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Background: Patients with prostate enlargement have an increased risk of recurrent urinary tract infections. This study determined the resistance profile of bacteria causing urinary tract infection (UTI) and the magnitude of multidrug-resistant (MDR) bacteria among patients with symptomatic prostate enlargement in a tertiary hospital in Dar es Salaam. Methods: This cross-sectional study was conducted at Muhimbili National Hospital between August 2021 and January 2022. Male patients aged 40–90 years with symptomatic enlarged prostate, confirmed by digital rectal examination, were enrolled consecutively. We used conventional biochemical methods and analytical profile index (API) 20-E & API 20-NE to identify the uropathogens. In addition, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method. Results: A total of 422 participants were enrolled, of whom 196 (46.4%) had laboratory-confirmed UTI. In total, 203 bacterial pathogens were isolated. Gram-negative bacteria (GNB) were the predominant uropathogens accounting to 165/203 (81.3%). The prevalent isolates were E. coli 49 (24.1%), followed by K. pneumoniae 40 (19.7%). Most, 157 (77.3%) pathogens were MDR, of which 33 (21.0%) were resistant to all tested antibiotic classes. The proportion of methicillin-resistant Staphylococcus aureus was 75.8%, while 45.5% of S. aureus were inducible clindamycin resistant. Among Enterobacterales, 98 (70.5%) were Extended-spectrum beta-lactamases (ESBL) producers, and 33 (20.0%) were carbapenem resistant. Four of forty-one (9.6%) non-ESBL producers were class C β-lactamase producers. Conclusions: There is a relatively high proportion of MDR strains of uropathogens, which limits treatment options for UTI among men with prostate enlargement. These findings call for the revision of the current UTI treatment guidelines and continuous antimicrobial resistance surveillance to monitor antibiotic resistance and guide treatment options within the hospital. [ABSTRACT FROM AUTHOR]

To explore the surgical effect and cost-effectiveness of day surgery versus inpatient surgery for photoselective vaporization of the prostate (PVP) in Chinese population. We retrospectively collected 240 patients undergoing day-surgery PVP (April 2016 to March 2018) and 156 patients undergoing inpatient-surgery PVP (May 2014 to March 2016). Differences between groups in demographics, perioperative outcomes, complications, and postoperative changes were calculated. Economical results in terms of hospital stay and relevant preoperative, intraoperative, and postoperative cost were evaluated. There was no significant difference in operative time, incidence of postoperative complications, and other functional outcomes between two groups (P > 0.05), but the waiting time for admission and the hospital cost including the drug charges, bed fee, nursing fee, laboratory test, and imaging fee of day-surgery group were significantly lower than that of inpatient-surgery group (P < 0.05). Day surgery of PVP has firm and well accepted position in ambulatory surgery of urology. It could significantly reduce the waiting time for admission and hospitalization costs in BPH patients. [ABSTRACT FROM AUTHOR]

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 socio-cultural 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. • Hypoxis species are used to treat a wide variety of ailments in Tanzania. • Corms of different Hypoxis species are used as the same ethnospecies. • Bioactivity and toxicity study of the species is required in Tanzania. [ABSTRACT FROM AUTHOR]

Abstract Background Postoperative urinary retention (POUR) after laparoscopic inguinal hernia repair has an incidence of 2%-30%. POUR can lead to increased length of stay, decreased patient satisfaction, and increased health-care costs. The objective of this study was to determine the patient risk factors at our institution contributing to POUR after laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Methods A retrospective chart review of patients who underwent a laparoscopic TEP inguinal hernia repair at our institution from 2009 to 2016. POUR is defined as the inability to urinate requiring urinary straight or indwelling catheterization in the postoperative period. Univariate analyses were performed on perioperative variables and their correlation with POUR. Results In total, 578 laparoscopic TEP inguinal hernia repair patients were included in the study: 277 (48%) indirect, 144 (25%) direct, 6 (1%) femoral, and 151 (26%) combination of direct, indirect, and/or femoral hernias. Of these, 292 (51%) were bilateral, and 286 (49%) were unilateral. Overall, 64 (11.1%) of the 578 patients developed POUR. POUR was significantly associated with benign prostatic hyperplasia, age 60 y or older, urinary tract infection within 30 d, and decreased body mass index. Conclusions Patients aged greater than 60 y, with benign prostatic hyperplasia, and a decreased body mass index (≤25.8 kg/m2) were more likely to develop POUR after laparoscopic TEP inguinal hernia repair. In addition, these patients were more likely to develop a urinary tract infection within 30 d. Future quality initiatives can be explored to minimize the incidence of POUR in high-risk patient populations. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the efficacy of treatment in patients with non-bothering nocturia. Materials and Methods: In this prospective multicenter study, patients who visited hospitals for treatment of voiding symptoms were enrolled. Inclusion criteria were: 1) men >45 years, and 2) nocturia .2 confirmed by a three-day voiding diary. Subjects were divided into non-bothering and bothering groups based on International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) question 2b. Changes in voiding symptoms, frequency of nocturia, and bothersomeness were evaluated with international prostate symptom score (IPSS), ICIQ-N, and three-day voiding diary at 4 and 12 weeks after treatment. Results: A total of 48 patients in the non-bothering nocturia group and 50 patients in the bothering nocturia group who completed the 12-week treatment were analyzed. The total IPSS was decreased by 5.8 in the non-bothering group and 5.2 in the bothering group. There was no significant difference in decrease of IPSS between the two groups. Both groups showed significant reduction in discomfort of nocturia. The ICIQ-N 2b score decreased from 3.9 to 2.7 (p=0.01) in the non-bothering group and from 6.9 to 4.6 (p=0.02) in the bothering group. The number of nocturia episodes was significantly decreased in both groups. Conclusions: Regardless of discomfort associated with nocturia, both groups showed significant improvement in nocturia-related discomfort and voiding symptoms. These results suggest that patients with nocturia who were unaware of its discomfort benefited from treatment. [ABSTRACT FROM AUTHOR]

Lower urinary tract function is modulated by neural, vascular and urethral and bladder structural elements. The pathophysiological mechanisms of lower urinary tract symptoms (LUTS) encompass prostate enlargement, alterations in urethra histological structure bladder fibrosis and alterations in pelvic neuronal and vascular networks, The complex pathophysiological relationship between testosterone (T) deficiency (TD) and the constellations LUTS, and metabolic dysfunction manifested in the metabolic syndrome (Met S) remains poorly understood. TD has emerged as one the potential targets by which Met S may contribute to the onset and development as well as worsening of LUTS. Because it has been recognized that treatment of men with Met S with T therapy ameliorates Met S components, it is postulated that T therapy may represent a therapeutic target in improving LUTS. Furthermore, the effect of TD on the prostate remains unclear, and often debatable. It is believed that T exclusively promotes prostate growth, however recent evidence has strongly contradicted this belief. The true relationship between benign prostatic hyperplasia, TD, and LUTS remains elusive and further research will be required to clarify the role of T in both benign prostatic hypertrophy (BPH) and LUTS as a whole. Although there is conflicting evidence about the benefits of T therapy in men with BPH and LUTS, the current body of literature supports the safety of using this therapy in men with enlarged prostate. As the population afflicted with obesity epidemic continues to age, the number of men suffering from Met S and LUTS together is expected to increase. [ABSTRACT FROM AUTHOR]

D-004 is a lipid extract of Roystonea regia (royal palm) fruits that consists in a mixture of free fatty acids that prevents prostate hyperplasia induced with testosterone in rodents. D-004 has shown to inhibit the enzyme activity of prostate 5-reductase in vitro. The objective of this study was investigate the possible reproductive toxicity of D-004 administered to fertile Sprague Dawley rats of both sexes. Rats were randomised into four groups: a control group, treated with the vehicle and three groups with D-004 at 500, 750 or 1 000 mg/kg/d, respectively. Female rats were treated for 15 d prior mating, during mating and pregnancy, and until lactation (day 21). Male rats were treated 10 weeks before and during mating. No evidence of D-004-related toxicity was observed. Thus, maternal body weight and food consumption, litter size, survival through the weaning period and weights of male and female pups did not show differences between control and treated groups. Drug-treated and control groups offspring were comparable in both physical and sensorial development and in reproductive performance. There were no significant differences among F2 generation groups in the number of born pups, mean pup's weight and postnatal pup's survival. It is concluded that D-004 orally administered to rats of both sexes did not affect the fertility and general reproductive function, which indicates that it does not alter the lactation, growth, development and sexual maturation of the progeny. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of tadalafil on storage and voiding function in treatment‐naïve patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia, based on a urodynamic study. Methods: This was an open‐labeled, single‐center, prospective study. A total of 80 untreated outpatients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia received tadalafil 5 mg/day for 12 weeks. Subjective symptoms and objective findings on voiding and storage function obtained through urodynamic studies, including cystometry and pressure flow study, were evaluated before and after treatment. Results: A total of 71 patients with a mean age of 70.2 years and a mean prostate volume of 45.6 mL were included in the analysis. In the International Prostate Symptom Score and Overactive Bladder Symptom Score, mean total scores significantly improved from 18.2 to 13.4 (P < 0.001) and 6.5 to 4.7 (P < 0.001), respectively, after treatment. Mean maximum bladder capacity significantly increased by approximately 35 mL (P < 0.001). Detrusor overactivity disappeared in 15 (39.5%) of 38 patients with detrusor overactivity at baseline (P < 0.001). Mean maximum flow rate on pressure flow study significantly increased from 7.1 to 9.1 mL/s (P < 0.001) and mean bladder outlet obstruction index significantly decreased from 61.3 to 47.1 (P < 0.001). Conclusions: Treatment with tadalafil 5 mg once daily effectively relieves lower urinary tract symptoms based on objective improvement of storage and voiding function, such as detrusor overactivity and bladder outlet obstruction, in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. [ABSTRACT FROM AUTHOR]

α 1 -Adrenoceptor ( α 1 -AR) antagonists are considered to be the most effective monotherapy agents for lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). In this study, we synthesized compounds 2 – 17 , which are novel piperazine derivatives that contain methyl phenylacetate. We then evaluated the vasodilatory activities of these compounds. Among them, we found that compounds 2 , 7 , 12 , which contain 2-OCH 3 , 2-CH 3 or 2, 5-CH 3 , respectively, exhibited potent α 1 -blocking activity similar to protype drug naftopidil ( 1 ). The antagonistic effects of 2 , 7 , and 12 on the (−)-noradrenaline-induced contractile response of isolated rat prostatic vas deferens ( α 1A ), spleen ( α 1B ) and thoracic aorta ( α 1D ) were further characterized to assess the sub receptor selectivity. Compared with naftopidil ( 1 ) and terazosin, compound 12 showed the most desirable α 1D/1A subtype selectivity, especially improved α 1A subtype selectivity, and the ratios p A 2 ( α 1D )/p A 2 ( α 1B ) and p A 2 ( α 1A )/p A 2 ( α 1B ) were 17.0- and 19.5-fold, respectively, indicating less cardiovascular side effects when used to treat LUTS/BPH. Finally, we investigated the chiral pharmacology of 12 . We found, however, that the activity of enantiomers ( R )- 12 and ( S )- 12 are not significantly different from that of rac - 12 . [ABSTRACT FROM AUTHOR]

Elderly patients suffering from lower urinary tract symptoms with benign prostatic hyperplasia (BPH) are widely prescribed α 1 -adrenoceptor blockers (α 1 -blockers) to improve voiding and storage symptoms. The mechanism of action for improvements in voiding symptoms is well understood; tonus of the urethra and prostate are decreased and urinary flow rate is increased by α 1 -blockers. However, the mechanisms underlying storage symptoms have remained unclear, although detrusor hyperactivity has been identified as a significant factor. Previous investigations have yielded informative results, such as amelioration of reduced blood flow and afferent C-fiber activation, and the importance of the urothelium. Recently, the fascinating role of α 1A - and α 1D -adrenoceptor subtypes have been investigated for bladder function. Furthermore, the scope of this pathology covers both the bladder and that part of the central nervous system related to the micturition reflex. This review describes the beneficial effects of α 1 -blockers on storage symptoms and the pathogenesis of storage symptoms related to BPH, discusses the mechanisms of action for α 1 -blockers with reference to results from cystometry to suggest improvements in management that suppress detrusor hyperactivity, and examines the potential influence of α 1A - and α 1D -adrenoceptor subtypes on bladder activity. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of tadalafil on vascular endothelial function and cardiovascular risk in patients with prostatic hyperplasia. Methods Tadalafil 5 mg was given to 20 patients with prostatic hyperplasia for whom an α1-blocker was ineffective. Voiding symptoms and vascular endothelial function were investigated before and after 4 and 12 weeks of administration, using commercial tests for vascular function and vascular endothelial function. Results The participants had a median age of 65 years, a mean body mass index of 24.2 and a mean prostate volume of 36.2 mL measured using transabdominal sonography. Voiding symptoms were significantly improved by tadalafil, based on the International Prostate Symptom Score, quality of life index and overactive bladder symptom score ( P < 0.05). There were also significant improvements in vascular function (change of brachial-ankle pulse wave velocity from 1701 [before] to 1657 [4 weeks tadalafil] and 1525 [10 weeks tadalafil] cm/s [ P < 0.05]) and vascular endothelial function (change of reactive hyperemia index from 1.36 to 1.56 and 1.89 [ P < 0.05]). The change in reactive hyperemia index was significantly correlated with International Prostate Symptom Score, quality of life index and brachial-ankle pulse wave velocity. Conclusions The improvement in intrapelvic blood flow by tadalafil can result in improved vascular endothelial function, in addition to improvement of voiding symptoms. The change in reactive hyperemia index seems to correlate with the severity of voiding symptoms, with tadalafil being most effective in patients with mild voiding symptoms. [ABSTRACT FROM AUTHOR]

Objective: To investigate the accuracy of the bladder and prostate sonomorphologic parameters for the diagnosis of bladder outlet obstruction (BOO) in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH).Patients and Methods: First-visit men, aged ≥ 50 years, with LUTS/BPH were prospectively enrolled. Added to the initial basic evaluation, all patients underwent pelvic ultrasonography and pressure flow study. The pressure flow study was used as a reference standard for BOO, and according to its results, patients were divided into BOO and non-BOO groups. The sonomorphologic findings were compared between both groups, and the diagnostic accuracy of the significant parameters was determined.Results: In total, 157 patients were included. Of these, 48 (30.57%) had BOO and 109 (69.43%) did not. Bladder wall thickness (BWT), ultrasound estimated bladder weight (UEBW), and intravesical prostatic protrusion (IPP) were the sonomorphologic parameters that differed significantly between both groups (P < .001). By receiver operating characteristic curve analysis, the optimal cutoff values distinguishing patients with BOO were BWT of 3.7 mm (area under the curve [AUC]: 0.940), UEBW of 31.5 g (AUC: 0.835), and IPP of 10.9 mm (AUC: 0.874). The sensitivity, specificity, and accuracy of BWT, UEBW, and IPP were 95.00%, 90.91%, and 93.55%; 75.44, 57.97%, and 65.62%; and 87.90%, 76.43%, and 82.17%, respectively.Conclusion: BWT, UEBW, and IPP measurements can be used to detect BOO in LUTS/BPH patients. The simple estimation of these sonomorphologic parameters by suprapubic approach makes these measurements potentially suitable methods to judge BOO noninvasively during the routine clinical evaluation of BPH. [ABSTRACT FROM AUTHOR]

The urolift device has emerged as a novel intervention for men with lower urinary tract symptoms secondary to benign prostatic hyperplasia, and in recent years there has been an increasing amount of primary research published on it. However, critical medium-term appraisal remains lacking. Our objective was to perform a systematic review and therefore identify, appraise, and synthesize the existing evidence for the minimally invasive technique. [ABSTRACT FROM AUTHOR]

Objectives To assess the effect of energy density (kJ/mL) applied on adenoma during photoselective vaporization of the prostate ( PVP) treatment for benign prostate hyperplasia ( BPH) on functional outcomes, prostate-specific antigen ( PSA) reduction and complications. Patients and Methods After exclusions, a total of 440 patients who underwent GreenLight tm laser XPS-180W lithium triborate PVP for the treatment of BPH were retrospectively reviewed. Data were collected from seven different international centres (Canada, USA, UK and France). Patients were stratified into four energy density groups (kJ/mL) according to intra-operative energy delivered and prostate volume as determined by preoperative transrectal ultrasonography ( TRUS): group 1: <3 kJ/mL; group 2: 3-5 kJ/mL; group 3: 5-7 kJ/mL; and group 4: ≥7 kJ/mL. Energy density groups were chosen arbitrarily. PSA reduction and functional outcomes (International Prostate Symptom Score, quality of life, post-void residual urine volume, maximum urinary flow rate) were compared at 6, 12 and 24 months. Peri-operative complications and retreatment rates were also compared among the groups. Results The PSA reduction rates at 24 months after the procedure were 51, 61, 79 and 83% for the energy density groups <3, 3-5, 5-7 and ≥7 kJ/mL, respectively ( P ≤ 0.01). This held true after accounting for baseline confounders. Energy density was not associated with higher complication rates, including haematuria, stricture formation, incontinence, refractory urinary retention, urinary tract infection and conversion to transurethral resection of the prostate. Functional outcomes at 2 years of follow-up were equivalent among the groups ( P > 0.05 for all) and similar retreatment rates were observed ( P = 0.36). Conclusion Higher energy usage per cc of prostate was associated with a more significant reduction in PSA level (>50%) at 6, 12 and 24 months, suggesting increased vaporization of adenoma tissue; however, this did not translate into differences in functional outcomes at 2-year follow-up. [ABSTRACT FROM AUTHOR]

Objective To prospectively investigate the association of endothelial nitric oxide synthase ( eNOS) G894T gene polymorphism with responsiveness to a selective α1-blocker in men with benign prostatic hyperplasia related lower urinary tract symptoms ( BPH/ LUTS), as nitric oxide has recently gained increasing recognition as an important neurotransmitter of functions in the lower urinary tract. Patients and Methods In all, 136 men with BPH/ LUTS were recruited from urology outpatient clinics in a university hospital. Oral therapy with doxazosin gastrointestinal therapeutic system ( GITS) 4 mg once-daily was given for 12 weeks. The drug efficacy was assessed by the changes from baseline in the total International Prostate Symptom Score ( IPSS), maximum urinary flow rate ( Qmax) and post-void residual urine volume ( PVR) at 12 weeks of treatment. The 'responders' to doxazosin GITS were defined as those who had a total IPSS decrease of >4 points from baseline. eNOS G894T polymorphism was determined using the polymerase chain reaction-restriction fragment length polymorphism method. Results Patients had statistically significant improvements in total IPSS, quality of life score, and Qmax ( P < 0.01) after a 12-week period of treatment. Using multiple logistic regression analysis adjusted for age and IPSS, our results showed that being a eNOS 894T allele carrier was an independent risk factor for being a drug non-responder ( P = 0.03, odds ratio 4.19). Moreover, a decreased responder rate ( P = 0.01), as well as the lower improvements in IPSS ( P = 0.02) and Qmax ( P = 0.03) were significantly associated with increment in the T allele number. Conclusions The presence of the eNOS 894T allele had a significantly negative impact on responsiveness to a selective α1-blocker in BPH/ LUTS treatment, suggesting that eNOS G894T gene polymorphism may be a genetic susceptibility factor for α1-blocker efficacy in men with BPH/LUTS. [ABSTRACT FROM AUTHOR]

Objectives To assess the benefit-risk balance of silodosin in a real-life setting of benign prostatic hyperplasia patients with lower urinary tract symptoms. Methods A phase IV trial including men aged ≥60 years with a clinical diagnosis of benign prostatic hyperplasia with an International Prostate Symptom Score ≥12 was carried out. Patients received silodosin 8 mg for 24 weeks. The primary end-point was a decrease ≥25% in the total International Prostate Symptom Score. Secondary end-points were: changes in total, storage and voiding, and quality of life International Prostate Symptom Scores; changes in the International Continence Society-male questionnaire; changes in the frequency/volume chart; and satisfaction according to the Patient Perception of Study Medication questionnaire. Treatment-emergent adverse events were recorded. Results Overall, 1036 patients were enrolled. Of these, 766 patients (77.1%) had a decrease ≥25% in the total International Prostate Symptom Score. The mean total International Prostate Symptom Score, and storage and voiding symptoms subscores decreased from 18.9, 8.1 and 10.8 to 10.6, 4.9 and 5.7. Nocturia decreased from 85.7% to 52.4%. The mean International Prostate Symptom Score quality of life score decreased from 4.0 to 2.2. Half of the patients reported an improvement in the frequency and bothersomeness of the most frequent symptoms reported at baseline (all P < 0.001). A reduction in the number of voids was documented by the frequency/volume chart data. The most common treatment-emergent adverse event was ejaculation failure (185 patients; 17.9%), which led to study discontinuation in 2.4% of patients. Overall, 74.2% of patients were satisfied with the medication. Conclusions Silodosin improved lower urinary tract symptoms in three out of four patients, including diurnal voiding and storage symptoms, nocturia, and quality of life. This treatment showed a favorable safety profile in this setting. [ABSTRACT FROM AUTHOR]

Background: BPH is a common disease associated with age and obesity. However, the biological pathways between obesity and BPH are unknown. Our objective was to investigate biomarkers of systemic and prostate tissue inflammation as potential mediators of the obesity and BPH association. Methods: Participants included 191 men without prostate cancer at prostate biopsy. Trained staff measured weight, height, waist and hip circumferences, and body composition by bioelectric impedance analysis. Systemic inflammation was estimated by serum IL-6, IL-1β, IL-8, and TNF-α; and by urinary prostaglandin E2 metabolite (PGE-M), F2-isoprostane (F2iP), and F2-isoprostane metabolite (F2iP-M) levels. Prostate tissue was scored for grade, aggressiveness, extent, and location of inflammatory regions, and also stained for CD3 and CD20 positive lymphocytes. Analyses investigated the association between multiple body composition scales, systemic inflammation, and prostate tissue inflammation against BPH outcomes, including prostate size at ultrasound and LUTS severity by the AUA-symptom index (AUA-SI). Results: Prostate size was significantly associated with all obesity measures. For example, prostate volume was 5.5 to 9.0 mls larger comparing men in the 25th vs. 75th percentile of % body fat, fat mass (kg) or lean mass (kg). However, prostate size was not associated with proinflammatory cytokines, PGE-M, F2iP, F2iP-M, prostate tissue inflammation scores or immune cell infiltration. In contrast, the severity of prostate tissue inflammation was significantly associated with LUTS, such that there was a 7 point difference in AUA-SI between men with mild vs. severe inflammation (p = 0.004). Additionally, men with a greater waist-hip ratio (WHR) were significantly more likely to have severe prostate tissue inflammation (p = 0.02), and a high WHR was significantly associated with moderate/severe LUTS (OR = 2.56, p = 0.03) among those participants with prostate tissue inflammation. Conclusion: The WHR, an estimate of centralized obesity, was associated with the severity of inflammatory regions in prostate tissue and with LUTS severity among men with inflammation. Our results suggest centralized obesity advances prostate tissue inflammation to increase LUTS severity. Clinically targeting centralized fat deposition may reduce LUTS severity. Mechanistically, the lack of a clear relationship between systemic inflammatory or oxidative stress markers in blood or urine with prostate size or LUTS suggests pathways other than systemic inflammatory signaling may link body adiposity to BPH outcomes. [ABSTRACT FROM AUTHOR]

Introduction Most surgical treatments for male lower urinary tract symptoms and benign prostatic hyperplasia affect erectile and ejaculatory functions negatively, leading to patient dissatisfaction. Aim To determine whether water vapor thermal therapy, when conducted in a randomized controlled trial, would significantly improve lower urinary tract symptoms secondary to benign prostatic hyperplasia and urinary flow rate while preserving erectile and ejaculatory functions. Methods Men at least 50 years old with International Prostate Symptom Scores of at least 13, a peak flow rate of at least 5 to no higher than 15 mL/s, and prostate volume of 30 to 80 cm 3 were randomized 2:1 between Rezūm System thermal therapy and control. Thermal water vapor (103°C) was injected into lateral and median lobes as required for treatment of benign prostatic hyperplasia. The control procedure entailed rigid cystoscopy with simulated active treatment sounds. Main Outcome Measures Blinded group (active = 136, control = 61) comparison occurred at 3 months and the active arm was followed to 12 months for International Prostate Symptom Score, peak flow rate, and sexual function using the International Index of Erectile Function and the Male Sexual Health Questionnaire for Ejaculatory Function. The minimal clinically important difference in erectile function perceived by subjects as beneficial was determined for each erectile function severity category. Subjects not sexually active were censored from sexual function analysis. Results No treatment- or device-related de novo erectile dysfunction occurred after thermal therapy. International Index of Erectile Function and Male Sexual Health Questionnaire for Ejaculatory Function scores were not different from the control group at 3 months or from baseline at 1 year. Ejaculatory bother score improved 31% over baseline ( P = .0011). Also, 32% of subjects achieved minimal clinically important differences in erectile function scores at 3 months, and 27% at 1 year, including those with moderate to severe erectile dysfunction. International Prostate Symptom Score and peak flow rate were significantly superior to controls at 3 months and throughout 1 year ( P < .0001). Conclusion Convective water vapor thermal therapy provides sustainable improvements for 12 months to lower urinary tract symptoms and urinary flow while preserving erectile and ejaculatory functions. [ABSTRACT FROM AUTHOR]

Background: A significant percentage of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) achieve clinically meaningful improvement when receiving placebo or tadalafil 5mg once daily. However, individual patient characteristics associated with treatment response are unknown. Methods: This integrated clinical data mining analysis was designed to identify factors associated with a clinically meaningful response to placebo or tadalafil 5mg once daily in an individual patient with LUTS-BPH. Analyses were performed on pooled data from four randomized, placebo-controlled, double-blind, clinical studies, including about 1,500 patients, from which 107 baseline characteristics were selected and 8 response criteria. The split set evaluation method (1,000 repeats) was used to estimate prediction accuracy, with the database randomly split into training and test subsets. Logistic Regression (LR), Decision Tree (DT), Support Vector Machine (SVM) and Random Forest (RF) models were then generated on the training subset and used to predict response in the test subset. Prediction models were generated for placebo and tadalafil 5mg once daily Receiver Operating Curve (ROC) analysis was used to select optimal prediction models lying on the ROC surface. Findings: International Prostate Symptom Score (IPSS) baseline group (mild/moderate vs. severe) for active treatment and placebo achieved the highest combined sensitivity and specificity of 70% and ~50% for all analyses, respectively. This was below the sensitivity and specificity threshold of 80% that would enable reliable allocation of an individual patient to either the responder or non-responder group Conclusions: This extensive clinical data mining study in LUTS-BPH did not identify baseline clinical or demographic characteristics that were sufficiently predictive of an individual patient response to placebo or once daily tadalafil 5mg. However, the study reaffirms the efficacy of tadalalfil 5mg once daily in the treatment of LUTS-BPH in the majority of patients and the importance of evaluating individual patient need in selecting the most appropriate treatment. [ABSTRACT FROM AUTHOR]

Key Messages Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL)., As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK., LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners., LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH., To assess the burden of illness and unmet need arising from lower urinary tract symptoms ( LUTS) presumed secondary to benign prostatic hyperplasia ( BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/ BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45-49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/ BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms. [ABSTRACT FROM AUTHOR]

Objective To better risk stratify patients, using baseline characteristics, to help optimise decision-making for men with moderate-to-severe lower urinary tract symptoms ( LUTS) secondary to benign prostatic hyperplasia (BPH) through a secondary analysis of the Medical Therapy of Prostatic Symptoms ( MTOPS) trial. Patients and Methods After review of the literature, we identified potential baseline risk factors for BPH progression. Using bivariate tests in a secondary analysis of MTOPS data, we determined which variables retained prognostic significance. We then used these factors in Cox proportional hazard modelling to: i) more comprehensively risk stratify the study population based on pre-treatment parameters and ii) to determine which risk strata stood to benefit most from medical intervention. Results In all, 3047 men were followed in MTOPS for a mean of 4.5 years. We found varying risks of progression across quartiles. Baseline BPH Impact Index score, post-void residual urine volume, serum prostate-specific antigen (PSA) level, age, American Urological Association Symptom Index score, and maximum urinary flow rate were found to significantly correlate with overall BPH progression in multivariable analysis. Conclusions Using baseline factors permits estimation of individual patient risk for clinical progression and the benefits of medical therapy. A novel clinical decision tool based on these analyses will allow clinicians to weigh patient-specific benefits against possible risks of adverse effects for a given patient. [ABSTRACT FROM AUTHOR]

Objective To examine the safety and efficacy of quartz head laser ablation of the prostate (QLAP) in the treatment of large and huge prostates as compared with small- and medium-sized ones. Materials and Methods Two hundred forty-two patients with lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH) were included in the study, of which 210 patients were evaluable. Patients were divided into 2 groups: group A: patients with BPH volume of <80 mL (120 patients) and group B patients with gland size ≥80 mL. All patients were subjected to QLAP procedure. They were evaluated perioperatively and 1 week; 1, 3, and 6 months; and every 6 months thereafter postoperatively. Results Patients' demographics and preoperative data were similar except for the gland size (group A, 54.96 ± 15.49 mL [20-79 mL] and group B, 124.68 ± 40.88 mL [80-233 mL]). Operative time corrected to gland volume was shorter in group B. Only 10% of all patients needed 2 fibers. There was no significant electrolyte change in both groups. Hemoglobin has minimally decreased in both groups but was statistically significant. Group B outcome was significantly better regarding International Prostate Symptom Score, International Prostate Symptom Score quality of life, and uroflowmetry. Prostate size decreased by 47 ± 2% and 62.7 ± 2% at 6 months post operatively for groups A and B, respectively. Conclusion QLAP demonstrated good efficacy and safety in treating large and huge BPH. It possessed no added risk as compared with small prostates. It can be a good alternative to open prostatectomy especially in patients with significant comorbidities. [ABSTRACT FROM AUTHOR]

Objective To summarise and meta-analyse current literature on metabolic syndrome ( MetS) and benign prostatic enlargement ( BPE), focusing on all the components of MetS and their relationship with prostate volume, transitional zone volume, prostate-specific antigen and urinary symptoms, as evidence suggests an association between MetS and lower urinary tract symptoms ( LUTS) due to BPE. Methods An extensive Pub Med and Scopus search was performed including the following keywords: 'metabolic syndrome', 'diabetes', 'hypertension', 'obesity' and 'dyslipidaemia' combined with 'lower urinary tract symptoms', 'benign prostatic enlargement', 'benign prostatic hyperplasia' and 'prostate'. Results Of the retrieved articles, 82 were selected for detailed evaluation, and eight were included in this review. The eight studies enrolled 5403 patients, of which 1426 (26.4%) had MetS defined according to current classification. Patients with MetS had significantly higher total prostate volume when compared with those without MetS (+1.8 mL, 95% confidence interval [ CI] 0.74-2.87; P < 0.001). Conversely, there were no differences between patients with or without MetS for International Prostate Symptom Score total or LUTS subdomain scores. Meta-regression analysis showed that differences in total prostate volume were significantly higher in older (adjusted r = 0.09; P = 0.02), obese patients (adjusted r = 0.26; P < 0.005) and low serum high-density lipoprotein cholesterol concentrations (adjusted r = −0.33; P < 0.001). Conclusions Our results underline the exacerbating role of MetS-induced metabolic derangements in the development of BPE. Obese, dyslipidaemic, and aged men have a higher risk of having MetS as a determinant of their prostate enlargement. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia (BPH)is the most common condition in aging men, associated with lower urinary tract symptoms. It is caused due to the augmented levels of the androgen dihydrotestosterone. Dutasteride, a 5α-Reductase inhibitor has been recommended for the treatment of BPH upon oral administration. However, long term oral administration of dutasteride may cause sexual problem in man. Therefore the main objective of this study was to develop transdermal patch having nanoemulsion gel of dutasteride in order to enhance physical and chemical stability and eliminate adverse effect of dutasteride. Optimized nanoemulsion was prepared by aqueous phase-titration method and characterized by droplet size, viscosity and refractive index. In-vitro skin permeation of dutasteride through rat abdominal skin was determined by the Franz diffusion cell.Significant increase in the steady state flux (Jss), permeability coefficient (Kp) and enhancement ratio (Er) was observed in optimized nanoemulsion formulation A1 (p < 0.05). The Er of optimized nanoemulsion A1 was found to be 1.52 times with respect to control which indicates transdermal delivery may be better approach for BPH. Stability studies were performed for the period of 3 months. It was found that droplet size, viscosity and refractive index were slightly increased at refrigerator and room temperature in 3 months period. However, the changes in these parameters were not statistically significant (p ≥ 0.05). The shelf-life of optimized nanoemulsion A1 was found to be 2.18 years at room temperature. These results indicated that both physical as well as chemical stability of dutasteride in nanoemulsion formulation. [ABSTRACT FROM AUTHOR]

Background/aim: To investigate whether autonomic nervous system (ANS) hyperactivity may be a potential cause for the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Materials and methods: Twenty-four patients were recruited for this study. Complete physical examinations, urine analysis, uroflowmetry, and postvoid residual urine volume (PVRU) analysis were performed. The potential impact of some factors such as hyperglycemia, obesity, and hyperlipidemia were analyzed. These values were correlated with the various symptom scores. We performed an electromyographic and an electrocardiographic evaluation. The alterations after treatment with 2 different alpha-blockers were also analyzed. Results: The electromyographic and electrocardiographic assessments revealed a minimal increase in ANS activity and it did not change significantly after treatment (P > 0.05). After treatment, maximum flow rate increased and PVRU decreased significantly (P < 0.001 and P < 0.001, respectively); total and free testosterone levels increased significantly (P = 0.0068 and P = 0.0071, respectively). There was a statistically significant difference between the 2 treatment groups regarding the outcomes of the Danish Prostate Symptom Score questionnaire (P = 0.047). Conclusion: This current study suggested that the effect of ANS hyperactivity is not the fundamental factor underlying the relationship between LUTS and ED. [ABSTRACT FROM AUTHOR]

Objective To study the chemical components and formation causes of 86 cases of prostatic calculi. Methods Infrared spectroscopic analysis was used to analyze the chemical components of 86 cases of prostatic calculi, and the clinical data were combined to analyze the formation causes of prostatic calculi. Results In 86 cases of prostatic calculi, mixed calculi, simple calculi, calcium oxalate stone, carbonate apatite, magnesium ammonium phosphate stones, uric acid calculi accounted for 80.2%, 19.8%, 70.9%, 68.6%, 53.4% and 7.0%, respectively. 85 specimens were taken from patients with prostatic hyperplasia and 1 from patients with prostate cancer. 63 patients suffered from urinary tract infection, 21 cases with urethral stricture and 3 patients with bladder calculi. Conclusions There are statistically significant difference in the chemical components between prostatic calculi and upper and lower urinary calculi. The reasons of prostatic calculi are associated with variety of factors and infection is the main factor. [ABSTRACT FROM AUTHOR]

Objectives To assess the safety and efficacy of tadalafil once daily on lower urinary tract symptoms suggestive of clinical benign prostatic hyperplasia ( BPH-LUTS) in men without erectile dysfunction ( ED)., To compare these with effects in men with ED., Patients and Methods After a 4-week washout period and 4-week placebo run-in period, 1089 men without ED ( n = 338) and with ED ( n = 751) were randomly assigned to placebo or tadalafil 5 mg once daily for 12 weeks in three global clinical studies with similar designs., In the pooled dataset, post hoc analyses of covariance assessed the impact and severity of BPH-LUTS using the International Prostate Symptom Score ( IPSS) and the BPH Impact Index ( BII) and IPSS quality-of-life ( IPSS- QoL) subscores., Safety was assessed using treatment-emergent adverse events., The treatment-by- ED-status interaction was used to assess efficacy differences between the with/without ED subgroups., Results Men without ED were similar in BPH-LUTS severity/previous therapy to men with ED., Tadalafil significantly reduced BPH-LUTS from baseline when compared with placebo in men without ED ( IPSS −5.4 vs −3.3, P < 0.01; IPSS voiding subscore −3.5 vs −2.0, P < 0.01; IPSS storage subscore −1.9 vs −1.3, P < 0.05)., Tadalafil also significantly improved quality of life from baseline when compared with placebo in men without ED ( IPSS- QoL −1.0 vs −0.7, BII −1.4 vs −1.0; both P < 0.05)., Between- ED-subgroup interactions were not significant (all P > 0.68)., Tadalafil was safe and well tolerated., Conclusion Tadalafil 5 mg once daily improved BPH-LUTS in men without ED by a magnitude similar to that observed in men with ED., The adverse event profile in men without ED was consistent with that observed in men with ED. [ABSTRACT FROM AUTHOR]

Purpose: To investigate any associations between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and metabolic syndrome (MetS). Materials and Methods: In all, 1,224 male police officers in their 50s who had participated in health examinations were included. LUTS/BPH was assessed by serum prostate-specific antigen, International Prostate Symptom Score (IPSS), transrectal ultrasonography, maximum urinary flow rate (Q max), and postvoid residual urine volume (PVR). In addition, testosterone was also examined. The MetS was defined using NCEP-ATP III guidelines. We used the multiple linear regression test and logistic regression analyses to examine the relationships. Results: MetS was diagnosed in 29.0% of participants. There was no significant difference in the percentage of cases of BPH (IPSS >7, Q max <15 ml/sec, and prostate gland volume ≥ 20 ml) (14.2% in the non-MetS group vs. 17.2 in the MetS group; p value= 0.178). The total IPSS score and the Q max were not significantly different. The prostate volume and PVR were significantly greater in the subjects with MetS. After adjusting for age and testosterone, the presence of MetS was not associated with BPH (multivariate odds ratio, 1.122; 95% confidence interval, 0.593~2.120). Additionally, MetS was not related to IPSS (Beta, -0.189; p value=0.819), prostate volume (Beta, 0.815; p value=0.285), Q max (Beta, -0.827; p value=0.393), or PVR (Beta, 0.506; p value=0.837). [ABSTRACT FROM AUTHOR]

Study Type - Therapy (outcomes research) Level of Evidence 2c What's known on the subject? and What does the study add? It is known that benign prostatic hyperplasia is a common condition affecting most men by the age of 80 years. There are multiple treatment options available, including both medical and surgical interventions. However, what is not known is how affective the different types of interventions are in the general population. Previous studies have focused on centre-specific data. What is unique about our study is that it is a prospective cross-section analysis of a community cohort of men. Through this study we were able to assess the outcomes in the general population as opposed to in a high-volume surgical centre. Our findings show that in this community medical management was poor at symptomatic improvement, whereas surgical intervention produced the best improvement. OBJECTIVE To describe the use and symptomatic outcomes of different therapies for lower urinary tract symptoms (LUTS) in a community-based population of men followed for 17 years., PATIENTS AND METHODS Data from a randomly selected cohort of 2184 men, aged 40-79 years in 1990, from Olmsted County, Minnesota, USA were included in the study. Participants completed a questionnaire similar to the American Urological Association Symptom Index (AUASI) and reported on incontinence., Men were followed biennially through 2007 (median follow-up: 13.7 years; Q1, Q3: 8.8, 15.7). Medical and surgical treatments for LUTS were reported on biennial questionnaires and abstracted from community medical records., RESULTS Overall, 610 (28%) men received medical or surgical therapy for treatment of LUTS. Patients undergoing vaporization and transurethral resection of the prostate (TURP) had the highest pre-intervention AUASI scores ( P < 0.001) and the most rapid increase in scores over time ( P= 0.002) compared with those treated with medications or no therapy. After intervention, symptom progression slowed in all treatment groups., However, the greatest improvement in AUASI score (median % change) was observed in the TURP group: −27.45%. The TURP group also reported a significant decrease in incontinence after surgery (% change): TURP: −22.58%., CONCLUSION All therapies were effective at slowing the progression of LUTS, but only TURP patients reported a significant decrease in both LUTS and incontinence after therapy. [ABSTRACT FROM AUTHOR]

Purpose: Nocturia is a bothersome symptom that impacts sleep quality in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). This study was performed to evaluate the impact of nocturia on sleep quality. Materials and Methods: A total of 58 male patients with LUTS/BPH were enrolled. LUTS/BPH patients without nocturia were included in the control group. The inclusion criteria were eight or more points on the International Prostate System Score (IPSS) including more than one episode of nocturia and a prostate volume larger than 20 ml. IPSS, prostate volume, uroflowmetry, and the Pittsburgh Sleep Quality Index (PSQI) from each patient were recorded. Results: Patients with nocturia showed a higher mean global PSQI (8.5±0.4) than patients without nocturia (4.82±0.4) (p<0.01). Patients with nocturia showed a higher percentage of severe sleep disorders (74.1%) than patients without nocturia (35.3%) (p<0.01). The regression coefficient between the number of episodes of nocturia and mean global PSQI was 0.42 (p<0.01). Conclusions: Patients with nocturia showed poor sleep quality, and this was related to the number of episodes of nocturia. This suggests that nocturia has a strong impact on sleep quality in patients with LUTS/BPH. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Silodosin administered by 4 mg twice daily is as effective as tamsulosin 0.2 mg daily in treating patients with LUTS associated with BPH. Relative to tamsulosin, silodosin has less cardiovascular side effects as judged by the minimal changes of blood pressure and pulse rats after treatment. OBJECTIVE • To test the hypothesis that the efficacy of silodosin would not be inferior to tamsulosin in treating patients with lower urinary tract symptoms associated with benign prostate hyperplasia (BPH). PATIENTS AND METHODS • At nine medical centres, 209 patients with an International Prostate Symptom Score (IPSS) of ≥13 were randomized to silodosin (4 mg twice daily) or tamsulosin (0.2 mg once daily) for 12 weeks. • The primary efficacy measure was the mean change from baseline to endpoint in IPSS. • The non-inferiority margin of the IPSS change was set at 1.0. • Secondary efficacy measures included change in maximal urinary flow rate (Qmax) and health-related quality of life (HRQL) score. RESULTS • Of the 170 (81.3%) patients who completed the study, 86.2% in the silodosin group vs 81.9% in the tamsulosin group achieved a ≥25% decrease in IPSS ( P= 0.53). • The mean difference (silodosin minus tamsulosin) in IPSS change from baseline was −0.60 (95% confidence interval −2.15, 0.95), inferring the non-inferiority of silodosin to tamsulosin. • The mean changes in the Qmax and HRQL score from baseline were comparable between the groups (both, P > 0.05). Although patients receiving silodosin had a significantly higher incidence of abnormal ejaculation (9.7% vs tamsulosin 1.0%, P= 0.009), only 1.9% discontinued treatment. • Tamsulosin treatment resulted in a significant reduction in mean systolic blood pressure (−4.2 mmHg, within-group P= 0.004) relative to the negligible change of silodosin (−0.1 mmHg, within-group P= 0.96) CONCLUSION • The trial shows the non-inferiority of silodosin 4 mg twice daily to tamsulosin 0.2 mg once daily in patients with symptoms of BPH. [ABSTRACT FROM AUTHOR]

Our objective was to compare the effect of tamsulosin versus transurethral resection of the prostate (TURP) for the management of nocturia in previously untreated men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and no other predisposing factors for nocturia. The study group included 66 patients (mean age 68.9 years, range 52-81) randomized to receive either tamsulosin 0.4 mg per os daily ( n = 33) or TURP ( n = 33). Nocturia was assessed at baseline, after 3 months and after 1 year, by the number of nocturnal awakenings and hours of undisturbed sleep (HUS) obtained from a 72-h Frequency Volume Chart (FVC). Furthermore, the International Prostate Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) and the International Consultation on Incontinence Questionnaire Nocturia Quality of Life (ICIQ-NQoL) were recorded. At baseline, there were no statistically significant differences between the two groups. ICIQNQoL and ICIQ-N scores correlated with the number of awakenings and HUS, respectively. Both tamsulosin and TURP improved all examined parameters during the follow up. TURP was associated with a statistically significant improvement in the number of nocturnal awakenings and in the IPSS, ICIQ-N and ICIQ-NQol scores in comparison with tamsulosin. HUS increased in both groups, but without any statistically significant difference. In conclusion, TURP is superior in comparison with tamsulosin for the management of BPH-related nocturia. [ABSTRACT FROM AUTHOR]

Study Type – Symptom prevalence (retrospective cohort) Level of Evidence 2b OBJECTIVES To determine the role of treatment-associated improvement in nocturia in health-related quality of life (HRQL) in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia, and secondarily to confirm the role of nocturia in HRQL at baseline and to compare the effects of watchful waiting, transurethral microwave treatment (TUMT) and transurethral resection of the prostate (TURP) to those of α1-adrenoceptor antagonists (α-blockers) on nocturia. PATIENTS AND METHODS We retrospectively analysed using multiple regression a large single-centre database of patients receiving routine care for treatment-associated alterations of symptoms and HRQL (assessed at baseline, 2611 men) and 6–12 months after initiation of treatment (1258 men). RESULTS Among the symptoms assessed using the International Prostate Symptom Score, nocturia (together with urgency and weak stream) had the strongest correlation with HRQL at baseline and after treatment. Watchful waiting, α-blockers, TUMT and TURP reduced nocturia episodes by a mean (sd) of 7 (53)%, 17 (40)%, 32 (47)% and 75 (23)%, respectively. The treatment-associated improvements in nocturia (together with those of weak stream) had the strongest association with those of HRQL. CONCLUSIONS We conclude that among all LUTS assessed in the IPSS, nocturia has one of the strongest associations with HRQL, and that treatment-associated improvements in nocturia contribute considerably to overall improvements in HRQL. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the long-term efficacy and safety of laser vaporesection using the RevoLix™ 70 W 2 µm continuous wave (CW) laser in the treatment of benign prostatic hyperplasia (BPH). Background data: From January 2008 to December 2008, 162 patients with BPH underwent vaporesection using 2 µm CW laser. Materials and methods: The International Prostate Symptom Score (IPSS), quality of life (QoL), urinary flow rate (Qmax), post-voiding residual urine volume (PVR), and postoperative complications were observed at baseline and were followed at 3-, 6-, and 12-month intervals (range: 3-60 months). Results: A total of 146 patients completed the 5-year follow-up. At 60 months postoperatively, the mean Qmax increased from 7.5 to 21.2mL/sec, the mean PVR decreased from 94.3 to 9.4 mL, the mean IPSS score decreased from 20.4 to 6.6, and the mean QoL score decreased from 4.7 to 1.9. Complications included urinary tract infection (3.4%), urethral stricture rate (2.7%), and recurrent bladder outlet obstruction rate (2.1%). Overall, the reoperation rate was 3.4%, and no transurethral resection (TUR) syndrome or blood transfusion was reported. Conclusions: The 2 µm CW laser is a safe and effective option for the treatment of BPH. At the 5-year follow-up, the long-term clinical efficacy and safety are excellent, with low incidence of complications. [ABSTRACT FROM AUTHOR]

Abstract: Context: Benign prostatic hyperplasia (BPH) is a well-known condition characterised by prostate growth accompanied by lower urinary tract symptoms. Several mechanisms seem to be involved in the development and progression of BPH. Objective: To review the most important findings regarding the key mechanisms involved in the pathophysiology of BPH. Evidence acquisition: During the 2009 annual meeting of the European Association of Urology in Stockholm, Sweden, a satellite symposium was held on BPH and its treatment. This paper is based on one of the presentations at the symposium. A structured, comprehensive literature review was performed using data retrieved from recent review articles, original articles, and abstracts. Evidence synthesis: Several mechanisms seem to be implicated in the pathophysiology of BPH. These represent age-related tissue modifications, hormonal alterations, and metabolic syndrome as well as inflammation. Although androgens do not cause BPH, the development of BPH requires the presence of androgens. Moreover, several studies support the association between noninsulin-dependent diabetes mellitus, hypertension, obesity, and low high-density lipoprotein cholesterol and the development of BPH. Finally, recent increasing evidence seems to support the idea that BPH consists of an inflammatory-based disorder. Inflammation would be initiated by an unknown stimulus that would create a proinflammatory milieu within the gland. This theory is confirmed by several basic research and clinical studies that showed a statistically significant association between inflammation and BPH severity and progression. Conclusions: Although the pathogenesis of BPH is not yet fully understood, several mechanisms seem to be involved in the development and progression of the disease. These mainly include systemic and local hormonal and vascular alterations as well as prostatic inflammation that would stimulate cellular proliferation. Inflammation would be initiated by an unknown stimulus that would create a proinflammatory environment within the prostate. Therefore, from the recent clinical and basic research studies, a novel approach in the clinical management of BPH might focus on the inflammatory process involved in the development and progression of the disease. [Copyright &y& Elsevier]

OBJECTIVE To evaluate the safety, efficacy and short-term outcome of a new 980 nm high-intensity diode (HiDi) laser (Limmer Laser, Berlin, Germany) system in comparison to the diode-pumped solid-state laser high-performance system (HPS; GreenLightTM, AMS, Minnetonka, MI, USA) for treating benign prostatic hyperplasia (BPH) in a prospective non-randomized single-centre study. PATIENTS AND METHODS From February to September 2007, 117 consecutive patients with lower urinary tract symptoms secondary to BPH were included; 62 patients were treated with 120-W HPS laser vaporization and 55 with 980-nm HiDi laser ablation of the prostate. We evaluated perioperative variables, and complications during and after surgery. Patients presenting for follow-up completed the International Prostate Symptom Score, and had their maximum urinary flow rate and postvoid residual urine volume measured. RESULTS The mean (sd) age of the patients was 72.3 (8.8) years (HiDi) and 73.1 (10.8) years (HPS), with a mean preoperative prostate volume of 64.7 (29.7) and 67.4 (46.9) mL, respectively. The mean operative duration was comparable, at 56.4 (20.2) and 62.7 (36.3) min, respectively, whereas the mean energy delivery was significantly higher with the diode laser, at 313 (132) vs 187 (129) kJ ( P < 0.001). For patients treated with the HPS the rate of visual impairment from bleeding was higher (0% vs 12.9%, P < 0.01), as was prostate capsule perforation (0% vs 4.8%, P > 0.05). Soon after surgery the rate of dysuria (23.6% vs 17.7%, P > 0.05) and transient urge incontinence (7.3% vs 0%; P < 0.05) was higher for the HiDi laser. During the follow-up there were higher rates of bladder neck stricture (14.5% vs 1.6%, P < 0.01), re-treatment (18.2% vs 1.6%, P < 0.01) and stress urinary incontinence (9.1% vs 0%; P < 0.05) for the HiDi laser group. CONCLUSION Both systems investigated provide good tissue ablative properties. The HiDi laser at 980 nm is more favourable in terms of haemostasis. The penetration depths, resulting in coagulation necrosis and leading to increased re-treatment, bladder neck stricture and incontinence rates, were higher with the HiDi laser. [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]

The article discusses lower urinary tract symptoms (LUTS) LUTS is believed to be the cause of prostate enlargement and bladder outlet obstruction, otherwise known as benign prostatic obstruction (BPO) and originally related to benign prostatic hyperplasia (BPH). Al-blockers that targets the dynamic component of BPO and 5a-reductase inhibitors which cures the mechanical component of BPO are the most common medical treatments for male LUTS. The standard tool that quantifies LUTS is the International Prostate Symptom Score (IPSS).

The article offers information on how to manage patients with benign prostatic hyperplasia (BPH) in the U.S. It recommends the use of a urinary symptom scoring system, such as the 7-question Symptom Index for BPH and the International Prostate Symptom Score, to determine the severity of BPH and monitor the success of subsequent therapy. It highlights suggestions on dealing with other causes of BPH-like symptoms, focusing on lower urinary tract symptoms. It also indicates several approaches for the treatment of the disease that include nonselective and selective adrenergic alpha blockers as well as 5-alpha-reductase inhibitors.

OBJECTIVE To describe the profile and management of patients medically treated for benign prostatic hyperplasia (BPH) in primary care in four European countries, as the diagnosis and management of BPH have developed dramatically in the last decade, and recent information from actual practice is insufficient. PATIENTS AND METHODS This observational, cross-sectional study was carried out by general practitioners in France (141 patients), Spain (127) and Portugal (50), and by office-based urologists in Germany (162 patients) between July 2005 and June 2006. The physicians were unaware of the study sponsor. Patients aged ≥50 years were recruited if a decision for medical treatment of BPH was taken for the first time on that day. The patient and the investigator had to complete one questionnaire each. RESULTS The physicians included 480 patients, with a mean (sd) age of 65.0 (7.8) years. The mean (sd) International Prostate Symptom Score (IPSS) was 16.0 (7.3). There were geographical differences in age ( P = 0.009; patients in Germany being the youngest), IPSS ( P = 0.017; patients in Spain having the highest score), quality of life (QoL; IPSS item 8, P < 0.001, the least altered being in Germany), and sexual activity ( P = 0.010; the highest proportion of sexually active patients being in Portugal), but not for comorbidities and concomitant medication. The IPSS correlated poorly with age ( r = 0.21) and moderately with QoL ( r = 0.47). Severe symptoms (IPSS > 19) were not linked with sexual activity (age-adjusted P = 0.378). Serum prostate specific antigen testing, although not recommended for BPH, was widely used (83.8% overall). All other examinations were carried out disparately depending on the country ( P < 0.001 each). Digital rectal examination (DRE) and excluding urinary tract infection (urine culture) were used in ≈75% of study patients, but only half the patients in France had a urine culture, and 52% in Portugal had a DRE. A standardized assessment of symptoms and/or QoL was reported in 45% of study patients, with wide discrepancies among countries, i.e. 77.2% in Germany and 6.0% in Portugal. α-blocker monotherapy was the most frequently prescribed treatment (62.5% overall, 87.1% in Germany, 46.1% in France), followed by phytotherapy (23.5%), and 5α-reductase inhibitor monotherapy (3.75%); combinations were rare. Treatment varied according to the severity of the symptoms ( P = 0.008), phytotherapy being given to patients with the lowest IPSS, and combinations to those with the highest IPSS. CONCLUSION There were geographical discrepancies that could be attributed to either different cultural habits or merely organisational differences, e.g. the presence of office urologists in Germany or diverse modes of access to phytotherapy (prescription vs ‘over the counter’) in the various countries. [ABSTRACT FROM AUTHOR]

Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. It represents a significant worldwide public health issue, as mortality within the year following an AUR episode appears much higher than in the general population, especially in younger patients. Management of AUR involves immediate bladder catheterization usually followed, until recently, by prostatic surgery. The greater morbidity and mortality associated with emergency surgery (within a few days after AUR), and the potential morbidity associated with prolonged catheterization (bacteriuria, fever, urosepsis) has led to an increasing use of a trial without catheter (TWOC). TWOC involves catheter removal after 1–3 days, allowing 23–40% of patients to void successfully, so that surgery can be performed at a later stage, if needed. Use of an α1-blocker before a TWOC may also be of help, as it has been demonstrated that it increases the chances of successful voiding after catheter removal. In the UK, this TWOC policy has resulted in a progressive decrease in the number of surgical procedures following a first episode of AUR, with the detriment of a slight increase in the AUR recurrence rate. Currently, there is no consensus on the optimal management of AUR in terms of type of catheterization, duration of catheterization and management following catheterization. The Reten-World survey is aimed at assessing current practice in the management of AUR in France, Asia, Latin America, North Africa and the Middle East. Interim results based on 3785 men with AUR associated with benign prostatic hyperplasia show that a urethral catheter is inserted in most cases (87%). Following this initial step, a TWOC after a median of 3 days’ catheterization has become standard practice worldwide, with only a minority of men (6%) undergoing immediate surgery. Treatment with an α1-blocker before a TWOC improves the chances of success, regardless of the duration of catheterization. There is also evidence that prolonged catheterization (>3 days) is associated with a significantly higher rate of comorbidity and prolonged hospitalization due to adverse events. Every effort should thus be made to reduce the comorbidity and mortality associated with AUR. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Since decades plant extracts belong to the most popular drugs for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH)/benign prostatic enlargement (BPE). Herein we review biological mechanisms, the placebo effect, results of clinical trials, the role of meta-analyses and guideline recommendations. Methods: Review of the literature with particular reference to long-term (study period ≥6 months) controlled trials and of BPH-guideline recommendations. Results: Only few of the large number of available studies meet the criteria defined by the WHO-BPH consensus conference. The few, placebo-controlled, long-term (study period ≥6 months) studies suggest a positive effect of some extracts (saw palmetto, ß-sitosterol, urtica, saw palmetto/urtica combination) on LUTS, an effect on uroflow, post-void residual volume, prostate volume and PSA was not consistently demonstrable. Randomised trials against active comparators (α1-blocker, 5α-reductase inhibitors) are difficult to interpret. Due to the lack of prospective studies, several meta-analyses have been published that can not replace prospective studies according to WHO-BPH recommendations. None of the BPH-guidelines currently recommends plant extracts, yet universally conclude that this is an interesting approach. Conclusions: Further prospective studies according to WHO-standards are required to reliably determine the role of plant extracts in contemporary LUTS-management. [Copyright &y& Elsevier]

Abstract: The present paper discusses the consequences of nocturia in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) and summarises the available data on the impact of tamsulosin oral controlled absorption system (OCAS) on nocturia. The opinions of urologists on these data were assessed during a closed meeting in Marbella, Spain. Nocturia is the most bothersome symptom of LUTS/BPH. Especially waking up during the first 3–4h of sleep is considered detrimental for an individual''s quality of sleep (QoS) and quality of life (QoL). The hours of undisturbed sleep (HUS) has been suggested as a useful tool to measure the impact of BPH treatment on QoS and QoL. It was believed that because of its favourable pharmacokinetic profile, with a consistent and continuous 24-h drug release, tamsulosin OCAS would provide a good control of nocturia, increase HUS, and improve QoL more than placebo could. Interactive voting showed that the majority of urologists attending the closed meeting in Marbella agreed with the statements that “sleep disturbance is the major reason why nocturia is so bothersome,” that “nocturia is the most bothersome urinary symptom because it affects QoS,” that “HUS should be a key parameter for evaluating the effects of LUTS/BPH treatment on sleep,” and that “LUTS/BPH treatments should be evaluated for their effects on QoS and QoL.” [Copyright &y& Elsevier]

Abstract: Every year, an increasing quantity of new information is presented at the major urologic and oncologic congresses such as the European Association of Urology (EAU), the American Urological Association (AUA), the American Society of Clinical Oncology (ASCO), and so forth. Because of the delay until final publication of these data, it is very difficult for urologists to keep up to date with the new scientific information relevant for their own clinical practise. In light of this difficulty, a closed expert meeting “New Horizons in Urology” (NHU) was held in October 2006 in Marbella, Spain. The objective of this meeting was to provide practising urologists with the most important information with practical clinical relevance to urologists presented during the major urologic and oncologic meetings. This information was selected and presented by leading experts in the field of functional and oncologic urology. Nonmalignant disease areas that were considered were surgical interventions for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), benign bladder diseases, and stone disease. Malignant disease topics were prostate cancer, bladder cancer, and kidney cancer. Each session started with a clinical case workshop during which the attendee''s opinion on the management of the clinical case was assessed via interactive voting, followed by a discussion of the expert panel. The sessions were closed with a brief update lecture. The current paper summarises the highlights of the closed expert meeting. [Copyright &y& Elsevier]

OBJECTIVE To evaluate the potential of sildenafil, vardenafil and tadalafil, all phosphodiesterase-5 (PDE-5) inhibitors used for treating erectile dysfunction, for treating benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). MATERIALS AND METHODS The mRNA expression of the PDE-5 was determined in rat LUT tissues. The PDE-5 inhibitors were also tested in organ-bath experiments and in a partial bladder outlet obstruction (BOO) rat model in vivo. RESULTS The highest PDE-5 mRNA expression was in the bladder, followed by the urethra and prostate. PDE-5 inhibitors dose-dependently reduced the contraction of the isolated bladder, urethral and prostate strips. The rank order of potency was vardenafil > sildenafil > tadalafil. In human prostate stromal cells vardenafil inhibited cell proliferation and was more effective than tadalafil and sildenafil. In the BOO model, there was a reduction in the non-voiding contractions after bolus intravenous administration of 3 mg/kg sildenafil and vardenafil. CONCLUSION These results show that PDE-5 is expressed in LUT tissues. PDE-5 inhibitors induced significant relaxation of these tissues, inhibited the proliferation of human prostate stromal cells and reduced the irritative symptoms of BPH/LUTS in vivo. Therefore, PDE-5 inhibitors could be used as an effective treatment for BPH/LUTS. [ABSTRACT FROM AUTHOR]

Aim: The objective of the study was to compare the efficacy and safety of tamsulosin hydrochloride and doxazosin in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods: The safety and efficacy of tamsulosin (0.2 mg) and doxazosin (2 mg) was determined after once daily administration for 6 weeks in an open-label, randomized, multicenter study of 101 men with BPH. The International Prostatic Symptom Score (IPSS), maximal urinary flow rates (Qmax), average urinary flow rates (Qave) and residual urine were determined at baseline and again at 6 weeks as efficacy parameters. The primary parameters used for safety evaluation were vital signs (blood pressure and heart rate) and adverse events. The number of patients with a clinically significant response to treatment with tamsulosin or doxazosin was determined and defined as those with >20% improvement from the baseline Qmax or >20% decrease in total IPSS. Results: The total IPSS decreased significantly in both the tamsulosin and doxazosin groups compared to baseline. There was a significant difference in the decrease in total IPSS between two groups. Qmax, Qave and residual urine significantly improved only in the tamsulosin group. There were no significant differences in systolic blood pressure, diastolic blood pressure or heart rate profile in the tamsulosin group; however, doxazosin resulted in a significant difference in systolic and diastolic blood pressure. Tamsulosin was well tolerated; only three patients (6%) in the tamsulosin group reported an adverse event (dizziness) while 11 patients (22%) in the doxazosin group reported an adverse event (dizziness), one of whom withdrew from the study. Conclusions: Tamsulosin was shown to be more effective than doxazosin in the treatment of LUTS due to BPH. [ABSTRACT FROM AUTHOR]

Over the last decade, management of benign prostatic hyperplasia (BPH) has changed with a substantial decrease in the use of transurethral prostatectomy (TURP) and a simultaneous increase in the use of medical therapy and minimally invasive surgical therapy (MIST). The goal of management of this chronic progressive condition is not only to provide relief of lower urinary tract symptoms (LUTS) but also to reduce the lifetime risk of adverse outcomes. Recent clinical evidence has demonstrated a clear role for medical therapy, particularly with 5-alpha-reductase inhibitors (5ARIs) either alone or in combination with alpha-blockers, to reduce the risk of acute urinary retention and need for surgery and provide symptom relief. Clinical data on MISTs also indicate a more pronounced short-term effect; however, the long-term durability of these therapies remains uncertain. Minimally invasive surgical therapies confer treatment benefits in a single 1-h treatment session under local anesthesia. Recovery times and adverse events are improved compared with TURP, but issues such as hematuria, prolonged catheterization, urinary tract infection and retreatment remain commonly reported issues. Today, urologists are faced with the challenge of identifying the most appropriate treatment option for the long-term management of BPH. The initial choice for any given patient will depend on his presenting circumstances and the influence of treatment risks on these circumstances. Providing patients with informed treatment decisions is a key element of management.Prostate Cancer and Prostatic Diseases (2006) 9, 204–214. doi:10.1038/sj.pcan.4500869; published online 6 June 2006 [ABSTRACT FROM AUTHOR]

Abstract: An underlying scientific rationale exists for combining α-adrenergic blockade and 5α-reductase inhibition for the treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH), given that their modes of action in managing LUTS secondary to BPH are different and complementary. Both α-blockers and 5α-reductase inhibitors (5-ARIs) provide sustainable reductions in symptom scores. Although both classes of agents have data to support delays in acute urinary retention (AUR) and the need for invasive BPH therapy, only the 5-ARIs reduce the long-term risks of both events. Current evidence suggests that initiation of combination therapy should be considered in men with prostatic enlargement, elevated prostate-specific antigen (PSA) level, LUTS, and moderate or severe bother. The Medical Therapy of Prostate Symptoms (MTOPS) study provided evidence that the prostate volume threshold for benefit of a 5-ARI, and therefore of combination therapy, is lower than previously thought (>25cc). Cost effectiveness in this population has been demonstrated to increase in men with severe symptoms, although transurethral resection of the prostate (TURP) is probably more favourable in the long-term from a cost perspective. However, many men wish to avoid surgery, and for them, combination therapy offers significant benefits over monotherapy, especially over α-blocker therapy where no long-term reductions in the risk of AUR or surgery have been demonstrated. [Copyright &y& Elsevier]

Abstract: During the last 15 yr, there has been a steady decline in the use of watchful waiting and invasive treatment for symptomatic benign prostatic hyperplasia (BPH). During this same period, overall treatment for BPH has increased, mainly due to the advent of medical therapy, and to a lesser extent, minimally invasive surgical techniques. Despite this, observation, albeit with regular follow-up and reassessment of symptomatic status and degree of prostatic enlargement of the patient, still remains the predominant treatment choice for BPH. However, a significant proportion of men with lower urinary tract symptoms (LUTS) secondary to BPH have progressive disease that warrants active management beyond watchful waiting. Such men can be identified using baseline risk factors, such as age, prostate volume, and prostate-specific antigen level, and are candidates for medical therapy. Self-management, through a number of components including education, lifestyle modification, and the use of behavioural interventions, offers the opportunity to improve outcomes in men undergoing watchful waiting or, indeed, for those receiving medical therapy. Current evidence on the benefits of self-management are limited, and further data will shortly be available to judge its value in the management algorithm for LUTS in men with BPH. [Copyright &y& Elsevier]

Treatment with α1-adrenergic receptor blockers improves lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. This study was conducted to test the hypothesis that induction of apoptosis in prostate tissue could be a mechanism underlying the observed clinical benefit. This placebo-controlled, double-blind, randomized trial enrolled 536 men with LUTS who were treated with alfuzosin (10 or 15 mg) once daily or placebo for 3 months. Total prostate and transition zone volume was measured by standardized transrectal ultrasound measurements at baseline and 3 months. Total prostate volume increased by 0.4 ml from baseline in placebo patients but decreased by −0.25 ml in the combined alfuzosin groups. Percentage change was not statistically significantly different between the placebo and alfuzosin groups. Changes in transition zone volumes from baseline were similar in both treatment arms; percentage change was not statistically significantly different between the placebo and alfuzosin groups. Volume changes did not correlate with prostate volumes at baseline. Overall, neither total prostate nor transition zone volume increased or decreased systematically within the 3-month treatment period. If alfuzosin-induced apoptosis in prostate tissue, it was not evident by a measurable change in prostate volume after 3 months’ treatment. Further analysis at 1 and 2 years will determine the effect of longer-term treatment.Prostate Cancer and Prostatic Diseases (2006) 9, 121–125. doi:10.1038/sj.pcan.4500849; published online 9 May 2006 [ABSTRACT FROM AUTHOR]