Characteristics and outcomes of men who fail to leak on intubated urodynamics prior to artificial urinary sphincter placement

INTRODUCTION

To report the characteristics and anti-incontinence outcomes of men who fail to demonstrate incontinence on intubated urodynamics (UDS).

MATERIALS AND METHODS

From 2005 to 2013, the records of men who underwent UDS prior to artificial urinary sphincter (AUS) were reviewed. The histories, UDS, endoscopies, and anti-incontinence outcomes of men who failed to demonstrate incontinence on intubated UDS were recorded. In our UDS protocol, the urodynamic urethral catheter was removed and the UDS was repeated to elicit incontinence without the urethral catheter. The valsalva leak point pressure (VLPP) was obtained via the rectal catheter in these men.

RESULTS

All men were status post radical prostatectomy for prostate cancer. Nineteen percent (32) of the study population (169) had non-demonstrable incontinence on intubated UDS. Mean age at the time of UDS was 62 (range 48-81). All patients demonstrated incontinence on UDS upon removal of the urethral catheter. Their mean VLPP was 79.3 (SD 36.7). Fifty-six percent (18) of these men had an anastomotic stricture (AS) and 37.5% (12) had a history of radiotherapy treatment, of which six also had an AS. Mean pads per day at the time of UDS was 4.6 (SD 2.9). At a mean follow up of 40.7 months (SD 24.7) from AUS placement, mean pads per day was 0.87 (SD 1.2).

CONCLUSIONS

Men who fail to demonstrate incontinence on intubated UDS have a high rate of AS and history of radiotherapy treatment, which is a known cause for urethra fibrosis and scarring. Regardless, these men can achieve excellent anti-incontinence outcomes.

National study of utilization of male incontinence procedures

AIMS

We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries.

METHODS

All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included. Artificial urinary sphincter recipients, patients who underwent a sling operation and those receiving an injection of a bulking agent were identified with Current Procedure Terminology (CPT-4) and ICD-9 Procedure Codes.

RESULTS

The entire cohort of 1,246 patients were operated on between 2001 and 2011. 34.9% of them received an artificial urinary sphincter (AUS), 28.7% with a bulking agent, and 36.4% with a sling. There were no statistically significant differences in demographics or comorbidities between the treatment groups, except that more sling patients were obese (P = 0.006) and fewer bulk patients had diabetes (P = 0.007). There are, however, significant changes in procedures selected over time (P < 0.001). In the first year and over the entire follow-up after surgery, patients treated with bulking agents had the most subsequent interventions (40.1% and 52.9%), followed by sling (10.4% and 15.5%), and AUS (2.3% and 20%) (P < 0.001). Post-operative and 90 day complications were low.

CONCLUSIONS

All three treatments seem to be safe among Medicare beneficiaries with multiple comorbidities. The urological, infectious, and neurological complication occurrences were low.

Urodynamic characterization of lower urinary tract symptoms in women less than 40 years of age

INTRODUCTION

Lower urinary tract symptoms (LUTS) in young women is becoming a more recognized urologic issue that can arise from many causes, each with their own management strategy. The purpose of this study was to determine the rates of various etiologies for LUTS in women under 40 years of age.

MATERIALS AND METHODS

Video urodynamic studies (VUDS) were performed in 70 women age 40 years or less with LUTS for greater than 6 months between March 2005 and June 2012 at Weill Cornell Medical College. Patients with culture-proven bacterial urinary tract infections, pelvic organ prolapse greater than grade I, symptoms for less than 6 months, a history of neurologic disease, or previous urological surgery affecting voiding function, were excluded from the analysis.

RESULTS

The mean age of the patients was 31.95 ± 5.57. There were 48 patients that presented with more than one urinary symptom (68.57%). The most frequent complaints included: urinary frequency (n = 42, 34.15%), incontinence (n = 26, 21.14%), and urinary urgency (n = 22, 17.89%). The most common urodynamic abnormality was dysfunctional voiding (n = 25, 28.74%), detrusor overactivity (n = 15, 20.00%), bladder outlet obstruction (n = 8, 11.43%). There were no significant differences seen in complaints or AUA symptom and quality of life scores across diagnosis groups.

CONCLUSIONS

Persistent LUTS can present in younger women with an unclear etiology, which may be characterized using VUDS. The most common etiology found is dysfunctional voiding followed by detrusor overactivity. This study shows that the etiology can be more accurately determined using VUDs, which can assist in management.

Safety of robotic prostatectomy over time: a national study of in-hospital injury

OBJECTIVE

To assess national trends of iatrogenic complications and associated burden of care among patients undergoing open and minimally invasive prostatectomy using a population-based cohort.

METHODS

Using the nationally representative cohort, we identified patients who were diagnosed with prostate cancer, and underwent prostatectomy during 2001 and 2011. We determined the risk of iatrogenic complication and length of stay (LOS) over time among open and minimally invasive surgery (MIS) patients. Hierarchical multivariable logistic regression was performed to assess the changes over time and elucidate independent predictors of iatrogenic complications.

RESULTS

We identified 556,932 and 219,434 prostate cancer patients undergoing open and minimally invasive prostatectomy. We found that iatrogenic complications for MIS were less frequent in later years (years 09-11 vs. year 01-02 odds ratio (OR), 0.21; 95% confidence intervals (CI), 0.09-0.40). MIS was associated with higher risk of iatrogenic complications in early period (years 01-02 OR, 3.81; 95% CI, 1.72-8.41), but lower risk in late period (years 09-11 OR 0.72 95% CI 0.61-0.86). Patients who experienced iatrogenic complications tended to have longer LOS (Median: Open vs. MIS, 4 days vs. 3 day) than those who didn't (Median: Open vs. MIS, 2 days vs. 1 day), regardless of procedure type.

CONCLUSION

We found that minimally invasive prostatectomy is associated with lower risk of iatrogenic complications when compared with open surgery (OS). However, as "learning curve" is overcome over time, MIS becomes safer than OS. Iatrogenic complications are not benign and seem to be associated with higher burden of inpatient care.

Image-based simulation of urethral distensibility and flow resistance as a function of pelvic floor anatomy

AIMS

The goal of this study is to develop an image-based model of urethral distention and resistance in women with and without SUI.

METHODS

A biomechanical vector force model was created to simulate the mechanical deformation of pelvic floor structures during cough and Valsalva in order to measure urethral distension and predict flow resistance patterns. Dynamic MRI images were used to create a spatial model to construct an accurate representation of tissue thickness and location, which was combined with tissue property values (MATLAB 2011a, MathWorks, Natick, MA). Spatial profiles were created to demonstrate the effects of hypermobility and tissue property variability on distensibility and flow resistance along the urethra. Sensitivity analyses were conducted to demonstrate the relationship between flow resistance and various tissue properties.

RESULTS

The average distension for incontinent cases (3.8 mm) was significantly greater than that of continent cases (2.6 mm) (t = 3.3083, df = 8, P < 0.01), corresponding to a 70% drop in average resistance to urine flow. Sensitivity analyses demonstrated that the stiffness and contractility of the vagina and urethra had the greatest effect on continence.

CONCLUSIONS

We present a novel, 2-dimensional biomechanical model of female stress urinary incontinence (SUI) that relates the effects of various factors such as tissue elasticity, pelvic floor structure, and muscle activation. A better understanding of the pathophysiology underlying SUI has potential implications for the creation of novel targeted treatments.

Surgical Treatment of Benign Prostatic Hyperplasia—Lift or Laser?

INTRODUCTION

We review modern office based therapies for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

METHODS

A search was performed for the literature between 2005 and 2014 on office based therapies for benign prostatic hyperplasia focusing on prostatic urethral lift and office based laser therapies.

RESULTS

Prostatic urethral lift is a novel technology that functions on mechanical compression alone. Initial trials have demonstrated improvement in symptom scores by 42% and in maximum flow by 30% at 2 years of followup.

CONCLUSIONS

The prostatic urethral lift device represents a novel approach in the array of office based technologies to treat benign prostatic hyperplasia, although additional information on ease of insertion, reproducibility and durability is needed.

Randomized, double-blind, placebo controlled pilot study of intradetrusor injections of onabotulinumtoxinA for the treatment of refractory overactive bladder persisting following surgical management of benign prostatic hyperplasia

INTRODUCTION

We assessed the efficacy of onabotulinumtoxinA (BOTOX, Allergan Inc., Irvine, CA, USA) in patients with refractory overactive bladder (OAB) after treatment for benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

This was a two-center, randomized, double-blinded pilot study conducted in patients with OAB secondary to bladder outlet obstruction (BOO), refractory to anticholinergic medication and persistent for greater than 3 months after surgical intervention to relieve obstruction, with an International Prostate Symptom Score (IPSS) > 12. Patients were randomized in 1:1 fashion to either 200 units of onabotulinumtoxinA versus placebo. Fifteen patients received onabotulinumtoxinA versus 13 who received placebo. Follow up was performed at 1 week and then 1, 3, 6, and 9 months. The primary endpoint was reduction in the frequency of micturition per 24 hours by 3-day voiding diary. Secondary endpoints were maximum flow rate (Qmax), post-void residual (PVR), and IPSS scores.

RESULTS

Patients receiving onabotulinumtoxinA demonstrated significantly improved quality of life scores at 180 and 270 days after treatment (p = 0.02 and 0.03, respectively) as well as significantly lower International Consultation on Incontinence Questionnaire (ICIQ) scores (p < 0.05). Baseline urinary frequency was 10.5 versus 11.0 voids/day (p = 0.47). Frequency episodes improved from 11 episodes per day to 8 episodes per day in the treatment arm. The placebo arm did not have a decrease in frequency episodes. This response was durable up to 90 days, although this was not statistically significant. IPSS, PVR, and urgency were unchanged postoperatively in both groups.

CONCLUSIONS

OnabotulinumtoxinA was safe in patients with refractory irritative lower urinary tracts symptoms after surgical treatment of BPH. There were improvements in daily frequency, although the results were not statistically significant. Larger trials are needed to help characterize the utility of onabotulinumtoxinA in the treatment of OAB secondary to BPH.

A cost-effectiveness analysis of retropubic midurethral sling versus transobturator midurethral sling for female stress urinary incontinence

AIMS

To compare the cost-effectiveness (CE) of retropubic midurethral sling (RMS) versus transobturator midurethral sling (TMS) for the treatment of female stress urinary incontinence (SUI).

METHODS

A Markov chain decision model was created to simulate treatment of SUI with RMS versus TMS. Costing data were obtained from the Medicare RBRVS. Data regarding the efficacy and complications associated with RMS versus TMS was compiled from a literature review of 21 randomized RCTs with a minimum of 12 months follow-up, as were corresponding utilities for different continence states. Deterministic and probabilistic estimates of cost-effectiveness (CE) for each procedure were calculated and compared, and sensitivity analyses were performed.

RESULTS

In the base-case deterministic analysis, the efficacy of RMS was 6.275 versus 6.272 QALYs for TMS. QALYs represent a measure of disease burden accounting for both quantity and quality of life lived and are used to assess the monetary value of a medical intervention. The average cost for treatment with RMS however was higher at $9,579 versus $9,017 with TMS. TMS was therefore overall more cost-effective than RMS (CE = $1,438/QALY vs. $1,527/QALY). Sensitivity analysis demonstrated that physician and sling characteristics such as device cost, surgeon fee, efficacy of treatment, operative time, and duration of hospitalization could all affect the relative CE of the therapies.

CONCLUSIONS

Our study demonstrated that TMS was more cost-effective than RMS as a treatment for female SUI. The efficacy of the two treatments could be affected by physician and sling characteristic factors.

Tolterodine for the treatment of urge urinary incontinence

INTRODUCTION

Overactive bladder (OAB) and its resultant urge urinary incontinence (UUI) are significant problems that medically, psychologically and financially affect people. The constellation of symptoms comprising OAB affects ∼ 16% of the adult population and its prevalence increases with aging. The typical class of medications used to treat OAB is antimuscarinics.

AREAS COVERED

OAB medications, with a focus on tolterodine for the treatment of UUI are reviewed. A thorough review of English language literature using EMBASE/Medline and PubMed has been performed.

EXPERT OPINION

Tolterodine provides a reasonable starting point when treating patients with OAB and UUI. Efficacy and tolerability are generally comparable between tolterodine and other newer antimuscarinics. Tolterodine is a good option as part of the algorithm in the treatment of OAB and UUI.

Cost-effectiveness analysis of tension-free vaginal tape vs burch colposuspension for female stress urinary incontinence in the USA

OBJECTIVE

To compare the cost-effectiveness (CE) of tension-free vaginal tape (TVT) with that of burch colposuspension (BC) for the treatment of female stress urinary incontinence (SUI).

MATERIALS AND METHODS

A Markov-chain decision model was created to simulate treatment of SUI with TVT or BC using Treeage Pro 2011 software (Treeage Software Inc., Williamstown, MA, USA). Costing data were obtained from the Medicare Resource-Based Relative Value Scale. Data regarding the success of TVT vs BC were obtained from the peer-reviewed literature, as were corresponding utilities for different continence states. The CE of each procedure was calculated and compared, and sensitivity analyses were performed.

RESULTS

At 10-year follow-up, TVT was more cost-effective (CE = $1495/quality-adjusted life year [QALY]) than BC (CE = $1824/QALY). Sensitivity analysis showed that TVT was more cost-effective than BC if the cost of the TVT device was <$3220. If the probability of success after TVT was <42%, then BC became the more cost-effective strategy (CE = $1827/QALY).

CONCLUSION

Our study showed that TVT was more cost-effective than BC as a treatment for female SUI. Both cost of TVT device and efficacy of the procedure affect the CE analysis.

Management of anastomotic stricture after artificial urinary sphincter placement in patients who underwent salvage prostatectomy

OBJECTIVE

To report on a safe endoscopic management technique for the treatment of an anastomotic stricture (AS) in patients with an artificial urinary sphincter (AUS).

METHODS

Five patients with a history of salvage prostatectomy after radiation therapy that developed an AS after AUS placement were treated with a rigid ureteroscope and a Holmium YAG (Ho: YAG) laser to incise the AS. The AUS was opened and deactivated but not decoupled or removed during the procedure. The rigid ureteroscope allowed complete control of the laser fiber to incise the stricture at the 3 and 9 o' clock positions and then circumferentially.

RESULTS

There were no intraoperative complications and the mean operative time was 42.6 minutes. Of the 5 patients who underwent holmium laser incision of an AS after AUS placement, none developed AUS malfunction or required device replacement. No patients reported worsening of urinary incontinence after treatment. Two patients required repeat holmium laser incision for AS recurrence.

CONCLUSION

Using a rigid ureteroscope and a holmium laser to incise an AS after AUS placement seems to be a safe management option that does not damage the AUS or result in worsening incontinence. This treatment strategy provides an endoscopic alternative to using open surgical technique to uncouple or remove the AUS while treating the AS.

Use of the Bulbocavernosus Reflex System in assessing voiding dysfunction

PURPOSE

The Bulbocavernosus Reflex System (BRS) (Laborie, Canada) is an office-based procedure used to measure the bulbocavernosus reflex (BCR) latency period. The aim of this study is to evaluate the BCR as a predictor of specific voiding dysfunction patterns confirmed by urodynamics (UDS).

METHODS

A total of 87 men were evaluated with BRS, UDS, and electromyography at Weill Cornell Medical College from March to August 2010. Baseline characteristics, demographics, UDS, and latency parameters were recorded. Multivariate logistic regression analysis was performed to evaluate prolonged BCR (latency >45 ms) as a predictor of specific voiding dysfunction patterns.

RESULTS

The median age of men was 70.4 years (IQR 57.6-75.6). Based on UDS, 60 men were given a primary or secondary diagnosis of bladder outlet obstruction (BOO), 43 a diagnosis of detrusor overactivity (DO), 11 a diagnosis of intrinsic sphincter deficiency (ISD), and 4 a diagnosis of detrusor sphincter dyssynergia (DSD). Median BCR latency was 57.0 ms (IQR 47.5-76.5) and 68 (78%) men demonstrated a prolonged latency. In multivariate analysis, latency period was not significantly associated with DO, BOO, ISD, or DSD (p = 0.067, 0.696, 0.999, 0.971, respectively).

CONCLUSIONS

Prolonged bulbocavernosus reflex latency was not associated with DO, BOO, ISD, or DSD. Although evidence in the literature suggests a link between this reflex arc and voiding, its specific diagnostic role remains unclear. Large prospective trials are needed to further explore the role of BCR in the evaluation of patients with voiding dysfunction.

Comparison of techniques for transurethral laser prostatectomy: standard photoselective vaporization of the prostate versus transurethral laser enucleation of the prostate

BACKGROUND AND PURPOSE

Transurethral laser enucleation of the prostate (TLEP) using the potassium-titanyl-phosphate (KTP) laser offers an alternative technique to traditional photovaporization. The study objective was to determine the comparative efficacy between transurethral photovaporization of the prostate (PVP) with a TLEP technique using the 80W 532 nm KTP laser.

PATIENTS AND METHODS

A series of 97 vs 170 patients who underwent PVP vs TLEP, respectively, with the KTP laser system at Weill Cornell Medical College from September 2001 to May 2009 was studied retrospectively. Outcome measures included laser time, prostate volume lased per unit time, International Prostate Symptom Score (IPSS), postvoid residual (PVR), and maximum flow rate (Qmax). Statistical analyses were performed using the Shapiro-Wilk, Mann-Whitney, Wilcoxon, and unpaired t tests.

RESULTS

Baseline parameters were similar between groups, although volume was greater in the TLEP group (83 vs 63 cc, P=0.04). Median laser time was longer in the TLEP group (90 vs 50 min, P<0.001) with a higher median energy used (308 vs 165 kJ, P<0.001). The volume lased per unit time was shorter, however, for TLEP (0.92 cc/min) than for PVP (1.26 cc/min). A greater median number of fibers were used in TLEP (2.5 vs 2.0, P=0.001). Improvements in median IPSS and PVR were seen in the TLEP group (5.0, P<0.001; 55.5, P=0.02, respectively) but not in the PVP group (P=0.40 and 0.30). Median Qmax and prostate-specific antigen (PSA) level improved similarly in both groups. Final IPSS was lower for the TLEP group (P<0.001), but other final parameters were statistically equivalent.

CONCLUSIONS

In our series, both PVP and TLEP techniques were safe and effective. Although changes in Qmax and PSA were similar between the two techniques, improvement in urinary symptoms and PVR was superior with the TLEP technique. The TLEP technique was a more efficient method for laser prostatectomy.

Use of herbal supplements for overactive bladder

Anticholinergics, specifically antimuscarinic agents, are the most common medications prescribed for overactive bladder (OAB). The most common side effects of these agents are dry mouth and constipation, although other more concerning effects include changes in blood pressure, pulse rate, or heart rhythm when treatment is initiated. Herbal treatments are an increasingly popular alternative for treating OAB. A 2002 survey of US adults aged ≥ 18 years conducted by the Centers for Disease Control and Prevention indicated that 74.6% of those with OAB had used some form of complementary and alternative medicine. The World Health Organization estimates that 80% of the world's population presently uses herbal medicine for some aspect of primary health care. Women were more likely than men to use complementary and alternative medicine. The authors review the most commonly used herbal medications for OAB.

Conservative treatment for postprostatectomy incontinence

Postprostatectomy incontinence (PPI) is a bothersome complication of radical prostatectomy. Although most men recover from PPI, some men continue to have persistent urinary incontinence. The initial management of persistent PPI usually consists of conservative measures such as pelvic floor muscle exercises. Surgical treatments are usually not entertained for men with urinary incontinence until conservative treatments have failed. This article discusses risk factors for PPI and various options for its treatment, including biofeedback and pharmacotherapy.

Experience with the combination of dutasteride and tamsulosin in the long-term management of benign prostatic hyperplasia

Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) commonly affect older men. These bothersome symptoms can lead to a decreased quality of life. Currently, two classes of drugs - α-adrenergic blockers and 5α-reductase inhibitors - are prescribed to treat LUTS secondary to BPH. Due to their different mechanisms of action, these medications work in a synergistic manner. Trials of combination therapy have been conducted to assess its effect compared with monotherapy. Current data support combination therapy in men with moderately enlarged prostates and moderate to severe symptoms.

A prospective randomized double-blind trial of grape juice antioxidants in men with lower urinary tract symptoms

AIMS

Many patients take alternative medications for their lower urinary tract symptoms (LUTS) either in addition or as a substitute for traditional therapies, despite a lack of clinical data. Grapes products are hypothesized to improve bladder function due to their antioxidant and membrane-protective actions. There is increasing evidence that progression of obstructed bladder dysfunction is related to bladder ischemia, reperfusion injury and free radical damage. We prospectively studied a standardized grape product on urinary symptoms.

METHODS

Men >45 years with significant LUTS were randomized to 240 ml daily of either 100% Concord grape juice or placebo. Participants were followed with validated questionnaires for LUTS, erectile dysfunction, and quality of life in addition to PSA, uroflow, and serum and urinary antioxidant levels. The primary endpoint was change in LUTS in Male International Continence Symptom score. The secondary endpoint was correlation between the level of antioxidants and changes in symptom scores.

RESULTS

One hundred thirteen participations were randomized with 96 completing the 3-month follow-up. There was no difference in the primary endpoint between the groups. (ISCmale score improved by a mean of 1.6 points in both groups.) There was no statistical difference between groups by PSA or secondary questionnaires. A statistical significance was found between uroflow rates. Linear regression analysis gave no correlation between antioxidants (serum or urine) and changes in symptom scores or grape juice consumption.

CONCLUSIONS

Our study did not demonstrate any difference in LUTS in men taking a daily 240 ml 100% grape juice versus placebo after 3 months.

The use of synthetic mesh and the management of mesh extrusion in vaginal surgery

The authors present a review of the literature regarding the management of mesh extrusion in vaginal surgery. As used in traditional surgical techniques, the use of mesh theoretically allows for a broader base of support and eliminates the need to rely on pre-existing weakened fascia. In this article, the different physical properties and types of synthetic mesh used, and their respective advantages and disadvantages in terms of mesh extrusion, are reviewed.

Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms

Study Type - Prognosis (cohort). Level of Evidence 2a. What's known on the subject? and What does the study add? The metabolic syndrome, or Syndrome X, has traditionally been associated with an increased risk of cardiovascular disease and sexual dysfunction. Emerging data however now suggest that the metabolic syndrome may also have a heretofore unrecognized negative effect on voiding function as well. Weight loss through either behavioural modification or bariatric surgery has been shown to lead to improvement in stress and urge incontinence as well as LUTS. A potential relationship may be drawn between obesity and BPH. This study adds the knowledge that WC can represent a simple metric not only for elements of the metabolic syndrome but also for worsened voiding. These obese men may be at high risk of male pelvic dysfunction.

OBJECTIVES

• To determine if central obesity as measured by waist circumference (WC) is a risk factor in metabolic dysfunction, which includes hypertension, dyslipidaemia and type 2 diabetes (DM2). • To test the hypothesis that central obesity and WC are associated with and predictive of the severity of voiding dysfunction.

METHODS

• Men aged ≥ 40 years with moderate or severe lower urinary tract symptoms (LUTS, International Prostate Symptom Score ≥ 8) with no previous treatment were included for study. • Subjects were divided into three groups according to WC (<90, 90-99 and ≥ 100 cm). • Baseline parameters including International Prostate Symptom Score, prostate volume, serum prostate-specific antigen, presence of erectile dysfunction and ejaculatory dysfunction, and the prevalence of hypertension, coronary artery disease and DM2 were compared among the three WC categories. • The association between WC and all parameters assessed was tested using multivariate logistic regression analysis.

RESULTS

• In the 409 consecutive men analysed, WC was significantly and positively associated with prostate volume, serum prostate-specific antigen and International Prostate Symptom Score. • Higher WCs were also significantly associated with a greater prevalence of hypertension, coronary artery disease, DM2 and obesity as well as the presence of erectile dysfunction and ejaculatory dysfunction.

CONCLUSIONS

• Increased WC is associated with worsened voiding. • There was a significantly increased prevalence of components of the metabolic syndrome in patients with higher WC. • Obese men, in particular those with other features of the metabolic syndrome, are at increased risk of male pelvic dysfunction and can be easily recognized by measurement of WC.

Update on Phosphodiesterase Type 5 Inhibitors for the Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

Many aging men will experience both erectile dysfunction (ED) and benign prostatic hyperplasia (BPH), resulting in lower urinary tract symptoms (LUTS). Basic and clinical evidence suggests common pathogenic mechanisms underlying both LUTS and ED. Decreases in the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway with age result in decreased levels of intracellular cGMP and calcium, leading to diminished smooth muscle relaxation of the bladder and prostate and worsening LUTS. Phosphodiesterase type 5 inhibitors as monotherapy in combination with α-blockers have shown efficacy in treating both LUTS and ED. Tadalafil has recently been approved by the US Food and Drug Administration for the treatment of LUTS secondary to BPH, with or without concomitant ED.

Inflammation and benign prostatic hyperplasia: clinical implications

Prostatic inflammation may be a large contributor to hyperplastic changes in the prostate. There have been several studies looking at the varieties of growth factors and cytokines that are involved in both the inflammatory process and in the epithelial/stromal prostatic cells interactions. We reviewed the recent international literature using a PubMed search to analyze new findings supporting a role for inflammation in benign prostatic hyperplasia (BPH) progression. This article reviews the factors that lead to both intrinsic and extrinsic causes of prostatic inflammation. There are several exciting studies supporting that inflammation can promote chronic prostatic diseases, such as BPH.