[Clinical management of patient with benign prostatic hyperplasia in Spain]

Combined low-frequency ultrasound and microbubble contrast agent for the treatment of benign prostatic hyperplasia

BACKGROUND AND PURPOSE

Benign prostatic hyperplasia is one of the most common conditions in middle-aged and elderly men. The aim of the study was to investigate the treatment effects of low-frequency ultrasound combined with a microbubbles agent on benign prostatic hyperplasia.

METHODS

Eighteen 7-year-old male beagles with prostatic hyperplasia were randomly divided into six groups (n=3): Control group, 21 kHz ultrasound group, 21 kHz ultrasound and microbubble contrast agent group, 1 MHz ultrasound group, 1 MHz ultrasound and microbubble contrast agent group, and microbubble contrast agent group. The histopathologic damage to prostate cells was assessed via transmission electron microscopy and optical microscopy. The protein expressions of prostate-specific antigen (PSA), inducible nitric oxide synthase (iNOS), and super oxidase dimutase (SOD) were detected by enzyme-linked immunosorbent assay. Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine (Cr) were detected by the Biochemistry Automatic Analyzer.

RESULTS

Significant tissue injury, mitochondria injury, and cell apoptosis were observed in 21 kHz ultrasound and the microbubble contrast agent group. Compared with the control and microbubbles contrast agent groups, the decrease in levels of PSA or increase in levels of iNOs and SOD in the other four groups were statistically significant (P<0.05). The lowest level of PSA and the highest levels of iNOs and SOD were observed in the 21 kHz ultrasound and microbubbles contrast agent group. No significant changes in levels of AST, ALT, BUN, and Cr were observed between the six groups.

CONCLUSIONS

Our results suggest that lower frequency ultrasound may have a better effect on benign prostatic hyperplasia, and microbubble contrast agent application further strengthens this biological effect.

Indicadores de calidad en hiperplasia benigna de próstata. Un estudio cualitativo

Objetivo

Valorar posibles indicadores de calidad de la atención a la hiperplasia benigna de próstata (HBP) y sus fortalezas y debilidades para su incorporación a los sistemas de información sanitaria.

Diseño

Reunión de expertos, estructurada siguiendo procedimientos adaptados de las técnicas de grupo nominal y método de consenso Rand.

Emplazamiento

Escuela Valenciana de Estudios de la Salud.

Participantes y/o contextos

Participaron 40 panelistas (74% médicos, 70% del ámbito de la atención primaria) con experiencia en el manejo de la HBP pertenecientes a 15 Departamentos de la Agencia Valenciana de Salud.

Método

Se realizaron 3 talleres simultáneos (exploración y diagnóstico, tratamiento farmacológico y adecuación y resultados) en los que se valoraron los 15 indicadores seleccionados por el grupo coordinador.

Resultados

Once de los 15 indicadores obtuvieron puntuaciones en el rango de alta relevancia. Los 5 mejor valorados fueron: el uso de alfabloqueante + inhibidores de la 5 alfa-reductasa a partir de determinado nivel de gravedad, el tacto rectal en la valoración inicial, el seguimiento con el Índice Internacional de Síntomas Prostáticos (IPSS), la tasa de sondaje urgente en urgencias hospitalarias, la valoración inicial con el IPSS y el uso de alfabloqueante previo a la retirada de sonda por retención aguda de orina.

Conclusiones

Parte de los indicadores valorados pueden ser útiles para su incorporación a los sistemas de información sanitaria.

Effects of low-frequency ultrasound combined with microbubbles on benign prostate hyperplasia

INTRODUCTION

Our objective is to assess the effects of low-frequency ultrasound combined with microbubbles on benign prostate hyperplasia (BPH).

METHODS

Sixteen Beagle dogs with BPH were randomly assigned into 4 groups (n = 4): control group (without treatment), G1 group (injection with 2 mL of microbubble contrast agent); G2 group (21 kHz ultrasound); and G3 group (injection with 2 mL of micro-bubble contrast agent +21 kHz ultrasound). The histopathological damage to prostate cells was assessed via transmission electron microscopy and optical microscopy. The protein expressions of prostate-specific antigen (PSA), inducible nitric oxide synthase (iNOS), superoxide dismutase (SOD) of vessels were detected by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Histopathologically, the prostate cells exhibited nuclear chromatin contraction, mitochondrial swelling, degranulation of rough endoplasmic reticulum, basement membrane rupture and cell apoptosis in the G2 and G3 groups; it was especially obvious in the G3 group, while no changes were observed in the control and G1 groups. Although prostate volume using imaging was not significantly changed in all groups after treatment, PSA was significantly reduced in the G2 and G3 groups, and especially obvious in the G3 group (p < 0.05). The iNOS and SOD, which are important oxidative stress factors, significantly increased after treatment in the G2 and G3 groups, but not in the control and G1 groups (p < 0.05).

CONCLUSIONS

Low-frequency ultrasound is effective in treating BPH; low-frequency ultrasound combined with microbubbles improves the treatment efficacy.

Severity profiles in patients diagnosed of benign prostatic hyperplasia in Spain

OBJECTIVES

To analyse the severity profiles and progression criteria in patients diagnosed of benign prostatic hyperplasia (BPH) in urology clinics in Spain.

MATERIAL AND METHODS

A multicentre observational epidemiological study conducted in Spain between May-November 2008. A representative sample of 392 urologist gathered socio-demographic, clinical and patient-centered data from three consecutive patients with new diagnostic of BPH in urology clinics.

RESULTS

A total of 1.115 patients were evaluated. Mean age was 65.7 years old. Mean time from the onset of symptoms to diagnostic was 18,8 months. Mean IPSS score was 17.2. 63 patients (5,7%) had mild symptoms; 670 (60,1%) had moderate symptoms with a mean IPSS score of 14.6 and 382 (34.3%) had severe symptoms with a mean IPSS score of 23.7. Mean PSA was 2.6 ng/ml and ultrasound measured prostatic volume was 49.2cc. A total of 713 (63,9%) patients met progression criteria (PSA >1.5 ng/ml and volume>30 cc). Symptoms severity was directly correlated with age, prostatic volume, PSA, presence of progression criteria and time from the onset of symptoms and inversely correlated with urine flow rate (P<.001). Progression criteria was directly correlated with age, symptoms severity and inversely with urine flow rate (P<.01).

CONCLUSIONS

More than 90% of patients diagnosed of BPH in urology clinics in Spain had moderate to severe symptoms. Two thirds met progression criteria that correlate with age and severity of symptoms.