to March); and spring and fall (comfortable season: April, May, October and November). Furthermore, when the IPSS was examined by dividing it into storage symptoms (frequency, urgency and nocturia) and voiding symptoms (incomplete emptying, intermittency, weak stream and straining), no significant seasonal changes were detected. Only Qmax showed a significant seasonal change, being higher in both the cold season (median 10.4 ml/s) and the comfortable season (median 10.1 ml/s) than in the hot season (median 9.4 ml/s). Conclusions. It has generally been thought that LUTS worsen in winter. Our results indicate that the IPSS and the QOL score remain nearly constant if they are determined regularly over an extended period of time. Qmax may however be influenced by seasonal changes in temperature. [ABSTRACT FROM AUTHOR]

Objective. To estimate and compare the costs of dutasteride, finasteride, tamsulosin and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) from a Norwegian health service perspective. Material and methods. A Markov model was developed to estimate the clinical progression that a cohort of 1000 men would undergo and the care they would receive over 4- and 15.5-year periods. Transitions between health states [BPH symptoms, improvement in symptoms, acute urinary retention (AUR), TURP, prostate cancer and death] were estimated from the published literature and knowledge of the Norwegian healthcare system. Sensitivity analyses were conducted of indirect costs, discount rates, the costs and probabilities of AUR and TURP and the probability of symptom improvement. Results. The total costs of BPH management for patients initially treated with dutasteride, finasteride, tamsulosin or TURP at 4 years were NOK 13 946 (€1703), NOK 16 111 (€1967), NOK 16 833 (€2054) and NOK 46 309 (€5655), respectively and at 15.5 years NOK 32 137 (€3924), NOK 37 173 (€4539), NOK 40 528 (€4946) and NOK 50 471 (€6164), respectively. One- and multi-way sensitivity analyses did not significantly alter the relative order of the total costs. Conclusions. Given the conservative nature of the model and the robustness of the sensitivity analysis, it is concluded that dutasteride is less costly than finasteride, TURP or tamsulosin at both 4 and 15.5 years. Therefore, considering cost containment restraints in Norway, dutasteride is an appropriate choice of therapy for patients with moderate/severe symptoms and an enlarged prostate (>30 ml). [ABSTRACT FROM AUTHOR]

Objectives. Firstly, to describe self-reported urinary symptoms and bothersomeness, including disease-specific quality of life (QOL), in patients with symptomatic benign prostatic obstruction (BPO) before and 6 months after intervention. Secondly, to identify factors which predict disease-specific QOL. Thirdly, to develop and test the reliability of an instrument to evaluate incontinence, the Linköping Incontinence Questionnaire (LIQ). Finally, to translate and test the reliability of Swedish versions of the International Prostate Symptom Score, including the bother question, the American Urological Association Symptom Problem Index (SPI) and the Benign Prostatic Hyperplasia Impact Index. Material and methods. Disease-specific QOL was studied in 572/720 consecutively treated patients using structured questionnaires. The reliability of the instruments was tested in 122 patients with lower urinary tract symptoms (LUTS) or BPO. Results. The frequency and weak stream items of the SPI were among those that best explained the patients' disease-specific QOL both before and after intervention. Before and after intervention the prevalence of urinary incontinence, assessed using the LIQ instrument, was 46% and 16%, respectively. Symptoms and disease-specific QOL improved most in the surgery group, intermediately in the transurethral incision of the prostate/transurethral microwave thermotherapy group and least in the drug therapy group. Conclusions. The frequency and weak stream items of the SPI were the factors that best explained disease-specific QOL. The prevalence of incontinence before and after intervention was higher than that previously reported. [ABSTRACT FROM AUTHOR]

Objective. We compared the 2-year safety and efficacy of two transurethral resection techniques—transurethral vapor resection of the prostate (TUVRP) and conventional loop transurethral resection of the prostate (TURP)—in the surgical management of benign prostatic hyperplasia. Material and methods. Between August 1997 and September 2002, 441 patients underwent transurethral prostatectomy, either TUVRP (n=221) or TURP (n=220). TUVRP was performed using a “RollerLoop” resection loop. All patients were assessed preoperatively by means of International Prostate Symptom Score (IPSS), quality of life (QOL) score, prostate volume, peak urinary flow (Qmax) and post-void residual volume (PVR) measurements and a sexual function questionnaire. Patients were followed up for 3, 6, 12 and 24 months after surgery, and this was followed by a comparison of the incidences of sexual dysfunction, complications and re-treatment. Results. After 2 years of follow-up, no differences were noted between the TUVRP and TURP groups with respect to average IPSS (p&VeryThinSpace;=&VeryThinSpace;0.9), QOL scores (p&VeryThinSpace;=&VeryThinSpace;0.56), Qmax (p&VeryThinSpace;=&VeryThinSpace;0.89) or PVR (p&VeryThinSpace;=&VeryThinSpace;0.55), as well as the incidences of bladder neck contracture or urethral stricture (p&VeryThinSpace;=&VeryThinSpace;0.34), re-treatment (p&VeryThinSpace;=&VeryThinSpace;0.49) or sexual dysfunction (p&VeryThinSpace;=&VeryThinSpace;0.57). However, significant reductions in operative time (p&VeryThinSpace;=&VeryThinSpace;0.005), decrease in serum hemoglobin levels (p&VeryThinSpace;<&VeryThinSpace;0.001), catheterization time (p&VeryThinSpace;<&VeryThinSpace;0.001), postoperative hospital stay (p&VeryThinSpace;<&VeryThinSpace;0.001) and hospitalization costs (p&VeryThinSpace;<&VeryThinSpace;0.001) were observed in the TUVRP group compared to the TURP group. Conclusion. Our results suggest that TUVRP provides equivalent safety and efficacy to TURP during a 2-year follow-up period, in which short-term advantages in perioperative morbidity and cost savings were also demonstrated. [ABSTRACT FROM AUTHOR]

Objective. To examine factors affecting prostatic growth in young men treated for cryptorchidism in childhood. Material and methods. Prostatic volume was measured in 76 formerly cryptorchid 16–28-year-old men treated by means of orchidopexy and/or hormonally for cryptorchidism in childhood. Correlations between prostatic volume and different hormonal parameters, sperm quality and body dimensions were investigated. Results. There were no significant correlations between adult prostatic volume and age, body dimensions or testicular size. There was, however, a significant positive correlation between prostatic volume and semen volume (R=0.341; p=0.0143), as well as a negative correlation between prostatic volume and serum testosterone concentration (R=0.459; p=0.0008). There was a trend towards smaller prostatic volumes in men who had received human chorionic gonadotropin as hormonal treatment than in those who had been treated with surgery only (median 9.5 vs 12 ml; p=0.1595). Conclusions. Measured prostatic volumes were small in previously cryptorchid men. However, small prostatic volumes did not result from low testosterone levels. [ABSTRACT FROM AUTHOR]

Objective . To investigate the effects of mepartricin, a polyene macrolide antibiotic, on estrogen-induced hyperplastic prostate and seminal vesicle (SV) growth in castrated rats. Material and methods . Immature rats aged 3 weeks were castrated and left untreated for 1 week. Then, 17β-estradiol benzoate (E 2 -BA) was subcutaneously injected at a dose of 10 µg/day twice weekly, and mepartricin was orally administered at doses of 2.5, 5 and 10 mg/kg once daily for 3 weeks. The weights and hydroxyproline contents of the prostate and SV, the activity of growth factors (GFs) in the dorsolateral prostate (DLP) and the serum estrogen level were measured. Histological examination of the prostate and SV was also performed. Results . Mepartricin dose-dependently suppressed the increase in the serum estrogen level, the weights and hydroxyproline contents of the DLP and SV and the elevation of GF activity in the DLP induced by E 2 -BA treatment. Histological examination also revealed that treatment with mepartricin reduced collagen accumulation and thickening of the smooth muscle layer in the DLP and SV, and proliferation of the glandular epithelium in the DLP. Conclusions . These results suggest that mepartricin suppresses hyperplastic growth of the DLP and SV induced by estrogen in immature castrated rats, the underlying mechanism being a reduction in the serum estrogen level, thereby suppressing stromal cell proliferation and activation. [ABSTRACT FROM AUTHOR]

Objective To study the characteristics of patients with incidental prostate cancer. Material and methods The proportion of incidentally diagnosed prostate cancer was investigated in patients who underwent transurethral resection of the prostate (TURP) at our clinic over a 5-year period. "True" incidental prostate cancer was defined as cases where the preoperative digital rectal examination (DRE) and the prostate-specific antigen (PSA) value were normal. Patients with known malignancy of the prostate were excluded, together with those with PSA >4 ng/ml and/or a positive DRE. The characteristics of these patients were compared to those of benign prostatic hyperplasia patients and the group as a whole. Results Of the 786 patients operated on between 1999 and 2003, 34 (4.3%) had a positive pathology report for "true" incidental prostate cancer. An increased frequency of poorly differentiated tumors (32.3%) was noted. Of the 34 patients, 17 were stage T1a and 17 T1b; 11 patients had a Gleason sum of 7-10, all of them in the T1b group. In the T1b group the mean age was 74 years, the mean PSA level 2.9 ng/ml and the mean weight of tissue resected 11.1 g. Corresponding values in the T1a patients were 70.1 years, 3.32 ng/ml and 18.2 g. Conclusions Compared to previous studies, we noticed a low incidence of "true" incidental prostatic carcinoma but a high ratio of poorly differentiated tumors (all stage T1b). Compared to the group as a whole, patients with incidental prostate cancer were older and had smaller prostate and transition zone volumes. Further research is needed to identify parameters that may aid in the earlier identification of incidental prostate cancer, as patients may benefit from curative treatment. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the importance of transition zone (TZ) biopsy in benign prostatic hyperplasia (BPH) patients with serum prostate-specific antigen (PSA) >10 ng/ml and prior negative peripheral zone (PZ) biopsy and to estimate the sensitivity of TZ biopsy. Material and methods A total of 273 BPH patients with PSA >10 ng/ml and prior negative PZ biopsy underwent an extended biopsy protocol. In patients with a TZ volume <25 cm 3 , four TZ biopsies were taken (two cores per side from the apex and base). In patients with a TZ volume ≥25 cm 3 ( n =183), six TZ biopsies were taken (three cores per side from the apex, middle and base). Overall, 215 patients were subjected to either transurethral resection of the prostate ( n =162) or open enucleation of the adenoma ( n =53). Results The extended biopsy revealed prostate cancers in 21.2% of cases (58/273). The zonal distribution of the positive cores was as follow: PZ cancers only in 67.2% of cases (39/58), TZ cancers only in 13.8% (8/58) and PZ+TZ cancers in 19% (11/58). Overall, 73.6% (14/19) and 36.8% (7/19) of TZ cancers were detected at the apex and middle of the TZ, respectively, while no TZ cancers at all were detected at the base ( p =0.00015). The incidence of carcinoma on definitive pathology was 5.6% (12/215). Consequently, TZ biopsy detected only 61.3% (19/31) of TZ cancers. The incidence of pure TZ cancers was 7.3%. On the χ 2 test, patient age, serum PSA, transrectal ultrasonography findings and PSA density did not correlate significantly with the detection rate of TZ cancer. Prostate volume ( p =0.023), TZ volume ( p =0.027) and PSA/TZ density ( p =0.007) were predictive of TZ cancers. Conclusions Although TZ biopsy was the sole site of cancer in only 2.9% of cases (8/273), it improved the cancer detection rate by 14% in this selected group of patients. The majority (74%) of TZ cancers were detected at the apex site. TZ biopsy has a low sensitivity (61%). [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the intensity of lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) with and without diabetes. We also determined whether α1-blockers improve subjective and objective symptoms similarly in these patients. Material and Methods: The study subjects comprised 281 patients (60 with diabetes and 221 non-diabetics with clinically diagnosed BPH) who were treated with α1-blockers (doxazosin, terazosin, alfuzosin and tamsulosin). The international prostate symptom score (IPSS), bother score, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were determined at baseline and after treatment for a minimum of 6 months. Results: Diabetic patients had a lower baseline Qmax than non-diabetics ( p < 0.001), while the IPSS, bother score and PVR did not differ significantly between the two groups. After treatment with α1-blockers, lower urinary tract symptoms improved significantly. The improvement rates of the IPSS and bother score were significantly higher in the diabetic patients than in the non-diabetics ( p < 0.01). The relationship between the duration of diabetes and the effect of α1-blockers on IPSS, bother score, Qmax and PVR was not statistically significant ( p > 0.05). Conclusions: The voiding function of the bladder may be more affected by diabetes than the storage function in patients with BPH. Treatment with α1-blockers appears to be useful for diabetic patients with BPH and its effectiveness is not altered by the duration of diabetes. [ABSTRACT FROM AUTHOR]

Objective: Whether there is an association between the development of benign prostatic hyperplasia (BPH) and clinical prostate cancer is controversial. The present report tests the hypothesis of an association between BPH growth and the development of clinical prostate cancer by examining stage, grade and PSA-level in men with recently discovered clinical prostate cancer with slow or fast-growing BPH. If the hypothesis is true, men with fast-growing BPH would have a more advanced clinical prostate cancer. Material and Methods: Two hundred and twenty patients in whom a clinical prostate cancer was diagnosed were consecutively included. The prevalence of atherosclerotic disease, non-insulin-dependent diabetes mellitus (NIDDM) or treated hypertension was provided by the respective patient's medical history. Tallness, body weight, waist measurement, hip measurement and blood pressure were determined. The body mass index (BMI) and waist/hip ratio (WHR) were calculated. Blood samples were drawn to determine triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, uric acid, ALAT and the fasting plasma insulin level. The prostate gland volume was measured using transrectal ultrasound. The annual BPH growth rate was calculated, assuming that the total prostate gland volume was 20 mL at the patient age of forty. The prostate cancer diagnosis was established using the technique of transrectal ultrasound-guided automatic needle biopsy of the prostate. Results: Men with clinical prostate cancer, PSA <50 ng/mL, and with fast-growing BPH had a higher systolic (p = 0.009) and diastolic (p = 0.020) blood pressure, were taller (p < 0.001) and more obese, as determined by body weight (p < 0.001), BMI (p = 0.005), waist measurement (p < 0.001) and hip measurement (p = 0.003). They also had a higher fasting plasma insulin level (p = 0.014) and a lower HDL-cholesterol level (p = 0.067) than men with slow-growing BPH. Moreover, men with clinical prostate cancer, PSA <50 ng/mL, and fast-growing BPH had more pronounced clinical prostate cancer, as measured by grade (p = 0.029) and PSA-level (p = 0.016), than men with slow-growing BPH. In the total material, including men with clinical prostate cancer, PSA ≥50 ng/mL, men with fast-growing BPH also had a higher prevalence of NIDDM (p = 0.039) and a borderline statistical significance for higher stage (p = 0.09) than men with slow-growing BPH. The BPH growth rate was significantly associated with the clinical prostate cancer grade (p = 0.018) and PSA-level (p = 0.002) but not with the clinical cancer stage in a multivariate statistical analysis. Conclusions: This report confirms findings in previous studies that fast-growing BPH is a risk factor for NIDDM, hypertension, tallness, obesity, dyslipidaemia and hyperinsulinaemia. The present report extends this list of risk factors to include atherosclerotic disease manifestations, hyperuricaemia and higher ALAT levels. The study suggests that fast-growing BPH is a risk factor for developing clinical prostate cancer and, thus, supports the hypothesis of an association between the development of BPH and clinical prostate cancer. The study generates the hypothesis that clinical prostate cancer is a component of the metabolic syndrome and that insulin is a promoter of clinical prostate cancer. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of the high energy cutting current that is used in conjunction with the thick loop on erectile function in patients with benign prostatic hyperplasia (BPH) undergoing prostatectomy. Patients and methods: Seventy patients with BPH were included in this prospective study. All patients underwent transurethral vaporization resection of the prostate (TUVRP) using the "Wing" thick loop and 250-Watt cutting current. Potency questionnaire to define if the patient was fully potent, partially potent or impotent was obtained both pre operatively and 3 months post-TUVRP. Adequate preoperative counseling on the procedure and its outcome particularly in relation to sexual activity was given to all patients that were sexually active. Age of the patients, size of the prostate, resectate weight and operation time was recorded for correlation with erectile function post-TUVRP. Results: The mean age of patients was 70.1 ± 6.3 years, the mean prostate size was 53.9 ± 31.1 grams. Thirty-two patients (46%) were either impotent or sexually inactive at presentation. Thirty men were fully potent and 8 patients presented with reduced potency. Only 2 patients (5.2%) developed impotence post-TUVRP, both were partially impotent at presentation. Conclusions: Our results indicate that the frequency of erectile dysfunction following TUVRP may be low. It seems that the higher energy use in TUVRP does not adversely affect potency possibly because of the cooling effect of the circulating blood in the neurovesical bundles and the use of irrigation fluids intraoperatively. [ABSTRACT FROM AUTHOR]

Objective: To validate a computer version of the Danish Prostatic Symptom Score (DAN-PSS) questionnaire and compare it with the paper version. Material and methods: Ninety-three male patients (aged 25-87 years), referred to a department of urology for lower urinary tract symptoms (LUTS), filled in a personal computer (PC) version and a paper version of the DAN-PSS questionnaire. Subsequently they answered a questionnaire concerning their preferences and computer experience. Results: A fair correlation between the total scores from the paper and PC versions was found. The differences were independent of both total score and age. In the PC version all LUTS questions were answered while 9.8% were left blank in the paper version. The sexual questions were answered by 71% of patients in the paper version and by 87.5% in the PC version. For the questions in the PC version a learning curve was observed in terms of the time taken to answer the questions. Previous computer experience did not influence answering time, difference in score between paper and PC versions or total score. Almost all patients preferred the PC version to the paper version. Conclusion: The PC scores are reasonably reliable judging by comparison with previously validated traditional paper scores. The PC questionnaire had a higher response rate and was preferred by the majority of patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the role of insulin-like growth factor-I (IGF-I), a strongly mitogenic and anti-apoptotic factor, in the development of benign prostatic hyperplasia (BPH). The bioactivity of IGF-I within tissues depends on circulating levels, as well as on the local production of IGF-I and the presence of IGF-binding proteins (IGFBPs). The IGFBPs regulate the efflux of IGF-I to the extravascular space and the bioavailability of IGF-I within tissues. Material and Methods: Within the Northern Sweden Health and Disease Study, 60 cases of BPH defined by a history of prostate resection were identified, and two controls per case were selected. IGF-I, IGFBP-1, IGFBP-3 and insulin were measured by immuno-radiometric assays in stored plasma samples drawn a mean of 3.2 years before surgery. Results: The risk of BPH increased with increasing quartile levels of IGF-I adjusted for IGFBP-3 ( p[sub trend] = 0.10) up to a relative risk of 2.16 (95% confidence interval 0.83-5.64) for the highest quartile. The risk decreased with increasing levels of IGFBP-1 (p[sub trend] = 0.10). Conclusions: Our results suggest that elevated IGF-I bioactivity may stimulate the development of BPH; however, they were not statistically significant and require confirmation from larger studies. [ABSTRACT FROM AUTHOR]

Objective: We report long-term (3 years) follow-up data of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) using a lower-power treatment protocol. Material and methods: Ninety-one patients were treated in a 1-h session with the PRIMUS U + R device. Results: Forty-five of the patients were still on TUMT monotherapy at 3-year follow-up, while 32 received additional therapy for their lower urinary tract symptoms. In patients with monotherapy there was a 45% decrease in international prostate symptom score (IPSS) when compared to pretreatment values. The moderate increase in peak uroflow seen early after TUMT could not be observed after 3 years. No serious side-effects were seen. Conclusion: Three years after lower-power TUMT, 49% of patients treated were on TUMT monotherapy, while 35% received additional therapy for their voiding symptoms. Symptom score decreased 45% in patients with TUMT monotherapy concomitant with unchanged uroflow. [ABSTRACT FROM AUTHOR]

Objective: The present study is designed to evaluate the incidence, histological features and significance of prostatic adenocarcinoma in patients undergoing cystoprostatectomy for Transitional Cell Carcinoma (TCC) of the bladder. Patients, Material and Methods: From January 1990 to December 1996, 59 male patients (mean age 66.5 years), with no evidence of prostatic malignancy on preoperative clinical and biochemical assessment, underwent cystoprostatectomy for TCC of the bladder. The bladder was adequately sampled and the entire prostate sectioned at 5-mm intervals and examined histologically, in order to identify unsuspected prostatic cancer (PCa). Results: Sixteen out of 59 patients (27%) were found to have PCa, which was multifocal in 5 cases (31.25%). The mean tumor size was 0.24 cm. The tumors were equally distributed in the anterior and posterior parts of the prostate and in the peripheral and transition zones, with uniform distribution in both prostatic lobes. In 5 patients (31.25%), the single focus of the tumor was in the apex. All were grade I tumors except one, and all were organ-confined with no capsular penetration. The follow-up ranged from 12–74 months (mean 39 months). Within this period, 7 patients died from metastatic bladder cancer. One patient with PCa localized in the prostatic apex had recurrent prostatic disease in the urethroileal anastomosis of an orthotopic bladder substitute; he is alive and on androgen deprivation. The remaining patients are relapse-free. Conclusions: Incidental PCa is quite a common finding in cystoprostatectomy specimens of bladder cancer patients. Its tendency to appear in the apex of the prostate demands careful and complete excision of the organ. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of position on voiding using uroflowmetry and post-void residual (PVR) urine volume assessment in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Material and Methods: A total of 44 patients (mean age 61.7 years; range 47-72 years) with symptomatic BPH and 44 healthy men (mean age 60.3 years; range 40-67 years) who were used as controls were enrolled in the study. The uroflowmetric studies were performed in both standing and sitting positions. At least two measurements were obtained for both voiding positions for each participant. The PVR volumes were measured by means of a transabdominal ultrasound probe after each voiding. The maximum flow rate (Qmax), average flow rate (Qave), voided volume (VV) and PVR values were compared between the two different voiding positions. Results: The mean Qmax values for the standing and sitting positions in the patient group were 10.2 ± 0.49 and 9.5 ± 0.55 ml/s, respectively and the mean Qave values were 4.7 ± 0.25 and 4.7 ± 0.31 ml/s, respectively. The mean VV values for the standing and sitting positions in the patient group were 292.6 ± 17.19 and 271.1 ± 15.51 ml, respectively and the mean PVR values were 82.2 ± 10.97 and 85.5 ± 12.46 ml, respectively. The mean Qmax values for the standing and sitting positions in the control group were 24.8 ± 0.78 and 25.3 ± 0.78 ml/s, respectively and the mean Qave values were 13.2 ± 0.36 and 13.5 ± 0.33 ml/s, respectively. The mean VV values for the standing and sitting positions in the control group were 275.9 ± 10.79 and 278.0 ± 10.23 ml, respectively and the mean PVR values were 11.9 ± 1.16 and 10.7 ± 1.06 ml, respectively. There were no significant differences between voiding positions regarding the Qmax ( p = 0.360), Qave ( p = 0.978), VV ( p = 0.355) or PVR ( p = 0.842) values in the patient group. [ABSTRACT FROM AUTHOR]

Objective: The variability of the International Prostate Symptom Score (I-PSS) was tested in patients with benign prostatic hyperplasia (BPH) by comparing questionnaire results obtained in the physician's office and, 1 week later, in the patient's home. Material and Methods: A total of 210 consecutive men with lower urinary tract symptoms (LUTS) completed the I-PSS questionnaire in the physician's office. One week later the questionnaire was mailed to each patient's home, completed by the patient and then returned. Scores were compared specifically in terms of clinically significant differences defined by a total symptom score difference of ≥6 points and/or a difference of ≥2 points in the quality-of-life (QOL) measure. Results: The mean patient age was 67 years. Questionnaires were completed and returned by 127/210 (60%) men. Pearson's correlation coefficient for the I-PSS and QOL results was 0.81 and 0.74, respectively. Clinically significant differences in results were seen in 33/127 (26%) patients. When grouping patients into mild, moderate and severe symptom categories based on the I-PSS results, 31/127 (24%) changed categories when comparing "office" and "home" results. Conclusions: Clinically significant variations in I-PSS and QOL results may exist and may affect treatment decisions in >25% of men. [ABSTRACT FROM AUTHOR]