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Introduction: The periurethral and transition zones of the prostatic gland develop benign prostatic hyperplasia and represent an inevitable phenomenon for the ageing male population. Prostatic specific antigen, is a serine protease, level rises in the blood if the barrier between thelining epithelium and the blood stream is damaged. Benign prostatic hyperplasia, prostatic carcinoma and prostatitis are three common diseases where PSA in the serum is raised. Prostate volume also increases according to age, which can be estimated by trans-abdominal ultrasonography. Objective: The aim of the study is to estimate the PSA level in blood and its relationship with prostate volume in benign prostatic hyperplasia patients. Methodology: It is a descriptive cross-sectional study which was carried out between a periods of 1st April 2018 to 31st March 2019 at Birat Medical College Teaching Hospital. All the patients diagnosed with benign prostate hyperplasia at the department of urology were included in the study. Blood samples of patients were analyzed for Prostate specific antigen level estimation by chemiluminescence immunosorbent assay. Prostatic volume of the patients was measured by Transabdominal ultrasound technique. Data were entered and analyzed in Microsoft Excel. Results: A total of 68 patients were diagnosed with benign prostate hyperplasia. The mean age of the patients was 61.8±12.3 years. The maximum number 23 of patients with BPH was there in age group 51-60. The maximum no of patients 38 were having their PSA level between the range of 4.0-10.0 ng/ml. The maximum no of patients 28 was having Prostate volume in the range of 40-60 gm. The maximum number of patients 31 was having diabetes mellitus as a co-morbid association. The maximum mean PSA level and prostate volume in the patients were observed in age group >80 years,which was 20.1±8.6 ng/ml and >80 gm respectively. Conclusion: The prostate specific antigen level and prostate volume both increase in advance age group of patients suffering with benign prostate hyperplasia.

To perform a global survey to identify contemporary practice patterns of transurethral therapies for benign prostatic hypertrophy. A REDCap survey was distributed to the ~ 3500 members of the Endourological Society. Surgeons completed demographic information and then selected the BPH therapies they perform 10 cases/year. There were four categories of BPH therapies: ablation, enucleation, resection/vaporization, and MIST (minimally invasive surgical technique). Within each category, there were subcategories to account for different energy modalities. All statistical analyses were performed using SAS 9.4. A total of 175 surgeons responded to our survey. Prostate resection/vaporization remained the most commonly utilized technique (51.9%, n = 147/283) followed by enucleation (22.6%, n = 64/283). Bipolar TURP (bTURP) was the most common modality for prostate resection (69.4%, n = 102/147). Holmium laser enucleation (HoLEP) was the most common modality for enucleation (46.9%, n = 30/64). Urolift® was performed more often than Rezūm™ (55.9% vs. 44.1%, n = 19/34 vs. 15/34, respectively). Among surgeons performing ablation, country of practice was a significantly associated with length of stay (LOS), p

Amaç: Çalışmamızda 50 yaş üzeri erkeklerde ortaya çıkan alt üriner sistem semptomlarını, bu semptomların yaşam kalitesini etkileme derecesini araştırmayı amaçladık.Materyal ve Metot: Çalışmaya İstanbul il Sağlık Müdürlüğüne bağlı Ümraniye 1 nolu Aile Sağlığı Merkezi’ne 01.01.2020–01.03.2020 tarih aralığında başvuran 50 yaş üstü 307 erkek hasta dahil edildi. Onamları alınarak çalışmaya dahil edilen tüm hastalara 23 soruluk anket uygulandı. Anketteki soruların bir kısmı alt üriner sistem semptomlarının varlığı ve bu semptomların hastalara psikolojik, sosyal, fiziksel ve cinsel etkilerine yönelik sorular; diğerleri de hastaların özgeçmiş bilgilerine yönelik sorulardı. Bulgular: Yaşam kalitesi skoruna göre yapılan gruplamada hastaların 292’sinin (%95,1) yüksek, 14’ünün (%4,6) orta, birinin (%0,3) düşük yaşam kalitesi grubunda olduğu görüldü. Ortalama toplam yaşam kalitesi skoru %92,1±12,3 olarak belirlendi. Ortalama psikolojik skor %81,1±14,4, sosyal skor ise %90,0±20,8 olarak saptandı. Her bir şikâyet için; şikayeti olan hastalardaki yaşam kalitesi skoru, psikolojik, fiziksel, sosyal ve cinsel skorların her birisi şikayeti olmayanlara göre anlamlı düşük bulundu (Her birisi için p

Introduction:The inverse relationship between benign prostate hypertrophy and incidence/severity of prostate cancer is well documented in the clinical literature. However, this phenomenon i...

I-wave heat therapy produces microwave-like energy using a high-frequency electromagnetic field to achieve an optimal hyperthermia effect on the targeted organs. One of the advantages of this non-invasive and effective method is that it uses the body’s natural response to the application of heat to produce a desired therapeutic effect. This innovative, non-invasive and very promising method, which also requires no anesthesia, is performed in the practitioner’s office on an outpatient basis. Regarding urological indications, it is Benign Prostate Hypertrophy and inflammatory prostatitis including pelvic dysfunction that will be mainly treated. However, many other indications are applicable and some are under evaluation. In this paper, we present a review of one of these techniques concerning the principle of i-wave external thermotherapy. In a separate article we will present our patient group and the first clinical results in Switzerland.

OBJECTIVE To investigate the symptom deterioration of patients with benign prostatic hyperplasia (BPH) according to the difference in daily temperature. PATIENTS AND METHODS From the National Health Insurance Service database, we collected and analyzed data on patients with BPH in 6 major metropolitan areas in Korea between January 2008 and December 2017. We investigated the rate of emergency room visits as well as the rate of urethral catheter insertion. RESULTS In total, 1,446,465 patients were enrolled in this study. When the daily temperature difference was below 4°C, 28.5 patients visited the emergency room daily, while 42.2 patients visited the emergency room daily when the daily temperature difference exceeded 14°C. When the daily temperature difference was more than 14°C, about 48.0% more patients visited the emergency room than when the daily temperature difference was below 4°C. After visiting the emergency room, there were 11.9 patients who had a catheter inserted daily at the daily temperature difference below 4°C. When the daily temperature difference was more than 14°C, the number of catheter insertion cases was 17.8 patients daily, which was 49.2% higher than that of below 4°C. By time, surgery was performed most frequently within 3 months after visiting the emergency room. CONCLUSION Day temperature difference appear to be related to the Lower urinary tract symptom of BPH patients.

Background Many factors could contribute to the cases of residual benign prostate hypertrophy (BPH) volume after transurethral resection of the prostate (TURP), such as age, obesity, testosterone level, and inflammation. The goal of this study was to determine the risk of tumor necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β) in prostate tissue, serum prostate-specific antigen (PSA), serum testosterone, and age in promoting prostate volume progression after TURP. Patients and Methods This was a prospective cohort study on 83 BPH patients who underwent TURP at five hospitals in Bali, Indonesia. Trans-rectal ultrasonography (TRUS) was carried out to examine the prostate's size. Three years after, we redo the TRUS examination to collect the data of the latest prostate size. TNF-α, TGF-β, serum PSA, testosterone, and age were registered for analysis. We used Pearson's and Spearman's correlation tests and multivariate analytic linear regression test (coefficient β) by SPSS 13.0 software. Results Age, testosterone, PSA, TNF-α, TGF-β were positively correlated to prostate's volume progression. The prostate volume was strongly correlated with age (r= 0.749, p

Resume Introduction L’information preoperatoire est determinante a l’adhesion du patient au traitement mais peut etre insuffisamment assimilee par le patient du fait de sa densite et de sa complexite. L’objectif de cette etude etait d’evaluer la comprehension et la satisfaction des patients de l’information preoperatoire de chirurgie de l’hypertrophie benigne de prostate (HBP). Les facteurs influencant la comprehension etaient egalement etudies. Methodes Il s’agissait d’une etude monocentrique sur questionnaire incluant tous les patients devant se faire operer d’une HBP quelle que soit la technique chirurgicale. Un questionnaire etait envoye a chaque patient, a domicile, apres la consultation urologique preoperatoire. Resultats Deux cent dix questionnaires ont ete envoyes et 106 patients (50,5 %) ont renvoye le questionnaire. L’information etait jugee excellente (cotee 9/10 et 10/10 sur l’echelle numerique) par 38,68 % (41/106) des patients et « tres bonne » (cotee 7–8) par 45,28 % des patients (48/106). Les complications postoperatoire les plus frequemment citees par les patients etaient l’ejaculation retrograde (39,6 % des patients, n = 42/106) et le saignement (29,2 %, n = 31/106). 57,6 % des patients (n = 61) se rappelaient avoir recu la fiche d’information ecrite. Apres rappel des complications eventuelles, 5,7 % des patients (n = 6/106) hesitaient a se faire operer. Seul l’âge des patients etait significativement associe a une difference de comprehension (p Conclusion L’information dispensee aux patients avant chirurgie d’HBP paraissait satisfaisante bien qu’elle semble mal comprise, notamment concernant les complications. Cette etude pourrait permettre de modifier notre vision de l’information du patient, en passant d’un modele paternaliste a un modele de « partenariat » avec le patient. Niveau de preuve 3.

Background Studies have shown that human polyomavirus infection may be associated with various human cancers. We investigated the potential relationship between the prevalence of JCPyVor BKPyV and prostate cancer (PC) in patients from Taiwan. Methods Patients with PC and benign prostate hypertrophy (BPH; 76 and 30 patients, respectively) were recruited for this study. Paraffin-embedded tissues and clinical information of the patients were obtained. The tissue sections were used for viral DNA detection and immunohistochemistry analysis was performed for examining viral large T (LT) and VP1 proteins. Regression analysis was used to evaluate the relationship between the clinical characteristics of the patients and the risk of JCPyV/BKPyV infection. Results The prevalence of JCPyV/BKPyV DNA was different in PC and BPH tissues (27/76 [35.52%] and 2/30 [6.7%], respectively, p = 0.003)]. The LT and VP1 proteins were detected in 27 (35.52%) and 29 PC (38.2%) specimens, respectively, but neither protein was detected in BPH samples (p p = 0.003). Patients with PC showing high levels of prostate-specific antigen and high Gleason scores were associated with a high risk of viral infection (ORs 1.1, 95% CI 1.000–1.003; p = 0.045 and ORs 6.18, 95% CI 1.26–30.33, p = 0.025, respectively). The expression of LT protein associated with the risk of PC increased 2923.39-fold (95% CI 51.19–166,963.62, p Conclusions The findings indicate that JCPyV infection in PC cells may be associated with prostate cancer progression and prognosis. Graphical abstract

INTRODUCTION AND OBJECTIVE:Holmium Laser Enucleation of Prostate (HoLEP) is a size-independent treatment for benign prostate hypertrophy (BPH). Moses™ is a new technology developed by Lumenis® for ...

This article demonstrates the use of a representative commercially available automated vessel-tracking software originally intended for liver-only application (Vessel Assist Flight Plan for Liver; GE) in 4 patients. Treatment settings included embolization of small bowel hemorrhage source, treatment of renal cell carcinoma, management of symptomatic benign prostate hypertrophy, and detection with subsequent closure of a mesenteric pseudoaneurysm. All patients were treated successfully.

The corms of different Hypoxis species (Hypoxidaceae) are used for the treatment and management of a variety of human ailments and disorders in African traditional medicine. However, the used corms are morphologically similar and it is not known whether this has resulted in different species being harvested, prescribed and sold as the same species. Ethnomedicinal information regarding its use in Tanzania is scanty and the available ethnobotanical information about the plants is mostly from various studies done outside Tanzania. The objective of the study was to document the diverse uses of Hypoxis in Tanzania and study what species are used and whether preferences exist for specific species. Focus group discussions and in depth interviews with informants were done in 15 regions of Tanzania to document local uses of Hypoxis species and collect vouchers for identification. Traditional practitioners use Hypoxis to manage a variety of human illness in Tanzania, and appear to use different species indiscriminately for medicine, socio-cultural applications and for food. Medicinal uses include treatment of benign prostate hypertrophy, cancer, diabetes, gout, headache, HIV/AIDS, infertility, ringworms, stomachache, and urinary tract infections. In Tanzania, different Hypoxis species are used indiscriminately for a range of sociocultural and medicinal purposes. The reported medicinal uses could aid testing and evaluation of traditional herbal medicine and more research is needed to test their pharmacological effects. (C) 2018 SAAB. Published by Elsevier B.V. All rights reserved.

Backgrounds The aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group). Methods Between March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC. Results Our study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94–0.99), p = 0.008) and recatherization (OR 5.6 (1.02–30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume 3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups. Conclusion This study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

The prostate-specific antigen (PSA) threshold of 3.0 ng/ml is obsolete because it yields a test that is too sensitive. Urologists should adopt a more nuanced approach that accounts for benign prostate hypertrophy. This includes the use of magnetic resonance imaging, PSA density, and age-specific PSA reference ranges.

Aim: Many studies support an inverse relationship between benign prostate hypertrophy (BPH) size and incidence of prostate cancer (PCa), but the causal link between these conditions is poorly understood. Recent studies suggest that a growing transition zone (TZ) in the prostate may induce pressure on the outer peripheral zone (PZ), leading to atrophy of the glandular tissue where PCa often originates, providing a possible explanation for this interaction. To further investigate this phenomenon, our pilot study uses magnetic resonance imaging (MRI) to examine quantitative zonal changes in a consecutive cohort of prostates. Methods: MRI scans of male patients [ n = 204, 61.57 ± 13.90 years, average body mass index (BMI) 29.05 kg/m2] with various prostate sizes were analyzed statistically to identify possible associations between prostate parameters, such as total prostate volume (TPV) and peripheral zone thickness (PZT). Results: TPV and PZT demonstrated a weak, inverse correlation ( r = −0.21, p = 0.002). However, when examining the plotted data, the relationship between TPV and PZT was significantly different when the cohort was divided into two groups; lower TPV: ⩽87.5 ml ( n = 188, TPV xˉ = 36.01 ± 18.18 ml), and higher TPV: >87.5 ml ( n = 17, TPV xˉ = 125.69 ± 41.13 ml). Average PZT differed significantly between these groups (z = −3.5554, p = 0.0004). Conclusions: PZT was significantly different for patients with lower versus higher TPVs, suggesting that, above a certain point of BPH growth, the PZ is unable to withstand pressure from an expanding TZ, supporting the notion that growing BPH causes compression of the PZ glandular tissue, and, therefore, BPH may be protective against PCa.

Introduction: Prostate cancer (PCa) is the second most commonly diagnosed cancer and the sixth most common cause of cancer-related mortality among men worldwide. Obesity increases the prevalence and mortality of multiple cancers. Consequently, the relationship between obesity and cancer is receiving more and more attention. Objective: To evaluate the impact of body mass index (BMI) on prostate cancer detection and aggressiveness in Cameroonian population. Methodology: This was a comparative cross-sectional study carried out at the hospitals in Cameroon. The study included Cameroonians who underwent prostate biopsies during a 9-year period, from 2008 to 2016. We analysed the BMI, age, prostate volume, and PSA of patients with prostate cancer in comparison with patients with benign prostate tissue who underwent prostate biopsies. Data entry was performed using CSpro 6.3.2, analysis was done using SPSS version 23.0. Results: A total of 316 patients were included in our study, 158 PCa and 158 BPH. The patients had a mean age ± standard deviation of 67.8 ± 10.32 with a modal class of 61 and 70 years. In our study, the mean age ± SD of the PCa group (71.48 ± 8.96) was significantly greater than that of the BPH group (64.17 ± 10.31) (p 0.05). The median total PSA and the median PSA f/t ratio was significantly different in both groups (p

The chapter discusses practical considerations arising in subgroup exploration exercises in late-stage clinical trials. Subgroup identification strategies are commonly applied to characterize the efficacy profile of an experimental treatment based on the results of a failed trial with a non-significant outcome in the overall patient population. Considering this setting, we present a comprehensive overview of relevant considerations related to the selection of clinically candidate biomarkers, choice of statistical models, including the role of covariate adjustment in subgroup investigation, and selection of subgroup search parameters. The subgroup identification methods considered in the chapter rely on the SIDES family of subgroup search algorithms. We discuss applications of this methodology to failed clinical trials and its key features such as biomarker screening, complexity control and Type I error rate control. The statistical methods and considerations discussed in the chapter will be illustrated using a Phase III clinical trial for the treatment of benign prostate hypertrophy.

Prostate cancer (PCa) is one of the most common cancers in male population. Multiparametric prostate magnetic resonance imaging (mp-MRI) has assumed a primary role in the diagnosis of PCa, combining morphological and functional data. Among different sequences, functional diffusion weighted imaging (DWI) is a powerful clinical tool which provides information about tissue on a cellular level. However, there is a considerable overlap between either BPH (Benign Prostate Hypertrophy) and prostatic cancer condition, as a different DWI signal intensity could be shown in the normal architecture gland. Apparent diffusion coefficient (ADC) has shown an increasing accuracy in addition to the DWI analysis in detection and localization of PCa. Notably, ADC maps derived DWI sequences has shown an overall high correlation with Gleason score (GS), considering the importance of an accurate grading of focal lesion, as main predictor factor. Furthermore, beyond the comparative analysis with DWI, ADC values has proven to be an useful marker of tumor aggressiveness, providing quantitative information on tumor characteristics according with GS and Gleason pattern, even more strenuous data are needed in order to verify which ADC analysis is more accurate.

Background: In this study, a novel quantitative structure activity relationship (QSAR) model has been developed for inhibitors of human 5-alpha reductase type II, which are used to treat benign prostate hypertrophy (BPH). Methods: The dataset consisted of 113 compounds-mainly nonsteroidal-with known inhibitory concentration. Then 3D structures of compounds were optimized and molecular structure descriptors were calculated. The stepwise multiple linear regression was used to select descriptors encoding the inhibitory activity of the compounds. Multiple linear regression (MLR) was used to build up the linear QSAR model. Results: The results obtained revealed that the descriptors which best describe the activity were atom type electropological state, carbon type, radial distribution function (RDF), barysz matrix and molecular linear free energy relation. The suggested model could achieve satisfied square correlation coefficient of R2 = 0.72, higher than of many previous studies, indicating its superiority. Rigid validation criteria were met using external data with Q2 ˃ 0.5 and R2 = 0.75, reflecting the predictive power of the model. Conclusion: The QSAR model was applied for screening botanical components of herbal preparations used to treat BPH, and could predict the activity of some, among others, making reasonable attribution to the proposed effect of these preparations. Gamma tocopherol was found to be an active inhibitor, in consistence with many previous studies, anticipating the power of this model in the prediction of new candidate molecules and suggesting further investigations.

Background Three-quarters of aged men experience lower urinary tract symptoms with benign prostate hypertrophy (BPH). Transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) are standard endosurgical procedures in patients with BPH. Previous studies reported better results in patients undergoing HoLEP than in those undergoing TURP. Methods This study compared the efficiency and safety of conventional morcellation and morcellation performed after X-incision during enucleation, a newly added technique in HoLEP. Overall, 174 patients were selected as the final study population. The populations were stratified with respect to resected volumes. A t-test were used to compare the conventional morcellation and X-incision procedure groups. Results In morcellation times and rates, there were significant differences in stratified resected mass (g) between the groups. The results also showed a decreased incidence of bladder injury as a surgical complication. Conclusion We believe morcellation performed after X-incision procedure during enucleation is efficient and safe for older adults with BPH.

(Vatashthila) Benign prostate hypertrophy (BPH) is one of the disease frequently seen in ageing male above 50 years old. Ageing occurs as the testosteron level decreases and oestrogen level increases. The prostate gland which is normally about the size and shape of a walnut wraps around the urethra between the pubic bone and rectum below the bladder. Main function of prostate gland is to store and produce seminal fluid. A mans prostate gland usually start to enlarge after middle age, this menifest as a benign (non cancerous) enlargement of prostate that blocks the flow of urine through the urethra. In early stage of prostate enlargement the bladder muscles forces urine through the narrow urethra that counteracting more powerfully. As a result the bladder muscles become thicker and more sensitive causing more to urinate more often. It is estimated that each year in U.S. about 1.7million of people have to visit hospital due to menifestation of this disease among these 4000 have surgical intervention. In Ayurveda the enlargement of the prostate is called vatashthila this enlargement usually caused by imbalence of vata dosha. By ayurvedic treatment, we can definitely prevent the prognosis of BPH in early onset age. In this study varun bark is used for the management of vatashthila, bark of varun believed to have antioxident, anti-inflammatory, antimicrobial and urinary-renal supportive qualities.

Purpose To report the prevalence of psychological/mental disorders and determine the factors associated with them in hospitalized patients with chronic diseases. Design and methods This was as cross-sectional study. One hundred and fifty patients were randomly selected from one hospital having at least one chronic disease. Findings The rate of depression, anxiety, and stress in our sample were 21.3%, 61.3%, and 48.7%, respectively. Benign prostate hypertrophy, dysthyroidism, avoidance of thoughts and feelings as a coping mechanism, and a longer hospital stay were associated with higher depression. Hypertension, female gender, and a higher education level were associated with higher anxiety. Female gender and a longer stay in hospital were predictors of stress. Practice implications Hospitalized patients with chronic illnesses have high levels of psychological distress, showing the importance of getting psychological counseling in these settings.

The histoculture drug response assay (HDRA) has been adapted to determine androgen sensitivity in Gelfoam histoculture of human benign prostatic tissue as well as prostate cancer. Gelfoam histoculture was used to measure androgen-independent and androgen-dependent growth of benign and malignant prostate tissue. The androgen-sensitivity index was significantly higher in 23 paired specimens of prostate cancer compared to benign prostate hypertrophy (BPH). Genistein decreased the androgen-sensitivity index of BPH and prostate cancer in Gelfoam® histoculture in a dose-dependent manner.

Objectives Elderly patients seem vulnerable to digoxin toxicity because of their diminished organ functions and tendency to encounter drug interactions. The aim of this research was to explore the extent of the concurrent use of digoxin with Chinese medications (CMs), its contributing factors, and the relevant consequences. Methods A retrospective population-based cohort study was conducted using Longitudinal Health Insurance databases in Taiwan. Those elderly patients being prescribed with digoxin in outpatient settings in 2006 were evaluated for the incidence, prevalence, and duration of concurrent use with concentrated CMs in 2006. After 1:1 random matching to select the corresponding digoxin-only elderly users, univariate and multivariate logistic regression analyses were performed to explore factors associated with concomitant incident digoxin-CM use and incident digoxin-specific CM use. The relevant clinical and economic outcomes for a 3-month follow-up period from the initial exposure of incident digoxin-CM use were compared. Results Of 185,076 elderly, 6,374 were prescribed with digoxin and 789 were CM-digoxin users in 2006. The prevalence and incidence of concomitant CM use among digoxin elderly users were 0.43% and 0.22%, respectively. Although the other factors were not statistically significantly associated with incident CM-digoxin use, patients with heart diseases and with benign prostate hypertrophy had an increased likelihood of incident CM-digoxin use of 115% and 102%, respectively. Almost all the concerned clinical and economic outcomes were not statistically significantly different between incident exposure or not, except for the use of potassium-sparing and nonsteroidal anti-inflammatory drugs. Conclusions There was a relatively low incidence of digoxin-CM use among the elderly in Taiwan. Although no significant effects on clinical and economic outcomes occurred, it is necessary to monitor potential side effects of digoxin more aggressively for those vulnerable elderly using digoxin with CMs, especially for those who tended to expose to incident digoxin-CM use elderly patients.

Objective To prospectively evaluate the efficacy, safety and postoperative complications of prostate resection for benign prostate hypertrophy (BPH) by bipolar photovaporisation using the transurethral resection in saline (TURis) system (BPV) in a day surgery setting. Methods Over a 21-month period, 520 patients who fulfilled the selection criteria were recruited to have day surgery prostate resection using BPV. Preoperative International Prostate Symptoms Score (IPSS) and urine flow data were obtained in every patient. Perioperatively, we measured prostate resection time, weight of resected tissue and occurrence of any complications. Bladder residual content and duration of transurethral drainage were measured postoperatively. Results The mean (range) prostate tissue weight was 51 (45–80) g. The mean (range) operative duration was 45 (35–70) min. No conversions and no major complications occurred in any cases. The transurethral catheter was removed in 110 cases before discharge and in 410 cases the following day. All cases left hospital the same day. All patients had noticeable improvement in IPSS and maximum urinary flow rate. Conclusion BPV of BPH in selected patients can be carried out safely as a day care procedure and has beneficial outcomes for patients and services.

The aim of this study was to determine whether there are correlations between medication use for lower urinary tract symptoms/benign prostate hypertrophy (LUTS/BPH) and alteration in incidence and indications for transurethral resection of the prostate (TURP).The number of TURP patients between 1984 and 2008 in Iceland was obtained from hospital registries. The number of defined daily doses (DDDs) of 5-alpha-reductase inhibitors (5aRIs) and alpha-blockers (ABs) sold was obtained from the Icelandic Medicines Control Agency. Charts of all surgical BPH patients in Iceland from 1998 to 2008 were retrospectively reviewed. The main outcomes measures were: DDDs sold of 5aRIs and ABs, total numbers of TURP, indications for TURP and complications.After the introduction of ABs and 5aRIs, sales increased annually at a near linear rate. TURP rates peaked in 1992, then declined. In 2008, 81 and 3.4 of 1000 men over the age of 50 used LUTS/BPH medications or underwent TURP, respectively. There was an inverse correlation between LUTS/BPH medication use and (i) overall TURP (R(2) = 0.85), (ii) TURP done for absolute indications (R(2) = 0.91), and (iii) LUTS with (R(2) = 0.77) and (iv) without previous medical therapy (R(2) = 0.75). As medication use rose, fewer TURPs were performed for previous history of urinary retention, and more for recurrent urinary tract infections.Increased use of ABs and 5aRIs in the Icelandic population correlated with decreasing incidences of TURP procedures for both LUTS and absolute indications. The sequelae of BPH and indications for TURP are changing as medication use increases, although a clear causative link is hard to establish.

Resume La resection transuretrale de prostate (RTUP) reste le traitement chirurgical de reference de l’hypertrophie prostatique compliquee ou refractaire au traitement medical. La photovaporisation prostatique (PVP) au laser Greenlight ® a ete developpee dans le but d’ameliorer la securite de l’hemostase. Le but de ce travail etait de rapporter les resultats de la PVP a partir de la litterature. Materiel et methode Une revue systematique de la litterature sur la base de recherche Pubmed etait effectuee en utilisant les mots cles : benign prostate hyperplasia ; greenlight ; photovaporisation ; Laser ; IPSS score ; endoscopicsurgery ; morbidity ; complication . Les etudes prospectives et retrospectives etaient selectionnees a partir de la premiere utilisation chez l’homme en 1998. Resultats Certains parametres techniques sont bien definis (vitesse de rotation de la fibre, angle d’attaque et distance avec le tissu) mais d’autres restent debattus (nombre de joules par volume prostatique). Versus RTUP, la PVP offrirait les memes resultats fonctionnels a moyen terme mais avec un risque de saignement plus faible. L’heterogeneite des techniques d’evaluation et des populations etudiees rend difficile l’evaluation de la fonction erectile mais elle ne semblerait pas associee a un risque accru versus RTUP. L’absence de materiel histologique devrait motiver un depistage du cancer de prostate avant PVP. L’economie generee par la diminution de la duree moyenne de sejour n’a pas ete formellement analysee en France. Conclusion La PVP est une technique sure. Le nouveau generateur XPS semble arrive a maturite. Son developpement permettra certainement d’obtenir une evaluation a long terme avec des niveaux de preuve satisfaisants.

Hypovitaminosis D is increasingly recognized as a cofactor in several diseases. In addition to bone homeostasis, vitamin D status influences immune system, muscle activity and cell differentiation in different tissues. Vitamin D is produced in the skin upon exposure to UVB rays, and sufficient levels of serum 25(OH)D are dependent mostly on adequate sun exposure, and then on specific physiologic variables, including skin type, age and Body Mass Index (BMI). In contrast with common belief, epidemiologic data are demonstrating that hypovitaminosis D must be a clinical concern not only in northern Countries. In our study, we investigated vitamin D status in a male population enrolled in a urology clinic of central Italy. In addition, we evaluated the correlation between vitamin D status and UVB irradiance measured in our region. The two principal pathologies in the 95 enrolled patients (mean age 66years) were benign prostate hypertrophy and prostate carcinoma. >50% of patients had serum 25(OH)D values in the deficient range (

金沢大学附属病院泌尿器科, Purpose. We performed a randomised controlled study regarding the effects of androgen replacement therapy (ART) on lower urinary tract symptoms (LUTS) in hypogonadal men with benign prostate hypertrophy (BPH). Methods. Fifty-two patients with hypogonadism and BPH were randomly assigned to receive testosterone (ART group) as 250 mg of testosterone enanthate every 4 weeks or to the untreated control group. We compared International Prostate Symptom Score (IPSS), uroflowmetry data, post-voiding residual volume (PVR) and systemic muscle volume at baseline and 12 months after treatment. Results. Forty-six patients (ART group, n=23; control, n=23) were included in the analysis. At the 12-month visit, IPSS showed a significant decrease compared with baseline in the ART group (15.7±8.7 vs. 12.5 ± 9.5; p < 0.05). No significant changes were observed in the control group. The ART group also showed improvement in maximum flow rate and voided volume (p < 0.05), whereas no significant improvements were observed in the controls. PVR showed no significant changes in either group. In addition, the ART group showed significant enhancement of mean muscle volume (p < 0.05), whereas no significant changes were seen in the controls. Conclusion. ART improved LUTS in hypogonadal men with mild BPH. © 2010 Informa UK, Ltd.

Generally, in Europe quality assurance is demanded increasingly in health care settings. European Health Act specifies new demands concerning quality assurance through documentation, monitoring of health services and follow-up considering patient flow and optimal use of resources. The aim of this study was to investigate the agreement between European guidelines and clinical practice and the association between patient satisfaction and level of documentation, recommendations and improvements of voiding function in patients with benign prostate hypertrophy (BPH). The study population encompassed men between 60 and 80 years referred to specialist treatment due to lower urinary tract symptoms. Random samples of 250 medical records were extracted from national registers. Indicators were reported as proportions. Bivariate and multivariate analyses were reported as odds ratio with a 95% confidence interval. A total of 178 patient pathways were included, and the overall documentation rate was 77%. Agreement between national recommendations and clinical practice was found in 38%. No significant associations were found regarding patient satisfaction and level of documentation, adherence to national guidelines and improvements of the voiding function. There is a need for stringency in quality assessment and reporting indicators to national databases and increased application of European evidence-based guidelines. More complete are necessary for decision-makers in the future to qualify management of BPH rehabilitation ensuring the quality of the individual patient pathways.

Uroflowmetry is a non-invasive and easily performed method to diagnose the benign prostate hypertrophy(BPH) which is frequently found in the aged men. There are some manufactures to provide a diagnosis tool for the benign prostate hypertrophy. Conventional products, however, render only the result of parameters related with prostate hypertrophy, not additional information such as the uroflowmetry variation and related personal information. In this paper, we developed an effective system for feature extraction of prostate hypertrophy as well as online program for wireless networked database management which can be used under ubiquitous environments and Labview based Window program.

Resume Certaines protheses intra-prostatiques, telles que la prothese Urospiral™, ont un interet dans la prise en charge de l’hypertrophie benigne de prostate (HBP). Elles peuvent traiter les patients âges presentant des contre-indications medicales ou anesthesiques avec pronostic vital mis en jeu. Le sevrage de la sonde vesicale a demeure est ainsi obtenu. Elles sont egalement interessantes comme « test therapeutique » chez des patients presentant des troubles urinaires obstructifs (aigus ou chroniques) et/ou irritatifs attribuables ou suspects d’etre lies a des maladies neurologiques. L’Urospiral™ est une prothese prostatique temporaire, non expansible de calibre Ch 21, dont il existe differentes tailles, en fonction de la mesure col vesical-veru montanun. La partie mediane de la prothese permet le maintien de la continence. La pose et l’ablation se font sous anesthesie locale au gel de xylocaine lors d’une urethro-cystoscopie.

Uroflowmetry is of great convenience to diagnose benign prostate hypertrophy common in aged men. The urinary flow rate is obtained by weight measurement using load cell, however, sensitive to impact noise. An alternative technique was recently proposed to measure hydraulic pressure instead of weight and demonstrated to introduce significantly reduced noise. In this paper, we described the measured diagnostic parameters between the weight and pressure measuring techniques in 10 normal men. The weight and pressure signals were simultaneously acquired during urination, converted into urine volumes, then differentiated to obtain flow rate signals, which showed very similar waveforms. Diagnostic parameters evaluated by pressure measuring technique were well correlated with the standard weight measuring technique (correlation coefficient > 0.99). Therefore, the new uroflowmetry based on hydraulic pressure measurement can provide accurate diagnostic parameters, which would be clinically valid.

Prostate artery embolization (PAE) has been performed for intractable haematuria for many years and has most recently come to the forefront as a novel treatment for benign prostate hypertrophy (BPH). PAE has many advantages over surgical treatment options. The current literature for PAE has shown the procedure to be a safe, effective, and minimally invasive treatment option for BPH. We describe a case of PAE and discuss tips and tricks, including pre-operative imaging techniques as well as techniques for optimal visualization of the arteries for successful cannulation.

Background Prostate cancer (Pca) disease burden is highest among male blacks. Oxidative stress due to hemoglobin-related oxygen reactive species is a risk factor for cancer development. The polymorphic haptoglobin (Hp) protein inhibits hemoglobin-related oxidative stress. The antioxidant capacity of Hp is genetically determined. We studied the effect of Hp polymorphism on susceptibility to Pca. Subjects and methods In a case–control study, 201 participants (60 hospital-based controls, 62 benign prostate hypertrophy (BPH) and 79 prostate cancer (Pca) patients were studied. Serum prostate specific antigen (PSA) was measured using an immunoradiometric assay and Hp phenotype was determined using starch gel electrophoresis. Haptoglobin phenotype distribution was compared between groups according to disease state. Results Serum PSA concentrations were markedly elevated in BPH and Pca patients compared to control subjects. Overall, Hp 1–1 was present in 50 individuals (25%), Hp 2–1 in 91 persons (46%) and 46 subjects (23%) had Hp 2–2. Thirteen individuals (6%) were anhaptoglobinaemic. The Hp1 allele frequency was not significantly different according to clinical history; 0.472 (95% CI 0.343–0.601), 0.567 (95% CI 0.395–0.619) and 0.507 (95% CI 0.441–0.693) for control group, BPH and Pca patients, respectively. Conclusion Our results suggest that Hp polymorphism is neither associated with risk of developing Pca nor outcome of the disease.

Jack is a 78-year-old retired salesman who presents with a 3-week history of left lower back pain that began without any identifiable inciting cause. Jack has a past medical history that includes coronary artery disease with two stents placed, hypertension, diabetes type II, benign prostate hypertrophy, chronic obstructive pulmonary disease, gall bladder surgery, and diverticulitis. Although his medical history is significant, Jack considers himself to be “pretty healthy all things considered.”

Medical applications of RF/microwaves are highlighted in this paper. The emphasis is placed on newer emerging diagnostic and therapeutic applications, such as microwave breast cancer detection, and treatment with localized high power used in ablation of the heart, and liver, benign prostate hypertrophy, angioplasty, and others. A very brief outline of biological effects of RF/microwaves and associated issues is given as background to the applications.

The aim of this study is to evaluate the accuracy of three-dimensional (3D) ultrasound in comparison with conventional bidimensional (2D) sonography in prostatic calculations. The study was performed using a Kretztechnik Voluson 530D machine with a 7.5 MHz endocavitary transducer. From March 1998 to March 2000, we examined 80 patients (63–74 years, mean 68 years). There were 59 patients with benign prostate hypertrophy (BPH) and 21 with prostate cancer awaiting a radical prostatectomy. The mean absolute error in 3D ultrasound measurement was ±0.2–3 mL. (range of error was 6.5%). Volume measurement using 2D ultrasound methods was much less accurate than 3D ultrasound methods: ±0.4–5 mL. (range of error was 35%). Both 2D and 3D measurements show that the margin of error depends on the frequent presence of a third prostatic lobe, on the morphology, and on the size of the prostatic gland. The precise estimation of prostate volumes may provide information on the real effectiveness of some therapies that act on the reduction in volume of benign alteration, such as in prostatic hypertrophy, and may eliminate the current limits of 2D sonography with a significant clinical contribution for virtually no extra cost.

Introduction Transurethral resection of the prostate (TURP) is still regarded as the gold standard for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction in prostates between 30 and 80 mL. Endoscopic treatment of large prostate is not adequately discussed in literature. Our objective was to evaluate the efficacy and safety of TURP in large prostate glands (≥80 ml) in patients with BPH. Material and methods From May 2004 to September 2012, 62 patients with high volume of BPH (≥80 ml) treated with TURP by single surgeon, were evaluated retrospectively. Perioperative and postoperative full blood count and serum electrolytes, complications, operative time, weight of resected prostate tissue, time for catheter removal, and hospitalization time were recorded. Conventional TURP was performed using a standard technique. Results The mean PSA levels and prostate volumes were 8 ±5.38 ng/ml and 90.93 ±13.95 gm, respectively. The mean operating time was 55.96 ±8.04 minutes. The mean amount of tissue resected was 52.21 ±7.59 gm. Compare with baseline, there were significant improvements in International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine after surgery. There was no major bleeding complication. There was no TUR syndrome or intraoperative death. Requiring re–catheterization was detected for 3 (4.8%) patients. Transient urge incontinence was observed for 3 (4.8%) patients. Bulbar urethral stricture was developed for 2 (3.2%) patients. Conclusions Morbidity of the TURP is decreased with the technological improvements. Conventional monopolar TURP can be effectively performed in large prostate (≥80 mL) with the experience.

A retrospective study was carried out on patients with gastrointestinal complaints, who were accidentally found to have varying degrees of hydronephrosis between October 1989 and April 1991. The criteria for hydronephrosis given by Ellenbogen et al were used for ultrasonographic diagnosis. Grade 0 and 1 were classified as mild degree and grade 2 and 3 as moderate and severe, respectively. The causes of hydronephrosis were determined by intravenous pyelography, retrograde pyelography, and/or computed tomography. Of 44 patients with hydronephrosis who had complete studies, 20 had a mild degree of hydronephrosis, 18 had a moderate degree, and 6 had a severe degree. All 24 patients with moderate and severe degrees of hydronephrosis had obstruction as the etiology, but only 50% of the cases with mild hydronephrosis were found to have pathological lesions. Urolithiasis (79.4%) was the most common cause of hydronephrosis in this study. Benign prostate hypertrophy, carcinomas, external compression, and tuberculosis followed. Hydronephrosis found accidentally by sonography in the patients with gastrointestinal complaints is significant.

The significance of six sextant ultrasound guided biopsies of the prostate (SS-biopsy) was evaluated in a total of 114 patients. The presence of prostate cancer was suspected (Pca) in 59 subjects through mass screening (MS) for Pca and in 47 patients in out-patient clinics (OPC). The recurrence (REC) was suspected in 3 patients diagnosed previously as Pca. All of them had elevated PSA, abnormal digital rectal examination (DRE) and/or abnormal transrectal ultrasonography (TRUS). All of these tests in 5 patients with benign prostate hypertrophy (BPH) were normal. Moreover, in 34 patients among them, oriented biopsies were performed to the area where Pca was suspected by DRE and or TRUS. Twelve Pca patients were detected in MS group (20.3%), 17 Pcas in OPC group (36.2%) and 3 Pcas in REC group (100%). No Pca patients were detected in BPH group. In 12 Pca patients with T1 or T2, only one Pca patient (8.3%) had over 3 Pca samples among the samples obtained by SS-biopsy. In 20 patients with T3 or T4, 13 patients (65%) had over 3 Pca samples. There was significant relationship between T category and Pca sample numbers among 6 samples obtained by SS-biopsy (p < 0.01). Ten of 12 Pca patients in MS group (83.3%) and 8 of 17 patients in OPC group (47.1%) had less 3 Pca samples. Pca was detected in 9 of 34 patients examined by the oriented biopsy. However al of these Pca were detected by SS-biopsy. It may be not necessary to examine Pca suspected patients by the oriented biopsy if they were examined by this SS-biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Up to now control of the microwave heating of the prostate was only possible with rectal or urethral surface catheters. This problem has finally been solved with the help of the Prostcare apparatus (Bruker Spectrospin, Wissembourg, France) and radiometry: the prostate can be treated by the urethral or endorectal route with a 915-MHz generator and coaxial antennae, a unique device which allows us to measure real intraprostatic temperature, to regulate the microwave emission power and to eliminate classic surface controls. A sole antenna is used for the urethral catheter; it is introduced within the Foley-type probe and allows us to heat and measure the heat (radiometry). In this preliminary report, we present clinical results of the first 105 treated patients over 18 months by the transurethral route in a single 1-hour session: 7 have a protuberant median lobe and the treatment is without any effect; 76 patients can be analyzed and the Madsen score before treatment, at 3 months and at 6 months moves from 11.2 to 2.5 and 3.1, the maximum flow rate from 9.6 to 12.3 and 12.5 ml/s, the residue decreases from 102 to 68 and 53 ml. The session is well tolerated and patients mention that the effects are better than those of medical treatment. Hyperthermia is a simple method that will find its place between medical and surgical treatment once the numerous randomized studies have determined the most suitable therapeutic procedures.

Elevated vascular endothelial growth factor (VEGF) blood concentration reflects its prostatic production, making this a potentially interesting tumour marker to support the decision of submitting a patient for prostatic biopsy. The objective was to review systematically the evidence on the role of VEGF blood concentration in prostate cancer detection. Published studies addressing the relation between serum or plasma VEGF levels and prostate cancer were identified by searching Pubmed, ISI Web of Knowledge, SCOPUS and LILACS up to January 2010, and reviewed following a standardized protocol. Three studies reported higher plasma VEGF (pg/ml) in patients with localized prostate cancer than in healthy controls (7.0 vs. 0.0, 9.9 vs. 2.2, and 210 vs. 26.5, P

You are asked to evaluate an 80-year-old retired railroad porter who stumbled and fell while walking his dog. He has left upper extremity and forehead abrasions. According to his family, he lives alone and is completely independent. The patient denies any medical problems with the exception of diabetes mellitus and benign prostate hypertrophy. He has a normal mental status and is hemodynamically stable. Outside of the abrasion, patient’s physical examination is unremarkable. Which of the following should be the management plan for this patient? (A) Overnight observation in the hospital (B) Outpatient management (C) Refer patient to a rehabilitation center (D) Obtain plain radiography of the head (E) Obtain head computed tomography scan

Aim: To investigate the frequency of atypical adenomatous hyperplasia (AAH) and its associations with benign prostate hypertrophy (BPH) and latent histological carcinoma of the prostate (LPC) in autopsy material. Methods: Two hundred and twelve prostate specimens obtained from autopsy material were subjected to whole mount analysis in an attempt to investigate the associations among BPH, AAH and LPC. Results: Most histological carcinomas and AAH lesions were found in enlarged prostates with intense hypertrophy. No statistically significant relation was found between BPH and the main characteristics of LPC, such as tumor volume, histological differentiation and biological behavior. Our data regarding multi-focal tumors showed a tendency for multi-focal carcinomas to develop in larger prostates, and a tendency of AAH lesions to develop in larger prostates. No statistically significant relation was found between AAH and LPC. Conclusion: There seems not any causative aetiopathogenetical or topographical relation between AAH lesions and prostate adenocarcinoma. AAH lesion seems to be a well-defined mimicker of prostatic adenocarcinoma, and the reported association of AAH with prostatic carcinoma could probably be an epiphenomenon.