1
|
Lee PK, Hess JJ, Gomella AA, Loening AM, Hargreaves BA. A diffusion-prepared reduced FOV sequence for prostate MRI near metallic implants. Magn Reson Med 2024. [PMID: 39221478 DOI: 10.1002/mrm.30280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To enable diffusion weighted imaging in prostate patients with metallic total hip replacements in clinically feasible scan times for prostate cancer screening, and avoid distortion and dropout artifacts present in the conventionally used Echo Planar Imaging (EPI). METHODS A reduced field of view (FOV) diffusion-prepared sequence that is robust to the B 0 $$ {\kern0em }_0 $$ inhomogeneities produced by total hip replacements was achieved using high radiofrequency (RF) bandwidth pulses and manipulation for stimulated echo pathways. The reduced FOV along the A/P direction was obtained using slice-select gradient reversal, and the prepared magnetization was imaged with a three-dimensional RF-spoiled gradient echo readout. The sequence was validated in phantom experiments, in vivo in healthy volunteers with and without total hip replacements, and in vivo in patients undergoing a standard MRI prostate exam. RESULTS The proposed sequence is robust to shading and distortion artifacts that are encountered by standard diffusion-weighted EPI in the presence of moderate off-resonance. Apparent diffusion coefficient estimates obtained by the proposed sequence were comparable to those obtained with diffusion-weighted EPI. CONCLUSION Acquisition of distortionless diffusion weighted images of the prostate is feasible in patients with total hip replacements on conventional, whole-body 3T MRI, using a b-value of 800s / mm 2 $$ \mathrm{s}/{\mathrm{mm}}^2 $$ and nominal resolution of 1.7× $$ \times $$ 1.7× $$ \times $$ 4 mm3 in scan times of 6 min.
Collapse
Affiliation(s)
- Philip K Lee
- Radiology, Stanford University, Stanford, California, USA
| | - Jeremiah J Hess
- Radiology, Stanford University, Stanford, California, USA
- Bioengineering, Stanford University, Stanford, California, USA
| | | | | | - Brian A Hargreaves
- Radiology, Stanford University, Stanford, California, USA
- Bioengineering, Stanford University, Stanford, California, USA
- Electrical Engineering, Stanford University, Stanford, California, USA
| |
Collapse
|
2
|
Kang JW, He JP, Liu YN, Zhang Y, Song SS, Xu QX, Wei SW, Lu L, Meng XQ, Xu L, Guo B, Su RW. Aberrant activated Notch1 promotes prostate enlargement driven by androgen signaling via disrupting mitochondrial function in mouse. Cell Mol Life Sci 2024; 81:155. [PMID: 38538986 PMCID: PMC10973062 DOI: 10.1007/s00018-024-05143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 04/02/2024]
Abstract
The prostate is a vital accessory gonad in the mammalian male reproductive system. With the ever-increasing proportion of the population over 60 years of age worldwide, the incidence of prostate diseases, such as benign prostatic hyperplasia (BPH) and prostate cancer (PCa), is on the rise and is gradually becoming a significant medical problem globally. The notch signaling pathway is essential in regulating prostate early development. However, the potential regulatory mechanism of Notch signaling in prostatic enlargement and hyperplasia remains unclear. In this study, we proved that overactivation of Notch1 signaling in mouse prostatic epithelial cells (OEx) led to prostatic enlargement via enhancing proliferation and inhibiting apoptosis of prostatic epithelial cells. Further study showed that N1ICD/RBPJ directly up-regulated the androgen receptor (AR) and enhanced prostatic sensitivity to androgens. Hyper-proliferation was not found in orchidectomized OEx mice without androgen supply but was observed after Dihydrotestosterone (DHT) supplementation. Our data showed that the number of mitochondrion in prostatic epithelial cells of OEx mice was increased, but the mitochondrial function was impaired, and the essential activity of the mitochondrial respiratory electron transport chain was significantly weakened. Disordered mitochondrial number and metabolic function further resulted in excessive accumulation of reactive oxygen species (ROS). Importantly, anti-oxidant N-Acetyl-L-Cysteine (NAC) therapy could alleviate prostatic hyperplasia caused by the over-activation of Notch1 signaling. Furthermore, we observed the incremental Notch signaling activity in progenitor-like club cells in the scRNA-seq data set of human BPH patients. Moreover, the increased number of TROP2+ progenitors and Club cells was also confirmed in our OEx mice. In conclusion, our study revealed that over-activated Notch1 signaling induces prostatic enlargement by increasing androgen receptor sensitivity, disrupting cellular mitochondrial metabolism, increasing ROS, and a higher number of progenitor cells, all of which can be effectively rescued by NAC treatment.
Collapse
Affiliation(s)
- Jin-Wen Kang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Jia-Peng He
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Ying-Nan Liu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Yu Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Shan-Shan Song
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Qi-Xin Xu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Shu-Wen Wei
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Lei Lu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China
| | - Xiang-Qi Meng
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Lin Xu
- College of Sports and Human Science, Harbin Sport University, Harbin, PR China.
| | - Bin Guo
- College of Veterinary Medicine, Jilin University, Changchun, PR China.
| | - Ren-Wei Su
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, PR China.
- Key Laboratory of Animal Vaccine Development, Ministry of Agriculture, Guangzhou, PR China.
| |
Collapse
|
3
|
Abuelnaga M, Elawady H, Mahmoud MA, Mostafa D, Samir M. Does the duration of catheterization have an impact on the outcome of trial without catheter in patients with acute urine retention (AUR) due to benign prostatic hyperplasia (BPH)? A prospective randomized study. Urologia 2024; 91:107-111. [PMID: 38044812 DOI: 10.1177/03915603231215936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND To study the impact of early in comparison to late catheter removal following acute urine retention (AUR) secondary to benign prostatic hyperplasia (BPH) using silodosin therapy on the outcome of trial without catheter (TWOC). METHODS Two hundred sixty patients with AUR 2ry to BPH were catheterized then were randomly divided to receive silodosin 8 mg either for three or 7 days followed by catheter removal and successful voiding unaided was assessed. RESULTS Out of the 260 men (mean age 64.8 ± 6.5 years) treated, 74 men who were receiving 3 days of silodosin and 88 patients who were receiving 7 days of silodosin didn't require re-catheterization on the day of TWOC (57% and 68% respectively, p = 0.096). Complications like urinary leakage, acute urinary tract infection, hematuria, or catheter blockage recorded in 21 men (16.2%) who received 3 days of silodosin, and in 63 men (48.5%) who received 7 days of silodosin (p ⩽ 0.001). CONCLUSION Patients catheterized after AUR 2ry to BPH can spontaneously void following catheter removal if treated by silodosin, independent of the catheterization duration, while side effects have increased with prolonged catheterization.
Collapse
Affiliation(s)
- Mohamed Abuelnaga
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Hossam Elawady
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Mahmoud A Mahmoud
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Diaa Mostafa
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Mohamed Samir
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| |
Collapse
|
4
|
Tang X, Liu Z, Ren J, Cao Y, Xia S, Sun Z, Luo G. Comparative RNA-sequencing analysis of the prostate in a mouse model of benign prostatic hyperplasia with bladder outlet obstruction. Mol Cell Biochem 2023; 478:2721-2737. [PMID: 36920576 PMCID: PMC10628026 DOI: 10.1007/s11010-023-04695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
In ageing men, benign prostatic hyperplasia (BPH) is a chronic disease that leads to progressive lower urinary tract symptoms (LUTS) caused by obstruction of the bladder outlet (BOO). Patients with LUTS (such as increased frequency and urgency of urination) and complications of BOO (such as hydronephrosis and bladder stones) are at risk of serious health problems. BPH causes a rapidly rising burden of LUTS far exceeding that of other urological conditions. Treatment outcomes are unsatisfactory for BPH largely due to the lacking of fully understanding of the pathogenesis. Hormonal imbalances related to androgen and oestrogen can cause BPH, but the exact mechanism is still unknown, even the animal model is not fully understood. Additionally, there are no large-scale data to explain this mechanism. A BPH mouse model was established using mixed slow-release pellets of testosterone (T) and estradiol (E2), and we measured gene expression in mouse prostate tissue using RNA-seq, verified the results using qRT‒PCR, and used bioinformatics methods to analyse the differentially expressed genes (DEGs).
Collapse
Affiliation(s)
- Xiaohu Tang
- Medical College, Guizhou University, Guiyang, 550025, Guizhou, China
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China
| | - Zhiyan Liu
- Guizhou Medical University, GuiyangGuizhou, 550025, China
| | - Jingwen Ren
- Guizhou Medical University, GuiyangGuizhou, 550025, China
| | - Ying Cao
- Medical College, Guizhou University, Guiyang, 550025, Guizhou, China
| | - Shujie Xia
- Department of Urology Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, 201620, China
| | - Zhaolin Sun
- Medical College, Guizhou University, Guiyang, 550025, Guizhou, China
| | - Guangheng Luo
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China.
| |
Collapse
|
5
|
Gold SA, Goueli R, Mostardeiro TR, Carpinito GP, El-Eishy A, Mauck R, Woldu SL, Strand DW, Lotan Y, Roehrborn CG, Costa DN, Gahan JC. Optimal Prostate Cancer Diagnostic Pathways for Men With Prostatomegaly in the MRI Era. Urology 2023; 179:95-100. [PMID: 37182648 DOI: 10.1016/j.urology.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/17/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To evaluate utilities of multiparametric MRI and targeted biopsy to detect clinically significant prostate cancer in men with prostatomegaly. MATERIALS AND METHODS We conducted a retrospective review of multiparametric MRI obtained for elevated PSA between 2017 and 2020. We selected patients with prostates ≥80 g who had undergone biopsy. Clinically significant prostate cancer was defined as grade group ≥2. Predictive and logistic regression analyses quantified impacts of diagnostic components. RESULTS A total of 338 patients met inclusion criteria: 89 (26.3%) had clinically significant prostate cancer. On MRI, positive predictive value for clinically significant prostate cancer was 26.5% for PIRADS 4% and 73.5% for PIRADS 5; negative predictive value for MRI without suspicious lesions was 98.8%. Applying PSA density to MRI yielded a negative predictive value of 78.9% for PIRADS 4 lesions at PSA density <0.05 and a positive predictive value of 90.5% for PIRADS 5 lesions at PSA density ≥0.15. Targeted (versus standard) biopsy reduced likelihood of missing clinically significant prostate cancer by >50% (12.2% vs 28.3%). MRI in-bore biopsies trended towards better accuracy versus MRI-transrectal ultrasound fusion biopsies (75% versus 52%). On logistic regression analyses, MRI improved predictive accuracy (area under the curve 0.91), and PIRADS score demonstrated the strongest association with clinically significant prostate cancer (odds ratio 6.42, P < .001). CONCLUSION For large prostates, MRI is less predictive of clinically significant prostate cancer but effectively rules out malignancy. PSA density better informs biopsy decisions for PIRADS 4 and 5 lesions. There may be a pronounced role for targeted biopsy, specifically in-bore, in prostatomegaly.
Collapse
Affiliation(s)
- Samuel A Gold
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ramy Goueli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Alfarooq El-Eishy
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ryan Mauck
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Douglas W Strand
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Daniel N Costa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
6
|
Marghani BH, Ezz MA, Ateya AI, Fehaid A, Saleh RM, Rezk S. Comparative effects of finasteride and laser-irradiated silver nanoparticles on testicular function and histology in testosterone induced benign prostatic hyperplasia in rats. Life Sci 2023; 324:121747. [PMID: 37137466 DOI: 10.1016/j.lfs.2023.121747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
AIMS The objective of this study was to compare the effects of finasteride, a medication used to treat benign prostatic hyperplasia (BPH), and laser irradiated silver nanoparticles (AgNPs), a potential candidate for BPH therapy (Sanchez-Salas, 2017; Marghani et al., 2022) [1,2], on the sex hormone profiles, sperm quality, steroidogenesis, testicular oxidative stress, and histomorphology changes in BPH rats. MATERIALS AND METHODS BPH was induced in male Sprague-Dawley (SD) rats via intramuscular (i.m.) injection of 5 mg/kg BW testosterone propionate (TP) for 14 days. Once the BPH model was induced, rats were divided into four groups (n = 6) as follows: the control group; the BPH group; the BPH/Fina group, which received 5 mg/kg BW finasteride by oral gavage daily for 14 days; and the BPH/AgNPs group, which received a daily intraperitoneal (i.p.) injection of 50 mg/kg BW AgNPs, followed by 5 min of exposure to a 532 nm NIR laser in the prostatic area for the constitutive 14 days. KEY FINDINGS On day 14, the BPH rats had a significant increase in prostate specific antigen (PSA), dihydrotestosterone, and prostate weights, while testicular weights and sperm quality were significantly lower than in the control rats. On day 28, laser irradiated AgNps treated BPH rats showed improved sex hormone balance, testicular weights, sperm quality, steroidogenesis, and an ameliorative effect on testicular histopathology compared to finasteride. SIGNIFICANCE Surprisingly, these findings suggest that laser irradiated AgNPs can be used as an alternative therapy to finasteride for the treatment of BPH without causing negative effects on the testes.
Collapse
Affiliation(s)
- Basma H Marghani
- Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt; Department of Biochemistry, Physiology, and Pharmacology, Faculty of Veterinary Medicine, King Salman International University, South of Sinaa 46612, Egypt.
| | - Mohamed Aboul Ezz
- Department of Theriogenology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed I Ateya
- Department of Husbandry & Development of Animal Wealth, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Alaa Fehaid
- Department of Forensic Medicine and Toxicology, Faulty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Rasha M Saleh
- Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Shaymaa Rezk
- Department of Cytology and Histology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| |
Collapse
|
7
|
Al-Bakri A, Al-Jaser A, Al-Gamdi K, Al-Reshaid R, Al-Enizi A, Al-Kharji AA, Al-Zahrani I, Al-Modahi N, Al-Harbi M, Al-Mani A. Safety of transurethral resection of large prostate. Urol Ann 2023; 15:162-165. [PMID: 37304516 PMCID: PMC10252772 DOI: 10.4103/ua.ua_192_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/18/2022] [Accepted: 06/02/2022] [Indexed: 06/13/2023] Open
Abstract
Background Benign prostatic hyperplasia is a common benign disease occurs in older men. Some patients can be treated medically but eventually, most of them will need a surgical intervention, and the most commonly applied procedure is transurethral resection of the prostate (TURP). Objectives The objective of this study is to assess the feasibility and safety of performing transurethral resection of large prostate (80 g and more). Methodology Out of 153 patients reviewed 48 cases included in this study. The main data collected from patients' files and patient interview. The criteria of exclusion were prostate size <80 g and previous history of TURP. The collected data were analyzed by the Statistical Package for the Social Sciences (SPSS). Results The main results showed that 93.7% of patients did not experience major bleeding postoperatively, neither major drop in hemoglobin level. Moreover, the patient's distribution according to the presence of TUR syndrome was only 2.1% with mild symptoms. No patient had an episode of retention during the hospital stay or in the follow-up. Conclusion Surgeon experience, systematic resection approach, and strict time of resection are important factors to assure the safety of TURP in large prostate. In cases of huge prostate size >100 g, staged TURP can be offered safely or if patients' obstructive symptoms do not resolve after the first procedure.
Collapse
Affiliation(s)
- Ayman Al-Bakri
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Abdullah Al-Jaser
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Khalid Al-Gamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Reshaid Al-Reshaid
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Abdullah Al-Enizi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Ali Ali Al-Kharji
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Ibrahim Al-Zahrani
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Nawaf Al-Modahi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Moath Al-Harbi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| | - Abdullah Al-Mani
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh Region, Kingdom of Saudi Arabia
| |
Collapse
|
8
|
Awedew AF, Han H, Abbasi B, Abbasi-Kangevari M, Ahmed MB, Almidani O, Amini E, Arabloo J, Argaw AM, Athari SS, Atlaw D, Banach M, Barrow A, Bhagavathula AS, Bhojaraja VS, Bikbov B, Bodicha BBA, Butt NS, Caetano dos Santos FL, Dadras O, Dai X, Doan LP, Eftekharzadeh S, Fatehizadeh A, Garg T, Gebremeskel TG, Getachew ME, Ghamari SH, Gilani SA, Golechha M, Gupta VB, Gupta VK, Hay SI, Hosseini MS, Hosseinzadeh M, Humayun A, Ilic IM, Ilic MD, Ismail NE, Jakovljevic M, Jayaram S, Jazayeri SB, Jema AT, Kabir A, Karaye IM, Khader YS, Khan EA, Landires I, Lee SW, Lee SWH, Lim SS, Lobo SW, Majeed A, Malekpour MR, Malih N, Malik AA, Mehrabi Nasab E, Mestrovic T, Michalek IM, Mihrtie GN, Mirza-Aghazadeh-Attari M, Misganaw AT, Mokdad AH, Molokhia M, Murray CJL, Narasimha Swamy S, Nguyen SH, Nowroozi A, Nuñez-Samudio V, Owolabi MO, Pawar S, Perico N, Rawaf DL, Rawaf S, Rawassizadeh R, Remuzzi G, Sahebkar A, Sampath C, Shetty JK, Sibhat MM, Singh JA, Tan KK, Temesgen G, Tolani MA, Tovani-Palone MR, Valadan Tahbaz S, Valizadeh R, Vo B, Vu LG, Yang L, Yazdanpanah F, Yigit A, Yiğit V, Yunusa I, Zahir M, Vos T, Dirac MA. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. THE LANCET. HEALTHY LONGEVITY 2022; 3:e754-e776. [PMID: 36273485 PMCID: PMC9640930 DOI: 10.1016/s2666-7568(22)00213-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia is a common urological disease affecting older men worldwide, but comprehensive data about the global, regional, and national burden of benign prostatic hyperplasia and its trends over time are scarce. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated global trends in, and prevalence of, benign prostatic hyperplasia and disability-adjusted life-years (DALYs) due to benign prostatic hyperplasia, in 21 regions and 204 countries and territories from 2000 to 2019. METHODS This study was conducted with GBD 2019 analytical and modelling strategies. Primary prevalence data came from claims from three countries and from hospital inpatient encounters from 45 locations. A Bayesian meta-regression modelling tool, DisMod-MR version 2.1, was used to estimate the age-specific, location-specific, and year-specific prevalence of benign prostatic hyperplasia. Age-standardised prevalence was calculated by the direct method using the GBD reference population. Years lived with disability (YLDs) due to benign prostatic hyperplasia were estimated by multiplying the disability weight by the symptomatic proportion of the prevalence of benign prostatic hyperplasia. Because we did not estimate years of life lost associated with benign prostatic hyperplasia, disability-adjusted life-years (DALYs) equalled YLDs. The final estimates were compared across Socio-demographic Index (SDI) quintiles. The 95% uncertainty intervals (UIs) were estimated as the 25th and 975th of 1000 ordered draws from a bootstrap distribution. FINDINGS Globally, there were 94·0 million (95% UI 73·2 to 118) prevalent cases of benign prostatic hyperplasia in 2019, compared with 51·1 million (43·1 to 69·3) cases in 2000. The age-standardised prevalence of benign prostatic hyperplasia was 2480 (1940 to 3090) per 100 000 people. Although the global number of prevalent cases increased by 70·5% (68·6 to 72·7) between 2000 and 2019, the global age-standardised prevalence remained stable (-0·770% [-1·56 to 0·0912]). The age-standardised prevalence in 2019 ranged from 6480 (5130 to 8080) per 100 000 in eastern Europe to 987 (732 to 1320) per 100 000 in north Africa and the Middle East. All five SDI quintiles observed an increase in the absolute DALY burden between 2000 and 2019. The most rapid increases in the absolute DALY burden were seen in the middle SDI quintile (94·7% [91·8 to 97·6]), the low-middle SDI quintile (77·3% [74·1 to 81·2]), and the low SDI quintile (77·7% [72·9 to 83·2]). Between 2000 and 2019, age-standardised DALY rates changed less, but the three lower SDI quintiles (low, low-middle, and middle) saw small increases, and the two higher SDI quintiles (high and high-middle SDI) saw small decreases. INTERPRETATION The absolute burden of benign prostatic hyperplasia is rising at an alarming rate in most of the world, particularly in low-income and middle-income countries that are currently undergoing rapid demographic and epidemiological changes. As more people are living longer worldwide, the absolute burden of benign prostatic hyperplasia is expected to continue to rise in the coming years, highlighting the importance of monitoring and planning for future health system strain. FUNDING Bill & Melinda Gates Foundation. TRANSLATION For the Amharic translation of the abstract see Supplementary Materials section.
Collapse
|
9
|
Laschkar S, Montagne S, De Kerviler E, Roupret M, Lucidarme O, Cussenot O, Renard Penna R. Zonal anatomy of the prostate using magnetic resonance imaging, morphometrics, and radiomic features: impact of age-related changes. Br J Radiol 2022; 95:20210156. [PMID: 34541863 PMCID: PMC8978243 DOI: 10.1259/bjr.20210156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the impact of age on the zonal anatomy of the prostate by MRI using morphometric and textural analysis. METHODS A total of 154 men (mean age: 63 years) who underwent MRI due to a high prostate-specific antigen (PSA) level were included retrospectively. At each MRI examination the following variables were measured: overall dimensions of the prostate (whole gland (WG), transitional zone (TZ), and peripheral zone (PZ)), and thickness of the anterior fibromuscular stroma (AFMS) and the periprostatic venous plexus (PPVP) on T2 weighted images. Identical regions of interest (ROIs) were delineated on the apparent diffusion coefficient (ADC) map on the anterior (horn) and posterior part of the PZ. Textural (TexRAD®) parameter differences between TZ and PZ ROIs on T2 weighted images were analyzed by linear regression. Results were correlated with age (distributed into five decades from 22 to 89 years). RESULTS Age was positively correlated with PSA level and glandular volumes (WG, TZ, and TZ/WG ratio; p < 0.0001) and was negatively correlated with AFSM and PPVP thickness (p < 0.0001). There was a positive correlation between ADC values of the PZ and age (p = 0.003) and between entropy of the TZ and PZ and age (p < 0.001). CONCLUSION Gradual variations in morphologic and textural features of the prostate were observed with age, mainly due to the increase in TZ volume while PZ volume tended to decrease. These modifications resulted in textural changes mainly at the expense of entropy. ADVANCES IN KNOWLEDGE Entropy could be relevant for studying the process of aging of the prostate.
Collapse
Affiliation(s)
- Sophie Laschkar
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Eric De Kerviler
- Academic Departement of Radiology, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Olivier Lucidarme
- Academic Department of Radiology, Hôpital Pitié-Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | | |
Collapse
|
10
|
Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Buchner A, Stief CG, Magistro G. How does symptom severity impact clinical outcomes of men with lower urinary tract symptoms after holmium laser enucleation or transurethral resection of the prostate? Cent European J Urol 2022; 75:387-394. [PMID: 36794034 PMCID: PMC9903167 DOI: 10.5173/ceju.2022.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/12/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction International Prostate Symptom Score (IPSS) is a validated outcome measure for the evaluation of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). When treating patients with transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP), patient selection is key to achieve the best clinical outcome. Therefore, we analyzed how the severity of LUTS as determined by IPSS influenced postoperative functional outcomes. Material and methods We conducted a retrospective, matched-pair analysis of 2,011 men who underwent HoLEP or TURP for LUTS/BPO between 2013-2017. We included 195 patients in the final analysis (HoLEP n = 97; TURP n = 98), who were matched for prostate size (50 cc), age, and body mass index. Patients were then stratified by IPSS. Groups were compared for perioperative parameters, safety and short-term functional outcomes. Results While preoperative symptom severity was a significant predictor of postoperative clinical improvement, patients who received HoLEP showed superior postoperative functional results with higher peak flow rates and 2-fold greater improvement in IPSS. In patients presenting with severe symptoms, we observed 3- to 4-fold less Clavien-Dindo grade ≥II and overall complications after receiving HoLEP compared to TURP. Conclusions Patients with severe LUTS were more likely to experience clinically significant improvement after surgery than patients with moderate LUTS, and HoLEP showed superior functional outcomes than TURP. However, patients with moderate LUTS should not be denied surgery, but may warrant a more comprehensive clinical work-up.
Collapse
Affiliation(s)
| | - Melanie Schott
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Patrick Keller
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Michael Atzler
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Benedikt Ebner
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Alexander Buchner
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Christian G Stief
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Giuseppe Magistro
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| |
Collapse
|
11
|
Greenwood MP, Hull KL, Brink-Hull M, Lloyd M, Rhode C. Feed and Host Genetics Drive Microbiome Diversity with Resultant Consequences for Production Traits in Mass-Reared Black Soldier Fly ( Hermetia illucens) Larvae. INSECTS 2021; 12:1082. [PMID: 34940170 PMCID: PMC8706267 DOI: 10.3390/insects12121082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/25/2023]
Abstract
Mass rearing the black soldier fly, Hermetia illucens, for waste bioremediation and valorisation is gaining traction on a global scale. While the health and productivity of this species are underpinned by associations with microbial taxa, little is known about the factors that govern gut microbiome assembly, function, and contributions towards host phenotypic development in actively feeding larvae. In the present study, a 16S rDNA gene sequencing approach applied to a study system incorporating both feed substrate and genetic variation is used to address this knowledge gap. It is determined that the alpha diversity of larval gut bacterial communities is driven primarily by features of the larval feed substrate, including the diversity of exogenous bacterial populations. Microbiome beta diversity, however, demonstrated patterns of differentiation consistent with an influence of diet, larval genetic background, and a potential interaction between these factors. Moreover, evidence for an association between microbiome structure and the rate of larval fat accumulation was uncovered. Taxonomic enrichment analysis and clustering of putative functional gut profiles further suggested that feed-dependent turnover in microbiome communities is most likely to impact larval characteristics. Taken together, these findings indicate that host-microbiome interactions in this species are complex yet relevant to larval trait emergence.
Collapse
Affiliation(s)
- Matthew P. Greenwood
- Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa; (M.P.G.); (K.L.H.); (M.B.-H.)
| | - Kelvin L. Hull
- Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa; (M.P.G.); (K.L.H.); (M.B.-H.)
| | - Marissa Brink-Hull
- Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa; (M.P.G.); (K.L.H.); (M.B.-H.)
| | - Melissa Lloyd
- Insect Technology Group Holdings UK Ltd., 1 Farnham Road, Guildford, Surrey GU2 4RG, UK;
| | - Clint Rhode
- Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa; (M.P.G.); (K.L.H.); (M.B.-H.)
| |
Collapse
|
12
|
Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. The impact of preoperative lower urinary tract symptoms medication on the functional performance of holmium laser enucleation of the prostate. Cent European J Urol 2021; 74:429-436. [PMID: 34729233 PMCID: PMC8552942 DOI: 10.5173/ceju.2021.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Medical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) targets prostate size, to prevent disease progression, and prostate smooth muscle tone for rapid relieve of LUTS. Holmium laser enucleation of the prostate (HoLEP) is a size-independent method for surgical treatment of LUTS/BPO in medication-refractory patients and offers durable long-term results with reduced perioperative morbidity. As up to 50% of patients receive medical treatment for LUTS/BPO prior to surgery, we analyzed the impact of alpha-blockers and 5-alpha reductase inhibitors (5-ARI) on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS. Material and methods We retrospectively gathered data of 1,057 patients, who underwent HoLEP for LUTS/BPO from 2013–2018, and divided patients into group 1 (no medication), group 2 (α-blockers), and group 3 (5-ARI and α-blockers). Perioperative parameters, short-term functional outcomes and safety were assessed and statistical analysis was performed using SPSS V26.0 software. Results Even though preoperative LUTS profile was significantly different between groups, all patients improved significantly after HoLEP, irrespective of preoperative LUTS medication. Median improvement of IPSS was 9, 8 and 7 points, of Qmax was 10, 12 and 9.5 ml/s, with significant improvement of quality of life (QoL) and reduction of post-void residual volume (PVR) for groups 1–3, respectively, 30 days after surgery. With only 4.0% (42/1,057) of patients experiencing a Clavien-Dindo grade ≥II complication, there was no difference in prevalence of perioperative complications between groups (p = 0.943). Conclusions Although preoperative LUTS medication does not impair efficacy of HoLEP with acceptable perioperative morbidity, the time gap between medical therapy and surgical treatment may favor an earlier response.
Collapse
Affiliation(s)
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
13
|
Sunoqrot MRS, Selnæs KM, Sandsmark E, Langørgen S, Bertilsson H, Bathen TF, Elschot M. The Reproducibility of Deep Learning-Based Segmentation of the Prostate Gland and Zones on T2-Weighted MR Images. Diagnostics (Basel) 2021; 11:diagnostics11091690. [PMID: 34574031 PMCID: PMC8471645 DOI: 10.3390/diagnostics11091690] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 01/02/2023] Open
Abstract
Volume of interest segmentation is an essential step in computer-aided detection and diagnosis (CAD) systems. Deep learning (DL)-based methods provide good performance for prostate segmentation, but little is known about the reproducibility of these methods. In this work, an in-house collected dataset from 244 patients was used to investigate the intra-patient reproducibility of 14 shape features for DL-based segmentation methods of the whole prostate gland (WP), peripheral zone (PZ), and the remaining prostate zones (non-PZ) on T2-weighted (T2W) magnetic resonance (MR) images compared to manual segmentations. The DL-based segmentation was performed using three different convolutional neural networks (CNNs): V-Net, nnU-Net-2D, and nnU-Net-3D. The two-way random, single score intra-class correlation coefficient (ICC) was used to measure the inter-scan reproducibility of each feature for each CNN and the manual segmentation. We found that the reproducibility of the investigated methods is comparable to manual for all CNNs (14/14 features), except for V-Net in PZ (7/14 features). The ICC score for segmentation volume was found to be 0.888, 0.607, 0.819, and 0.903 in PZ; 0.988, 0.967, 0.986, and 0.983 in non-PZ; 0.982, 0.975, 0.973, and 0.984 in WP for manual, V-Net, nnU-Net-2D, and nnU-Net-3D, respectively. The results of this work show the feasibility of embedding DL-based segmentation in CAD systems, based on multiple T2W MR scans of the prostate, which is an important step towards the clinical implementation.
Collapse
Affiliation(s)
- Mohammed R. S. Sunoqrot
- Department of Circulation and Medical Imaging, NTNU—Norwegian University of Science and Technology, 7030 Trondheim, Norway; (K.M.S.); (T.F.B.); (M.E.)
- Correspondence:
| | - Kirsten M. Selnæs
- Department of Circulation and Medical Imaging, NTNU—Norwegian University of Science and Technology, 7030 Trondheim, Norway; (K.M.S.); (T.F.B.); (M.E.)
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.S.); (S.L.)
| | - Elise Sandsmark
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.S.); (S.L.)
| | - Sverre Langørgen
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.S.); (S.L.)
| | - Helena Bertilsson
- Department of Cancer Research and Molecular Medicine, NTNU—Norwegian University of Science and Technology, 7030 Trondheim, Norway;
- Department of Urology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Tone F. Bathen
- Department of Circulation and Medical Imaging, NTNU—Norwegian University of Science and Technology, 7030 Trondheim, Norway; (K.M.S.); (T.F.B.); (M.E.)
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.S.); (S.L.)
| | - Mattijs Elschot
- Department of Circulation and Medical Imaging, NTNU—Norwegian University of Science and Technology, 7030 Trondheim, Norway; (K.M.S.); (T.F.B.); (M.E.)
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway; (E.S.); (S.L.)
| |
Collapse
|
14
|
Adriansyah IA, Afriansyah A, Siregar MAR, Purnomo N, Mirza H, Seno DH. Efficacy of holmium laser enucleation of the prostate in patients with detrusor underactivity: systematic review and meta-analysis. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Benign prostatic hyperplasia (BPH) is commonly found in the aging male. Treatment of BPH can be in form of conservative or surgical intervention. Transurethral resection of the prostate (TURP) is the gold-standard treatment for BPH according to the guideline. However, there is no evidence that there is a benefit for TURP in patients with detrusor underactivity (DUA). Holmium laser enucleation (HoLEP) is theorized to have a better outcome due to its property of complete prostate enucleation. Therefore, this meta-analysis aims to determine the benefit of HoLEP for BPH patients with DUA.
Main body
We performed systematic literature searching from five databases including PubMed, Scopus, Embase, Science Direct, and Web of Science for articles up to 31 December 2020 for relevant studies. A total of five articles are eligible for this meta-analysis. A total of 2.180 subjects participated in all of the studies included. Two studies comparing patients with and without DUA that was treated with HoLEP, two studies comparing HoLEP with other surgical approaches for BPH, and one study comparing both parameters. IPSS score reduction is significantly higher in the patients with DUA (Mean Difference = 3.28, 95% CI 1.91 to 4.64, p < 0.01). Qmax and PVR are not significantly different between both groups. HoLEP also showed better improvement in IPSS and Qmax compared to TURP (IPSS: Mean Difference = -4.80, 95% CI − 7.83 to − 1.77, p = 0.002; Qmax: Mean Difference = 4.20, 95% CI 0.58 to 7.82, p = 0.02) and PVP (IPSS: Mean Difference = − 2.47, 95% CI − 4.47 to − 0.47, p = 0.02; Qmax: Mean Difference = 2.31, 95% CI 0.34 to 4.28, p = 0.02).
Conclusion
HoLEP showed better improvement in IPSS scores in patients with DUA. HoLEP can be considered to be performed in the BPH patients with DUA for better outcomes for the patients.
Collapse
|
15
|
Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. Holmium laser enucleation of the prostate: A truly size-independent method? Low Urin Tract Symptoms 2021; 14:17-26. [PMID: 34323002 DOI: 10.1111/luts.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/13/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the impact of prostate size on functional outcomes and perioperative morbidity, we analyzed patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms (LUTS). As LUTS secondary to benign prostatic obstruction (BPO) are a chronic progressive disease, prevalence and prostate size increase with age. HoLEP is a size-independent method for surgical treatment of LUTS/BPO and can be offered in medication-refractory patients with durable long-term results and reduced perioperative morbidity. METHODS We retrospectively collected data of 852 patients who underwent HoLEP for LUTS secondary to BPO between 2014-2018. Patients were divided into group 1 (≤60 cc), group 2 (>60 < 120 cc), group 3 (≥120 cc). Perioperative parameters, safety and short-term functional outcomes were assessed and analyzed. RESULTS Patients in group 3 were significantly older and showed a significantly higher median prostate-specific antigen level. Perioperative parameters, such as enucleation time and morcellation time significantly differed in favor of smaller prostate sizes, while enucleation and morcellation speed showed favorable results for larger prostate sizes. Larger prostates ≥120 cc showed a significantly higher postoperative drop in hemoglobin. However, patients did not differ in postoperative functional outcomes or Clavien-Dindo grade ≥II complications (4.8% of all patients [41/852]). There was no difference in perioperative complications between all groups (P = 0.760). CONCLUSION While larger prostates take significantly longer to operate on, postoperative functional outcomes show no difference between all sizes. In conclusion, HoLEP is a size-independent and effective method for surgical treatment of LUTS/BPO in prostates ≥30 cc.
Collapse
Affiliation(s)
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
16
|
Bhat SA, Rather SA, Islam N. An overview of benign prostatic hyperplasia and its appreciation in Greco-Arab (Unani) system of medicine. Asian J Urol 2021; 9:109-118. [PMID: 35509487 PMCID: PMC9051355 DOI: 10.1016/j.ajur.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/30/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
|
17
|
Tobaiqy M, Aalam W, Banji D, Al Haleem ENA. Intraoperative Floppy Iris Syndrome Induced by Tamsulosin: The Risk and Preventive Strategies. Middle East Afr J Ophthalmol 2021; 28:51-56. [PMID: 34321822 PMCID: PMC8270016 DOI: 10.4103/meajo.meajo_561_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/04/2022] Open
Abstract
Tamsulosin is an antagonist of a subtype-specific alpha-1A- and alpha-1D-adrenoceptor (AR) that is expressed in the prostate gland, urethra, and bladder. Several reports have shown a possible relationship between ophthalmologic adverse effects and the use of alpha-1-receptor medicines, including tamsulosin. This descriptive review evaluates the intraoperative floppy iris syndrome (IFIS) associated with tamsulosin. A search of the Medline and PubMed databases was conducted to identify control trials, case reports, and observational examinations published in English. The publication dates were restricted (January 1, 2000, to January 1, 2020). Keywords (tamsulosin, alpha-blocker, ocular, eye, adverse reaction, and IFIS) were used in the searches. The searches identified 66 studies including in vitro or in vivo studies, trials, and observational studies. Twenty-two (33.33%) studies were articles citing tamsulosin and IFIS as having confirmed potential risk to ocular safety. The results of this review, including a comprehensive summary of published research on tamsulosin use in different populations, have identified several articles showing associations between tamsulosin and IFIS that merit further investigation. Suspending of potential causative pharmacological treatment of IFIS before ocular surgery including tamsulosin, proper identification of at-risk patients, preoperative prophylaxis treatments, and surgical technique modifications clearly can mitigate the anticipated risk of IFIS induced by tamsulosin.
Collapse
Affiliation(s)
- Mansour Tobaiqy
- Department of Pharmacology, College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - Waseem Aalam
- Department of Ophthalmology, College of Medicine, University of Jeddah, Jeddah, Kingdom of Saudi Arabia
| | - David Banji
- Department of Pharmacy Practice, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Ekram N Abd Al Haleem
- Department of Pharmacology and Toxicology, College of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| |
Collapse
|
18
|
Pascal LE, Dhir R, Balasubramani GK, Chen W, Hudson CN, Srivastava P, Green A, DeFranco DB, Yoshimura N, Wang Z. Claudin-1 down-regulation in the prostate is associated with aging and increased infiltration of inflammatory cells in BPH. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:53-64. [PMID: 33816694 PMCID: PMC8012836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVE Benign prostatic hyperplasia (BPH) is an age-related disease that is frequently associated with chronic prostatic inflammation. In previous studies, we detected the presence of PSA protein in the stroma of BPH nodules and down-regulation of junction proteins E-cadherin and claudin-1. Transmission electron microscopy (TEM) imaging showed a decrease in tight junctions suggesting the luminal epithelial barrier in BPH tissues may be compromised. Recent in vitro studies showed that stimulation of benign prostate epithelial cell lines with TGF-β1 induced a decrease in claudin-1 expression suggesting that inflammation might be associated with alterations in the prostate epithelial barrier. This study explored the potential associations between aging and loss of junction proteins and the presence of inflammatory cells in prostate tissue specimens from young healthy donors and aged BPH patients. METHODS Immunostaining of serial prostate sections from 13 BPH patients and five healthy young donors was performed for claudin-1, CD4, CD8, CD20 and CD68. H-Scores and the number of inflammatory cells were calculated for the same area in donor, normal adjacent prostate (NAP) to and BPH specimens. Quantification and statistical correlation analyses were performed. RESULTS Claudin-1 immunostaining was inversely associated with increasing age, and inflammation in prostate specimens. B-cell infiltration increased with age and BPH was associated with an increased infiltration of T-cells and macrophages compared to NAP. CONCLUSIONS These findings suggest that aging is associated with down-regulation of claudin-1 and claudin-1 is further decreased in BPH. Claudin-1 down-regulation was associated with increased infiltration of inflammatory cells in both NAP and BPH tissues. Claudin-1 down-regulation in the aging prostate could contribute to increased prostatic inflammation, subsequently contributing to BPH pathogenesis.
Collapse
Affiliation(s)
- Laura E Pascal
- Department of Urology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
- UPMC Hillman Cancer Center, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Rajiv Dhir
- Department of Pathology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | | | - Wei Chen
- Department of Urology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Chandler N Hudson
- Department of Urology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Pooja Srivastava
- Department of Pathology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Anthony Green
- Department of Pathology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Donald B DeFranco
- Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh School of MedicinePittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, and University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, and University of Pittsburgh School of MedicinePittsburgh, PA, USA
| | - Zhou Wang
- Department of Urology, University of Pittsburgh School of MedicinePittsburgh, PA, USA
- UPMC Hillman Cancer Center, University of Pittsburgh School of MedicinePittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, and University of Pittsburgh School of MedicinePittsburgh, PA, USA
| |
Collapse
|
19
|
Xiong Y, Zhang Y, Li X, Qin F, Yuan J. The prevalence and associated factors of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging males. Aging Male 2020; 23:1432-1439. [PMID: 32583703 DOI: 10.1080/13685538.2020.1781806] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To investigate the prevalence and associated factors of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) in Chinese aging males. METHOD Data downloaded from the China Health and Retirement Longitudinal Study (CHARLS) was subjected to descriptive statistics followed by univariate logistic regression and multivariate logistic regression. RESULTS A total of 8563 participants with an overall LUTS/BPH prevalence of 11.97% were enrolled. With aging, the LUTS/BPH prevalence increased (p < 0.001). Men aged over 70 years suffered the highest prevalence of 22.70%. Marital status did nothing to the suffering of LUTS/BPH. Subjects receiving more education or assessed as depression displayed higher incidence of LUTS/BPH (p < 0.001). In rural villages, settlers showed lower prevalence of 10.00% compared to 16.49% for urban residents. Smoking, sleeping time and alcohol consumption seemed to play a protective role in the occurrence of LUTS/BPH. One who slept more than 8 h, was smoking, and drank more than once a month had the lowest prevalence (p ≤ 0.001). CONCLUSIONS For Chinese aging population, LUTS/BPH prevalence increased with aging and was interfered by educational level, depression, sleeping time, geographical region, smoke and alcohol consumption.
Collapse
Affiliation(s)
- Yang Xiong
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yangchang Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiaoyu Li
- Laboratory of Innovation, Basic Medical Experimental Teaching Centre, Chongqing Medical University, Chongqing, China
| | - Feng Qin
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong Yuan
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, China
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
20
|
Wu Y, Ding Y, Cao QF, Qian SB, Wang C, Duan HQ, Gu J, Shen HB. The relationship between glucose homeostasis status and prostate size in aging Chinese males with benign prostatic hyperplasia. World J Urol 2020; 38:2923-2931. [PMID: 31965286 PMCID: PMC7644519 DOI: 10.1007/s00345-020-03084-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/06/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Increasing evidence shows that many metabolic factors are involved in the progression of benign prostatic hyperplasia (BPH). We aimed to assess the relationship between the status of glucose homeostasis and prostate size in aging Chinese males undergoing transurethral resection of the prostate (TURP) for BPH. METHODS A total of 1006 medical records of BPH patients undergoing TURP were reviewed. Prostate size was measured by transrectal ultrasound. Annual total prostate (TP) and transitional zone (TZ) growth rates were calculated. According to the American Diabetes Association criteria, the patients were categorized as normoglycemic, prediabetic, or diabetic. Levels of glucose homeostasis and other variables were considered independent variables in an effort to evaluate any potential correlations using non-adjusted and multivariate-adjusted regression models. RESULTS A total of 659 individuals were included in the study. BPH patients < 70 years old and ≥ 70 years old in the normoglycemic group had a stable prostate growth rate. The change in prostate size in those younger than 70 years, however, was faster in the prediabetic and diabetic group. Further analysis revealed that abnormal glucose homeostasis was positively correlated with prostate size. In those younger than 70 years, compared with the normal glucose group, the adjusted odds ratio (OR) for TP and TZ enlargement in the prediabetic group was 2.27 (95%CI 1.29-4.00) and 3.19 (95%CI 1.78-5.72), respectively, and the adjusted ORs were 4.74 (95%CI 2.18-10.30) and 6.16 (95%CI 2.70-14.06), respectively, for men with diabetes. However there was no significant difference among men aged ≥ 70 years. CONCLUSIONS Among patients undergoing TURP, the prostate volume and growth rate were affected by different status of glucose homeostasis. Hyperglycemia may play an important role in prostate growth.
Collapse
Affiliation(s)
- Y Wu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Y Ding
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Q F Cao
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - S B Qian
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - C Wang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - H Q Duan
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - J Gu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - H B Shen
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| |
Collapse
|
21
|
Chen X, Man Q, Wei X, Ren X, Li G, Lu Z, Zhang X, Qin C. Predictive value of preoperative comprehensive evaluation on the efficacy of HoLEP. Transl Androl Urol 2020; 9:1603-1610. [PMID: 32944522 PMCID: PMC7475670 DOI: 10.21037/tau-20-504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background With the aging of the population, prostate hyperplasia is more and more perplexing to the old men. This study aimed to evaluate the predictive value of international prostatic symptom score-voiding/storage score ratio (IPSS-V/S), urodynamic examination, intravesical prostatic protrusion (IPP) and residual urine volume (RUV) on the efficacy of holmium laser enucleation of the prostate (HoLEP) before operation. Methods Ninety-six patients with benign prostatic hyperplasia (BPH) were enrolled in this study. Each patient was diagnosed as BPH and completed all the evaluations as described above before the same urologist surgeon performed HoLEP. Three months later, another IPSS questionnaire would be finished by each patient to assess the efficacy of the operation. According to the results of IPSS after operation, the group with significant effect and the group with poor effect were divided. Then compare the difference of preoperative examination results between the two groups. Results In single factor analysis, the differences of the age, voiding symptom score, V/S, RUV, Qmax and IPP between the two groups were statistically significant (P<0.05). While there was no significant difference in IPSS score and score of urine storage period. In the logistic regression analysis, the age of patients, V/S, RUV, IPP and Qmax can establish a good prediction model. In this model, the younger the patients are, the less the RUV is, the larger the V/S and IPP are, the more likely they are to achieve good efficacy of HoLEP. Conclusions In conclusion, HoLEP was more effective in BPH patients with younger age, more IPP, less RUV, less Qmax and those whose IPSS score was mainly based on voiding symptoms.
Collapse
Affiliation(s)
- Xinglin Chen
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiuhong Man
- Department of Clinical Laboratory, Shanghai Fourth People's Hospital Affiliated to School of Medicine, Tongji University, Shanghai, China
| | - Xiyi Wei
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohan Ren
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guangyao Li
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongwen Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Qin
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
22
|
Increased One-Year Recurrent Ischemic Stroke after First-Ever Ischemic Stroke in Males with Benign Prostatic Hyperplasia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155360. [PMID: 32722374 PMCID: PMC7432020 DOI: 10.3390/ijerph17155360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/21/2022]
Abstract
(1) Background: Patients with benign prostatic hyperplasia (BPH) were questioned about quality of life and sleep. Most BPH patients were treated with alpha-1 adrenergic receptor antagonists, which could improve cerebral blood flow for 1–2 months. Patients with ischemic stroke (IS) could experience cerebral autoregulation impairment for six months. The relationship between BPH and recurrent IS remains unclear. The aim of this study was to determine the risk of one-year recurrent IS conferred by BPH. (2) Methods: We used data from the Taiwanese National Health Insurance Database to identify newly diagnosed IS cases entered from 1 January 2008 to 31 December 2008. Patients were followed until the recurrent IS event or 365 days after the first hospitalization. The risk factors associated with one-year recurrent IS were assessed using Cox proportional hazards regression. (3) Results: Patients with BPH had a higher risk of recurrent IS (12.11% versus 8.15%) (adjusted hazard ratio (HR): 1.352; 95% confidence interval (CI): 1.028–1.78, p = 0.031). Other risk factors included hyperlipidemia (adjusted HR: 1.338; 95% CI: 1.022–1.751, p = 0.034), coronary artery disease (adjusted HR: 1.487; 95% CI: 1.128–1.961, p = 0.005), chronic obstructive pulmonary disease (adjusted HR: 1.499; 95% CI: 1.075–2.091, p = 0.017), and chronic kidney disease (adjusted HR: 1.523; 95% CI: 1.033–2.244, p = 0.033). (4) Conclusion: Patients with BPH who had these risk factors had an increased risk of one-year recurrent IS. The modification of risk factors may prevent recurrent IS.
Collapse
|
23
|
Kohestani Y, Kohestani B, Shirmohamadi Z, Faghani M. Effect of tamsulosin on testis histopathology and serum hormones in adult rats: Experimental study. Int J Reprod Biomed 2020; 18:531-538. [PMID: 32803117 PMCID: PMC7385916 DOI: 10.18502/ijrm.v13i7.7370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 10/12/2019] [Accepted: 01/14/2020] [Indexed: 01/18/2023] Open
Abstract
Background Tamsulosin is an inhibitory factor of alpha-adrenergic receptors that is used for relieving of the clinical symptoms and management of acute urinary retention. Objective The aim of this study was to evaluate the effects of tamsulosin on the endocrine axis and testicular tissue in adult male rats. Materials and Methods In this experimental study, 30 adult male Wistar rats (weighing 250-300 gr) were divided into three groups: 1) control (received distilled water), 2) experimental 1 (received 0.2 mg/kg/day tamsulosin) and 3) experimental 2 (received 0.4 mg/kg/day tamsulosin) through oral gavage for 28 days. Serum hormones level and testicular histopathology were evaluated at the end of the experiment. Results In this study, the testicular weight decreased significantly in the experimental groups compared to the control group. A significant decrease was seen in testicular weight (p = 0.004) and the number of Leydig cells in tamsulosin-treated groups (p = 0.012). Tamsulosin improved the hormone profile in experimental groups. Also, higher dose of tamsulosin significantly changed the number of Leydig, spermatogonia cells, the thickness of germinal layer, and the diameter of the seminiferous tubules. Conclusion Results showed that using tamsulosin, possibly reduces the testosterone concentration through adrenergic axis system and in turn has destructive effects on proliferative activity of germ cells.
Collapse
Affiliation(s)
- Yegane Kohestani
- Department of Anatomical Sciences, Bandar-Anzali Pardis, Faculty of Medicine, Guilan University of Medical Sciences, Bandar-Anzali, Iran
| | - Bentolhoda Kohestani
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Shirmohamadi
- Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Faghani
- Department of Anatomical Sciences, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
24
|
Kosilov KV, Kuzina IG, Kuznetsov V, Kosilova EK. Improvement of the symptoms of lower urinary tract and sexual dysfunction with tadalafil and solifenacin after the treatment of benign prostatic hyperplasia with dutasteride. Prostate Int 2020; 8:78-84. [PMID: 32647644 PMCID: PMC7335965 DOI: 10.1016/j.prnil.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this research is to study the influence of simultaneous taking of tadalafil and solifenacin in standard and double dosage on the lower urinary tract symptoms (LUTS) and sexual dysfunction in men with benign prostatic hyperplasia after the course of dutasteride. Materials and methods The research included 326 patients older than 50 years with benign prostatic hyperplasia coupled with LUTS and sexual dysfunction having undergone the course of treatment with dutasteride. After random division into three groups, patients from the Group A (n = 107) got tadalafil 5 mg/d as monotherapy, from the Group В (n = 107) got tadalafil 5 mg/d and solifenacin 10 mg/d, and from the Group С (n = 112) got tadalafil 5 mg/d and solifenacin 20 mg/d. The duration of treatment was 12 weeks. The rating of sexual function was made with the questionnaires International Index of Erectile Function and other. Results The results of rating of sexual function with the questionnaires MSHQ-EjD and International Index of Erectile Function correlated among themselves. According to MSHQ-EjD, overall rating of the sexual function increased in each of the three groups (A: 67.9 (12.4)/91.5 (10.4), P ≤ 0.05; B: 72.4 (14.5)/102.6 (16.9), P ≤ 0.05; C: 76.6 (16.3)/109.6 (15.6), P ≤ 0.05). The level of hyperactivity symptoms decreased in Groups В and С (В: urgency −2.9 (0.7)/1.1 (0.6), P ≤ 0.05; nocturia 2.7 (1.0)/0.7 (0.5), P ≤ 0.05; C: urgency −2.5 (0.5)/0.8 (0.6), P ≤ 0.05; nocturia −2.8 (0.6)/1.0 (0.5), P ≤ 0.05), and it did not change in the Group A. Conclusions The use of tadalafil as monotherapy significantly improves the sexual function but does not affect overactive bladder symptoms. The combination therapy of tadalafil and solifenacin leads to dramatic improvement of sexual function and reversibility of detrusor hyperactivity symptoms.
Collapse
Affiliation(s)
- Kirill V Kosilov
- Department of Social Sciences, School of Humanities, Far Eastern Federal University, Vladivostok, Primorsky Region, Russian Federation
| | - Irina G Kuzina
- Department of Social Science, Far Eastern Federal University, Vladivostok, Primorsky Region, Russian Federation
| | - Vladimir Kuznetsov
- Department of Public Health, Pacific State Medical University, Vladivostok, Primorsky Region, Russian Federation
| | - Ekaterina K Kosilova
- Pacific State Medical University, Vladivostok, Primorsky Region, Russian Federation
| |
Collapse
|
25
|
Zitoun OA, Farhat AM, Mohamed MA, Hamad MR, Aramini B, Haider KH. Management of benign prostate hyperplasia (BPH) by combinatorial approach using alpha-1-adrenergic antagonists and 5-alpha-reductase inhibitors. Eur J Pharmacol 2020; 883:173301. [PMID: 32592768 DOI: 10.1016/j.ejphar.2020.173301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/23/2022]
Abstract
Currently, the main available treatments for benign prostate hyperplasia (BPH) are alpha-1 adrenergic receptor antagonists (ARAs), 5-alpha reductase inhibitors (5-αRI), anticholinergics, and Phosphodiesterase-5 inhibitors. Recent studies support the combined therapy approach using ARAs with 5-αRI for lower urinary tract symptoms (LUTS) in BPH patients at risk of clinical progression. We aimed to review BPH management in select group of randomized controlled trials by combination therapy with ARAs and 5-αRIs compared to monotherapy with either drug with respect to the safety and efficacy. A total of 6 randomized controlled trials (RCTs) involving comparison of combination therapy with monotherapy using ARAs and 5-αRIs were retrieved from PubMed Central and reviewed for international prostate symptom score (IPSS), quality of life (QoL), post-residual urinary flow rate (PUF), and clinical progression. The results significantly favour the treatment group that received the combination therapy in comparison with the groups receiving monotherapy. However, outcome with regard to prostate volume showed insignificant improvement when the combination therapy is compared with 5- αRIs alone, rather than ARAs. In conclusion, combination therapy using ARAs and 5-αRI is better than monotherapy in the patients of BPH. Fixed dose combination (FDC), a type of combination, is also cost-effective and its side-effects profile resembles to that of monotherapy.
Collapse
Affiliation(s)
- Osama A Zitoun
- Sulaiman AlRajhi University, Al Bukairiyah, Kingdom of Saudi Arabia.
| | | | - Mohamed A Mohamed
- Sulaiman AlRajhi University, Al Bukairiyah, Kingdom of Saudi Arabia.
| | - Mohammad R Hamad
- Sulaiman AlRajhi University, Al Bukairiyah, Kingdom of Saudi Arabia.
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | | |
Collapse
|
26
|
Kusuma Duarsa GW, Sari YA, Gde Oka AA, Santosa KB, Yudiana IW, Wisnu Tirtayasa PM, Putra Pramana IB, Kloping YP. Serum testosterone and prostate-specific antigen levels are major risk factors for prostatic volume increase among benign prostatic hyperplasia patients. Asian J Urol 2020; 8:289-297. [PMID: 34401336 PMCID: PMC8356038 DOI: 10.1016/j.ajur.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/09/2020] [Accepted: 04/22/2020] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
- Corresponding author.
| | - Yudit Anastasia Sari
- General Surgery Department, Faculty of Medicine Udayana University, Denpasar, Bali, Indonesia
| | - Anak Agung Gde Oka
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - Kadek Budi Santosa
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - I Wayan Yudiana
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - Pande Made Wisnu Tirtayasa
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | - Ida Bagus Putra Pramana
- Department of Urology, Sanglah General Hospital, Faculty of Medical and Health Sciences of Udayana University, Denpasar, Bali, Indonesia
| | | |
Collapse
|
27
|
Liu D, Shoag JE, Poliak D, Goueli RS, Ravikumar V, Redmond D, Vosoughi A, Fontugne J, Pan H, Lee D, Thomas D, Salari K, Wang Z, Romanel A, Te A, Lee R, Chughtai B, Olumi AF, Mosquera JM, Demichelis F, Elemento O, Rubin MA, Sboner A, Barbieri CE. Integrative multiplatform molecular profiling of benign prostatic hyperplasia identifies distinct subtypes. Nat Commun 2020; 11:1987. [PMID: 32332823 PMCID: PMC7181734 DOI: 10.1038/s41467-020-15913-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/23/2020] [Indexed: 12/15/2022] Open
Abstract
Benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate, is among the most common diseases affecting aging men, but the underlying molecular features remain poorly understood, and therapeutic options are limited. Here we employ a comprehensive molecular investigation of BPH, including genomic, transcriptomic and epigenetic profiling. We find no evidence of neoplastic features in BPH: no evidence of driver genomic alterations, including low coding mutation rates, mutational signatures consistent with aging tissues, minimal copy number alterations, and no genomic rearrangements. At the epigenetic level, global hypermethylation is the dominant process. Integrating transcriptional and methylation signatures identifies two BPH subgroups with distinct clinical features and signaling pathways, validated in two independent cohorts. Finally, mTOR inhibitors emerge as a potential subtype-specific therapeutic option, and men exposed to mTOR inhibitors show a significant decrease in prostate size. We conclude that BPH consists of distinct molecular subgroups, with potential for subtype-specific precision therapy.
Collapse
Affiliation(s)
- Deli Liu
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jonathan E Shoag
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Poliak
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Ramy S Goueli
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | | | - David Redmond
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aram Vosoughi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jacqueline Fontugne
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Heng Pan
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Daniel Lee
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Domonique Thomas
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Keyan Salari
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Zongwei Wang
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alessandro Romanel
- Department of Cellular, Computational and Integrative Biology (CIBIO), Trento, Italy
| | - Alexis Te
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Richard Lee
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Aria F Olumi
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Juan Miguel Mosquera
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Demichelis
- Department of Cellular, Computational and Integrative Biology (CIBIO), Trento, Italy
| | - Olivier Elemento
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Mark A Rubin
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA
- Department of BioMedical Research, University of Bern and Inselspital, Bern, Switzerland
| | - Andrea Sboner
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY, USA.
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA.
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Christopher E Barbieri
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
- Department of Urology, Weill Cornell Medicine, New York, NY, USA.
- Englander Institute for Precision Medicine of Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA.
| |
Collapse
|
28
|
Averback P, Gohal R, Fuska M, Prins K, Wang P. Fexapotide Triflutate Induces Selective Prostate Glandular Pharmaco-Ablation in the Rat. Res Rep Urol 2019; 11:343-350. [PMID: 31909043 PMCID: PMC6929934 DOI: 10.2147/rru.s231334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction A clinical challenge for interventional prostate treatments for localized prostate cancer has been to elicit cancer tissue eradication which can avoid undesirable toxicities and irreparable damage to adjacent structures. Fexapotide triflutate (FT) has been shown in human clinical trials to be a well-tolerated pharmaco-ablative agent with therapeutic benefit in patients with prostate enlargement and low-grade prostate cancer. Methods Studies were undertaken in vitro and in the normal male rat to characterize and quantify selective ablation of prostate glandular cells exposed to fexapotide triflutate (FT) injections. N=371 2-month-old Sprague Dawley rats received direct intraprostatic injections under ether anesthesia with laparotomy (n=268 given 0.3 mL FT 0.1–2.0 mg/mL at varied schedules, and n=103 controls), and were sacrificed at intervals of 24 hr-12 months, with measurements of prostate volume, assessments of apoptosis, prostatic nerve structures, connective tissue stroma, and vasculature. In vitro prostate cell lines treated with FT were studied by electron microscopy and RNA quantification. Results Evidence shows that FT leads to prostate glandular cell loss not found in controls, by apoptosis within 24–72 hrs that is highly selective for achieving near-total loss of glandular epithelium at 6 to 12 months, without any adverse microscopic effects to adjacent periprostatic nerves, vascular elements, and stroma. Conclusion Histological studies in the rat demonstrate that FT ablative effect is selective for prostate glandular epithelium, sparing adjacent tissues and structures in the prostate including nerves, vasculature, and stroma.
Collapse
Affiliation(s)
| | | | | | | | - Ping Wang
- Nymox Corporation, Montreal, QC, Canada
| |
Collapse
|
29
|
Park JS, Koo KC, Kim HK, Chung BH, Lee KS. Impact of metabolic syndrome-related factors on the development of benign prostatic hyperplasia and lower urinary tract symptoms in Asian population. Medicine (Baltimore) 2019; 98:e17635. [PMID: 31626149 PMCID: PMC6824778 DOI: 10.1097/md.0000000000017635] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study aimed to investigate the metabolic syndrome-related risk factors for the development of benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) in healthy men.A total of 4880 healthy men who underwent transrectal ultrasonography at our hospital during routine health examinations were included in this study. Those who had undergone a prior biopsy or surgery for prostate disease, were suspected of having urinary tract infection, or were taking BPH/LUTS or metabolic syndrome medications were excluded. BPH/LUTS was defined as an International Prostate Symptom Score (IPSS) of ≥8 and a prostate volume (PV) of ≥30 cm.The subjects had a mean age of 54.1 years, PV of 29.2 cm, prostate-specific antigen (PSA) level of 1.20 ng/mL, and IPSS of 9.2. The annual PV growth rate was 0.48 cm/year. Age, body mass index (BMI), PSA, basal metabolic rate, apolipoprotein A-1, fasting blood glucose, high-density lipoprotein (HDL) cholesterol levels were significant predictive factors for PV. Age, PSA, apolipoprotein B, fasting blood glucose, cholesterol, HDL, and low-density lipoprotein (LDL) levels were predictors of BPH/LUTS at the initial health examination. A decreased fat mass and LDL level were a significant risk factor for the development of BPH/LUTS within 5 years in men without a BPH/LUTS diagnosis at the initial examination.Metabolic syndrome-related variables were strongly associated with BPH/LUTS and by decreasing fat mass and LDL levels, development of BPH/LUTS could be prevented within 5 years in healthy Korean men.
Collapse
Affiliation(s)
- Jee Soo Park
- Department of Urology, Yonsei University College of Medicine
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine
| | - Hye Kyung Kim
- Health Promotion Center, Gangnam Severance Hospital, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Yonsei University College of Medicine
| | - Kwang Suk Lee
- Department of Urology, Yonsei University College of Medicine
- Health Promotion Center, Gangnam Severance Hospital, Seoul, Korea
| |
Collapse
|
30
|
Liang QF, Zhang SC, Yu XH, Li JH, Zheng JB, Zhao J, Liang GQ, Shi HJ, Zhou WJ, Zhu QX. Longitudinal changes in prostate volume in a community-based cohort study of middle-aged and elderly men in rural China. Andrology 2019; 8:358-363. [PMID: 31539457 DOI: 10.1111/andr.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 08/31/2019] [Accepted: 09/16/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Prostate volume (PV) and its change rate are important for the progression of prostate disease, but studies on their estimates are inconsistent. OBJECTIVES To investigate whether age, prostate-specific antigen (PSA), and other specific characteristics are associated with PV and its change rate. MATERIALS AND METHODS A community-based cohort study was conducted in a rural area of China among male residents aged 40-80 years. PV was estimated at baseline and at 4 years of follow-up by trans-abdominal ultrasound. Annual PV change rate (PVCR) was calculated as change in volume divided by time interval. Baseline characteristics, including age, serum PSA, and hormones, were evaluated. And their relationships with PV or PVCR were assessed with Pearson correlation and multivariate linear regression analyses. RESULTS Totally, 462 participants completed the follow-up with baseline PV (PV0 ) of 15.6 ± 5.5 ml. PV0 was highly correlated with age and PSA in pairwise correlations (Pearson r = 0.35 and 0.34, respectively, p < 0.01). Multivariate linear regression showed similar associations that PV0 tended to increase with age and PSA. The average PVCR was 0.7 ± 1.8 ml/year. In pairwise correlations, PVCR was inversely correlated with PV0 and positively correlated with PSA, while it was not significantly related to baseline age. Linear regression of PVCR on age and PSA in groups classified by PV0 quartile showed that age was not a significant estimator of PVCR, whereas PSA was. In each PV0 group, PVCR tended to increase with PSA. DISCUSSION AND CONCLUSION PV was positively associated with age and PSA, and it tended to grow faster in men with smaller baseline PV and higher PSA. PSA can be a valuable parameter for estimating both the size and the growth speed of prostate. Although age is associated with prostate enlargement, it does not appear to be related to the longitudinal change rate of PV.
Collapse
Affiliation(s)
- Q-F Liang
- Department of Reproductive Epidemiology and Social Science, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - S-C Zhang
- Department of Cell Biology, National Research Institute for Family Planning, Beijing, China
| | - X-H Yu
- Department of Urology, The First People's Hospital of Jiashan, Zhejiang, China
| | - J-H Li
- Department of Reproductive Epidemiology and Social Science, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - J-B Zheng
- Department of Urology, The First People's Hospital of Jiashan, Zhejiang, China
| | - J Zhao
- Department of Cardiology, the Key Laboratory of Cardiovascular Disease, The First Hospital of Lanzhou University, Lanzhou, China
| | - G-Q Liang
- Department of Urology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - H-J Shi
- Department of Reproductive Epidemiology and Social Science, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - W-J Zhou
- Department of Reproductive Epidemiology and Social Science, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Q-X Zhu
- Department of Reproductive Epidemiology and Social Science, NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| |
Collapse
|
31
|
The new kids on the block: prostatic urethral lift (Urolift) and convective water vapor energy ablation (Rezūm). Curr Opin Urol 2019. [PMID: 29538166 DOI: 10.1097/mou.0000000000000502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The main objective of novel minimally invasive treatment options is to provide relief of bothersome lower urinary tract symptoms (LUTS) equally effective to current standard techniques, but with a more favorable safety profile. Here we present the first clinical experience with the prostatic urethral lift (Urolift) and the convective water vapor energy ablation (Rezūm). RECENT FINDINGS Urolift offers rapid and durable relief of LUTS with complete preservation of sexual function. It is not as effective as the reference method transurethral resection of the prostate (TURP) in terms of symptom relief and urodynamic parameters, but it in selected patients with special interest in sexual activity and rapid recovery it may be an attractive option. The Rezūm system also offers rapid and safe relief of LUTS without compromising sexual function. But it targets all critical prostatic zones including an obstructive middle lobe. SUMMARY In selected patients with bothersome LUTS, who seek a minimally invasive procedure offering a fast return to daily activity and complete preservation of sexual function, Urolift is a good option. First 3-year clinical data on Rezūm demonstrated efficacy and safety in a prospective randomized, sham-controlled trial. It addresses all critical zones of benign prostatic obstruction including the middle lobe without compromising sexual function. Long-term data and the direct comparison with the reference method TURP are missing to define its role in the surgical spectrum of minimally invasive treatment options.
Collapse
|
32
|
Zhang W, Zhang X, Li H, Wu F, Wang H, Zhao M, Hu H, Xu K. Prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) in China: results from the China Health and Retirement Longitudinal Study. BMJ Open 2019; 9:e022792. [PMID: 31221864 PMCID: PMC6589042 DOI: 10.1136/bmjopen-2018-022792] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Rapid population ageing in China is increasing the prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) among older people. The associated economic burden is increasing as well. Relevant data from China are currently insufficient. DESIGN Secondary analysis of a cohort sample. SETTING A nationally representative, cross-sectional survey-the China Health and Retirement Longitudinal Study (CHARLS)-was conducted in 2011 in mainland China. PARTICIPANTS The study included individuals in the community selected from CHARLS by multistage probability sampling. A total of 5888 participants aged 50 years and above were included. OUTCOME MEASURES Self-reported morbid state was derived from a structured questionnaire. The weighted prevalence of LUTS/BPH was estimated and stratified by age group, marital status, education level, economic level, residential area and geographical region. Multivariable weighted logistic regression was used to examine the association of socioeconomic status with the odds of BPH. RESULTS The weighted overall prevalence of LUTS/BPH was 10.66% (95% CI 9.36 to 12.12). Among individuals aged over 70 years, the prevalence was 14.67% (95% CI 11.80 to 18.09) and it increased with ageing (p<0.05). The prevalence of LUTS/BPH among subjects residing in urban areas was higher (13.55%, 95% CI 10.95 to 16.64) than those living in rural areas (8.38%, 95% CI 6.90 to 10.15). The prevalence of LUTS/BPH was lowest in the South-Central and South-West regions and highest in the North-West region. CONCLUSIONS We found an increasing trend of prevalence of LUTS/BPH with ageing. It varied according to marital status, socioeconomic status and geographical region.
Collapse
Affiliation(s)
- Weiyu Zhang
- Urology, Peking University People’s Hospital, Beijing, China
| | - Xiaopeng Zhang
- Urology, Peking University People’s Hospital, Beijing, China
| | - Haibin Li
- Epidemiology and Health Statistics, Capital Medical University, Beijing, China
| | - Feng Wu
- Chinses PLA center for Disease Control and Prevention, Beijing, China
| | - Huanrui Wang
- Urology, Peking University People’s Hospital, Beijing, China
| | - Meishan Zhao
- Urology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hao Hu
- Urology, Peking University People’s Hospital, Beijing, China
| | - Kexin Xu
- Urology, Peking University People’s Hospital, Beijing, China
| |
Collapse
|
33
|
Shore N, Tutrone R, Roehrborn CG. Efficacy and safety of fexapotide triflutate in outpatient medical treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia. Ther Adv Urol 2019; 11:1756287218820807. [PMID: 30719081 PMCID: PMC6348527 DOI: 10.1177/1756287218820807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/03/2018] [Indexed: 02/01/2023] Open
Abstract
Male lower urinary tract symptoms (LUTS) is an increasingly important problem for the majority of late middle aged and elderly men. Fexapotide triflutate (FT) is a first in-class compound given by local injection via the transrectal intraprostatic route under ultrasound guidance. Data from >1700 FT and control injections in prospective randomized blinded controlled multicenter trials are reviewed and discussed in relation to current developments in the field of treatments for LUTS associated with benign prostatic hyperplasia (BPH). Long-term studies of FT in the United States have shown statistically significant improvement in BPH symptoms and objective outcomes including significant reduction in both spontaneous acute urinary retention as well as the subsequent incidence of BPH surgery. FT has been shown to be well tolerated with an excellent safety profile, and is an efficacious clinic-based treatment for BPH involving an intraprostatic injection that requires only a few minutes to administer, with no catheter nor anesthesia requirements.
Collapse
Affiliation(s)
| | - Ronald Tutrone
- Chesapeake Urology Research Associates, Baltimore, MD, USA
| | | |
Collapse
|
34
|
Kim JH, Baek MJ, Sun HY, Lee B, Li S, Khandwala Y, Del Giudice F, Chung BI. Efficacy and safety of 5 alpha-reductase inhibitor monotherapy in patients with benign prostatic hyperplasia: A meta-analysis. PLoS One 2018; 13:e0203479. [PMID: 30281615 PMCID: PMC6169865 DOI: 10.1371/journal.pone.0203479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022] Open
Abstract
Background Although combination therapy with 5 alpha-reductase inhibitor (5ARI) and alpha-blocker is one of the standard interventions in symptomatic benign prostatic hyperplasia (BPH), 5ARI monotherapy is seldom the focus of attention. Adverse events associated with 5ARI include depression and suicidal attempts in addition to persistent erectile dysfunction. The aim of this study is to update our knowledge of clinical efficacy and incidence of adverse events associated with 5ARI treatment in symptomatic BPH. Methods and findings A meta-analysis of randomized controlled clinical trials (RCTs) from 1966 until March, 2017 was performed using database from PubMed, Cochrane Collaboration and Embase. A total of 23395 patients were included in this study and the inclusion criteria were: RCTs with 5ARI and placebo in symptomatic BPH patients. Parameters included prostate specific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPPS), post-void residual urine (PVR), voiding symptoms of IPSS (voiding IPSS), maximum urinary flow rate (Qmax), and adverse events (AEs). A meta-analysis with meta-regression was performed for each effect size and adverse events, sensitivity analysis, cumulative analysis along with the analysis of ratio of means (ROM) in the placebo group. A total of 42 studies were included in this study for review, and a total of 37 studies were included in the meta-analysis, including a total of 23395 patients (treatment group: 11392, placebo group: 12003). The effect size of all variables except PVR showed a significant improvement following 5ARI treatment compared with placebo. However, the effect size of differences showed declining trend in PV, IPSS and Qmax according to recent years of publication. In ROM analysis, PV showed no significant increase in the placebo group, with a ROM of 1.00 (95% CI, 0.88, 1.14). The 5ARI treatment resulted in a significantly higher incidence of decreased libido (OR = 1.7; 95% CI, 1.36, 2.13), ejaculatory disorder (OR = 2.94; 95% CI, 2.15, 4.03), gynecomastia (OR = 2.32; 95% CI, 1.41, 3.83), and impotence (OR = 1.74; 95% CI, 1.32, 2.29). Our study has the following limitations: included studies were heterogeneous and direct comparison of efficacy between alpha blocker and 5ARI was not performed. Adverse events including depression or suicidal attempt could not be analyzed in this meta-analysis setting. Conclusions Although there was a significant clinical benefit of 5ARI monotherapy compared with placebo, the effective size was small. Moreover, the risk of adverse events including sexually related complications were high. Additional head-to-head studies are needed to re-evaluate the clinical efficacy of 5ARI compared with alpha-adrenergic receptor blockers.
Collapse
Affiliation(s)
- Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States of America
- Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
- * E-mail: , (JHK); (BL)
| | - Min Jung Baek
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, Seongnam, Korea
| | - Hwa Yeon Sun
- Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - Bora Lee
- Department of Statistics, Graduate School of Chung-Ang University, Seoul, Korea
- * E-mail: , (JHK); (BL)
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, CA, United States of America
| | - Yash Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States of America
- University of California, San Diego School of Medicine, San Diego, CA, United States of America
| | | | - Benjamin I. Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States of America
| |
Collapse
|
35
|
Kosilov K, Kuzina I, Kuznetsov V, Gainullina Y, Kosilova L, Prokofyeva A, Loparev S. Cognitive functions and health-related quality of life in men with benign prostatic hyperplasia and symptoms of overactive bladder when treated with a combination of tamsulosin and solifenacin in a higher dosage. Aging Male 2018; 21:121-129. [PMID: 29113548 DOI: 10.1080/13685538.2017.1398723] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AIM To study the cognitive functions and health-related quality of life (HRQoL) in individuals taking a combination of tamsulosin and solifenacin in a higher dosage. METHODS All patients (n = 262) were assigned to group A (N = 93, tamsulosin 0.4 mg + solifenacin 10 mg per day), group B (N = 83, tamsulosin 0.4 mg + solifenacin 20 mg), and control group C (N = 86; tamsulosin 0.4 mg + placebo). The lower urinary tract (LUT) condition was assessed on the scales International Prostate Symptom Score, Over Active Bladder Awareness Tool and uroflowmetry. The state of cognitive status was assessed on the scales Mini-mental State Examination, Controlled Oral Word Association Test, Wechsler Adult Intelligence Scale-Revised, Wechsler III, Color Trails Test, California Verbal Learning Test. RESULTS The values of cognitive function indicators in the individuals from all groups after treatment did not significantly differ from the respective values at the baseline (p > .05). The values of most HRQoL parameters of the functional state of the LUT significantly improved in groups A and B. A significant correlation between the state of cognitive status and HRQoL, as well as LUT was absent (r <0.3). CONCLUSION The combination of solifenacin in a double dosage along with tamsulosin can be recommended for elderly benign prostatic hyperplasia patients with overactive bladder symptoms.
Collapse
Affiliation(s)
- Kirill Kosilov
- a Department of Social Sciences, School of Humanities , Far Eastern Federal University , Vladivostok , Russian Federation
- b Department of Public Health , Pacific State Medical University , Vladivostok , Russian Federation
| | - Irina Kuzina
- c Department of Social Science , Far Eastern Federal University , Vladivostok , Russian Federation
| | - Vladimir Kuznetsov
- b Department of Public Health , Pacific State Medical University , Vladivostok , Russian Federation
| | - Yuliya Gainullina
- a Department of Social Sciences, School of Humanities , Far Eastern Federal University , Vladivostok , Russian Federation
| | - Liliya Kosilova
- d Department of Functional Diagnostics , Med. Association № 2 of Vladivostok-city , Vladivostok , Russian Federation
| | - Alexandra Prokofyeva
- c Department of Social Science , Far Eastern Federal University , Vladivostok , Russian Federation
| | - Sergey Loparev
- e Department of Urology , City Polyclinic № 3 , Vladivostok , Russian Federation
| |
Collapse
|
36
|
Heidler S, Drerup M, Lusuardi L, Bannert U, Bretterbauer K, Bures J, Dietersdorfer F, Dlouhy-Schütz E, Hessler C, Karpf R, Mittellehner LA, Mitlöhner B, Schwarz S, Thomay G, Lösch G, Freibauer C, Albrecht W. The Correlation of Prostate Volume and Prostate-specific Antigen Levels With Positive Bacterial Prostate Tissue Cultures. Urology 2018. [DOI: 10.1016/j.urology.2018.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Audouin M, Girshovich A, Cussenot O, Renard-Penna R. Typology of intravesical prostatic protrusions, or so-called median lobes, in middle-aged and older men. Surg Radiol Anat 2018. [PMID: 29536129 DOI: 10.1007/s00276-018-1999-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Changes related to prostatic ageing include an increase of prostate volume and morphologic distortions of the prostatic edges in middle-aged and older men. These changes of the prostate exhibit a certain level of heterogeneity, which is clinically obvious for surgeons, radiologists, and anatomists, and which can be explained by the complex nature of the embryologic/anatomic development of the prostate. While the etiology of the median lobe has typically been attributed to a growth and protrusion of the prostatic area at the top of the utricle, we argue that this is not necessarily the case as intravesical protrusions of the prostate have also been observed laterally and anteriorly to the bladder neck, suggesting the involvement of other prostatic zones, thereby highlighting the need to refine the concept of the median lobe. MATERIAL The current study examined a large series of 478 prostate magnetic resonance imaging scans (MRIs). Intravesical prostatic protrusions were classified, based on their topography: anterior (A), posterolateral (P), and dual (D). Data were analyzed using MedCalc®11.6.1.1.0 software. Pearson's correlations with coefficients (r) and P values were calculated for the patient's age, prostate volume, and IVPP size. RESULTS An intravesical prostatic protrusion was observed in 27% of cases, with type A occurring in 18% (3% isolated), type P in 96% (81% isolated), and type D in 15%. CONCLUSION The new insights regarding the variability in prostate anatomy will contribute to the improved management of prostate hypertrophy by radiologists and surgeons.
Collapse
|
38
|
Wang Z, Olumi AF. Metformin: an antiproliferative agent and methylation regulator in treating prostatic disease? Am J Physiol Renal Physiol 2018; 314:F407-F411. [PMID: 29117997 PMCID: PMC5899225 DOI: 10.1152/ajprenal.00443.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Existing drugs that have been used in clinical practice for other purposes can prove useful for reutilization, since much of the safety profile and pharmacokinetics have been completed. Therefore, the drugs can enter clinical practice for a variety of causes with less regulatory burden. Metformin may prove to be such a drug; it may have a role in other diseases, besides the management of diabetes. In this perspective, we provide our findings and understanding of metformin as an alternative way to treat urological abnormal proliferation. We propose the potential mechanisms into two hallmarks: direct antiproliferative function via insulin-like growth factor (IGF) signaling pathway and epigenetic modulating via adjusting DNA methylation. These specific hallmarks may ultimately contribute to a better understanding of metformin in treating prostatic diseases.
Collapse
Affiliation(s)
- Zongwei Wang
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aria F. Olumi
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
39
|
Wang Z, Hu L, Salari K, Bechis SK, Ge R, Wu S, Rassoulian C, Pham J, Wu CL, Tabatabaei S, Strand DW, Olumi AF. Androgenic to oestrogenic switch in the human adult prostate gland is regulated by epigenetic silencing of steroid 5α-reductase 2. J Pathol 2017; 243:457-467. [PMID: 28940538 DOI: 10.1002/path.4985] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/19/2017] [Accepted: 09/10/2017] [Indexed: 12/25/2022]
Abstract
Benign prostatic hyperplasia is the most common proliferative abnormality of the prostate. All men experience some prostatic growth as they age, but the rate of growth varies among individuals. Steroid 5α-reductase 2 (SRD5A2) is a critical enzyme for prostatic development and growth. Previous work indicates that one-third of adult prostatic samples do not express SRD5A2, secondary to epigenetic modifications. Here we show that the level of oestradiol is dramatically elevated, concomitant with significant upregulation of oestrogen response genes, in prostatic samples with methylation at the SRD5A2 promoter. The phosphorylation of oestrogen receptor-α in prostatic stroma is upregulated when SRD5A2 expression is absent. We show that tumour necrosis factor (TNF)-α suppresses SRD5A2 mRNA and protein expression, and simultaneously promotes expression of aromatase, the enzyme responsible for conversion of testosterone to oestradiol. Concomitant suppression of SRD5A2 and treatment with TNF-α synergistically upregulate the aromatase levels. The data suggest that, in the absence of prostatic SRD5A2, there is an androgenic to oestrogenic switch. These findings have broad implications for choosing appropriate classes of medications for the management of benign and malignant prostatic diseases. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Zongwei Wang
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Libing Hu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Urology, Yan'an Affiliated hospital of Kunming Medical University, Yunnan, PR China
| | - Keyan Salari
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seth K Bechis
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rongbin Ge
- Department of Pathology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Shulin Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cyrus Rassoulian
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Pham
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahin Tabatabaei
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas W Strand
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Aria F Olumi
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
40
|
Gordon A, Skarecky D, Babaian KN, Dhaliwal H, Ahlering TE. Diminished long-term recovery of peak flow rate (PFR) after robotic prostatectomy in men with baseline PFR <10 mL/s and incidental association with high-risk prostate cancer. Low Urin Tract Symptoms 2017; 11:78-84. [PMID: 29193833 DOI: 10.1111/luts.12199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/18/2017] [Accepted: 08/03/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of robot-assisted radical prostatectomy (RARP) on uroflowmetry (UF) parameters among men with baseline peak flow rates (PFR) <10 mL/s. METHODS A single-surgeon RARP database of 1082 men who underwent prospective UF testing was analyzed. Men filled out International Prostate Symptom Score questionnaires and underwent uroflowmetry and post-void bladder ultrasound before surgery and at each follow-up visit. Patients were divided into 2 groups based on preoperative PFR: those with PFR <10 mL/s (n = 158) and those with PFR ≥10 mL/s (n = 924). Univariate and multivariate regression models tested the association of preoperative characteristics in predicting postoperative PFR improvement. Within the PFR <10 mL/s group, preoperative variables were analyzed to predict pathologic outcomes. RESULTS Three months after RARP, men with baseline PFR <10 mL/s had a 3-fold improvement in PFR (from mean of 7.0 to 24.2 mL/s), whereas in men with PFR ≥10 mL/s there was a 50% improvement (from mean of 19.7 to 28.9 mL/s; P < .001). Improvement in PFR remained stable for >5 years, but mean postoperative PFR was 20% lower in men with baseline PFR <10 mL/s. Preoperative prostate-specific antigen (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.59-0.95) and PFR (OR 0.52; 95% CI 0.34-0.80) were independent predictors of the percentage improvement in men with baseline PFR <10 mL/s. Preoperative PFR ≤7 mL/s was an independent predictor of Gleason score ≥8 (P = .016), seminal vesicle invasion (P = .010), and lymph node invasion (0.029). CONCLUSIONS After RARP, PFR improved significantly, with the improvement persisting over long-term follow-up. However, men with baseline PFR <10 mL/s had a 20% lower postoperative PFR over 5 years, suggesting permanent damage to the bladder and the need for early treatment to maintain bladder health. There appears to be an association between baseline PFR ≤7 mL/s and adverse pathologic features.
Collapse
Affiliation(s)
- Adam Gordon
- Department of Urology, University of California Irvine, Orange, California.,Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Douglas Skarecky
- Department of Urology, University of California Irvine, Orange, California
| | - Kara N Babaian
- Department of Urology, University of California Irvine, Orange, California
| | - Harleen Dhaliwal
- Department of Urology, University of California Irvine, Orange, California
| | - Thomas E Ahlering
- Department of Urology, University of California Irvine, Orange, California
| |
Collapse
|
41
|
Kosilov K, Loparev S, Kuzina I, Kosilova L, Ivanovskaya M, Prokofyeva A. Health-related quality of life's dependence on socio-economic status and demographic characteristics among men with benign prostatic hyperplasia. Andrologia 2017; 50. [DOI: 10.1111/and.12892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- K. Kosilov
- Department of Social and Psychological Sciences; School of Humanities; Far Eastern Federal University; Vladivostok Russian Federation
- Department of Public Health; Pacific State Medical University; Vladivostok Russian Federation
| | - S. Loparev
- Department of Urology; City Polyclinic no 3; Vladivostok Russian Federation
| | - I. Kuzina
- Department of Social and Psychological Sciences; School of Humanities; Far Eastern Federal University; Vladivostok Russian Federation
| | - L. Kosilova
- Department of Functional Methods of Diagnostic; Medical Association no 2 of Vladivostok-city; Vladivostok Russian Federation
| | - M. Ivanovskaya
- Department of Law; Far Eastern Fisheries University; Vladivostok Russian Federation
| | - A. Prokofyeva
- Department of Social and Psychological Sciences; School of Humanities; Far Eastern Federal University; Vladivostok Russian Federation
| |
Collapse
|
42
|
Magistro G, Stief CG, Gratzke C. Prostatic Urethral Lift Versus Transurethral Resection of the Prostate (TURP). Curr Urol Rep 2017; 18:82. [PMID: 28852996 DOI: 10.1007/s11934-017-0725-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) represent one of the most common bothersome conditions impairing quality of life in men. Its management comprises conservative treatment, pharmacotherapy, and various surgical techniques. Medication and surgical procedures provide meaningful relief of LUTS, but their therapeutic efficacy has to be counterbalanced against the associated adverse events and morbidity. With the advent of novel minimally invasive treatment options, the surgical standards are challenged for at least equally effective approaches with a much more favorable safety profile. Clinical randomized controlled trials confirmed that PUL is able to provide rapid and durable relief of LUTS without compromising sexual function. However, in order to define the value and true benefit of a novel technique among established surgical procedures, the direct comparison with the reference method TURP is necessary. This was the main objective of the BPH6 study, which evaluated symptom relief, recovery experience, sexual function, urinary continence, and safety of PUL compared to TURP. Over a 2-year follow-up, no relevant negative impact on erectile function, urinary continence, and treatment-related safety was observed for both procedures. Improvement of LUTS was better after TURP, whereas PUL turned out to be superior in terms of quality of recovery, ejaculatory function, and quality of sleep. PUL can be considered in selected patients with bothersome LUTS, with special interest in the complete preservation of sexual function and a rapid and smooth return to daily activity.
Collapse
Affiliation(s)
- Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany.
| |
Collapse
|
43
|
Cao N, Lu Q, Si J, Wang X, Ni J, Chen L, Gu B, Hu B. The Characteristics of the Transitional Zone in Prostate Growth With Age. Urology 2017; 105:136-140. [DOI: 10.1016/j.urology.2017.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/26/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
|
44
|
Metabolic syndrome and voiding dysfunction. Curr Opin Urol 2017; 27:403-408. [PMID: 28604411 DOI: 10.1097/mou.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The metabolic syndrome (MetS) is an ever growing pandemic consisting of a constellation of abnormalities. Many hypotheses have been put forth to establish a link between this syndrome and voiding dysfunction. We created a layout of the possible, probable, and proven relationships connecting the MetS with voiding dysfunction in men. RECENT FINDINGS There has been growing interest in the relationship linking MetS and voiding dysfunction, with or without benign prostatic hyperplasia, during the past several years. Different mechanisms have been proposed to establish the connection. SUMMARY A clear-cut association between MetS and voiding dysfunction is not clearly defined; rather, voiding dysfunction occurring in men with MetS has been shown to be related to numerous pathologies. MetS is a complex disease that includes numerous pathophysiological aspects that may contribute to the causation and advancement of voiding dysfunction. In light of this association, future research is needed to better define this relationship to enable therapy targeted against MetS in patients with voiding dysfunction.
Collapse
|
45
|
Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol 2017; 4:148-151. [PMID: 29264223 PMCID: PMC5717991 DOI: 10.1016/j.ajur.2017.06.004] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022] Open
Abstract
Clinical benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms (LUTS). The prevalence of BPH increases after the age of 40 years, with a prevalence of 8%-60% at age 90 years. Some data have suggested that there is decreased risk among the Asians compared to the western white population. Genetics, diet and life style may play a role here. Recent reports suggest the strong relationship of clinical BPH with metabolic syndrome and erectile dysfunction, as well as the possible role of inflammation as a cause of the prostatic hyperplasia. Lifestyle changes including exercise and diet are important strategies in controlling this common ailment.
Collapse
Affiliation(s)
- Kok Bin Lim
- Raffles Urology Centre, Raffles Hospital, Singapore
| |
Collapse
|
46
|
Distribution of Neuroendocrine Cells in the Transition Zone of the Prostate. Adv Urol 2017; 2017:8541697. [PMID: 28348583 PMCID: PMC5350492 DOI: 10.1155/2017/8541697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/10/2017] [Accepted: 02/14/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives. To evaluate the distribution of neuroendocrine (NE) cells which may influence the development of benign prostatic hyperplasia (BPH) in the transition zone (TZ). Methods. We reviewed specimens from 80 patients who underwent radical prostatectomy in our institution and evaluated the density of NE cells in the TZ. They were histologically classified into 3 groups: those with no adenomatous nodule in the TZ (group A), those with small nodules with normal epithelium and stroma around them in the TZ (group B), and those with large nodules occupying the TZ (group C). In the patients of group B, intra-adenoma (adenomatous nodules) and extra-adenoma (normal tissue) NE cells in the TZ were separately counted. Results. There were 22, 23, and 35 patients in groups A, B, and C, respectively. The median density of NE cells in the TZ of group B patients, 2.80/mm2, was significantly higher than that of NE cells in group A, 1.43/mm2, and group C, 0.61/mm2 (p < 0.001). In group B, the median density of extra-adenoma NE cells was significantly higher than that of intra-adenoma. Conclusions. Many NE cells exist around small adenoma in the TZ. NE cells may influence the initial growth of BPH in a paracrine fashion. Trial Registration. This study approved by our institutional review board was retrospectively registered (#272-14).
Collapse
|
47
|
Matsugasumi T, Fujihara A, Ushijima S, Kanazawa M, Yamada Y, Shiraishi T, Hongo F, Kamoi K, Okihara K, de Castro Abreu AL, Oishi M, Shin T, Palmer S, Gill IS, Ukimura O. Morphometric analysis of prostate zonal anatomy using magnetic resonance imaging: impact on age-related changes in patients in Japan and the USA. BJU Int 2017; 120:497-504. [PMID: 28220583 DOI: 10.1111/bju.13823] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the impact of morphometric magnetic resonance imaging (MRI) analysis of the prostate zonal anatomy on aging, prostatic hypertrophy and lower urinary tract symptoms in patients from Japan and the USA. SUBJECTS AND METHODS A retrospective analysis of 307 men, including 156 men from Japan and 151 from the USA, who consecutively underwent 3-Tesla MRI and International Prostate Symptom Score (IPSS) assessment because of elevated PSA levels. Using Synapse-Vincent (Fujifilm), the prostatic zones were segmented in each axial step-section of the T2-weighted MRI to reconstruct a three-dimensional model of the prostate, which was used to calculate: zonal volumes (whole-gland prostate, transition zone and peripheral zone volumes); the presumed circle area ratio (PCAR); and PZ thickness. Bivariate associations were quantified using Spearman's rank correlation coefficients. RESULTS The USA subgroup had a greater prostate volume (49 vs 42 mL; P = 0.003) and TZ volume (26 vs 20 mL; P < 0.001) than the Japan subgroup, with no difference in PZ volume (19 vs 20 mL; P = 0.2). There was no age-related increase in PZ volume in either of the subgroups or in the entire cohort (P = 0.9, P = 0.2, P = 0.3, respectively). PZ thickness had a significant negative correlation with PCAR (P < 0.001) and TZ volume (P < 0.001). The greater the increase in the TZ volume with the increase in PCAR, which probably correlates with obstructive pressure, the thinner the PZ became. PCAR had a significant positive correlation with IPSS (P = 0.003) and obstructive symptoms (P = 0.007), while PZ thickness had a significant negative correlation (P = 0.018). CONCLUSIONS No age-related increases and no differences between the Japanese and the US subgroups were found with regard to PZ volume. The more TZ volume increased, the higher the obstructive pressure and the thinner the PZ became; these changes were associated with increased obstructive symptoms. MRI analysis of prostate zonal anatomy enhanced our understanding of age-related changes in morphology and urinary symptoms.
Collapse
Affiliation(s)
- Toru Matsugasumi
- Institute of Urology, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - So Ushijima
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Motohiro Kanazawa
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuhiro Yamada
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazumi Kamoi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Masakatsu Oishi
- Institute of Urology, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshitaka Shin
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Suzanne Palmer
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Osamu Ukimura
- Institute of Urology, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
48
|
Ho Lee S, Kon Lee S. Does Race/Ethnicity Have a Role in a Link Between Lower Urinary Tract Symptoms and Metabolic Syndrome? EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Metabolic syndrome (MS) is a highly prevalent disease related to the risk of cardiovascular disease and diabetes. A large body of evidence has suggested a link between MS and the components of MS with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) complex. The pathogenesis of MS is complex and not fully understood. Furthermore, recent results from epidemiological studies, including multiple Asian reports, have not been consistent. The risk of BPH is lower in Asian men compared with white men and the prevalence of MS varies by race and ethnicity. An elevated risk of Type 2 diabetes mellitus, hypertension, and dyslipidaemia is closely related to MS and is observed in Asian men even if their body mass index is low. However, the role of race and ethnic disparity in the link between MS and LUTS secondary to BPH is not elucidated. It has been suggested that the pathogenesis of LUTS is multifactorial rather than developing from BPH, which is the traditional concept. Lifestyle and genetic factors may substantially modify the risk of MS and LUTS/BPH. This comprehensive literature review summarises the scientific evidence of the racial/ethnic disparity regarding the association between MS and LUTS/BPH in order to improve current understanding of this controversial issue.
Collapse
Affiliation(s)
- Seong Ho Lee
- Department of Urology, School of Medicine, Hallym University, Chuncheon, South Korea
| | - Sang Kon Lee
- Department of Urology, School of Medicine, Hallym University, Chuncheon, South Korea
| |
Collapse
|
49
|
Prostate volume growth rate changes over time: Results from men 18 to 92 years old in a longitudinal community-based study. ACTA ACUST UNITED AC 2016; 36:796-800. [PMID: 27924517 DOI: 10.1007/s11596-016-1664-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 03/09/2016] [Indexed: 10/18/2022]
Abstract
Previous investigations have shown that changes in total prostate volume (TPV) are highly variable among aging men, and a considerable proportion of aging men have a stable or decreasing prostate size. Although there is an abundance of literature describing prostatic enlargement in association with benign prostatic hyperplasia, less is known about the appropriate age cut-off points for TPV growth rate. In this community-based cohort study, TPV was examined once a year in men who had consecutive health checkup, during a follow-up of 4 years. A total of 5058 men (age 18-92 years old) were included. We applied multiple regression analyses to estimate the correlation between TPV growth rate and age. Overall, 3232 (63.9%) men had prostate growth, and 1826 (36.1%) had a stable or decreased TPV during the study period. The TPV growth rate was correlated negatively with baseline TPV (r=-0.32, P<0.001). Among 2620 men with baseline TPV <15 cm3, the TPV growth rate increased with age (β=0.98, 95% CI: 0.77%-1.18%) only up to 53 years old. Among 2188 men with baseline TPV of 15-33.6 cm3, the TPV growth rate increased with age (β=0.84, 95% CI, 0.66%-1.01%) only up to 61 years old after adjusting for factors of hypertension, obesity, baseline TPV, diabetes mellitus and dyslipidemia. In this longitudinal study, the TPV growth rate increased negatively with baseline TPV, only extending to a certain age and not beyond. Further research is needed to identify the mechanism underlying such differences in prostate growth.
Collapse
|
50
|
Medium-term Outcomes of Urolift (Minimum 12 Months Follow-up): Evidence From a Systematic Review. Urology 2016; 97:20-24. [DOI: 10.1016/j.urology.2016.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/25/2016] [Accepted: 05/03/2016] [Indexed: 12/21/2022]
|