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Obiesie AE, E Nwofor AM, Oranusi CK, Mbonu OO. Correlation between prostate volume measured by ultrasound and symptoms severity score in patients with benign prostatic hypertrophy in Southeastern Nigeria. Niger J Clin Pract 2022; 25:1279-1286. [DOI: 10.4103/njcp.njcp_54_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Awaisu M, Ahmed M, Lawal AT, Sudi A, Tolani MA, Oyelowo N, Muhammad MS, Bello A, Maitama HY. Correlation of prostate volume with severity of lower urinary tract symptoms as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00122-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of the study is to find the correlation between the prostate volume and severity of lower urinary tract symptoms (LUTS) as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia (BPH).
Methods
The study was a prospective correlational study conducted between June 2016 and November 2017. A total of 290 patients who presented with LUTS suggestive of BPH and satisfied the inclusion criteria were consecutively recruited. Clinical evaluation including digital rectal examination of the prostate was done. Symptoms severity was assessed using the self-administered international prostate symptoms score (IPSS) questionnaire. Prostate volume was determined by transrectal ultrasound scan, and the urine flow rate was measured using uroflowmeter. Data were analyzed using SPSS version 20.0, and p value < 0.05 was taken to be statistically significant.
Results
The mean age of the patients was 64.22 ± 9.04 years with a range of 40 to 95 years. Most of the patients had moderate symptoms (55%) on IPSS with the mean IPSS value of 16.41 ± 7.43. The mean Qmax value was 16.55 ± 7.41 ml/s, and the median prostate volume (IQR) was 45.05 (35, 59). There was a positive significant correlation between prostate volume and IPSS (r = 0.179, p = 0.002) and a negative significant correlation between prostate volume and Qmax (r = − 0.176, p = 0.003).
Conclusion
This study showed a significant correlation between the prostate volume and IPSS, and also between prostate volume and maximum flow rate (Qmax).
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Shim M, Bang WJ, Oh CY, Lee YS, Cho JS. Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size. World J Urol 2019; 38:1997-2003. [PMID: 31646381 DOI: 10.1007/s00345-019-02990-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/13/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery. METHODS The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3 months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression. RESULTS Among patients with prostate volume < 50 mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3 months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50 mL. CONCLUSION Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.
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Affiliation(s)
- Myungsun Shim
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea.
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
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Schulz A, Schilling TM, Vögele C, Schächinger H. Visceral-afferent signals from the cardiovascular system, but not urinary urge, affect startle eye blink. Physiol Behav 2018; 199:165-172. [PMID: 30448351 DOI: 10.1016/j.physbeh.2018.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/30/2018] [Accepted: 11/14/2018] [Indexed: 01/23/2023]
Abstract
The aim of the current study was to investigate if startle methodology is suitable to reflect urinary urgency. Eighteen healthy men were tested on two separate days, each including an ingestion of fluid until 80% of the subjective urge to micturate was reached. EMG responses to acoustic startle stimuli were assessed before and after micturition, as well as in the early and late cardiac cycle phases (230 vs. 530 ms after a cardiac R-wave). Sonographic assessment confirmed bladder-filling status. Emotional arousal, stress, urge and unpleasantness ratings, as well as mean blood pressure were higher before than after micturition. Startle eye blink responses were lower during the early than during the late cardiac cycle phase, but were not affected by bladder filling status. We conclude that startle methodology is suitable for the investigation of afferent signals from the cardiovascular system, but not to reflect urinary urgency. This result may be due to different neurophysiological mechanisms underlying afferent signals from the bladder compared to other visceral organs or interference with affective states or sympathetic activation associated with bladder filling. Notwithstanding, the present research protocol of fluid intake, sonographic assessment of the bladder, and subjective reports, can be applied to examine effects of urinary urge on physiological and psychological processes.
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Affiliation(s)
- André Schulz
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Division of Clinical Psychophysiology, Institute of Psychobiology, University of Trier, Trier, Germany.
| | - Thomas M Schilling
- Division of Clinical Psychophysiology, Institute of Psychobiology, University of Trier, Trier, Germany
| | - Claus Vögele
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Hartmut Schächinger
- Division of Clinical Psychophysiology, Institute of Psychobiology, University of Trier, Trier, Germany
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Pyun JH, Kang SG, Kang SH, Cheon J, Kim JJ, Lee JG. Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non-neurogenic bladder dysfunction. Kaohsiung J Med Sci 2017; 33:458-463. [DOI: 10.1016/j.kjms.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/25/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022] Open
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Ko YH, Kim TH, Song PH, Kim BH, Kim BS, Kim KH, Cho J. Structural Variations of the Prostatic Urethra Within the Prostate Predict the Severities of Obstructive Symptoms: A Prospective Multicenter Observational Study. Urology 2017; 104:160-165. [PMID: 28322900 DOI: 10.1016/j.urology.2017.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/26/2017] [Accepted: 03/04/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe distinctive morphologic variations of the prostate associated with the prostatic urethra, and to determine whether structural changes of the urethra within the prostate resulting from gland enlargement, rather than prostrate volume itself, lead to male lower urinary tract symptom (LUTS). MATERIALS AND METHODS After standardizing measurements, 7 ultrasonography-determined variables, that is, prostate volume, transitional zone volume, transitional zone-to-total volume ratio, presence of intraprostatic protrusion, prostatic urethral angle, prostatic urethral length (PUL), and PUL-to-volume ratio (rPUL), were obtained prospectively in 293 men who had not taken LUTS medication during the 3 months prior to initial visits. Correlations between these variables and international prostate symptom scores (IPSS) were then investigated. RESULTS By simple correlation, only rPUL showed a significant association with IPSS. Multiple linear regression revealed IPSS were significantly correlated with age (beta = .179, P = .04) and rPUL (beta = .139, P = .019). Subanalysis with respect to the symptoms of IPSS revealed only rPUL was correlated with voiding symptoms (Q1,3,5,6; beta = .122, P = .036), and that age alone was correlated with storage symptoms (Q2,4,7; beta = .262, P < .001). When dividing 4 groups by applying mean cut-offs for PUL (62 mm) and prostate volume (30 g), long PUL with small volume had significantly higher IPSS score than short PUL with large volume (P = .042). CONCLUSION Structural differences of prostate related to prostatic urethra as reflected by rPUL were found to be significantly correlated with the severity of voiding symptoms. This finding suggests structural change of the prostatic urethra inducted by prostate enlargement underlies the development of male LUTS.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Byung Hoon Kim
- Department of Urology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Ki Ho Kim
- Department of Urology, Dongguk University School of Medicine, Gyeongju, Republic of Korea.
| | - Jaeho Cho
- Department of Radiology, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Hou CP, Lin YH, Chen CL, Tsai YL, Chang PL, Tsui KH. Impact of the static prostatic urethral angle on men with lower urinary tract symptoms. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2014.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kwon JK, Han JH, Choi HC, Kang DH, Lee JY, Kim JH, Oh CK, Choi YD, Cho KS. Clinical significance of peripheral zone thickness in men with lower urinary tract symptoms/benign prostatic hyperplasia. BJU Int 2015; 117:316-22. [PMID: 25807886 DOI: 10.1111/bju.13130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the clinical impact of prostate peripheral zone thickness (PZT), based on presumed circle area ratio (PCAR) theory, on urinary symptoms in men with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) as a novel prostate parameter. PATIENTS AND METHODS Medical records were obtained from a prospective database of first-visit men with LUTS/BPH. Age, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), maximum urinary flow rate (Qmax ), and post-void residual urine volume (PVR) were assessed. Total prostate volume (TPV), transition zone volume (TZV), transition zone index (TZI), and PZT were measured by transrectal ultrasonography. Reliability analysis was also performed. RESULTS In all, 1009 patients were enrolled for the analysis. The mean (sd) PZT was 11.10 (2.50) mm, and patients were classified into three groups PZT thickness groups; PZT <9.5 mm, ≥9.5 to <13 mm, and ≥13 mm. As the PZT became smaller, all urinary symptom scores including IPSS, quality of life (QoL), and OABSS significantly increased. Uroflowmetry variables, such as Qmax and PVR, also showed significant differences. PZT showed a high intra-class correlation coefficient (0.896). Multivariate analysis revealed that the PZT was independently associated with IPSS (P < 0.001), QoL (P = 0.003), OABSS (P = 0.001), and PVR (P = 0.001), but PZT influence on Qmax was only of borderline significance (P = 0.055). CONCLUSION PZT is a novel, easy-to-measure prostate parameter that is significantly associated with urinary symptoms. Our present findings suggest that clinical usefulness of PZT should be further validated for managing men with LUTS/BPH.
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Affiliation(s)
- Jong Kyou Kwon
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jang Hee Han
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Chul Choi
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Yangpyeong Health Center, Yangpyeong, Korea
| | - Joo Yong Lee
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Sooncheonhyang University Hospital, Suncheonhyang University College of Medicine, Seoul, Korea
| | - Cheol Kyu Oh
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Deuk Choi
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Ko YH, Song PH. Structural Variation of Prostate Urethra Reflected by the Ratio Between Prostate Volume and Prostatic Urethral Length is Associated with the Degrees of Lower Urinary Tract Symptoms. Low Urin Tract Symptoms 2014; 8:113-9. [PMID: 27111623 DOI: 10.1111/luts.12083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/16/2014] [Accepted: 10/05/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Because it is well known that the prostate volume is not directly associated with the degrees of lower urinary tract symptom (LUTS), we hypothesized that change of the prostatic urethra led by prostatic enlargement as missing links between them. To provide an integral description, we determined the ratio between prostate volume and prostatic urethral length (RPVL), and investigated its clinical implication. METHODS Prostate volume, prostatic urethral length, RPVL was measured from transrectal ultrasonography for 213 consecutive patients. The degree of LUTS was investigated using the international prostate symptom score (IPSS) and uroflowmetry, then the correlations were analyzed. RESULTS While no variables were significantly linked with total IPSS, obstructive symptoms (IPSS Q247) showed a negative association (r = -0.3, P < 0.001) and irritative symptoms (IPSS Q1356) showed a positive association solely with RPVL (r = 0.186, P = 0.007). These relevancies were enhanced (r = -0.471 [P = <0.001] and 0.3 [P = 0.004], respectively) in patients with a larger prostate (over 30 g, n = 93), but disappeared in their smaller counterparts (below 30 g, n = 120), (r = -0.133 [P = 0.143] and 0.75 [P = 0.410], respectively). In uroflowmetry, prostate urethral length showed positive correlation (r = 0.319 [P < 0.001]), and RPVL showed negative correlation (r = -0.195 [P = 0.004]) with post voiding residual amount, but these relationships similarly vanished in men with a smaller prostate. CONCLUSIONS The structural variation of the prostatic urethra within the prostate reflected by RPVL showed correlation with the degree of LUTS, with a tendency toward increasing prostatic urethra in obstructive and decreasing prostatic urethra in irritative symptoms, in men with a relatively large prostate.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Phil Hyun Song
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
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Kang DH, Lee JY, Hah YS, Chung DY, Lee DH, Cho KS. Correlation of prostatic urethral angle with the severity of urinary symptom and peak flow rate in men with small prostate volume. PLoS One 2014; 9:e104395. [PMID: 25127394 PMCID: PMC4134204 DOI: 10.1371/journal.pone.0104395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 07/12/2014] [Indexed: 12/22/2022] Open
Abstract
Purpose To evaluate the effects of prostatic anatomical factors on male lower urinary tract symptoms (LUTS) and the peak flow rate (Qmax) in patients with small prostate volume (PV). Materials and Methods Records were obtained from a prospectively maintained database of first-visit men with LUTS. Patients whose total PV (TPV) was greater than 30 mL were excluded; 444 patients were enrolled in the study. The TPV, transitional zone volume (TZV), transitional zone index (TZI), intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA) were measured by transrectal ultrasonography. LUTS were evaluated using the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) questionnaires. Uroflowmetric measurements were also made. Results PUA (r = 0.269, P<0.001), TZV (r = 0.160, P<0.001), and TZI (r = 0.109, P = 0.022) significantly correlated with the IPSS. Qmax (r = −0.334, P<0.001) and OABSS (r = 0.211, P<0.001) correlated only with PUA. In a multivariate regression analysis, PUA and age were independently associated with IPSS, OABSS, and Qmax. For IPSS of 20 or greater, the area under the ROC curve (AUC) of PUA was 0.667 and the cut-off value was 43.7°. When Qmax was 10 mL/s or less, the AUC of PUA was 0.664 and the cut-off value was 43.5°. Conclusions PUA has a significant association with symptom severity and Qmax among prostatic anatomical factors analyzed in men with LUTS and small PV. PUA should be considered as an important clinical factor in male LUTS management. Furthermore, the impact of PUA on response to medical treatment and disease progression needs to be investigated.
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Affiliation(s)
- Dong Hyuk Kang
- Department of Urology, Yangpyeong Health Center, Yangpyeong, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Soo Hah
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Doo Yong Chung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hun Lee
- Department of Urology, Severance Check-up, Yonsei University Health System, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Hou CP, Chen CL, Lin YH, Tsai YL, Chang PL, Juang HH, Tsui KH. Prostatic urethral angle might be a predictor of treatment efficacy of α-blockers in men with lower urinary tract symptoms. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:937-43. [PMID: 25075177 PMCID: PMC4106922 DOI: 10.2147/dddt.s62428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Purpose We investigated the association of the prostatic urethral angle (PUA) with peak urinary flow rate (Qmax) and the severity of lower urinary tract symptoms (LUTS) on the aging male. We also evaluated the effect of the PUA on the treatment efficacy of tamsulosin on men with LUTS. Materials and methods The records were obtained from a prospective database for first-visit male patients with LUTS in the outpatient department of our institution. These patients underwent a detailed physical examination and taking of medical history. A transrectal ultrasound was performed on these patients. The prostate size, length of intravesical prostatic protrusion (IPP), PUA, and International Prostate Symptom Score (IPSS) of the patients were evaluated. Uroflowmetry and a bladder scan for residual urine were also performed on every patient. Tamsulosin 0.2 mg per day was prescribed. The IPSS and uroflowmetry were reevaluated after they had received treatment for 3 months. Results A total of 178 patients were included, and 149 of them completed this cohort study. The mean PUA was 48.32°±13.74°. The mean prostate volume was 39.19±20.87 mL, and the mean IPP was 5.67±7.85 mm. On multivariate linear regression analysis, the PUA was independently associated with the IPSS (P<0.001), Qmax (P=0.004), post-treatment IPSS change (P=0.032), and post-treatment Qmax change (P<0.001). However, the prostate volume and IPP were not associated with these clinical items. Conclusion The PUA is significantly associated with Qmax and IPSS in men with LUTS. The PUA is also inversely correlated with changes in Qmax and IPSS after tamsulosin treatment. Namely, the PUA might be a predictor for the treatment efficacy of α-blockers in aging men with LUTS.
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Affiliation(s)
- Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Yu-Lun Tsai
- Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Horng-Heng Juang
- Department of Anatomy, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
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Does urinary bladder shape affect urinary flow rate in men with lower urinary tract symptoms? ScientificWorldJournal 2014; 2014:846856. [PMID: 24511301 PMCID: PMC3910387 DOI: 10.1155/2014/846856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/20/2013] [Indexed: 11/18/2022] Open
Abstract
We aimed to investigate the role of urinary bladder shape which may potentially change with advancing age, increased waist circumference, pelvic ischemia, and loosening of the urachus on bladder emptying and UFR. We retrospectively investigated the medical records of 76 men. The patients were divided into two groups according to bladder shapes in MRI scan (cone and spheric shapes). There was a significant difference between the two groups in terms of IPSS, Qmax, Qave, and waist circumference. A positive correlation has been demonstrated between mean peak urinary flow rate measured with UFM and mean flow rate calculated using the CP. There was a significant difference between mean urinary flow rates calculated with CP of cone and sphere bladder shapes. The change in the bladder shape might be a possible factor for LUTS in men and LUTS may be improved if modifiable factors including increased waist circumference and loosening of the urachus are corrected.
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Park DS, Oh JJ, Hong JY, Hong YK, Choi DK, Gong IH, Hwang JH, Kwon SW. Serum prostate-specific antigen as a predictor of prostate volume and lower urinary tract symptoms in a community-based cohort: a large-scale Korean screening study. Asian J Androl 2013; 15:249-53. [PMID: 23353717 DOI: 10.1038/aja.2012.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study is to assess the ability of serum prostate-specific antigen (PSA) to predict prostate volume (PV) and lower urinary tract symptoms (LUTS) represented by the international prostate symptom score (IPSS). From January 2001 to December 2011, data were collected from men who first enrolled in the Korean Prostate Health Council Screening Program. Patients with a serum PSA level of >10 ng ml(-1) or age <40 years were excluded. Accordingly, a total of 34 857 men were included in our study, and serum PSA, PV and the IPSS were estimated in all patients. Linear and age-adjusted multivariate logistic analyses were used to assess the potential association between PSA and PV or IPSS. The predictive value of PSA for estimating PV and IPSS was assessed based on the receiver operating characteristics-derived area under the curve (AUC). The mean PV was 29.9 ml, mean PSA level was 1.49 ng ml(-1) and mean IPSS was 15.4. A significant relationship was shown between PSA and PV, and the IPSS and PSA were also significantly correlated after adjusting by age. The AUCs of PSA for predicting PV >20 ml, >25 ml and >35 ml were 0.722, 0.728 and 0.779, respectively. The AUCs of PSA for predicting IPSS >7, >13 and >19 were 0.548, 0.536 and 0.537, respectively. Serum PSA was a strong predictor of PV in a community-based cohort in a large-scale screening study. Although PSA was also significantly correlated with IPSS, predictive values of PSA for IPSS above the cutoff levels were not excellent. Further investigations are required to elucidate the exact interactions between PSA and LUTS and between PSA and PV in prospective controlled studies. Such studies may suggest how PSA can be used to clinically predict PV and the IPSS.
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Affiliation(s)
- Dong Soo Park
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Bang WJ, Kim HW, Lee JY, Lee DH, Hah YS, Lee HH, Koo KC, Yu HS, Ham WS, Cho KS. Prostatic Urethral Angulation Associated With Urinary Flow Rate and Urinary Symptom Scores in Men With Lower Urinary Tract Symptoms. Urology 2012. [DOI: 10.1016/j.urology.2012.08.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Hara N, Saito H, Takahashi K, Takeda M. Lower urinary tract symptoms in patients with Niigata Minamata disease: A case-control study 50 years after methyl mercury pollution. Int J Urol 2012; 20:610-5. [DOI: 10.1111/iju.12001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 10/08/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Noboru Hara
- Division of Urology; Department of Regenerative and Transplant Medicine; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Hisashi Saito
- Department of Internal Medicine; Kido Hospital; Niigata; Japan
| | - Kota Takahashi
- Division of Urology; Department of Regenerative and Transplant Medicine; Graduate School of Medical and Dental Sciences; Niigata University; Niigata; Japan
| | - Masayuki Takeda
- Department of Urology; Interdisciplinary Graduate School of Medicine and Engineering; University of Yamanashi; Yamanashi; Japan
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17
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Tsukamoto T, Masumori N, Nakagawa H, Arai Y, Komiya A, Ichikawa T, Takei M, Yamaguchi A, Liu Y, Crane MM. Changes in prostate volume in Japanese patients with benign prostatic hyperplasia: Association with other urological measures and risk of surgical intervention. Int J Urol 2009; 16:622-7. [DOI: 10.1111/j.1442-2042.2009.02323.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Choi HS, Im CM, Kim SO, Kim MK, Kwon DD, Ryu SB. Lower Urinary Tract Symptoms after Radical Retropubic Prostatectomy: Preliminary Study. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.8.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyang Sik Choi
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Min Im
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ki Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Bang Ryu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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19
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Abstract
Instruments designed to assess the severity of lower urinary tract symptoms have become a routine component of the diagnostic evaluation of men with benign prostatic hyperplasia (BPH). Several validated tools have been developed to this end, including the International Prostate Symptom Score, which is used most commonly today. Despite attempts to correlate symptom score severity with commonly measured objective parameters of BPH, no clear relationships have been found. The reason for this is likely multifactorial and suggests a complex relationship among subjective and objective variables. However, symptom scores show a good correlation with the patient's perception of quality of life and degree of bother. This is critical because the decision to treat should be largely based on these subjective variables. Moreover, symptom scores have been shown to represent a meaningful endpoint in assessing treatment response in clinical studies.
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Affiliation(s)
- A Christopher Stage
- Division of Urology, University of Texas Health Sciences Center, Houston, TX 77030, USA
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20
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Steers WD, Kirby RS. Clinical ease of using doxazosin in BPH patients with and without hypertension. Prostate Cancer Prostatic Dis 2005; 8:152-7. [PMID: 15711605 DOI: 10.1038/sj.pcan.4500787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Clinical studies have demonstrated that doxazosin therapy reduced blood pressure (BP) in patients with benign prostatic hyperplasia (BPH) who were hypertensive at baseline but not in patients who were physiologically or pharmacologically normotensive at baseline. In patients with BPH and uncontrolled hypertension, despite treatment with other antihypertensive drugs, the addition of doxazosin resulted in improved control with significant reductions in BP. The new formulation, doxazosin gastrointestinal therapeutic system (GITS), is initiated at a therapeutic dose, simplifying dose titration. Based on its efficacy and pharmacokinetic and tolerability profiles, doxazosin GITS is an effective and well-tolerated treatment for normotensive and hypertensive patients with BPH.
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Affiliation(s)
- W D Steers
- University of Virginia Hospital West, Charlottesville, Virginia 22908, USA.
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21
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Lam JS, Cooper KL, Kaplan SA. Changing aspects in the evaluation and treatment of patients with benign prostatic hyperplasia. Med Clin North Am 2004; 88:281-308. [PMID: 15049579 DOI: 10.1016/s0025-7125(03)00147-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lower urinary tract symptoms are a common clinical symptom among men and a frequent reason for referring to a urologist. The most important information comes from the patient history because evaluation of symptoms is fundamental in the diagnosis and treatment planning for LUTS. Other aspects of the initial evaluation, such as the physical examination and initial laboratory values, can provide valuable additional information about the severity of the disease and the need for treatment. If treatment is warranted based on this information, additional diagnostic tests may be appropriate to set a pretreatment baseline, rule out other conditions, and plan treatment approach. Fortunately, a variety of effective medical and surgical treatments are available to treat this common disease.
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Affiliation(s)
- John S Lam
- Department of Urology, David Geffen School of Medicine, 10833 Le Conte Avenue, 66-128 CHS, Box 951738, Los Angeles, CA 90095-1738, USA
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22
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Patel H, Garcia-Montes F, Christopher N, Reeves B, Emberton M. Diagnostic accuracy of flow rate testing in urology. BJU Int 2003. [DOI: 10.1046/j.1464-410x.2003.04267.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Tubaro A, Carter S, Trucchi A, Punzo G, Petta S, Miano L. Early treatment of benign prostatic hyperplasia: implications for reducing the risk of permanent bladder damage. Drugs Aging 2003; 20:185-95. [PMID: 12578399 DOI: 10.2165/00002512-200320030-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A significant change has occurred in the management of symptomatic benign prostatic hyperplasia (BPH) since effective pharmacological treatment became available and led to a significant decrease in the number of surgical procedures in many Western countries. The hypothesis of a causative role of benign prostatic enlargement and bladder outflow obstruction (BOO) in lower urinary tract symptoms (LUTS) was based on the association between prostate growth and symptoms of prostatism in elderly men and on the dramatic reduction of LUTS upon relief of obstruction. Careful investigation into the epidemiology of LUTS and BPH failed to confirm such an association and opened new perspectives in the pathophysiology of lower urinary tract dysfunction and symptoms. The observation that LUTS were equally distributed in male and female cohorts, when matched for age, moved attention away from the prostate and towards the urinary bladder and its aging-related disorders. When BPH surgery was developed, the management of the disease was aimed at preventing death from chronic renal failure, but the picture has changed and modern medical treatment is now aimed at improving the patient's quality of life. The increasing size of elderly populations in the Western world and the consequent financial constraints of national healthcare systems have raised the question of when pharmacological treatment of symptomatic BPH should be initiated. Retrospective and prospective analysis of various BPH populations and clinical studies has clearly defined the capacity of pharmacological treatment to reduce the incidence of complications of BPH, such as acute urinary retention and the need for surgery, but the cost/benefit ratio is unclear. Notwithstanding the limitations inherent in the experimental models, there is evidence from various animal models, investigating the pathophysiology of the urinary bladder in the presence of outflow obstruction, to indicate that a cause and effect relationship between BOO and bladder decompensation has been established and to support the hypothesis that permanent bladder damage may occur when the obstruction is not relieved early enough. Preliminary experimental evidence also suggests that alpha(1)-adrenoceptor antagonists may have a role in reducing the damaging effects of BOO on the urinary bladder. At present, there is no evidence to support the need for early pharmacological treatment of symptomatic BPH with no BOO beyond the obvious target of improving the patient's quality of life. The evidence for early treatment of BOO and the need to preserve bladder function is clear. Further experimental and clinical research is required to identify markers of early bladder damage and decompensation which can be used to select patients for early pharmacological treatment of BPH.
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Affiliation(s)
- Andrea Tubaro
- Department of Urology, 2nd School of Medicine, 'La Sapienza' University, Rome, Italy.
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24
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Andersson KE. New roles for muscarinic receptors in the pathophysiology of lower urinary tract symptoms. BJU Int 2000; 86 Suppl 2:36-42; discussion 42-3. [PMID: 11501616 DOI: 10.1046/j.1464-410x.2000.00096.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K E Andersson
- Department of Clinical Pharmacology, Lund University Hospital, Sweden.
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25
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Affiliation(s)
- J L Donovan
- Department of Social Medicine, University of Bristol, UK
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26
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ROBERTS ROSEBUDO, JACOBSEN STEVENJ, JACOBSON DEBRAJ, RHODES THOMAS, GIRMAN CYNTHIAJ, LIEBER MICHAELM. LONGITUDINAL CHANGES IN PEAK URINARY FLOW RATES IN A COMMUNITY BASED COHORT. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- ROSEBUD O. ROBERTS
- From the Department of Health Sciences Research, Sections of Clinical Epidemiology and Biostatistics, and the Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, and the Epidemiology Department, Merck Research Laboratories, Blue Bell, Pennsylvania
| | - STEVEN J. JACOBSEN
- From the Department of Health Sciences Research, Sections of Clinical Epidemiology and Biostatistics, and the Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, and the Epidemiology Department, Merck Research Laboratories, Blue Bell, Pennsylvania
| | - DEBRA J. JACOBSON
- From the Department of Health Sciences Research, Sections of Clinical Epidemiology and Biostatistics, and the Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, and the Epidemiology Department, Merck Research Laboratories, Blue Bell, Pennsylvania
| | - THOMAS RHODES
- From the Department of Health Sciences Research, Sections of Clinical Epidemiology and Biostatistics, and the Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, and the Epidemiology Department, Merck Research Laboratories, Blue Bell, Pennsylvania
| | - CYNTHIA J. GIRMAN
- From the Department of Health Sciences Research, Sections of Clinical Epidemiology and Biostatistics, and the Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, and the Epidemiology Department, Merck Research Laboratories, Blue Bell, Pennsylvania
| | - MICHAEL M. LIEBER
- From the Department of Health Sciences Research, Sections of Clinical Epidemiology and Biostatistics, and the Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, and the Epidemiology Department, Merck Research Laboratories, Blue Bell, Pennsylvania
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CAN THE INTRAPROSTATIC CONCENTRATION OF EPIDERMAL GROWTH FACTOR INFLUENCE THE VARIANCE OF SERUM PROSTATE SPECIFIC ANTIGEN LEVELS IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA? J Urol 1999. [DOI: 10.1016/s0022-5347(01)62082-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Aarnink RG, Wijkstra H. Aspects of imaging in the assessment and follow up of benign prostatic hyperplasia. Curr Opin Urol 1999; 9:21-9. [PMID: 10726068 DOI: 10.1097/00042307-199901000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For assessing patients suffering from benign prostatic hyperplasia and monitoring subsequent treatment, symptom questionnaires, uroflowmetry, prostate volume measurements, postvoiding residual urine volume measurements and pressure-flow studies may be used. This review highlights aspects of imaging in the assessment of benign prostatic hyperplasia, including volume determinations of prostate and postvoiding residual urine, texture imaging and biopsy guidance. Future developments are also briefly discussed.
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Affiliation(s)
- R G Aarnink
- Department of Urology, University Hospital Nijmegen, The Netherlands.
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30
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Di Silverio F, Sciarra A, Monti S, Casale P, Seccareccia F. Can the intraprostatic concentration of epidermal growth factor influence the variance of serum prostate specific antigen levels in patients with benign prostatic hyperplasia? J Urol 1999; 161:128-32. [PMID: 10037384 DOI: 10.1097/00005392-199901000-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Except for prostate volume, little is known about the factors influencing serum prostate specific antigen (PSA) levels. Considering that dihydrotestosterone and epidermal growth factor are regulators of the proliferation and differentiation in the epithelial component of human prostate tissue and that PSA is produced only by the epithelial cells of the gland, studies were performed on patients with a histological diagnosis of benign prostatic hyperplasia (BPH) to establish whether a significant association exists between the intraprostatic concentration of dihydrotestosterone or epidermal growth factor and serum PSA levels. MATERIALS AND METHODS A total of 20 patients with BPH who had not been previously treated were part of a larger study on the correlation among PSA, prostate volume and age, and were evaluated according to the algorithm in the guidelines of the international consultation on BPH. All men underwent open suprapubic prostatectomy to enucleate the entire adenoma and in each case sections were made in the periurethral, subcapsular and intermediate zones of the BPH tissue. Dihydrotestosterone and epidermal growth factor concentrations were evaluated by radioimmunoassay in the periurethral zone and in total BPH tissue. RESULTS In these 20 patients with BPH serum PSA levels were significantly associated with epidermal growth factor but not with dihydrotestosterone concentrations in total BPH tissue (r = 0.7762, p = 0.00002836 and r = 0.3923, p = 0.0956307, respectively). A stronger association was found between PSA levels and the periurethral concentration of epidermal growth factor and dihydrotestosterone (r = 0.8117, p = 0.000005 and r = 0.5656, p = 0.0098326, respectively). On the contrary, epidermal growth factor and dihydrotestosterone were not significantly associated with prostate volume (p = 0.957415 and p = 0.531439, respectively). CONCLUSIONS To our knowledge this study is the first report in the literature to demonstrate an association between serum PSA, and dihydrotestosterone and epidermal growth factor levels, particularly in the periurethral zone of human BPH tissue. These data suggest the importance of epidermal growth factor and dihydrotestosterone in influencing serum PSA levels.
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Affiliation(s)
- F Di Silverio
- Department of Urology U. Bracci and II Endocrinology, University La Sapienza, Istituto Superiore di Sanita, Rome, Italy
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31
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Donovan JL. Use of symptom questionnaires in the assessment and follow-up of men with benign prostatic disease. Curr Opin Urol 1999; 9:3-7. [PMID: 10726065 DOI: 10.1097/00042307-199901000-00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The assessment of lower urinary tract symptoms is an essential component of the evaluation of men with benign prostatic disease in clinical practice and research. Symptom evaluation is necessary for the formal evaluation of the effectiveness of treatments in randomized controlled trials and in the assessment of outcome in individuals, and can also be useful in determining the numbers of individuals in the community who might potentially require or benefit most from treatment. Increasingly, symptom assessments are being undertaken using a small number of questionnaires that are self-completed by patients and have been tested for validity and reliability.
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Affiliation(s)
- J L Donovan
- Department of Social Medicine, University of Bristol, UK
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32
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Di Silverio F, Sciarra A, D'Eramo G, Casale P, Loreto A, Seccareccia F. Relationship among age, prostate-specific antigen, and prostate volume in men with lower urinary tract symptoms (LUTS) and in different groups of men with and without benign and malignant prostate diseases. Prostate 1998; 36:1-7. [PMID: 9650909 DOI: 10.1002/(sici)1097-0045(19980615)36:1<1::aid-pros1>3.0.co;2-m] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In order to enhance prostate-specific antigen (PSA) as a predictor of prostate cancer, it is necessary to understand the characteristics of this tumor marker in a population of men without evidence of prostate cancer but who are at risk for developing the condition. METHODS In an age-stratified population of 328 men with lower urinary tract symptoms (LUTS), we analyzed the distribution of PSA levels as a function of age and prostate volume, and we analyzed the percentage of age-related variance in PSA that can be explained by the age-related variance in prostate volume. RESULTS Classifying the 328 cases with LUTS according to four age groups, a correlation was found between PSA and prostate volume, becoming stronger from the younger (correlation coefficient, -0.1265) to the older group (correlation coefficient, 0.6044). Serum PSA variance per milliliter of prostate volume also increased from the younger (not significant, P > 0.1) to the older age decades (7.3% in men age 70 years or over). Moreover, the results of the regression analysis suggest that 10% of the variance in PSA with age can be accounted for by prostate volume in men under age 50 years, reaching 37% in men age 70 years or more. CONCLUSIONS These data confirm that the serum PSA concentration increases with advancing age in the absence of clinically evident prostatic malignancy. In younger patients with LUTS, serum PSA variance with age seems to be less dependent upon the age-related variance in prostate volume.
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Affiliation(s)
- F Di Silverio
- Department of Urology U. Bracci, University La Sapienza, Rome, Italy
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