Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors

Alterations in fecal short chain fatty acids (SCFAs) and branched short-chain fatty acids (BCFAs) in men with benign prostatic hyperplasia (BPH) and metabolic syndrome (MetS)

Gut microbiome-derived short-chain fatty acids (SCFAs) emerge in the process of fermentation of polysaccharides that resist digestion (dietary fiber, resistant starch). SCFAs have a very high immunomodulatory potential and ensure local homeostasis of the intestinal epithelium, which helps maintain the intestinal barrier. We analyzed the association between stool SCFAs levels acetic acid (C 2:0), propionic acid (C 3:0), isobutyric acid (C 4:0i), butyric acid (C 4:0n), isovaleric acid (C 5:0i) valeric acid (C 5:0n), isocaproic acid (C 6:0i), and caproic acid (C 6:0n)) in aging man with benign prostatic hyperplasia (BPH) and healthy controls. The study involved 183 men (with BPH, n = 103; healthy controls, n = 80). We assessed the content of SCFAs in the stool samples of the study participants using gas chromatography. The levels of branched SCFAs (branched-chain fatty acids, BCFAs): isobutyric acid (C4:0i) (p = 0.008) and isovaleric acid (C5:0i) (p < 0.001) were significantly higher in patients with BPH than in the control group. In healthy participants isocaproic acid (C6:0i) predominated (p = 0.038). We also analyzed the relationship between stool SCFA levels and serum diagnostic parameters for MetS. We noticed a relationship between C3:0 and serum lipid parameters (mainly triglycerides) in both healthy individuals and patients with BPH with regard to MetS. Moreover we noticed relationship between C4:0i, C5:0i and C6:0i and MetS in both groups. Our research results suggest that metabolites of the intestinal microflora (SCFAs) may indicate the proper function of the intestines in aging men, and increased BCFAs levels are associated with the presence of BPH.

Piperazine-Derived α1D/1A Antagonist 1- Benzyl-N- (3-(4- (2-Methoxyphenyl) Piperazine-1-yl) Propyl) -1H- Indole-2- Carboxamide Induces Apoptosis in Benign Prostatic Hyperplasia Independently of α1-Adrenoceptor Blocking

Previous studies have indicated that α_1D/1A antagonist naftopidil (NAF) suppresses prostate growth by decreasing cell proliferation without affecting apoptosis and prostate volume in benign prostatic hyperplasia (BPH). A NAF-derived α1D/1A antagonist 1- benzyl-N-(3-(4-(2-methoxyphenyl) piperazine-1-yl) propyl)-1H-indole-2- carboxamide (HJZ-12) has been reported from our laboratory, which exhibits high subtype-selectivity to both α_1D- and α_1A- AR (47.9- and 19.1- fold, respectively) with respect to a1B-AR in vitro. However, no further study was conducted. In the present study, a pharmacological evaluation of HJZ-12 in BPH was performed on an estrogen/androgen-induced rat BPH model and human BPH-1 cell line. In vivo, HJZ-12 exhibited better performance than NAF in preventing the progression of rat prostatic hyperplasia by not only decreasing prostate weight and proliferation (similar to NAF) but also, shrinking prostate volume and inducing prostate apoptosis (different from NAF). In vitro, HJZ-12 exhibited significant cell viability inhibition and apoptotic induction in BPH-1 cell line, without presenting cell anti-proliferation properties. Intriguingly, the role of HJZ-12 on cell viability and apoptosis was an α1-independent action. Furthermore, RNA-Seq analysis was applied to screen out six anti-apoptotic genes (Bcl-3, B-lymphoma Mo-MLV insertion region 1 [Bmi-1], ITGA2, FGFR3, RRS1, and SGK1). Amongst them, Bmi-1 was involved in the apoptotic induction of HJZ-12 in BPH-1. Overall, HJZ-12 played a remarkable role in preventing the progression of prostatic hyperplasia through α1-independent apoptotic induction, indicating that it will be a multi-target effective candidate for BPH treatment.

Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center

BACKGROUND AND AIMS

Prostatic urethral lift (Urolift™) is a minimally invasive technique to treat male lower urinary tract symptoms (LUTSs) due to benign prostatic hyperplasia (BPH). The aim of the present study was to assess safety and medium- to long-term outcomes in the relief of urinary symptoms.

METHODS

We included 35 men, affected by severe symptomatic BPH evaluated by International Prostate Symptom Score (IPSS), with normal erectile function (EF) and ejaculatory function (EjF) evaluated by the International Index of Erectile Dysfunction (IIEF-5) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD-SF). Exclusion criteria were prostate larger than 70 cm3, bladder neck sclerosis, concomitant third prostatic lobe, and/or other cervical urethral obstruction or cancer. All patients, preoperatively, performed uroflowmetry (UFM) with peak flow (Q-max) and post void residual volume (PVR), digital rectal exam, transrectal prostate ultrasound to measure prostate volume, PSA, and cystoscopy. Follow-up was scheduled at 1-3-6 months, then yearly, evaluating UFM, IPSS, IIEF-5, and MSHQ-EjD-SF.

RESULTS

All procedures were performed by a single senior surgeon and follow-up was 33.8 ± 12 months. Preoperative PSA was 0.82 ± 0.4 ng/ml and mean operative time was 19.6 ± 10 min and 3 (2-4) implants per patient were used. Parameters reported at last follow-up schedule were: Q-max increase of 68% (p = 0.001), PVR reduction 68% (p = 0.005), and IPSS reduction 55% (p < 0.0001). EF and EjF were similarly preserved, and no patients presented retrograde ejaculation. A total of 88.6% of patients were satisfied with LUTSs improvement and 100% satisfied with EjF.

CONCLUSION

Urolift can improve urinary disorders secondary to BPH, preserving EjF and EF. It is a safe and easy method, reproducible, and with low incidence of complications. Careful selection of patients is mandatory. The main reason for dissatisfaction is the higher expectation of better BPH symptoms relief although patients with high bladder neck and/or prostate volume >45 cm3 were aware of the possible failure.

Eight Days of Water-Only Fasting Promotes Favorable Changes in the Functioning of the Urogenital System of Middle-Aged Healthy Men

The aim of this study was to determine whether, after 8 days of water-only fasting, there are changes in the efficiency of the lower urinary tract, the concentration of sex hormones, and the symptoms of prostate diseases in a group of middle-aged men (n = 14). For this purpose, before and after 8 days of water-only fasting (subjects drank ad libitum moderately mineralized water), and the following somatic and blood concentration measurements were made: total prostate specific antigen (PSA-T), free prostate specific antigen (PSA-F), follicle stimulating hormone (FSH), luteotropic hormone (LH), prolactin (Pr), total testosterone (T-T), free testosterone (T-F), dehydroepiandrosterone (DHEA), sex hormone globulin binding (SHGB), total cholesterol (Ch-T), β-hydroxybutyrate (β-HB). In addition, prostate volume (PV), volume of each testis (TV), total volume of both testes (TTV), maximal urinary flow rate (Qmax), and International Prostate Symptom Score (IPSS) values were determined. The results showed that after 8 days of water-only fasting, Qmax and IPSS improved but PV and TTV decreased significantly. There was also a decrease in blood levels of PSA-T, FSH, P, T-T, T-F, and DHEA, but SHGB concentration increased significantly. These results indicate that 8 days of water-only fasting improved lower urinary tract functions without negative health effects.

Metabolic syndrome is associated worsened erectile function in patients undergoing TURP due to benign prostatic hyperplasia

INTRODUCTION

Transurethral resection of the prostate (TURP) is the gold standard method for surgical treatment of benign prostatic hyperplasia (BPH). So, the complications of TURP is important, in which erectile dysfunction is the most important. The aim of the present study is to evaluate erectile dysfunction in patients undergoing TURP treatment for BPH and investigate the correlation between metabolic syndrome and erectile dysfunction.

MATERIALS AND METHODS

This study included 120 patients who underwent surgery for BPH at Beylikdüzü State Hospital and Okmeydani Training and Research Hospital. IIEF-5 form was administered to the patients before the surgery and six months after the surgery. The Student's t-test, Wilcoxon, and chi-square test were used in the statistical analysis.

RESULTS

The patients were investigated by IIEF-5 scoring into three groups (severe, moderate, and non-ED (erectyl disfunction)-mild). The statistical analysis of IIEF-5 form administered to 120 patients who underwent surgery did not show any significant difference before surgery and six months after surgery (p > 0.05). Metabolic syndrome and erectile dysfunction correlation were examined, and a significant correlation was obtained between metabolic syndrome and severe erectile dysfunction (p < 0.05).

CONCLUSIONS

IIEF-5 results administered before and after surgery showed no significant difference. The study showed that patients with metabolic syndrome have a higher probability of having erectile dysfunction after TURP compared to patients without metabolic syndrome. Moreover, post-surgery, patients with metabolic syndrome seemed to be affected negatively regarding erectile dysfunction compared to patients with no metabolic syndrome.

Hyperlipidemia patients with long-term statin treatment are associated with a reduced risk of progression of benign prostatic enlargement

OBJECTIVE

To evaluate the impacts of statin treatment on the risk of benign prostatic enlargement (BPE) progression in hyperlipidemia patients.

METHODS

Newly diagnosed hyperlipidemia patients (n = 7961), identified from Taiwan's National Health Insurance Research Database, were divided into four statin cohorts (statin use >365 days, n = 1604; statin use 181-365 days, n = 813; statin use 91-180 days, n = 739; and statin use 31-90 days, n = 713) and one control cohort (cohort that used no statins, n = 4092). Study endpoint was occurrence of BPE progression (BPE diagnosis plus receiving BPE-related medications or surgery). Relative risks of BPE progression in the statin cohorts compared to the control cohort were analyzed.

RESULTS

Multivariable Cox proportional hazards regression analyses demonstrated that BPE progression risk in the cohort used statins for >365 days was significantly lower than the control cohort (adjusted hazard ratio: 0.70, 95% confidence interval: 0.58 ∼ 0.85, p < .001). However, BPE progression risks of the other three statin cohorts did not significantly differ from the control cohort. Trend analysis revealed that the effects of statin treatment on decreasing BPE progression risk were significantly related to statin treatment duration (p = .001).

CONCLUSIONS

Hyperlipidemia patients with long-term statin treatment (more than 365 days) are associated with a reduced risk of BPE progression.

The rising worldwide impact of benign prostatic hyperplasia

OBJECTIVES

To describe the trend in the impact of lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH) on a global scale using the Global Burden of Disease (GBD) database.

MATERIALS AND METHODS

Using the GBD database, worldwide data aggregated from registries and health systems from 1990 to 2017 were filtered for LUTS/BPH diagnoses. Calculation of years lived with disability (YLD) were compared with other urological diseases. YLD were calculated by a standardized method using assigned disability weights. The GBD-defined sociodemographic index (SDI) was used to assess impact of LUTS/BPH by global SDI quintile.

RESULTS

Global Burden of Disease data over the 1990-2017 study period were summarized and global numbers and trends noted with other urological diseases for comparison. A total of 2 427 334 YLD were attributed to BPH in 2017 alone, almost three times more than those attributed to the next highest urological disease, prostate cancer (843 227 YLD). When stratified by SDI quintile, a much lower impact of BPH was found in the bottom three quintiles, despite this subset representing 66.9% of the 2017 world population.

CONCLUSIONS

Lower urinary tract symptoms attributed to benign prostatic hyperplasia exert a rapidly rising human burden far exceeding other urological diseases. As the population ages and men in a lower SDI enjoy increased life expectancy and decreased competing mortalities, a continually accelerating wave of LUTS/BPH can be forecast. These epidemiological trends have serious implications for the future allocation of resources and the global urological workforce.

Readability Assessment of Internet-based Patient Education Materials Related to Treatment Options for Benign Prostatic Hyperplasia

RATIONALE AND OBJECTIVES

To assess the current readability levels for online Internet-Based Patient Education Materials (IPEMs) related to treatment options for benign prostatic hyperplasia, including transurethral resection of prostate (TURP) and prostate artery embolization (PAE).

MATERIALS AND METHODS

Using the Google search engine we identified 40 IPEMs pertaining to TURP and PAE. Readability analysis was performed using the following algorithms: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Formula (FKGL), Simple Measure of Gobbledygook (SMOG), and the Gunning Frequency of Gobbledygook (GFOG). Scores are categorized by difficulty (FRES) and grade level (FKGL, SMOG, GFOG).

RESULTS

Only 7.5% (3/40) websites met the United States Department of Health and Human Services recommendation of a sixth grade or lower comprehension levels, with FRES scores in the "fairly easy" category. Comparison of TURP to PAE groups showed that TURP readability scores with respect FRES and FKGL were significantly easier to read. According to SMOG and GFOG analysis there was no difference between the two groups by grade level, which demonstrated an average at the 12th grade reading level. Subgroup analysis of IPEM type, categorized as Health Networks (12), University Hospitals (14), Clinical Practices (6), and Miscellaneous (8), found no difference in reading level across all scoring systems.

CONCLUSION

Currently available IPEMs pertaining to benign prostatic hyperplasia treatment options are written at a level that is too difficult for the average American to understand. Physicians and health networks should take United States Department of Health and Human Services recommendations into consideration when designing IPEMs to optimize accessibility of health information to improve patient compliance and outcomes.

Escherichia coli, a common constituent of benign prostate hyperplasia-associated microbiota induces inflammation and DNA damage in prostate epithelial cells

BACKGROUND

The role of microbiota in the pathophysiology of benign prostate hyperplasia (BPH), especially in creating an inflammatory milieu may not be avoided. The major objectives of this study were to investigate the microbial composition of BPH tissues, its association with inflammation and check the effect of clinically isolated bacteria on prostate epithelial cells.

METHODS

The study includes 36 patients with a pathological diagnosis of BPH. Following strict aseptic measures, tissues were collected after transurethral resection of prostate, multiple pieces of the resected tissues were subjected to histopathological analysis, bacterial culture and genomic DNA extraction. Microbial composition was analyzed by culture and/or next-generation sequencing methods. Annotation of operational taxonomy unit has been done with an in-house algorithm. The extent of inflammation was scored through histological evaluation of tissue sections. The effect of clinical isolates on nuclear factor-κB (NF-κB) activity and induction of DNA-damage in the prostate epithelial cells were evaluated.

RESULTS

Histopathological analysis of the BPH tissues showed the presence of inflammation in almost all the tissues with a varied level at different regions of the same tissue section and the level of overall inflammation was different from patients to patients. Microbial culture of tissue samples showed the presence of live bacteria in 55.5% (20 out of 36) of the patient tissues. Majority of the isolates were coagulase-positive Staphylococcus, E. coli and Micrococcus spp. Further, V3 16S rRNA sequencing of the DNA isolated from BPH tissues showed the presence of multiple bacteria and the most common phylum in the BPH tissues were found to be Proteobacteria, Actinobacteria, Firmicutes, and Bacteroidetes. The E. coli, isolated from one of the tissue was able to activate NF-κB and induce DNA damage in prostate epithelial cells. Phospho-histone γH2A.X staining confirmed the presence of cells with damaged DNA lesion in BPH tissues and also correlated with the severity of inflammation.

CONCLUSION

Our study has shown that the BPH tissues do have a divergent microbial composition including the commonly found E. coli (phylum Proteobacteria), and these bacteria might contribute to the BPH-associated inflammation and/or tissue damage. The BPH-associated E. coli induced NF-κB signaling and DNA damage in prostate epithelial cells in vitro.

An Update on Minimally Invasive Surgery for Benign Prostatic Hyperplasia: Techniques, Risks, and Efficacy

Benign prostatic hyperplasia (BPH), a common cause of lower urinary tract symptoms in the elderly male population, has conventionally treated by transurethral resection of the prostate (TURP). During recent years, newer minimally invasive therapies (MITs) have entered the playing field and challenged TURP with their convenience, lack of sexual side effects, and overall safety. The present paper provides an update on the more heavily studied and most recent MITs, analyzing their mechanism of action, tolerability, and efficacy in clinical practice. Particularly, robust clinical data have propelled UroLift and Rezuum to the forefront in the armamentarium of minimally invasive BPH treatment. Newer mechanical therapies such as the temporary implantable nitinol device, ClearRing, ZenFlow Spring, and Butterfly are appealing options as they forego cutting, ablation, heating, or removing prostatic tissue. It is obvious that there is wide variation in the degree of clinical readiness of each modality and only time and long-term, multicenter studies will decide which of these therapies are accepted by the patient and urologist.

Prevalence of Community Acquired Uropathogens and their Antimicrobial Susceptibility in Patients from the Urology Unit of A Tertiary Care Medical Center

Urinary tract infections (UTI) are one of the most common community acquired infections and can also present with similar lower urinary tract symptoms (LUTS). Moreover, UTI can be a complication of these urological diseases. Thus, this study was conducted in patients with LUTS to find out the prevalence of uro-pathogens and their antibiotic susceptibility pattern so that appropriate antibiotics can be started on clinical suspicion of UTI. The study was conducted over a period of 12 months. Culture and susceptibility of urine specimen was done as per standard microbiological guidelines. Apart from the growth of common bacteria with their antibiogram, Methicillin-resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) was investigated among Enterococci, and metallo beta-lactamases(MBL) production was production was investigated among gram-negative pathogens. Out of 407 urine samples included in the study, 80 (19.6%) samples showed bacterial growth. The commonest isolate was E. coli 44 (55 %). Majority of the isolates were multidrug resistant with two E.coli strains showing pan-resistance to the first line drugs tested. Carbapenem resistance was seen in 67.2% of all gram negative isolates tested. Metallo beta-lactamases production was found to be highest among the Klebsiella isolates. Among the Enterobacterales, highest susceptibility was noted to Fosfomycin (87.7%) followed by Nitrofurantoin (62.7%). Similarly in gram positive group, highest susceptibility was again to Fosfomycin followed by Nitrofurantoin. Overall the prevalence of MDR is increasing however Fosfomycin or Nitrofurantoin, both oral antibiotics, can be the considered for starting empirical antibiotic therapy.

Zinc Deficiency in Men Over 50 and Its Implications in Prostate Disorders

Research has been consistently showing the role of zinc (Zn) in prostate function. In this article, we review the current literature on the anatomy and main functions of the prostate, highlighting the role of zinc. In particular, we will review the etiology of benign prostate enlargement (BPH), its prevalence in men over 50, the likelihood of BPH becoming prostate cancer (PCa), and explain the relationship of zinc and apoptosis in the prostate cells and the implications for BPH and PCa. We present a model that explains how endogenous factors provoke excretion of zinc or limit zinc absorption, and how exogenous factors like nutrition and drugs regularly used in men over 50 can significantly decrease zinc status and thereby increase the risk of BPH. Finally, we explain how Zn amino acid (AA) complexes may be capable of avoiding antagonists and inhibitors of zinc absorption, thereby increasing the bioavailability of zinc for the necessary biological processes in the prostate.

Efficacy and safety of tadalafil vs tamsulosin in lower urinary tract symptoms (LUTS) as a result of benign prostate hyperplasia (BPH)-open label randomised controlled study

INTRODUCTION & AIM

Several newer medications have emerged for the management of lower urinary tract symptoms secondary to benign prostate hyperplasia (BPH). The efficacy/safety of PDE-5 inhibitors (Tadalafil 5 mg) in BPH-lower urinary tract symptoms (LUTS) has been sparingly assessed in the published English literature as compared with their established role in erectile dysfunction. We aim to assess the efficacy/safety of tadalafil vs tamsulosin in symptomatic patients of BPH in a tertiary care teaching institution.

METHODS

After obtaining an informed written consent and institutional ethics clearance, 100 patients of BPH with an IPSS score of more than 7, without any complications of the disease were computer randomised to receive therapy with either tamsulosin 0.4 mg or tadalafil 5 mg once daily for a period of 2 months. They were evaluated for its efficacy (IPSS, Peak flow rate, IIEF-5, quality of life index [QOL] and PVR) and safety (side effect profile) with monthly visit assessments for 2 months. Data were analysed statistically using ANOVA and unpaired t-tests.The protocol was registered with the CTRI/2018/03/012825.

RESULTS

Patients in both groups were comparable on basis of their demographic data, renal function, PSA and baseline efficacy parameters. Significant improvements were visualised amongst/within both groups for IPSS, however the intergroup improvement was not significant (P = .096). Similar trends were seen with peak flow rate and PVR with intergroup improvement differences not being significant (P = .552 and P = .131, respectively).Improvements in QOL index were more significant in the tamsulosin group (mean difference -2.3 vs -3.06 P = .010).The adverse effects were minor and were managed symptomatically without any drug discontinuity.

CONCLUSIONS

In summary, therefore, we may conclude that that once daily monotherapy with tadalafil 5 mg or tamsulosin 0.4 mg was equally efficacious in the management of moderate to severely bothersome LUTS in majority of patients as a result of BPH. The role of Tadalafil monotherapy in BPH patients with predominant storage LUTS merits further evaluation with larger trials.

Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes

INTRODUCTION

This study aimed to assess the midterm outcomes and safety of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH).

METHODS

A single-center, retrospective review of PAE performed for BPH was performed. Validated International Prostate Symptom Score (IPSS), quality of life (QoL) index, and International Index for Erectile Function (IIEF-5) questionnaires were completed at baseline and at least 12 months post-procedure. Prostate imaging was performed preprocedure as well as 3 months and 12 months post-procedure to assess prostate volume (PV). Uroflowmetry was also performed at baseline and 12 months post-procedure to assess urine flow rate (Q_max) and post-void residual (PVR) volume. Adverse events were graded according to Society of Interventional Radiology (SIR) guidelines.

RESULTS

Eighty male patients underwent the PAE procedure (mean age 69 years). Prostate volume decreased significantly from a mean volume 156 to 107 mL after 12 months post-procedure, commensurate with a mean reduction of 27.5% (P < .05). Significant improvements were seen in IPSS (21.8 vs 10.5) and QoL (4.5 vs 2.0) from baseline to 12 months post-procedure (P < .05). There was no significant change in IIEF-5 score. There was a significant reduction in PVR (202 vs 105 mL) and improvement in Q_max (5.9 vs 10.0 mL/s) between baseline and 12 months post-procedure (P < .05). No major complications occurred; 4 minor complications occurred (SIR grade A or B).

CONCLUSION

Prostate artery embolization achieved a clinically and statistically significant prostate volume reduction, symptom and QoL improvement, and enhanced uroflowmetry parameters in patients with BPH.

Serum testosterone and prostate-specific antigen levels are major risk factors for prostatic volume increase among benign prostatic hyperplasia patients

Objective

Benign prostatic hyperplasia (BPH) is one of the most common diseases found among elderly men. Even though multiple risk factors of BPH have been identified in the past, the risk factors which have a direct impact on prostate volume have not been identified. In this study, we aim to determine the most significant contributing risk factors to prostate volume enlargement by analyzing possible associated risk factors previously studied.

Methods

This is a quantitative study with an analytical observational design, performed using a retrospective cohort approach. Total sampling was performed on 83 patients who underwent transurethral resection of the prostate (TURP) in Sanglah General Hospital from January to February 2019. Bivariate analysis is performed to examine each variable's association with prostate volume followed by a multivariate analysis. All variables were reassessed with path analysis to measure the direct effects, indirect effects, and total effects on prostate volume.

Results

Bivariate analysis shows that serum testosterone (R=0.208; p=0.059) and prostate-specific antigen (PSA) level (R=0.626; p=0.001) have a significant association with prostate volume. Multivariate analysis shows that serum PSA (B=1.4; p=0.001; 95% confidence interval [95% CI]=1.039–1.770) and testosterone (B=0.024; p=0.005; 95% CI=0.008–0.041) levels are significant among all the analyzed risk factors. There is a significant and strong effect of PSA to prostate volume (c=0.636; p=0.001) whereas testosterone has a significant albeit weak effect to prostate volume (c=0.246; p=0.009) based on the total effect of the path analysis.

Conclusion

Serum testosterone and PSA levels are significantly associated with prostatic volume increase among BPH patients.

Quality of Life in Older Adults with Benign Prostatic Hyperplasia

The purpose of this study is to identify factors that affect health-related quality of life (HRQOL) of older patients with Benign Prostatic Hyperplasia (BPH) and suggest ways to improve the same. Through this, we will improve the self-management practice of patients and promote the treatment of BPH in older patients. The 2015 Korea Health Panel Survey data were used in this study. A total of 422 BPH patients aged 65 or older were included. Logistic regression analysis was conducted to identify factors affecting the HRQOL of older patients with BPH. General characteristics of factors affecting older patients with BPH included income level and type of insurance. In addition, among medical-related characteristics and health behavior factors, subjective health status, unmet medical care needs, moderate physical activity, sitting time, and drinking influenced the HRQOL. Therefore, in order to improve the HRQOL of adult patients with BPH, it is necessary to improve medical accessibility by strengthening primary care. In addition, it is necessary to increase the amount of activity in daily life through healthcare medical devices.

Risk Factors for Prostate Volume Progression After Prostate-Transurethral Resection

Background

Many factors could contribute to the cases of residual benign prostate hypertrophy (BPH) volume after transurethral resection of the prostate (TURP), such as age, obesity, testosterone level, and inflammation. The goal of this study was to determine the risk of tumor necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β) in prostate tissue, serum prostate-specific antigen (PSA), serum testosterone, and age in promoting prostate volume progression after TURP.

Patients and Methods

This was a prospective cohort study on 83 BPH patients who underwent TURP at five hospitals in Bali, Indonesia. Trans-rectal ultrasonography (TRUS) was carried out to examine the prostate’s size. Three years after, we redo the TRUS examination to collect the data of the latest prostate size. TNF-α, TGF-β, serum PSA, testosterone, and age were registered for analysis. We used Pearson’s and Spearman’s correlation tests and multivariate analytic linear regression test (coefficient β) by SPSS 13.0 software.

Results

Age, testosterone, PSA, TNF-α, TGF-β were positively correlated to prostate’s volume progression. The prostate volume was strongly correlated with age (r= 0.749, p <0.001), PSA level (r=0.896, p <0.001), testosterone level (r=0.818, p <0.001), and TGF-β (r=0.609, p <0.001). The TNF-α level has a weak correlation to prostate’s volume progression (r=0.392, p <0.001).

Conclusion

TNF-α, TGF-β, PSA, testosterone, and age were significant as the risk factors in promoting the prostate volume progression after TURP.

Measurement of autophagy flux in benign prostatic hyperplasia in vitro

Background

Recent studies have suggested a novel therapeutic strategy for treatment of benign prostatic hyperplasia (BPH) via modulation of autophagy. However, it is not clear whether autophagy induction or inhibition can render better therapeutic efficacy for BPH treatment because autophagy activation in BPH tissue is not precisely known and still contradictory. The purpose of this study was to examine the levels of autophagy in BPH tissue cells.

Methods

We have analyzed and compared autophagic flux which is defined as a measure of autophagic degradation activity in two human prostate epithelial cell lines, RWPE-1 (normal prostate) and BPH-1 (BPH) using LC3-II turnover assay, to clarify the levels of autophagy in BPH.

Results

The in vitro autophagy flux assays showed that autophagy flux was significantly decreased in BPH-1 cell lines compared with RWPE-1 cells under all three conditions of using the original (~62%), the exchanged (~46%), and the same media (Hank's balanced salt solution (HBSS), ~40%), and these results were similar to those seen in the prostate of testosterone-induced BPH rats (~50%) (P < 0.05).

Conclusion

It is suggested that defective autophagy, which is decreased autophagy flux in the prostate gland, may be implicated in BPH, and activating autophagy flux of the prostate with BPH may be used as a potential therapeutic target for treating and alleviating BPH disease.

Lower urinary tract symptoms and health-related quality of life in Hong Kong primary care: a cross-sectional study

PURPOSE

To estimate the prevalence of lower urinary tract symptoms (LUTS) in primary care using the International Continence Society symptom definition; to evaluate the association between LUTS and health-related quality of life (HRQOL); and to evaluate the treatment gaps.

METHODS

Patients aged 40 and above were randomly recruited in a Hong Kong public primary care. Patients were asked (i) how often they experienced 18 individual LUTS during the past 4 weeks and (ii) whether they had sought treatments for their LUTS. The 12-Item Short Form Health Survey version 2 (SF-12 v2) and the modified Incontinence Impact Questionnaire-Short Form (IIQ-7) were used to measure HRQOL.

RESULTS

500 patients completed the survey. 75.8% of the patients had at least one LUTS "at least sometimes", with patients with a combination of storage, voiding, and post-micturition symptoms being the most prevalent (22.2%), followed by a combination of voiding and storage symptoms (14%). Only 14% of LUTS patients had sought treatments for their LUTS. LUTS was associated with a negative effect in all domains of the SF-12 v2 and IIQ-7 and patients with a combination of storage, voiding, and post-micturition symptoms had the worst HRQOL. Finally, having a combination of storage, voiding, and post-micturition symptoms and poorer HRQOL were factors associated with having sought treatments for LUTS.

CONCLUSION

A high prevalence of LUTS but low treatment-seeking rates implied possible unmet needs of LUTS patients in primary care, suggesting the potential for more active interventions to alleviate the negative impact of LUTS on patients' HRQOL.

Epidemiology and treatment modalities for the management of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting men. BPH can lead to a number of symptoms for patients commonly referred to as lower urinary tract symptoms (LUTS). Over the last decade, increased modifiable risk factors, such as metabolic disease and obesity, have resulted in an increased incidence of BPH. This increasing incidence has brought about a multitude of treatment modalities in the last two decades. With so many treatment modalities available, physicians are tasked with selecting the optimal therapy for their patients. Current therapies can first be divided into medical or surgical intervention. Medical therapy for BPH includes 5-alpha-reductase inhibitors and alpha-blockers, or a combination of both. Surgical interventions include a conventional transurethral resection of the prostate (TURP), as well as newer modalities such as bipolar TURP, holmium laser enucleation of the prostate (HoLEP), Greenlight and thulium laser, and prostatic urethral lift (PUL). Emerging therapies in this field must also be further investigated for safety and efficacy. This narrative review attempts to consolidate current and emerging treatment options for BPH and highlights the need for additional investigation on optimizing treatment selection.

Glycosylation products in prostate diseases

Although prostate cancer is notable for its high incidence and mortality in men worldwide, its identification remains a challenge. Biomarkers have been useful tools for the specific detection of prostate cancer. Unfortunately, benign prostate diseases cause similar alterations in screening assays thus reducing the potential for early and specific diagnosis. Changes in glycan and glycoprotein expression have often been associated with the onset and progression of cancer. Abnormal glycans and glycoproteins have been reported as new biomarkers of prostate metabolism that can distinguish benign prostate disease and cancer in non-aggressive and aggressive stages. Carbohydrate-binding proteins known as lectins have been valuable tools to detect these changes, investigate potential biomarkers and improve our understanding aberrant glycosylation in cancer. Here we review progress in elucidating prostate disease and discuss the roles of glycans in the differential detection of benign and cancerous prostate disease. We also summarize the lectin-based tools for detecting glycosylation changes.

Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment

Symptomatic benign prostatic hyperplasia is a common condition in the aging population that results in bothersome lower urinary tract symptoms and decreased quality of life. Patients often are treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is considered the traditional standard of care, but several minimally invasive surgical treatments also are offered. Prostatic artery embolization (PAE) is emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalization. The procedure is offered to patients with moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolization are critical to optimize results. To perform PAE safely and avoid nontarget embolization, interventional radiologists must have a detailed understanding of the pelvic arterial anatomy. Although the prostatic arteries often arise from the internal pudendal arteries, several anatomic variants and pelvic anastomoses are encountered. Prospective cohort studies, small randomized controlled trials, and meta-analyses have shown improved symptoms after treatment, with serious adverse effects occurring rarely. This article reviews the basic principles of PAE that must be understood to develop a thriving PAE practice. These principles include patient evaluation, review of surgical therapies, details of pelvic arterial anatomy, basic principles of embolization, and an overview of published results. Online supplemental material is available for this article. ^©RSNA, 2019.

Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

Purpose

To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other.

Materials and methods

The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry.

Results

There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed.

Conclusion

In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

Health-related quality of life in adult males with lower urinary tract symptoms

PURPOSE

To assess the status and impact of lower urinary tract symptoms (LUTS) on health-related quality of life (HRQoL) in a community-based sample of Korean adult males.

METHODS

We analyzed the data of 101,606 adult males aged ≥ 19 years of age obtained during the 2011 Korean Community Health Survey. Subject data were assessed for LUTS and HRQoL using international prostate symptom scores, and EuroQol-five-dimensions three-level version (EQ-5D-3L) and EuroQol-visual analogue scale (EQ-VAS) scores.

RESULTS

Of the 101,606 subjects, 53,323 (52.5%) reported having at least one LUTS and 3116 (3.1%) had an IPSS of ≥ 20, indicating severe LUTS. In those aged 19-39 years, 28.7% (8343/29,072) reported they had mild to severe LUTS. The prevalence of LUTS was high among those aged 40-59 years (47.7%), 60-79 years (80.5%), and ≥ 80 years (91.2%). In addition, EQ-5D-3L and EQ-VAS scores decreased as LUTS severity and frequency increased.

CONCLUSIONS

Adult men of all ages with mild to severe LUTS have poorer health statuses and quality of life. Even among young males, LUTS severity and was found to negatively affect HRQoL.

Beyond tribulus (Tribulus terrestris L.): The effects of phytotherapics on testosterone, sperm and prostate parameters

ETHNO-PHARMACOLOGICAL RELEVANCE

Phytotherapeutic approaches have been widely proposed to improve male health. Despite the well-touted effects of tribulus (Tribulus terrestris L) on men's health, an optimal phytotherapy remains an elusive challenge.

AIM OF THE REVIEW

We sought to critically analyze the evidence in the phytotherapic literature beyond the effects of tribulus on testosterone (T) concentration and sperm analysis to also include indications for prostate health.

MATERIALS AND METHODS

A focused literature search was conducted to include studies published in Cochrane, Pubmed, and Web of Science databases between the years 2002 and 2018.

RESULTS

The use of tribulus and maca (Lepidium meyenii Walp, Brassicaceae) were not scientifically supported to improve serum T levels in men. Moderate evidence supports the use of long Jack (Eurycoma longifolia Jack, Simaroubaceae), mucuna (Mucuna pruriens (L.) DC., Fabaceae), ashwagandha (Withania somnifera (L.) Dunal, Solanaceae), fenugreek (Trigonella foenum-graceum L., Fabaceae), and black seeds (Nigella sativa L., Ranunculaceae) to increase total T and improve seminal parameters. Data suggests an increase in total T with the use of 5000 mg/d of powdered mucuna seed and ashwagandha root (151 and 143 ng/dL, respectively) over a 12-week period in patients with oligozoospermia. The use of mucuna was supported for patients with oligozoospermia to improve sperm parameters, with an increase of 83.3 million/mL observed after use of 5000 mg/d of powdered mucuna seed over a 12-week period. Evidence supporting the use of saw palmetto (Serenoa repens, (W.Bartram) Small, Arecaceae) to improve prostate health remains equivocal; whereas, evidence supporting the use of Pygeum africanum Hook.f., Rosaceae, Urtica dioica L., Urticaceae, beta-sitosterols, pollen extract, onion, garlic, and tomato, appears favorable and promising.

CONCLUSION

Scientific evidence supports the use of mucuna and ashwagandha as phytotherapics for improving serum T concentrations and semen parameters. Despite inconclusive evidence for use of tribulus as a T booster, it may provide advantageous effects on sperm parameters in men with idiopathic infertility. Nutraceutical strategies and some phytotherapics may also be effective to promote prostate health. Popular foodstuffs (onion, garlic, and tomato), nutraceutical agents (pollen extract and beta-sitosterols), and herbal medicines (Pygeum africanum and Urtica dioica) are rational approaches.

Inhibition of the CXCL12/CXCR4 axis prevents periurethral collagen accumulation and lower urinary tract dysfunction in vivo

BACKGROUND

Several studies show that prostatic fibrosis is associated with male lower urinary tract dysfunction (LUTD). Development of fibrosis is typically attributed to signaling through the transforming growth factor β (TGF-β) pathway, but our laboratory has demonstrated that in vitro treatment of human prostatic fibroblasts with the C-X-C motif chemokine ligand 12 (CXCL12) chemokine stimulates myofibroblast phenoconversion and that CXCL12 has the capacity to activate profibrotic pathways in these cells in a TGF-β-independent manner. We have previously reported that feeding mice high-fat diet (HFD) results in obesity, type II diabetes, increased prostatic fibrosis, and urinary voiding dysfunction. The purpose of this study was to test the hypothesis that in vivo blockade of the CXCL12/CXCR4 axis would inhibit the development of fibrosis-mediated LUTD in HFD-fed mice.

METHODS

Two-month-old male senescence-accelerated mouse prone-6 mice were fed either a HFD or low-fat diet (LFD) for 8 months. Half of each dietary group were given constant access to normal water or water that contained the C-X-C chemokine receptor type 4 (CXCR4; CXCL12 receptor) antagonist CXCR4AIII. At the conclusion of the study, mice were weighed, subjected to oral glucose tolerance testing and cystometry, and lower urinary tract tissues collected and assessed for collagen content.

RESULTS

HFD-fed mice became significantly obese, insulin resistant, and hyperglycemic, consistent with acquisition of metabolic syndrome, compared with LFD-fed mice. Anesthetized cystometry demonstrated that HFD-fed mice experienced significantly longer intercontractile intervals and greater functional bladder capacity than LFD-fed mice. Immunohistochemistry demonstrated high levels of CXCR4 and CXCR7 staining in mouse prostate epithelial and stromal cells. Picrosirius red staining indicated significantly greater periurethral collagen deposition in the prostates of HFD than LFD-fed mice. Treatment with the CXCR4 antagonist CXCR4AIII did not affect acquisition of metabolic syndrome but did reduce both urinary voiding dysfunction and periurethral prostate collagen accumulation.

CONCLUSIONS

This is the first study to report that obesity-induced lower urinary tract fibrosis and voiding dysfunction can be repressed by antagonizing the activity of the CXCR4 chemokine receptor in vivo. These data suggest that targeting the CXCL12/CXCR4 signaling pathway may be a clinical option for the prevention or treatment of human male LUTD.

Prevalence and heritability of benign prostatic hyperplasia and LUTS in men aged 40 years or older in Zhengzhou rural areas

BACKGROUND

Benign prostate hyperplasia (BPH) is the most common disease among aging males, but no reports have addressed the prevalence of BPH in Zhengzhou. Therefore, we aimed to understand the prevalence of BPH in men aged 40 years or older in Zhengzhou's rural areas through a cross-sectional study and analyzed the correlation with epidemiologic factors and the heritability of the disease.

MATERIALS AND METHODS

A multistage sampling method was used to randomly select male respondents in Zhengzhou's rural areas. Men who were 40 years of age or older and their first-degree relatives were subjected to the International Prostate Symptom Score (IPSS) and related examinations. Heritability was calculated according to the prevalence of the first-degree relatives in the case and control groups.

RESULTS

The prevalence of BPH was 10.04%. Its prevalence increased with age, from 2.17% in men aged 40-44 years to 31.11% in men aged 80 years or older. The average volume of the prostate was 17.16 ± 7.96 mL, and the average IPSS was 5.89 ± 5.91. The analysis of the correlation between the associated risk factors and BPH revealed that prostatitis and a history of prostatic hyperplasia were significant factors. Obesity, smoking, drinking, diabetes, and hypertension were not correlated with BPH. Of the 94 first-degree relatives of the cases, 53 had BPH (56.38%); of the 106 first-degree relatives of the controls, five had BPH (4.72%). Heritability appeared to account for 40.48% of BPH cases. The heritability of incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia was 43.28, 71.37, 9.67, 5.67, 2.70, 53.36, and 19.12%, respectively.

CONCLUSION

The total prevalence of BPH in men aged 40 years or older in Zhengzhou's rural areas was 10.04%, and the heritability of prostatic hyperplasia was 40.48%.

Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature

We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.

Evaluation of quality of life in patients undergoing surgery for benign prostatic hyperplasia

INTRODUCTION

Benign prostatic hyperplasia (BPH) is one of the most common diseases in the world and also one of the most common causes of urinary complaints that occur with increasing age. Thus, BPH should be addressed with surgical procedures. To contribute to the relevant literature, the present study aims to investigate the effects of surgical therapies for BPH on the patients quality of life.

MATERIALS AND METHODS

This study included 120 patients who underwent surgery for BPH at a Training and Research Hospital. The short-form health survey (SF-36) was administered to the patients before the surgery and at three months after the surgery. Eight parameters of the SF-36 and mental (MCS) and physical (PCS) component summary scores were calculated. The Student's t-test, Wilcoxon, and chi-square test were used in the statistical analysis.

RESULTS

When the eight parameters within the SF-36 health questionnaire were examined separately, the findings showed that patients quality of life increased significantly with respect to physical functioning, social functioning, and role limitations because of emotional problems , vitality, bodily pain, general health perceptions, and mental health domains three months after surgery (p < .001). The PCS and MCS significantly increased after surgery (p < .001).

CONCLUSION

The SF-36 questionnaire results showed that a significant improvement in the patients quality of life was observed in patients who underwent surgery for BPH. Our findings suggest that SF-36 could be considered a reliable evaluation test to be used in the patients with BPH after surgery.

Genome-wide associations for benign prostatic hyperplasia reveal a genetic correlation with serum levels of PSA

Benign prostatic hyperplasia and associated lower urinary tract symptoms (BPH/LUTS) are common conditions affecting the majority of elderly males. Here we report the results of a genome-wide association study of symptomatic BPH/LUTS in 20,621 patients and 280,541 controls of European ancestry, from Iceland and the UK. We discovered 23 genome-wide significant variants, located at 14 loci. There is little or no overlap between the BPH/LUTS variants and published prostate cancer risk variants. However, 15 of the variants reported here also associate with serum levels of prostate specific antigen (PSA) (at a Bonferroni corrected P < 0.0022). Furthermore, there is a strong genetic correlation, r_g = 0.77 (P = 2.6 × 10⁻¹¹), between PSA and BPH/LUTS, and one standard deviation increase in a polygenic risk score (PRS) for BPH/LUTS increases PSA levels by 12.9% (P = 1.6×10⁻⁵⁵). These results shed a light on the genetic background of BPH/LUTS and its substantial influence on PSA levels.

Elderly males are often affected by benign prostatic hyperplasia and associated lower urinary tract symptoms (BPH/LUTS), but their link to prostate cancer risk is not well defined. Here, a genome-wide association study of BPH/LUTS patients from Iceland and the UK found 23 significant variants at 14 loci, and 15 of these variants associate with prostate specific antigen, which is linked to prostate cancer risk.

Hypogonadal men with moderate-to-severe lower urinary tract symptoms have a more severe cardiometabolic risk profile and benefit more from testosterone therapy than men with mild lower urinary tract symptoms

Purpose

To analyze data from an observational, prospective, cumulative registry study in 805 hypogonadal men stratified by mild or moderate-to-severe lower urinary tract symptoms (LUTS) according to International Prostate Symptom Score.

Materials and Methods

A total of 412 men underwent testosterone therapy (TTh) with injectable testosterone undecanoate, 393 men served as untreated controls. Measures of urinary function, anthropometric and metabolic parameters were performed at least twice per year.

Results

Data from 615 men with mild LUTS (253 treated, 362 untreated) and 190 with moderate-to-severe LUTS (159 treated, 31 untreated) were available. During a follow-up period of 8 years a significant improvement of LUTS was noted for all TTh-patients whereas the control-groups showed deterioration or fluctuation around initial values. Despite advancing age, TTh fully prevented worsening of symptoms. In parallel, a considerable improvement of anthropometric parameters, lipids and glycemic control, blood pressure, C-reactive protein, and quality of life was found. Moderate-to-severe LUTS was associated with worse cardiometabolic risk profile at baseline as well as worse cardiovascular outcomes during follow-up in comparison to mild LUTS. Effect size of TTh was more pronounced in men with moderate-to-severe than with mild LUTS.

Conclusions

Correcting hypogonadism by TTh is highly effective and safe for improving LUTS in hypogonadal men. TTh may also improve cardiometabolic risk and major adverse cardiovascular events.

Photoselective vaporization has comparative efficacy and safety among high-risk benign prostate hyperplasia patients on or off systematic anticoagulation: a meta-analysis

PURPOSE

The necessity to cease anticoagulation before photoselective vaporization (PVP) surgery remains nonconsensual. We aimed at assessing the efficacy and safety of PVP among high-risk benign prostate hyperplasia (BPH) patients on or off anticoagulation.

METHODS

We systematically searched Pubmed, Embase, and Cochrane Library Central Register of Controlled Trials (CENTRAL). 2299 patients from 11 studies were eventually included. Newcastle-Ottawa Scale (NOS) was employed to assess the quality and risk of bias of each study. All statistical analyses were conducted with Review Manager v.5.3 software.

RESULTS

Ten parameters (operation time, laser time, blood transfusion, urethral stricture, urinary tract infection, reoperation, dysuria, capsule perforation, catheterization time, and re-catheterization) from patients on or off anticoagulant therapy were collected. The patients without anticoagulants performed better at catheterization time [MD - 0.54, 95% CI (- 0.82, - 0.26), P = 0.96, I² = 0] with a reduction of 0.54 day than those on anticoagulants. Significant statistical difference was not observed from other parameters. Subgroup analysis, grouped by the power output of PVP systems (80 W, 120 W and 180 W), consistently showed no statistical significant difference except at catheterization time in the 180-W PVP subgroup.

CONCLUSION

PVP, a safe and effective option for high-risk BPH patients, work comparably regardless of anticoagulant therapy, despite non-anticoagulant patients have shorter catheterization time. It is implied that the use of anticoagulants might be unnecessary to stop for high-risk BPH patients undergoing PVP for the sake of safety, which certainly requires further investigations to confirm.

Inhibitory effects of Pycnogenol®, a pine bark extract, in a rat model of testosterone propionate-induced benign prostatic hyperplasia

Benign prostate hyperplasia (BPH) is a male reproductive disease that has gained increasing importance in recent years. The present study investigated whether Pycnogenol® (PYC), a standardized French maritime pine bark extract, could prevent BPH induced by testosterone propionate (TP) in rats. Male Sprague-Dawley rats were randomly divided into five groups of six rats. One group was used as a normal control rats and the other groups received subcutaneous injections of TP for 4 weeks to induce BPH. In the two treatment groups, PYC (20 or 40 mg/kg) was administered daily for 4 weeks by oral gavage concurrently with the induction of TP. All rats were sacrificed at the scheduled termination time, the prostates were weighed, and histopathologic examinations were conducted. Dihydrotestosterone (DHT) levels in serum and the prostate were measured, and the expression of proliferating cell nuclear antigen (PCNA) and Ki-67 proteins was investigated. BPH-treated animals showed increases in the relative weight of the prostate, higher concentrations of DHT in serum and the prostate, and higher expression of PCNA and Ki-67 in the prostate; in contrast, PYC-treated animals had significant reductions in these factors compared with the BPH animals. These findings indicated that PYC inhibited the development of BPH and that this was closely associated with a reduction in DHT concentration.

Predictors of the international prostate symptoms scores for patients with lower urinary tract symptoms: A descriptive cross-sectional study

Background

Lower urinary tract symptoms (LUTSs) can significantly reduce men's quality of life and may point to serious pathology of the urogenital tract. This study aimed at finding predictors of symptoms score on the International Prostate Symptom Score (IPSS) for patients with LUTS.

Materials and Methods

The study was cross-sectional conducted among 225 Ghanaian men visiting the urology clinic at Komfo Anokye Teaching Hospital. Trained interviewers used the IPSS, which adds a quality of life question to the American Urology Association symptom index to determine the extent to which patients are troubled by their symptoms. Five milliliters of blood was collected for total prostate-specific antigen (PSA) measurement. Transrectal ultrasonography was performed to evaluate the prostate volume (PV).

Results

The mean age of the participants was 67.96 ± 14.57. The average score obtained from the study participants using the IPSS scale was 17.52 ± 7.83. There was a significant association between bother score and IPSS symptoms grade (P < 0.0001). Regression plot of the participants' points for IPSS in relation to the age, PSA, and PV showed statistically significant positive associations (P < 0.05). However, the coefficients of determination (R²) were 0.156, 0.022, and 0.048, respectively. This means that each unit increase of age, PSA, and PV only influences 15.6%, 2.3%, and 4.8% of the change in the symptom score. There was statistically significant association between age and moderate-to-severe LUTS with age range of 75 years above recording the highest odds (adjusted odds ratio (AOR) = 18.72, (1.15-99.78), P < 0.0001). The PSA range 20.1-50 ng/ml was significantly associated with moderate-to-severe LUTS (AOR = 17.37 (2.19-223.45), P = 0.006). Moreover, other factors, which were significantly associated with moderate-to-severe LUTS, were smoking (AOR = 0.32 (0.11-0.94) P = 0.038) and being widowed (AOR = 0.05 (0.002-0.52), P =0.010) respectively.

Conclusion

The study found a statistically significant correlation between age, PSA, PV, and IPSS scores; however, these influences were mild.

The single nucleotide polymorphism rs700518 is an independent risk factor for metabolic syndrome and benign prostatic hyperplasia (MetS-BPH)

Studies have shown that 48.59% of benign prostate hyperplasia (BPH) is combined with metabolic syndrome (MetS). The mainstream view supports the correlation between MetS and BPH, but the pathogenesis of MetS‐BPH is not fully understood. Four hundred and seventy‐four men, aged 47 years or older, were recruited into this study by consecutive routine physical examination programs, and several parameters were obtained from each participant. Based on the diagnosis of BPH, MetS, and MetS‐BPH, the participants were divided into BPH and Non‐BPH groups, MetS and Non‐MetS groups, as well as MetS‐BPH and Non‐MetS‐BPH groups. The values of the obtained parameters were evaluated using Student's t‐test, chi‐square test, and logistic regression analysis. The value of estradiol (E2) was higher in the diseased groups (BPH, MetS, and MetS‐BPH groups) compared with the corresponding control groups (Non‐BPH, Non‐MetS, and Non‐MetS‐BPH groups), and the differences were statistically significant. Also, E2 had an independent association with BPH (OR = 2.286, 95% CI: 1.723–3.593, p < 0.001), MetS (OR = 1.406, 95% CI: 0.585–2.315, p < 0.001), and MetS‐BPH (OR = 1.249, 95% CI: 0.795–1.962, p < 0.001). Regarding SNPs of CYP19A1 gene, both the rs4646 genotypes (CC, CA, and AA) and the rs700518 genotypes (CC, CT, and TT) were present in every group, and all genotypes had statistically significant differences between the diseased and corresponding control groups. However, only the TT genotype of rs700518 was independently associated with BPH, MetS, and MetS‐BPH after adjusting for age. The TT genotype of rs700518 is an independent risk factor for the MetS‐BPH populations, and the CYP19A1 gene regulation of estrogen leads to MetS‐BPH.

PSA predicts development of incident lower urinary tract symptoms: results from the REDUCE study

BACKGROUND

The relationship between baseline prostate-specific antigen (PSA) and development of lower urinary tract symptoms (LUTS) in asymptomatic and mildly symptomatic men is unclear. We sought to determine if PSA predicts incident LUTS in these men.

METHODS

A post-hoc analysis of the 4-year REDUCE study was performed to assess for incident LUTS in 1534 men with mild to no LUTS at baseline. The primary aim was to determine whether PSA independently predicted incident LUTS after adjusting for the key clinical variables of age, prostate size, and baseline International prostate symptom score (IPSS). Incident LUTS was defined as the first report of medical treatment, surgery, or sustained clinically significant symptoms (two IPSS >14). Cox proportional hazards, cumulative incidence curves, and the log-rank test were used to test our hypothesis.

RESULTS

A total of 1534 men with baseline IPSS <8 were included in the study cohort. At baseline, there were 335 men with PSA 2.5-4 ng/mL, 589 with PSA 4.1-6 ng/mL, and 610 with PSA 6-10 ng/mL. During the 4-year study, 196 men progressed to incident LUTS (50.5% medical treatment, 9% surgery, and 40.5% new symptoms). As a continuous variable, higher PSA was associated with increased incident LUTS on univariable (HR 1.09, p = 0.019) and multivariable (HR 1.08, p = 0.040) analysis. Likewise, baseline PSA 6-10 ng/mL was associated with increased incident LUTS vs. PSA 2.5-4 ng/mL in adjusted models (HR 1.68, p = 0.016). This association was also observed in men with PSA 4.1-6 ng/mL vs. PSA 2.5-4 ng/mL (HR 1.60, p = 0.032).

CONCLUSIONS

Men with mild to no LUTS but increased baseline PSA are at increased risk of developing incident LUTS presumed due to benign prostatic hyperplasia.

Identifying predictors of change in the severity of untreated lower urinary tract symptoms in men: a systematic review protocol

REVIEW OBJECTIVE

The objective of this systematic review is to synthesize the best available evidence on the predictors of change in the severity of untreated lower urinary tract symptoms in men in a non-hospital setting.

Benign prostatic hyperplasia: A clinical review

Benign prostatic hyperplasia (BPH) is an increasingly common diagnosis seen in men over age 50 years. Primary care providers must be aware of patient presentation, diagnostic tests, appropriate lifestyle modifications, treatment options, and potential complications in order to properly manage and educate patients with BPH. If left untreated, BPH can significantly decrease a man's quality of life; however, many pharmacologic and surgical treatments are available to control the symptoms.

Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, and Urinary Retention

Lower urinary tract symptoms (LUTS) consist of a common set of urologic symptoms that can affect the elderly. The prevalence of LUTS is expected to rise owing to the continued increase of numbers of the elderly. Although benign prostatic hyperplasia is considered a common cause of LUTS, the broader potential causes of LUTS are myriad. A wide range of diagnostic modalities and treatments are available to manage patients with LUTS and their utilization should not be limited to the urologist.

Effects of metformin on prostatic tissue of rats with metabolic syndrome and benign prostatic hyperplasia

OBJECTIVES

To investigate the efficacy of insulin sensitizer on prostatic tissue in animal model with benign prostatic hyperplasia (BPH) secondary to metabolic syndrome (MetS).

METHODS

Models were established by providing Sprague-Dawley rats with high fat diet (HFD) combined with metformin or not. All objects were killed 40 days later with prostatic tissue being removed, weighed before stained, as well as the expression level of insulin-like growth factor I (IGF-1) and receptor (IGF-1R) being measured, and the level of insulin resistance (IR) has also been evaluated.

RESULTS

Model has been successfully established. Level of prostatic hyperplasia and IR as well as IGF-1 and IGF-1R expressions in the blank and saline control subunits of HFD group was higher than that of normal diet group (P < 0.05). In the subunit of metformin, along with the suppression of IR, the level of prostatic hyperplasia and the expression of IGF-1 pathway have both decreased (P < 0.05).

CONCLUSION

MetS can promote the growth of prostate during the formation of central obesity and IR. IGF-1 pathway may have an important role in the induction of BPH following IR. The application of metformin can suppress the expression of IGF-1 and IGF-1R, thus preventing the promotive effect of IR on prostate tissue in animal model of MetS.

Efficacy and Safety of Photoselective Vaporization of the Prostate with 120 W 532 nm Laser in Patients with Benign Prostatic Hyperplasia on Anticoagulation or Antiplatelet Therapy: Observations on Long-Term Outcomes

OBJECTIVE

The objective of this study was to evaluate the safety and effectiveness of photoselective vaporization of the prostate (PVP) in the treatment of patients with benign prostatic hyperplasia (BPH) on anticoagulant or antiplatelet therapy.

BACKGROUND

The "gold standard" of surgical treatment of BPH is transurethral resection of the prostate (TURP). Since the risk of complications associated with TURP is still significant, there is a continuous search for safer and equally effective procedures. One of them is PVP with a 532 nm potassium-titanyl-phosphate/lithium triborate (KTP/LBO) laser.

MATERIALS AND METHODS

A total of 109 patients underwent PVP with the use of the GreenLight HPS 120 W laser. Sixty-five (59.6%) of the patients were on anticoagulants or antiplatelet drugs, whereas 44 (40.4%) patients were not. Various objective and subjective parameters were evaluated intra- and postoperatively along with a 5-year follow-up to compare the results and safety of PVP in these two groups of patients.

RESULTS

No difference between the groups was found in intraoperative parameters, including operation and lasing time, as well as laser energy used. Also, no intraoperative complications were observed. There was no significant bleeding in any of the groups, and none of the patients required a blood transfusion. Catheterization and hospitalization time did not differ between both groups, and during the 5-year follow-up period, good objective and subjective results were observed, and the complication rates were comparable between the groups.

CONCLUSIONS

Our results demonstrate that PVP for patients with BPH is an effective and safe procedure with satisfactory long-term outcomes. Anticoagulant and antiplatelet drugs did not significantly influence the results, or the complication rates.