Benign prostatic hyperplasia: symptoms, symptom scores, and outcome measures

Efficacy and safety of electroacupuncture for benign prostatic hyperplasia: A systematic review and meta-analysis

BACKGROUND

This study aimed to evaluate the efficacy and safety of electroacupuncture (EA) in the treatment of benign prostatic hyperplasia.

METHODS

Seven databases were searched from the inception of each database to March 31, 2023, including PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure, Wanfang, and China Biology Medicine. The modified Jadad scale was used to assess literature quality, and literature inclusion and exclusion were conducted in strict accordance with the criteria of a score of ≥4. The risk of bias was evaluated using the Cochrane risk of bias tool. The pooled effect size of the binary data was measured by odds ratio (OR) and 95% confidence interval (CI), and the pooled effect size of the continuous data was presented as weighted mean difference (WMD) and 95% CI. If I² was larger than 50%, a random effects model was adopted, and otherwise, a fixed effects model was used. Additionally, publication bias assessment and sensitivity analysis were conducted.

RESULTS

A total of 325 records were retrieved, and finally 9 randomized controlled trial studies were included, involving 1045 patients. Meta-analysis revealed that the EA group had better improvement than the control group in terms of clinical effective rate (odds ratio = 3.92, 95% CI = 2.38 to 6.47, I² = 0%, P < .001), International Prostate Symptom Score (WMD = -4.99, 95% CI = -6.15 to -3.84, I² = 76.9%, P < .001), maximum urinary flow rate (WMD = -4.99, 95% CI = -6.15 to -3.84, I² = 87.4%, P < .001), and post-void residual volume (WMD = -17.12, 95% CI = -29.49 to -4.75, I² = 89.1%, P < .01). There was no statistical significance in prostate volume and adverse events between the EA group and the control group (P > .05).

CONCLUSION

EA is effective in the treatment of benign prostatic hyperplasia with acceptable overall safety.

Therapeutic role of Glycyrrhiza Uralensis fisher on benign prostatic hyperplasia through 5 alpha reductase regulation and apoptosis

BACKGROUND

Benign prostatic hyperplasia (BPH) is an age-related disease in adult men. There are two pharmacological treatments for BPH. However, these synthetic materials have various risks, many studies are being conducted to develop new drugs from natural sources.

PURPOSE

In this study, we proposed a beneficial effect of Glycyrrhiza uralensis Fischer on the development and progression of BPH, focusing on the androgen receptor (AR) and 5α-reductase 2 (5AR2) signaling axis.

METHODS

To explain the therapeutic efficacy of a water extract of G. uralensis (GUWE) for BPH, we used testosterone propionate (TP)-induced BPH rat models and TP-treated RWPE-1 human prostate epithelial cells.

RESULTS

In the TP-induced BPH rat models, GUWE reduced the enlarged prostate weight, prostate index, prostate epithelial thickness, and serum DHT levels. In addition, the protein levels of AR and 5AR2 in prostate tissues were significantly decreased by GUWE treatment. Furthermore, GUWE induced apoptosis signaling through an increase of Bcl-2 associated X protein (Bax), caspase 3, and Poly (ADP-ribose) polymerase (PARP) and a decrease of B-cell lymphoma-extra-large (Bcl-xL) in prostate tissues of TP-induced BPH rats. These findings were also confirmed in TP-treated RWPE-1 cells. Fi treatment markedly decreased the sperm count in the epididymis of BPH rats, but GUWE treatment did not affect the sperm count, suggesting less toxicity.

CONCLUSION

These findings suggested that GUWE reduces the development of BPH by inhibiting AR-5AR2 and activating the apoptosis signaling pathway. Furthermore, unlike finasteride, GUWE did not affect sperm count. Therefore, we suggest that GUWE has a potential as a safer alternative option for BPH treatment.

Nocturnal polyuria in men performing uroflowmetry for lower urinary tract symptoms

PURPOSE

To assess the prevalence of nocturnal polyuria (NP) in males performing uroflowmetry (UF) for lower urinary tract symptoms (LUTS), the impact of NP on UF outcomes, and bladder emptying, the association between NP and LUTS.

MATERIALS AND METHODS

Men scheduled for UF were recruited in two Centres. Data collected were medical history, IPSS, UF, post-void residual urine volume (PVR), 3-day frequency-volume charts (FVC). The NP index was used to assess NP with a threshold of ≥ 33%. The relationship between NP and patient's aging was assessed.

RESULTS

162 patients were included in the analysis. Mean age was 70.95 ± 8.04 years. The prevalence of NP was 54.9% (89/162). 110 (68%) patients reported nocturia, and among these, NP was documented in 76 (69%). Nocturia was found in 85% (76/89) of the population with NP. Total IPSS score, IPSS items #1, #2 and #7 showed a significant difference in men with NP compared with those without. Maximum flow rate and PVR did not significantly change comparing men with or without NP. Mean voiding volume (VV) of the night-time micturitions was significantly higher in men with NP compared to those without NP (532.1 ± 275.6 ml vs 175 ± 168.7 ml respectively, p < 0001), while mean VV day-time micturitions and mean VV at UF did not change between groups.

CONCLUSIONS

NP had a high prevalence in men with LUTS performing UF. Aged males were more commonly affected by NP. Data demonstrated a strong relationship between NP and nocturia and increased urinary frequency while voiding symptoms were poorly related to NP.

Corni Fructus attenuates testosterone-induced benign prostatic hyperplasia by suppressing 5α-reductase and androgen receptor expression in rats

BACKGROUND/OBJECTIVES

Benign prostatic hypertrophy (BPH) is a major cause of abnormal overgrowth of the prostate mainly in the elderly. Corni Fructus has been reported to be effective in the prevention and treatment of various diseases because of its strong antioxidant effect, but its efficacy against BPH is not yet known. This study was designed to evaluate the therapeutic efficacy of Corni Fructus water extract (CF) in testosterone-induced BPH rats.

MATERIALS/METHODS

To induce BPH, rats were intraperitoneal injected with testosterone propionate (TP). Rats in the treatment group were orally administered with CF with TP injection, and finasteride, which is a selective inhibitor of 5α-reductase type 2, was used as a positive control.

RESULTS

Our results showed that the increased prostate weight and histopathological changes in BPH model rats were suppressed by CF treatment. CF, similar to the finasteride-treated group, decreased the levels of testosterone and dihydrotestosterone by TP treatment in the serum, and it also reduced 5α-reductase expression and concentration in prostate tissue and serum, respectively. In addition, CF significantly blocked the expression of the androgen receptor (AR), AR co-activators, and proliferating cell nuclear antigen in BPH rats, and this blocking was associated with a decrease in prostate-specific antigen levels in serum and prostate tissue.

CONCLUSIONS

These results suggest that CF may weaken the BPH status through the inactivation of at least 5α-reductase and AR activity and may be useful for the clinical treatment of BPH.