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Zhang X, Chen Z, You J, Lu Q, Liu L, Cai D. Clinical practice of the transrectal shear-wave elastography in benign prostatic hyperplasia. Aging Male 2024; 27:2363267. [PMID: 38867423 DOI: 10.1080/13685538.2024.2363267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE To investigate the practical value of the transrectal two-dimensional shear-wave elastography (SWE) in benign prostatic hyperplasia (BPH). METHODS Consecutive male participants with and without BPH constituted the BPH and control group respectively were enrolled prospectively between March and December 2022. Transrectal conventional ultrasound and SWE examinations for the prostate were performed on these participants. Data of quantitative stiffness of the transitional zone (TZ) and peripheral zone (PZ) of prostate, volume of prostate (VP) and volume of TZ (VTZ) and prostate specific androgen (PSA), etc., were collected. Linear regression analyses were used to investigate the associations between quantitative stiffness data and other clinical parameters. RESULTS There were 200 participants evaluated, including 100 healthy participants and 100 BPH patients. For every one-year increment in age, it was correlated with 0.50 kPa increasement of TZ stiffness. VP and VTZ were correlated with TZ stiffness. Higher TZ stiffness was associated with higher free prostate specific antigen (PSA) and total PSA. CONCLUSIONS The prostate is stiffer and larger in BPH group compared to control group. Quantitative stiffness of the TZ was related with age, VP, VTZ and PSA.
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Affiliation(s)
- Xuhui Zhang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Zeyu Chen
- Department of Urology Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jia You
- Department of Urology Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Liangren Liu
- Department of Urology Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Diming Cai
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China
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Baran C. The effect of acute urinary retention on the results of transurethral resection of the prostate. Urologia 2023; 90:642-646. [PMID: 37491943 DOI: 10.1177/03915603231189627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. METHODS Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. RESULTS There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. DISCUSSION Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.
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Affiliation(s)
- Caner Baran
- Çukurova State Hospital, Department of Urology, Adana, Turkey
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Iqbal J, Mashkoor Y, Nadeem A, Tah S, Sharifa M, Ghani S, Thugu TR, Patel H, Bonner-Reid FT, Shrestha J, Hassen BA. Shifting Trends in Prostate Treatment: A Systematic Review Comparing Transurethral Resection of the Prostate and Holmium Laser Enucleation of the Prostate. Cureus 2023; 15:e46173. [PMID: 37905244 PMCID: PMC10613322 DOI: 10.7759/cureus.46173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Our systematic review aimed to assess the effectiveness and suitability of holmium laser enucleation of the prostate (HoLEP) as a treatment for benign prostatic hyperplasia (BPH) in comparison to transurethral resection of the prostate (TURP). We analyzed 12 studies involving male participants aged 45-85 years, all of whom had BPH. In our analysis, we compared HoLEP and TURP, with a focus on several primary outcomes, including postoperative International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, maximum flow rate (Qmax), and changes in sexual function post-treatment. HoLEP demonstrated advantages in certain aspects when compared to TURP. HoLEP generally resulted in an improved postoperative IPSS in some studies, but not all studies showed a significant difference when compared to TURP. HoLEP was associated with improved Qmax in most studies, but one study found no significant difference between HoLEP and TURP. Patients who underwent HoLEP showed improvement in the PVR volume in some studies, while others found no significant change in the PVR volume with either HoLEP or TURP. Some studies reported a reduction in orgasm and ejaculatory scores following TURP, while no significant changes were observed in erectile function, intercourse satisfaction, and overall satisfaction scores. It is worth noting that previous reviews and meta-analyses had limited data on the effects of HoLEP and TURP on sexual dysfunction. TURP is associated with a higher risk of morbidity and mortality, which has led to its replacement with HoLEP as the gold standard for treating BPH, particularly due to its size-independent applicability. HoLEP also demonstrated greater efficacy in the postoperative period.
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Affiliation(s)
- Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
| | - Yusra Mashkoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Abdullah Nadeem
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sunanda Tah
- Department of Internal Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Saroosh Ghani
- Department of Medicine and Allied Sciences, Isra University, Hyderabad, PAK
| | - Thanmai Reddy Thugu
- Department of Internal Medicine, Sri Padmavathi Medical College for Women, Tirupati, IND
| | - Harshkumar Patel
- Department of Internal Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Felicia T Bonner-Reid
- Department of Internal Medicine, Universidad de Ciencias Médicas de Granma, Manzanillo, CUB
| | - Jeena Shrestha
- Department of Internal Medicine, Jalalabad Ragib-Rabeya Medical College, Sylhet, BGD
| | - Buure A Hassen
- Department of Internal Medicine, Hayat Medical College, Addis Ababa, ETH
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Dhiman S, Kurmi BD, Asati V. Analytical reversed‐phase high‐performance layer chromatography method development for silodosin and solifenacin in bulk and marketed formulation using analytical quality by design approach. SEPARATION SCIENCE PLUS 2022. [DOI: 10.1002/sscp.202200117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Shubham Dhiman
- Department of Pharmaceutical Analysis ISF College of Pharmacy Moga India
| | - Balak Das Kurmi
- Department of Pharmaceutics ISF College of Pharmacy Moga India
| | - Vivek Asati
- Department of Pharmaceutical Analysis ISF College of Pharmacy Moga India
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Ayangbesan A, Kavoussi N. Racial Disparities in Diagnosis and Management of Benign Prostatic Hyperplasia: A Review. Curr Urol Rep 2022; 23:297-302. [PMID: 36217002 DOI: 10.1007/s11934-022-01118-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We sought to perform a contemporary literature review highlighting the racial disparities which exists in the evaluation and management of benign prostatic hyperplasia (BPH). RECENT FINDINGS Current literature suggests that racial disparities exist in the diagnosis of BPH and treatment lower urinary tract symptoms (LUTS). This is seen in the presentation and diagnosis of the disease as well as a difference in preventative care with discordant incidences of medical and surgical management among racial groups. The racial disparities that exist in the diagnosis and management of BPH and LUTS require further investigation to better identify the underlying causes. This will ultimately allow for continued improvement in care delivery and a more personalized approach in patient management.
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Affiliation(s)
- Abimbola Ayangbesan
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Nicholas Kavoussi
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
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Kobayashi Y, Arai H, Honda M. Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up. PLoS One 2022; 17:e0272652. [PMID: 35951591 PMCID: PMC9371260 DOI: 10.1371/journal.pone.0272652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. Objective To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. Material and methods We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5–7), b: moderate (8–11), c: mild to moderate (12–16), d: mild (17–21), and e: no erectile dysfunction (22–25). Data are displayed as median or median (interquartile range). Results The study comprised 51 patients with a median age of 75 (70.5–79.5) years. Median prostate and transition zone volumes were 69.5 (46.5–78.8) mL and 30.5 (19–43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). Conclusion TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.
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Affiliation(s)
- Yasuyuki Kobayashi
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
- * E-mail:
| | - Hiroki Arai
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
| | - Masahito Honda
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
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Yu SH, Jung SI. The Potential Role of Urinary Microbiome in Benign Prostate Hyperplasia/Lower Urinary Tract Symptoms. Diagnostics (Basel) 2022; 12:diagnostics12081862. [PMID: 36010213 PMCID: PMC9406308 DOI: 10.3390/diagnostics12081862] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
Historically, urine in the urinary tract was considered “sterile” based primarily on culture-dependent methods of bacterial detection. Rapidly developing sequencing methods and analytical techniques have detected bacterial deoxyribonucleic acid and live bacteria in urine, improving our ability to understand the urinary tract microbiome. Recently, many studies have revealed evidence of a microbial presence in human urine in the absence of clinical infections. In women, fascinating evidence associates urinary tract microbiota with lower urinary tract symptoms (LUTS). However, the association between urinary tract microbiota and men with LUTS, particularly those with benign prostate hyperplasia (BPH), has not been established. In addition, the identification of the proinflammatory cytokines and pathogens responsible for the clinical progression of BPH is still underway. This review article aimed to address microbiome-related evidence for BPH. Further studies are required for a comprehensive understanding of the relationship between the urogenital microbiome and BPH pathogenesis to facilitate the development of preventive and therapeutic approaches for male LUTS.
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Kutwin P, Falkowski P, Łowicki R, Borowiecka-Kutwin M, Konecki T. Are We Sentenced to Pharmacotherapy? Promising Role of Lycopene and Vitamin A in Benign Urologic Conditions. Nutrients 2022; 14:nu14040859. [PMID: 35215508 PMCID: PMC8874554 DOI: 10.3390/nu14040859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Benign prostatic hyperplasia, urolithiasis, recurrent urinary tract infections, and chronic prostatitis are diseases that are commonly diagnosed worldwide. Carotenoids, including lycopene, are widely available in fruits and vegetables, and it is postulated that they can be used in the prevention and treatment of benign urological conditions. The aim of this review is to familiarize doctors and their patients with the current knowledge on carotenoids and their conversion products in selected urological diseases. Most of the experimental and clinical trials show a moderate effect of lycopene and vitamin A on studied parameters. Lycopene was shown to improve the IPSS score in BPH patients, and alleviate symptoms in those with chronic prostatitis. Intake of Vitamin A was associated with decrease of urinary tract reinfection rates. In studied rat models retinol also decreased urolithiasis formation. Although the results of the cited studies are generally promising, it is evident that more detailed and extensive research must be done in this field of medicine.
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Affiliation(s)
- Piotr Kutwin
- 1st Department of Urology, Medical University of Lodz, 90-549 Lodz, Poland; (P.F.); (R.Ł.); (T.K.)
- Correspondence:
| | - Piotr Falkowski
- 1st Department of Urology, Medical University of Lodz, 90-549 Lodz, Poland; (P.F.); (R.Ł.); (T.K.)
| | - Roman Łowicki
- 1st Department of Urology, Medical University of Lodz, 90-549 Lodz, Poland; (P.F.); (R.Ł.); (T.K.)
| | | | - Tomasz Konecki
- 1st Department of Urology, Medical University of Lodz, 90-549 Lodz, Poland; (P.F.); (R.Ł.); (T.K.)
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Kosilov K, Kuzina I, Kuznetsov V, Barabash O, Fedorishcheva E. Efficacy of a combination of dutasteride, tadalafil, and solifenacin in the treatment of previously unsuccessful patients. Asian J Urol 2022; 9:42-50. [PMID: 35198395 PMCID: PMC8841250 DOI: 10.1016/j.ajur.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/15/2020] [Accepted: 09/09/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of simultaneous administration of dutasteride, tadalafil and solifenacin in the treatment of benign prostatic hyperplasia (BPH) with overactive bladder symptoms and lower urinary tract obstruction in previously unsuccessfully treated men. METHODS Patients in Group A (n=97) received dutasteride 0.5 mg/day, tadalafil 2.5 mg/day, and solifenacin 2.5 mg/day; Group B (n=95) received dutasteride 0.5 mg/day, tadalafil 5 mg/day, and solifenacin 5 mg/day; Group C (n=103) received dutasteride 0.5 mg/day, tadalafil 20 mg/day, and solifenacin 10 mg/day. The functional status of the lower urinary tract was assessed using the International Prostate Symptom Score (I-PSS), Overactive Bladder Questionnaire (OABq), International Index of Erectile Function (IIEF), and Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) as well as uroflowmetry. RESULTS The total score of the sexual function remained unchanged in Group B of patients 81.3 points vs. 80.2 points (p>0.05) according to MSHQ-EjD, 61.4 points vs. 51.2 points (p>0.05) according to IIEF data. The total assessment of symptoms of hyperactivity significantly decreased in Group C according to OABq data after the 4th week of the study (17.5 points vs. 26.1 points, p<0.05) and remained below the baseline until the end of the study (15.2 points). CONCLUSIONS The simultaneous administration of standard doses of dutasteride, solifenacin, and tadalafil for 3 months is safe, effective, and can be recommended for patients with BPH to reduce symptoms of obstruction and hyperactivity of the bladder and maintain sexual function.
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Affiliation(s)
- Kirill Kosilov
- Department of Social Sciences, School of Humanities, Far Eastern Federal University, Vladivostok, Primorsky region, Russian Federation,Department of Clinical Medicine, School of Medicine, Far Eastern Federal University, Vladivostok, Primorsky region, Russian Federation,Corresponding author. Department of Social Sciences, School of Humanities, Far Eastern Federal University, Vladivostok, Primorsky region, Russian Federation.
| | - Irina Kuzina
- Department of Social Sciences, School of Humanities, Far Eastern Federal University, Vladivostok, Primorsky region, Russian Federation
| | - Vladimir Kuznetsov
- Department of Public Health, Pacific State Medical University, Vladivostok, Primorsky region, Russian Federation
| | - Olga Barabash
- Department of Physical Culture and Health and Sports Work, Vladivostok State University of Economics and Service, Vladivostok, Primorsky region, Russian Federation
| | - Ekaterina Fedorishcheva
- Department of Public Health, Pacific State Medical University, Vladivostok, Primorsky region, Russian Federation
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Wang S, Li Y, Li W, Zhang K, Yuan Z, Cai Y, Xu K, Zhou J, Du Z. Curcuma oil ameliorates benign prostatic hyperplasia through suppression of the nuclear factor-kappa B signaling pathway in rats. JOURNAL OF ETHNOPHARMACOLOGY 2021; 279:113703. [PMID: 33340599 PMCID: PMC9586842 DOI: 10.1016/j.jep.2020.113703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 05/05/2023]
Abstract
ETHNO PHARMACOLOGICAL RELEVANCE Curcuma longa L is traditionally used as an anti-inflammatory remedy in Chinese traditional medicine. Curcuma oil (CO), a lipophilic fraction from Curcuma longa L. has been reported to have anti-proliferative, anti-inflammatory and anti-oxidant activities. However, CO has never been investigated for its possible therapeutic effects on benign prostatic hyperplasia (BPH). AIMS OF THE STUDY The study is thus to determine the therapeutic effects of curcuma oil on BPH and also the possible mechanism (s) of action. MATERIALS &METHODS A BPH-1 cell line and Sprague Dawley (SD) rats were used to establish BPH models in vitro and in vivo, respectively. Rats were treated by CO (2.4, 7.2 mg/kg/i.g.) and finasteride (5 mg/kg/i.g.), respectively. Histological changes were examined by hematoxylin and eosin (H&E) staining. Protein expression was analyzed for 5α-reductase (5AR), dihydrotestosterone (DHT), interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α by ELISA. Ki-67, Caspase-8,-9 and -3 expressions were evaluated via immunohistochemistry (IHC). RESULTS CO effectively induced apoptosis in BPH-1 cells. BPH was successfully established by administration of testosterone propionate (TP) in rats, which upregulated both 5α-reductase expression and DHT production. Importantly, TP establishment significantly stimulated the phosphorylation of p65, one subunit of NF-κB, thus led to activation of the NF-κB signaling pathway in prostatic tissues of rats. In turn, the activation of NF-κB pathway induced concomitant upregulation of proinflammatory factors IL-1β, IL-6, TNF-α, and COX-2 and significant increase of the Bcl2/Bax expression ratio for enhanced cell survival, contributing to the initiation and progression of BPH in rats. Notably, CO therapy significantly decreased prostate weight and hyperplasia in BPH-induced animals. Also CO was found to suppress the expression of 5α-reductase and thus the production of DHT, which is essential for the amelioration of BPH. More importantly, CO was shown to suppress the activation of NF-κB pathway through decreasing the expression of phosphorylated p65 and consequently reduced the inflammatory responses and cell survival in prostatic tissues, leading to the inhibition of BPH development in rats. CONCLUSION Curcuma oil is very effective for ameliorating BPH in rats. The underlying mechanisms involve in reduced inflammatory responses and cell survival through suppression of the NF-κB signaling pathway by CO in prostatic tissues.
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Affiliation(s)
- Shanshan Wang
- School of Biomedical and Phamaceutical Sciences, Gunagdong University of Technology, Guangzhou, 511400, China
| | - Yun Li
- R&D Centre, Infinitus (China) Company Ltd, Guangzhou, China
| | - Wenzhi Li
- R&D Centre, Infinitus (China) Company Ltd, Guangzhou, China
| | - Kun Zhang
- School of Biomedical and Phamaceutical Sciences, Gunagdong University of Technology, Guangzhou, 511400, China
| | - Zhengqiang Yuan
- School of Biomedical and Phamaceutical Sciences, Gunagdong University of Technology, Guangzhou, 511400, China
| | - Yina Cai
- School of Biomedical and Phamaceutical Sciences, Gunagdong University of Technology, Guangzhou, 511400, China
| | - Kuncheng Xu
- School of Biomedical and Phamaceutical Sciences, Gunagdong University of Technology, Guangzhou, 511400, China
| | - Jinrong Zhou
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
| | - Zhiyun Du
- School of Biomedical and Phamaceutical Sciences, Gunagdong University of Technology, Guangzhou, 511400, China; Conney Allan Biotechnology Company Ltd, Guangzhou, 510095, China.
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Pattabiraman G, Bell-Cohn AJ, Murphy SF, Mazur DJ, Schaeffer AJ, Thumbikat P. Mast cell function in prostate inflammation, fibrosis, and smooth muscle cell dysfunction. Am J Physiol Renal Physiol 2021; 321:F466-F479. [PMID: 34423679 DOI: 10.1152/ajprenal.00116.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intraurethral inoculation of mice with uropathogenic Escherichia coli (CP1) results in prostate inflammation, fibrosis, and urinary dysfunction, recapitulating some but not all of the pathognomonic clinical features associated with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). In both patients with LUTS and CP1-infected mice, we observed increased numbers and activation of mast cells and elevated levels of prostate fibrosis. Therapeutic inhibition of mast cells using a combination of a mast cell stabilizer, cromolyn sodium, and the histamine 1 receptor antagonist cetirizine di-hydrochloride in the mouse model resulted in reduced mast cell activation in the prostate and significant alleviation of urinary dysfunction. Treated mice showed reduced prostate fibrosis, less infiltration of immune cells, and decreased inflammation. In addition, as opposed to symptomatic CP1-infected mice, treated mice showed reduced myosin light chain-2 phosphorylation, a marker of prostate smooth muscle contraction. These results show that mast cells play a critical role in the pathophysiology of urinary dysfunction and may be an important therapeutic target for men with BPH/LUTS.NEW & NOTEWORTHY LUTS-associated benign prostatic hyperplasia is derived from a combination of immune activation, extracellular matrix remodeling, hyperplasia, and smooth muscle cell contraction in prostates of men. Using a mouse model, we describe the importance of mast cells in regulating these multiple facets involved in the pathophysiology of LUTS. Mast cell inhibition alleviates both pathology and urinary dysfunction in this model, suggesting the potential for mast cell inhibition as a therapeutic that prevents and reverses pathology and associated symptomology.
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Affiliation(s)
- Goutham Pattabiraman
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ashlee J Bell-Cohn
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephen F Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel J Mazur
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anthony J Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Praveen Thumbikat
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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12
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Dias US, de Moura MRL, Viana PCC, de Assis AM, Marcelino ASZ, Moreira AM, Leite CC, Cerri GG, Carnevale FC, Horvat N. Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications. Radiographics 2021; 41:1509-1530. [PMID: 34415807 DOI: 10.1148/rg.2021200144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Benign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as α-blockers and 5α-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Ubenicio Silveira Dias
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Maurício Ruettimann Liberato de Moura
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Publio Cesar Cavalcante Viana
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - André Moreira de Assis
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Antônio Sérgio Zanfred Marcelino
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Airton Mota Moreira
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Claudia Costa Leite
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Giovanni Guido Cerri
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Francisco Cesar Carnevale
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Natally Horvat
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
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13
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The Urinary Tract Microbiome in Male Genitourinary Diseases: Focusing on Benign Prostate Hyperplasia and Lower Urinary Tract Symptoms. Int Neurourol J 2021; 25:3-11. [PMID: 33504133 PMCID: PMC8022174 DOI: 10.5213/inj.2040174.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
The human body is sterile during gestation; however, but during and after birth, the entire body surface becomes host to an enormous variety of microorganisms. Urine in the urinary tract was once considered sterile based on the lack of cultured microorganisms. Many recent studies have revealed evidence of microorganisms in human urine in the absence of clinical infection. Sequencing methods and analytical techniques are rapidly evolving to improve the ability to detect bacterial DNA and living bacteria and to understand the microbiota of the urinary tract. In women, fascinating evidence associates urinary tract microbiota with lower urinary tract symptoms. However, in men, the relevance of urinary tract microbiota in low urinary tract symptoms and prostate disease has not been established. In this review, we highlight a recent study that increases our ability to understand the urinary tract microbiota in men with lower urinary tract symptoms.
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14
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Increased risk of subsequent benign prostatic hyperplasia in non-Helicobacter pylori-infected peptic ulcer patients: a population-based cohort study. Sci Rep 2020; 10:21719. [PMID: 33303936 PMCID: PMC7728766 DOI: 10.1038/s41598-020-78913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022] Open
Abstract
The vagus nerve plays an essential role in homeostasis and inflammation. Clinically, peptic ulcer patients without helicobacter pylori (HP) infection may provide a population for studying the effect of vagal hyperactivity. There were interests in the association of gastrointestinal disease and urogenital disorders. Herein, we try to investigate subsequent risk of benign prostatic hyperplasia (BPH) in non-HP infected peptic ulcer patients. We identified 17,672 peptic ulcer admission male patients newly diagnosed in 1998-2007 from Taiwan Health Insurance Database, and 17,672 male comparison without peptic ulcer, frequency matched by age, and index-year. We assessed subsequent incidence of BPH in each cohort by the end of 2013, and then compared the risk of developing BPH between individuals with and without peptic ulcer. In addition, peptic ulcer patients underwent surgery were also examined. There were 2954 peptic ulcer patients and 2291 comparisons noted with the occurrence of BPH (25.35 and 16.70 per 1000 person-years, respectively). Compared to comparisons, peptic ulcer patients had a 1.45- and 1.26-fold BPH risk in multivariable Cox model and Fine and Gray model (95% CI 1.37-1.54 and 1.19-1.34). In age-stratified analysis, the highest risk of BPH was in 45-59 years (interaction p < 0.05). Regarding surgery types, peptic ulcer patients who underwent simple suture surgery (i.e.: with integrated vagus nerve) had a significant higher BPH risk than comparison (HR 1.50 and 95% CI 1.33-1.74; SHR 1.26 and 95% CI 1.07-1.48), while patients underwent truncal vagotomy/pyloroplasty showed a lower incidence of BPH. In this study, non-HP-infected male peptic ulcer patients were found to have an increased risk of subsequent BPH. Indicating that there might be a role of vagus nerve. Based on the limitations of retrospective nature, further studies are required.
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15
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Sauer AK, Vela H, Vela G, Stark P, Barrera-Juarez E, Grabrucker AM. Zinc Deficiency in Men Over 50 and Its Implications in Prostate Disorders. Front Oncol 2020; 10:1293. [PMID: 32850402 PMCID: PMC7424038 DOI: 10.3389/fonc.2020.01293] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
Research has been consistently showing the role of zinc (Zn) in prostate function. In this article, we review the current literature on the anatomy and main functions of the prostate, highlighting the role of zinc. In particular, we will review the etiology of benign prostate enlargement (BPH), its prevalence in men over 50, the likelihood of BPH becoming prostate cancer (PCa), and explain the relationship of zinc and apoptosis in the prostate cells and the implications for BPH and PCa. We present a model that explains how endogenous factors provoke excretion of zinc or limit zinc absorption, and how exogenous factors like nutrition and drugs regularly used in men over 50 can significantly decrease zinc status and thereby increase the risk of BPH. Finally, we explain how Zn amino acid (AA) complexes may be capable of avoiding antagonists and inhibitors of zinc absorption, thereby increasing the bioavailability of zinc for the necessary biological processes in the prostate.
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Affiliation(s)
- Ann Katrin Sauer
- Department of Biological Sciences, University of Limerick, Limerick, Ireland.,Bernal Institute, University of Limerick, Limerick, Ireland.,Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Hector Vela
- Vela Staines y Asociados SA de CV, Monterrey, Mexico
| | - Guillermo Vela
- Zinpro Corporation, Eden Prairie, MN, United States.,Autismo ABP, Monterrey, Mexico
| | - Peter Stark
- Zinpro Corporation, Eden Prairie, MN, United States
| | | | - Andreas M Grabrucker
- Department of Biological Sciences, University of Limerick, Limerick, Ireland.,Bernal Institute, University of Limerick, Limerick, Ireland.,Health Research Institute (HRI), University of Limerick, Limerick, Ireland
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16
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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.
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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
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17
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Dornbier R, Pahouja G, Branch J, McVary KT. The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update. Curr Urol Rep 2020; 21:32. [PMID: 32607874 DOI: 10.1007/s11934-020-00985-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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18
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Cheon SY, Jin BR, Kim HJ, An HJ. Oleanolic Acid Ameliorates Benign Prostatic Hyperplasia by Regulating PCNA-Dependent Cell Cycle Progression In Vivo and In Vitro. JOURNAL OF NATURAL PRODUCTS 2020; 83:1183-1189. [PMID: 32191471 DOI: 10.1021/acs.jnatprod.9b01210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Oleanolic acid (OA) is a natural, biologically active pentacyclic triterpenoid found in Cornus officinalis. Although C. officinalis and OA have antiproliferative actions, the effects and mechanisms of OA in benign prostatic hyperplasia (BPH) are unclear. We examined the effect of OA in an animal model of testosterone-induced BPH. Male rats were injected with testosterone propionate with or without OA. The inhibitory effect of OA on BPH-1 cells was determined in vitro. Rats with BPH exhibited outstanding BPH symptoms, including prostatic enlargement, upregulated dihydrotestosterone and 5α-reductase 2 levels, and histological changes. Compared with the BPH group, the OA group showed fewer pathological alterations and regular androgen events. OA inhibited prostate cell proliferation by downregulating the expression of proliferating cell nuclear antigen (PCNA) and cell cycle markers in BPH-induced animals. This indicated that OA has superior therapeutic effect in the BPH animal model than finasteride. In vitro studies demonstrated upregulation of PCNA and cell cycle proteins, whereas OA clearly reduced this upregulation. Thus, OA may inhibit the development of BPH by targeting cell cycle progression markers. These suggest that OA is a potential agent for BPH treatment.
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Affiliation(s)
- Se-Yun Cheon
- Department of Pharmacology, College of Korean Medicine, Sang-ji University, Wonju-si, Gangwon-do 26339, Republic of Korea
- Department of Korean Medical Science, School of Korean Medicine and Healthy Aging Korean Medical Research Center, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Bo-Ram Jin
- Department of Pharmacology, College of Korean Medicine, Sang-ji University, Wonju-si, Gangwon-do 26339, Republic of Korea
| | - Hyo-Jung Kim
- Department of Pharmacology, College of Korean Medicine, Sang-ji University, Wonju-si, Gangwon-do 26339, Republic of Korea
| | - Hyo-Jin An
- Department of Pharmacology, College of Korean Medicine, Sang-ji University, Wonju-si, Gangwon-do 26339, Republic of Korea
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19
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Heidari F, Moussavi G, Abbaszadeh S, Noorbala MH. Evaluation of urethral stricture after transurethral resection of the prostate in benign prostatic hypertrophy patients. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Medical Therapies for Treatment of BPH: Special Considerations in Elderly Men. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-00299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Kosilov K, Kuzina I, Kuznetsov V, Kosilova L, Ivanovskaya M, Kosilova E. The Analysis of the Effects of Executive Functions, Working Memory and Other Factors on Medication Adherence in Elderly Men with Benign Prostatic Hyperplasia and Overactive Bladder Symptoms. Curr Aging Sci 2019; 13:72-80. [PMID: 31560296 DOI: 10.2174/1874609812666190927153152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 12/28/2022]
Abstract
AIM Evaluation of the executive function and working memory influence, as well as the general state of memory, on adherence to Benign Prostatic Hyperplasia (BPH) and overactive bladder symptoms treatment in elderly men. BACKGROUND The influence of the executive function and working memory on treatment adherence in older men with BPH has not been studied enough. OBJECTIVE To determine the level of influence of various factors on the treatment adherence in older men with BPH. METHODS The executive function and working memory evaluation, as well as a general memory assessment, were carried out using the Wisconsin Test, the Wechsler Memory Scale, and the California Verbal Test. Hierarchical and simultaneous regressions were calculated to study the effect of executive function and working memory. RESULTS After the end of the study, the symptoms of hyperactive bladder significantly decreased, the symptoms of evacuation did not change significantly, and the cognitive status of the patients remained unchanged. The predictor variables significantly influencing adherence of elderly men to BPH and overactive bladder (OAB) treatment are executive function and working memory composite (β = .33, p < .05), severe symptoms of lower urinary tract (-.34, p < .05), and age (-.27, p < .05). CONCLUSION The status of executive function and working memory, as well as the age and severity of the pathological symptoms of the lower urinary tract, should be taken into account when predicting the risks of rejecting BPH and OAB treatment in elderly patients.
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Affiliation(s)
- Kirill Kosilov
- Department of Social Sciences, School of Humanities, Far Eastern Federal University, Vladivostok, Primorsky Region, Russian Federation
| | - Irina Kuzina
- Department of Social Sciences, School of Humanities, Far Eastern Federal University, Vladivostok, Primorsky Region, Russian Federation
| | - Vladimir Kuznetsov
- Department of Public Health of the Pacific State Medical University, Vladivostok, Russian Federation
| | - Liliya Kosilova
- Department of Functional Diagnostics, Med. Association No. 2 of Vladivostok-City, Vladivostok, Russian Federation
| | - Marina Ivanovskaya
- Department of Law, Far Eastern Fisheries University, Vladivostok, Russian Federation
| | - Ekaterina Kosilova
- Department of Public Health of the Pacific State Medical University, Vladivostok, Russian Federation
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22
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Can Botulinum Toxin A Still Have a Role in Treatment of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia Through Inhibition of Chronic Prostatic Inflammation? Toxins (Basel) 2019; 11:toxins11090547. [PMID: 31546892 PMCID: PMC6784075 DOI: 10.3390/toxins11090547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022] Open
Abstract
Patients with benign prostatic hyperplasia (BPH) can exhibit various lower urinary tract symptoms (LUTS) owing to bladder outlet obstruction (BOO), prostatic inflammation, and bladder response to BOO. The pathogenesis of BPH involves an imbalance of internal hormones and chronic prostatic inflammation, possibly triggered by prostatic infection, autoimmune responses, neurogenic inflammation, oxidative stress, and autonomic dysfunction. Botulinum toxin A (BoNT-A) is well recognized for its ability to block acetylcholine release at the neuromuscular junction by cleaving synaptosomal-associated proteins. Although current large clinical trials have shown no clinical benefits of BoNT-A for the management of LUTS due to BPH, BoNT-A has demonstrated beneficial effects in certain subsets of BPH patients with LUTS, especially in males with concomitant chronic prostatitis/chronic pelvic pain syndrome and smaller prostate. We conducted a review of published literature in Pubmed, using Botulinum toxin, BPH, BOO, inflammation, LUTS, and prostatitis as the key words. This article reviewed the mechanisms of BPH pathogenesis and anti-inflammatory effects of BoNT-A. The results suggested that to achieve effectiveness, the treatment of BPH with BoNT-A should be tailored according to more detailed clinical information and reliable biomarkers.
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23
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Chung JH, Kim KS, Choi JD, Kim TH, Lee KS, Oh CY, Noh JH, Kim JS, Kim WT, Lee SH, Kim JH, Kim TN, Huh W, Lee SW. Effects of poloxamer-based thermo-sensitive sol-gel agent on urethral stricture after transurethral resection of the prostate for benign prostatic hyperplasia: a multicentre, single-blinded, randomised controlled trial. BJU Int 2019; 125:160-167. [PMID: 31444917 DOI: 10.1111/bju.14902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of poloxamer-based thermo-sensitive sol-gel instillation, after transurethral resection of the prostate (TURP), for preventing urethral stricture. PATIENTS AND METHODS In all, 198 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: groups A and B. Patients in Group A (100 patients, experimental group) received poloxamer-based thermo-sensitive sol-gel instillation and patients in the Group B (98 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 (V1), 12 (V2), and 24 weeks (V3) after TURP. The effectiveness of poloxamer-based thermo-sensitive sol-gel instillation was evaluated based on the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (QoL), Overactive bladder questionnaire (OAB-q), maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), and cystoscopy. RESULTS Amongst the initial 198 participants, 80 patients in Group A and 83 in Group B completed the study. There were no significant differences in IPSS-QoL and OAB-q between the groups. However, Qmax was significantly different between groups A and B, at a mean (SD) of 18.92 (9.98) vs 15.58 (9.24) mL/s (P = 0.028) at 24 weeks after TURP. On cystoscopic examination, urethral stricture after TURP was found in two of the 80 patients in Group A and 10 of 83 in Group B (P = 0.023). CONCLUSIONS Poloxamer-based thermo-sensitive sol-gel instillation after TURP lowered the incidence of urethral stricture.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyu Shik Kim
- Department of Urology, Hanyang University College of Medicine, Seoul, South Korea
| | - Jae Duck Choi
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Tae Hyo Kim
- Departments of Urology, College of Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Ki Soo Lee
- Departments of Urology, College of Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University College of Medicine, Seoul, South Korea
| | - Joon Hwa Noh
- Department of Urology, Kwangju Christian Hospital, Gwangju, South Korea
| | - Jun Seok Kim
- Department of Urology, Kwangju Christian Hospital, Gwangju, South Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Seung Hwan Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Tae Nam Kim
- Department of Urology, Pusan National University Hospital, Busan, South Korea
| | - Wan Huh
- Daewoong Pharmaceutical Co. Ltd, Seoul, South Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, South Korea
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Patel NH, Uppaluri N, Iorga M, Schulman A, Bloom JB, Phillips J, Fullerton S, Konno S, Choudhury M, Eshghi M. Device Malfunctions and Complications Associated with Benign Prostatic Hyperplasia Surgery: Review of the Manufacturer and User Facility Device Experience Database. J Endourol 2019; 33:448-454. [PMID: 30990073 DOI: 10.1089/end.2019.0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction and Objectives: Multiple surgical therapies for benign prostatic hyperplasia (BPH) have been developed to decrease complications and increase provider efficiency. We investigated contemporary BPH treatment device-related adverse events by searching a publicly available database. Materials and Methods: The Manufacturer and User Facility Device Experience (MAUDE) database was queried for contemporary BPH treatments. All devices were evaluated for malfunction, patient complications, and manufacturer review. The MAUDE adverse event classification system was used to standardize complications. Univariate analysis was performed to identify associations between BPH devices and adverse events. Results: A total of 2567 reports were identified: transurethral resection of the prostate (TURP) 197 (7.67%), holmium laser enucleation of the prostate (HoLEP) 39 (1.52%), GreenLight™ 2315 (90.2%), and UroLift® 16 (0.62%). The most common deviations for each modality included cutting loop detachment during TURP 116 (58.9%), morcellator dysfunction for HoLEP 23 (58.9%), tip fracture/detachment for GreenLight (68.8%), and failure to deploy during UroLift 10 (62.5%). Only 18 (0.7%) patients required medical/surgical management (MAUDE II-IV) due to a device complication. No significant relationship was seen between each modality and complications; however, morcellator use (27.8%) was observed in higher grade complications. Manufacturer review occurred in 61.7% of cases, with 41.3% of reviewed cases finding the operator the cause of the malfunction. Conclusion: Each BPH modality investigated had minimal patient harm with over 99% of patients experiencing no complication after device malfunction. Of note, great care should be taken with morcellator use during HoLEP as it had the greatest number of MAUDE II to IV complications among all devices. Manufacturer review revealed that over 40% of cases were due to misuse by the user. Therefore, urologists should select the modalities they are most familiar with to decrease patient harm and prevent device malfunctions.
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Affiliation(s)
- Neel H Patel
- 1 Department of Urology, New York Medical College, Valhalla, New York
| | - Nikil Uppaluri
- 1 Department of Urology, New York Medical College, Valhalla, New York
| | - Michael Iorga
- 1 Department of Urology, New York Medical College, Valhalla, New York
| | - Ariel Schulman
- 2 Department of Urology, Maimonides Medical Center, Brooklyn, New York
| | - Jonathan B Bloom
- 3 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John Phillips
- 1 Department of Urology, New York Medical College, Valhalla, New York
| | - Sean Fullerton
- 1 Department of Urology, New York Medical College, Valhalla, New York
| | - Sensuke Konno
- 1 Department of Urology, New York Medical College, Valhalla, New York
| | | | - Majid Eshghi
- 1 Department of Urology, New York Medical College, Valhalla, New York
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Campbell J, Reid J, Ordon M, Welk B. The Utilization of Benign Prostatic Hyperplasia and Bladder-Related Medications After a Transurethral Prostatectomy. Urology 2019; 130:126-131. [PMID: 31129193 DOI: 10.1016/j.urology.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine how often prostate- and bladder-specific medications for lower urinary tract symptoms are used following a transurethral prostatectomy (TURP). METHODS This study utilized several linked, routinely collected datasets from the province of Ontario, Canada to identify men older than 66 years who underwent their first TURP between April 2003 and March 2016. The primary outcome was the probability of using at least 30 days of either prostate-specific alpha blockers (AB), 5-alpha reductase inhibitors (5ARI), or anticholinergics/beta-3 agonists (AC/B3) after their TURP. RESULTS We identified 58,038 men (median age 75), with a median follow-up of 4.9 years. In the 6 months prior to their TURP, AB, 5ARIs or AC/B3 were used by 62%, 32%, and 6%, respectively. Following a 90-day washout period after TURP, these medications were used by 27%, 20%, and 15% of men, respectively. The cumulative probability of using these medications within the first 10 years after TURP was 38%, 28%, and 20%, respectively. Family physicians prescribed the majority of AB, while urologists prescribed the majority of the AC/B3. Among men on AC/B3 prior to TURP, 46% used them after TURP; in multivariate cox regression analysis age ≥75, diabetes, preoperative use of AC/B3, and no preoperative urinary retention predicted postoperative utilization of AC/B3 medications. CONCLUSION There is considerable use of AB and 5ARIs despite a lack of evidence for using these medications after a TURP. Given the well-characterized placebo response in BPH patients, this practice should be properly evaluated for clinical efficacy.
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Affiliation(s)
- Jeffrey Campbell
- Department of Surgery, Western University, London, Ontario, Canada
| | - Jennifer Reid
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Michael Ordon
- Department of Surgery, University of Toronto, London, Ontario, Canada
| | - Blayne Welk
- Department of Surgery, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
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Bajic P, Dornbier RA, Doshi CP, Wolfe AJ, Farooq AV, Bresler L. Implications of the Genitourinary Microbiota in Prostatic Disease. Curr Urol Rep 2019; 20:34. [PMID: 31104156 DOI: 10.1007/s11934-019-0904-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To summarize recent investigation into associations between the genitourinary microbiota and prostatic disease. RECENT FINDINGS The genitourinary tract is not sterile. There are microbial communities (microbiota) in each niche of the genitourinary tract including the bladder, prostate, and urethra, which have been the subject of increasing scientific interest. Investigators have utilized several unique methods to study them, resulting in a highly heterogeneous body of literature. To characterize these genitourinary microbiota, diverse clinical specimens have been analyzed, including urine obtained by various techniques, seminal fluid, expressed prostatic secretions, and prostatic tissue. Recent studies have attempted to associate the microbiota detected from these samples with urologic disease and have implicated the genitourinary microbiota in many common conditions, including benign prostatic hyperplasia (BPH), prostate cancer, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In this review, we summarize the recent literature pertaining to the genitourinary microbiota and its relationship to the pathophysiology and management of three common prostatic conditions: BPH, prostate cancer, and CP/CPPS.
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Affiliation(s)
- Petar Bajic
- Department of Urology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave. Building 54, Room 23A, Maywood, IL, 60153, USA.
| | - Ryan A Dornbier
- Department of Urology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave. Building 54, Room 23A, Maywood, IL, 60153, USA
| | - Chirag P Doshi
- Department of Urology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave. Building 54, Room 23A, Maywood, IL, 60153, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave. CTRE Building, Room 224, Maywood, IL, 60153, USA
| | - Ahmer V Farooq
- Department of Urology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave. Building 54, Room 23A, Maywood, IL, 60153, USA
| | - Larissa Bresler
- Department of Urology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave. Building 54, Room 23A, Maywood, IL, 60153, USA
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de Assis AM, Moreira AM, Carnevale FC, Marcelino ASZ, de Oliveira Cerri LM, Antunes AA, Srougi M, Cerri GG. Effects of Prostatic Artery Embolization on the Dynamic Component of Benign Prostate Hyperplasia as Assessed by Ultrasound Elastography: A Pilot Series. Cardiovasc Intervent Radiol 2019; 42:1001-1007. [PMID: 30993369 DOI: 10.1007/s00270-019-02220-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the effects of prostatic artery embolization (PAE) on prostatic elasticity as assessed by Ultrasound Elastography (US-E), as well as to describe the feasibility and role of US-E as a novel tool in both pre- and post-PAE evaluation. MATERIALS AND METHODS This is a prospective, single-center investigation that included eight patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline and 3-month follow-up evaluations were performed and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. US-E with measurement of the prostatic Elastic Modulus (EM) was performed before PAE and at 1-month follow-up. RESULTS After PAE, US-E showed a significant reduction of prostatic EM as assessed in kPa (33.14 vs. 47.24, - 29.8%, p = 0.002) and in m/s (3.75 vs. 4.63, - 19.0%, p < 0.001). Also, the transitional/peripheral zone ratio was significantly reduced by 45.36% (0.53 vs. 0.97, p < 0.05). All eight patients presented with significant LUTS improvement after PAE (p < 0.05 for IPSS, QoL, prostate volume, peak urinary flow rate and PSA). CONCLUSIONS Findings described in this study suggest that PAE significantly reduces prostatic EM, leading to a positive effect on BPH dynamic component related to prostatic elasticity. Also, it features US-E as an additional tool for pre- and post-PAE evaluation, describing a novel indication for this technology.
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Affiliation(s)
- André Moreira de Assis
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
- Interventional Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115 Bela Vista, São Paulo, SP, 01308-050, Brazil.
| | - Airton Mota Moreira
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
- Interventional Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115 Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
- Interventional Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115 Bela Vista, São Paulo, SP, 01308-050, Brazil
| | | | | | - Alberto Azoubel Antunes
- Urology Department, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Miguel Srougi
- Urology Department, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Giovanni Guido Cerri
- Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115, Bela Vista, São Paulo, SP, 01308-050, Brazil
- Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
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Analysis of Present Status for Surgery of Benign Prostatic Hyperplasia in Korea Using Nationwide Healthcare System Data. Int Neurourol J 2019; 23:22-29. [PMID: 30943691 PMCID: PMC6449663 DOI: 10.5213/inj.1836198.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 11/08/2022] Open
Abstract
Purpose There are no established statistical data available for the comparison of different surgical methods adopted for the resection of benign prostatic hyperplasia (BPH). This study investigates the present status related to BPH surgery in Korea for the past 8 years. Methods National-level data from the National Health Insurance Service and National Statistical Office were analyzed in this study. From 2010 to 2017, the trends of surgeries for BPH were reviewed according to the procedure code including transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), or high-power potassium titanyl phosphate (KTP), and this trend also analyzed by age, geographic distribution, and hospital type. Results Over the past 8 years, there was not much change in the total number of BPH-related surgeries (range, 10,393– 11,072). Although there was not much alteration in the number of conventional TURP (from 6,801 in 2010 to 6,645 in 2017), the number of HoLEP has dramatically increased (from 278 in 2010 to 3,805 in 2017). The number of HoLEP surgeries after 2011 exceeded the number of surgeries using KTP, and the gap is anticipated to rise. The number of surgeries by age group was most common in the 70s and the total number of surgeries is decreasing in all age groups; for HoLEP, the trend is steadily increasing over the age of 60 years. Most of the BPH surgeries were performed in metropolitan areas, such as Seoul, Gyeonggi-do, and Busan, and in larger hospitals compared to smaller hospital settings. Conclusions Through the data of the National Health Insurance Service, we could apprehend the present status of BPH-related surgery in Korea. Then, we could know about the trend according to several factors and we think these results will be valuable as academic references as well.
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Kosilov K, Kuzina I, Kuznetsov V, Gainullina Y, Kosilova L, Karashchuk E, Prokofyeva A, Loparev S. The Risk of Sexual Dysfunction and Effectiveness of Treatment of Benign Prostatic Hyperplasia With Severe Lower Urinary Tract Dysfunction With Combination of Dutasteride and Solifenacin. J Sex Med 2018; 15:1579-1590. [DOI: 10.1016/j.jsxm.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/10/2018] [Accepted: 09/17/2018] [Indexed: 11/16/2022]
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Fang CW, Liao CH, Wu SC, Muo CH. Association of benign prostatic hyperplasia and subsequent risk of bladder cancer: an Asian population cohort study. World J Urol 2018; 36:931-938. [PMID: 29427001 DOI: 10.1007/s00345-018-2216-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Few studies discussed the link between benign prostatic hyperplasia (BPH) and bladder cancer. We performed this cohort study to investigate whether there is an association between BPH and subsequent risk of bladder cancer. METHODS We identified 35,092 study subjects including 17546 BPH patients and 17546 comparisons from the National Health Insurance database. The comparison cohort was frequency matched with age and index-year. We measured subsequent bladder cancer rates (per 1000 person-years) in two cohorts. Attributable risks (ARs) was calculated based on the bladder cancer rates in two cohorts. The hazard ratios (HRs) and 95% confidence intervals (CIs) for bladder cancer were estimated via Cox proportional hazard regression. RESULTS BPH patients had a higher bladder cancer rate than comparisons (AR = 0.81 per 1000 person-years) and exhibited 4.69- and 4.11-fold increases in bladder cancer risk in the crude and adjusted Cox models, respectively (95% CIs = 4.15-6.99 and 2.70-6.26). The AR was highest in patients aged 65-74 years old (AR = 1.33). BPH patients with chronic kidney disease were at an elevated bladder cancer risk. Regarding the association between bladder cancer and transurethral prostatectomy (TURP), BPH patients who underwent TURP were at a higher risk of bladder cancer (AR = 1.69; HR = 6.17, 95% CI = 3.68-10.3) than those who did not (AR = 0.69; HR = 3.73, 95% CI = 2.43-5.74). CONCLUSIONS In this study, BPH patients were found to have an increased risk of subsequent bladder cancer. Based on the limitations of retrospective nature, further studies are needed.
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Affiliation(s)
- Chu-Wen Fang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Hsi Liao
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Urology, Taichung Armed Forces General Hospital, Taichung, Taiwan
- National Defense Medical Center, Taipei, Taiwan
| | - Shih-Chi Wu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University and Hospital, No. 2, Yuh-Der Road, Taichung, 404, Taiwan
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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.
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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
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Kardasevic A, Milicevic S. The Correlation Between Prostate Volume in Patients with Benign Prostatic Hyperplasia in Relation to Erectile Dysfunction. Med Arch 2018; 70:449-452. [PMID: 28210019 PMCID: PMC5292219 DOI: 10.5455/medarh.2016.70.449-452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The exact etiology of lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH) has not yet been determined, and the etiology of erectile dysfunction (ED) is often multicausal and includes organic and/or psychogenic causes, as well as their combinations. Although the relation of BPH, and thus the volume of the prostate (VP) with ED is indisputable, precise mechanisms of integration are still under examination. Goal: The objective was to evaluate the correlation between prostate volume and degree of erectile dysfunction in patients with symptoms of lower urinary tract caused by benign prostatic hyperplasia. Material and Methods. 150 subjects with BPH, and before starting the BPH treatment, which can affect the sexual function, were divided into three groups: 50 patients with prostate volume of 30 to 40 ml (group A), 50 patients with a volume of 40 to 60 ml (group B) and 50 patients with prostate volume above 60 ml (group C). Quantification of erectile function is performed in all respondents by International Index of Erectile Function with five questions (IIEF-5). Results: The mean IIEF-5 in group A was 20.52 points with a standard deviation of 3.22, in group B 17.08 points with a standard deviation of 4.10, while in group C 10.78 points, with a standard deviation of 3.29. Comparing the results of a statistical analysis from all three groups of patients with the degree of ED, Group A had the highest value of IIEF-5, group C the lowest mean value of IIEF-5. The results of ANOVA (F=96.375, p=0.000) indicated that there was a statistically significant difference (p<0.05) between groups at high values of IIEF-5. Additional analysis by Turkey test revealed that there was a statistically significant difference between the first and second groups (p=0.000 <0.05), the first and third groups (p=0.000 <0.05) and the second and third groups (p=0.000 <0.05). Results of Fisher’s exact test (p=0.000) confirmed that there was a statistically significant relationship (p<0.05) between prostate volume and the degree of erectile function. Results of Spearman correlation (ρ=-0.720; p=0.000) showed that prostate volume is negatively correlated with IIEF-5 score with a reliability of 99% (p<0.05), or that increase in the volume of the prostate reduces the IIEF score. Conclusion: Results of IIEF-5 score are inversely proportional to the volume of the prostate or the prostate volume increase, the more severe erectile dysfunction, because the increase in prostate volume leads to a decline in IIEF score.
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Affiliation(s)
- Amel Kardasevic
- Department of Urology. Cantonal Hospital "dr Irfan Ljubijankic" Bihac, Bosna and Hercegovina
| | - Snjezana Milicevic
- Urology Clinic. University Clinical Center of the RS, Banja Luka, Bosnia and Herzegovina
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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
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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]
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Kosilov K, Loparev S, Kuzina I, Shakirova O, Zhuravskaya N, Lobodenko A. The effective tool for self-assessment of adherence to treatment in patients with benign prostatic obstruction and overactive bladder symptoms. Aging Male 2017; 20:39-44. [PMID: 28074677 DOI: 10.1080/13685538.2016.1247435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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
PURPOSE Study of validity of the Medication Adherence Self-Report Inventory (MASRI) for use in clinical practice to treat patients with benign prostatic obstruction (BPO) accompanied with overactive bladder (OAB) symptoms. METHODS During 12 weeks of the randomized study, 452 patients with BPO and OAB symptoms (mean age of 61.3 (12.7)) were studied for adherence to the treatment with Tamsulosin, Solifenacin and Trospium using the MASRI. External monitoring instruments included the Brief Medication Questionnaire (BMQ) and the visual remaining pill count. The state of the prostate gland and the lower urinary tract was monitored using questionnaires I-PSS, OAB Awareness Tool, uroflowmetry and voiding diaries. RESULT Correlation between the percentage of men non-adherent to treatment (MASRI) and the percentage of patients having a belief barrier on the screen of the BMQ was r = 0.89, p ≤0.05, r = 0.92, p ≤0.01, r = 0.85, p ≤0.05, a number of missed doses on the Regimen Screen of the BMQ was r = 0.79; p ≤0.05; r = 0.81; p ≤0.05; r = 0.75, p ≤0.05, a number of non-adherent patients according to the BMQ was r = 0.83 (p ≤0.05), r = 0.88 (p ≤0.05), r = 0.79, p ≤0.05, the results of the pill count were r = 0.65-0.76; p ≤0.05-0.01. These data confirm high validity of the MASRI. CONCLUSION The MASRI is a valid tool for rapid assessment of adherence to treatment of patients with BPO and OAB receiving Tamsulosin and antimuscarinic drugs and may be recommended for use in clinical practice.
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Affiliation(s)
- Kirill Kosilov
- a Department of Social Sciences , Far Eastern Federal University , Vladivostok , Russia
| | - Sergey Loparev
- b Department of Urology , Sity Policlinic 3 , Vladivostok , Russia , and
| | - Irina Kuzina
- a Department of Social Sciences , Far Eastern Federal University , Vladivostok , Russia
| | - Olga Shakirova
- c Department of theory and methodology of adaptive physical training , Far Eastern Federal University , Vladivostok , Russia
| | - Natalya Zhuravskaya
- c Department of theory and methodology of adaptive physical training , Far Eastern Federal University , Vladivostok , Russia
| | - Alexandra Lobodenko
- a Department of Social Sciences , Far Eastern Federal University , Vladivostok , Russia
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Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am 2017; 43:289-97. [PMID: 27476122 DOI: 10.1016/j.ucl.2016.04.001] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article assesses the reported prevalence and incidence rates for benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS) by age, symptom severity, and race/ethnicity. BPH/LUTS prevalence and incidence rates increase with increasing age and vary by symptom severity. The BPH/LUTS relationship is complex due to several factors. This contributes to the range of reported estimates and difficulties in drawing epidemiologic comparisons. Cultural, psychosocial, economic, and/or disease awareness and diagnosis factors may influence medical care access, symptom reporting and help-seeking behaviors among men with BPH/LUTS. However, these factors and their epidemiologic association with BPH/LUTS have not been thoroughly investigated.
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Affiliation(s)
- Kathryn Brigham Egan
- Yale University, 2 Whalley Ave, New Haven, CT 06520, USA; New England Research Institutes Inc., 480 Pleasant Street, Watertown, MA 02472, USA.
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Singh K, Sinha RJ, Sokhal A, Singh V. Does prostate size predict the urodynamic characteristics and clinical outcomes in benign prostate hyperplasia? Urol Ann 2017; 9:223-229. [PMID: 28794586 PMCID: PMC5532887 DOI: 10.4103/0974-7796.210029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims: Bladder outlet obstruction (BOO) in large and small prostates is managed in a similar manner despite considerably different pathophysiology, which can result in higher failure rates. We investigate the clinical and urodynamic features and study the outcome of patients with benign prostate hyperplasia (BPH) according to their prostate size. Subjects and Methods: We prospectively analyzed 100 BPH patients undergoing urodynamic study between January 2015 and August 2016 and divided them into two groups according to their prostate size: small (≤30 mL) and large prostate (>30 mL) groups. We compared the groups regarding age, International Prostate Symptom Score, maximal flow rate (Qmax), postvoided residual, serum prostate-specific antigen (PSA), prostate volume measured by ultrasonography (USG), and urodynamic findings. Statistical Analysis Used: For testing the hypothesis, we used the Chi-square test, Student's t-test, and one-way analysis of variance when comparing between groups and conducted the logistic regression analysis for determining predictive factors of BOO. Results: Although the total prostate volume significantly correlated with the PSA, patients with a small prostate had lower Qmax (5.27 ± 4.8 mL/s vs. 6.14 ± 6.66 mL/s; P = 0.74), higher incidence of abnormal baldder capacity (39.9% vs. 31.25%), lower voiding efficiency (39.3 ± 40.5% vs. 40.57 ± 32.11%), low compliance (44.4% vs. 31.3%), higher incidence of indeterminate detrusor contractions (38.9% vs. 37.5%), lower incidence of detrusor underactivity (33.3% vs. 28.1%), lower BOO index (40.9 ± 43.2 vs. 49.10 ± 44.48), lower bladder contractility index (77.8 ± 48.84 vs. 92.09 ± 52.79), and lower PdetQmax (51.44 ± 42.23 vs. 61.38 ± 42.01 cmH2O). Small prostates had higher failed voiding trials postsurgery. Conclusions: BOO patients with a small prostate showed poor urodynamic parameters and reported higher postoperative complications.
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Affiliation(s)
- Kawaljit Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashok Sokhal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Shirani-Boroujeni M, Heidari-Soureshjani S, Keivani Hafshejani Z. Impact of oral capsule of Peganum harmala on alleviating urinary symptoms in men with benign prostatic hyperplasia; a randomized clinical trial. J Renal Inj Prev 2016; 6:127-131. [PMID: 28497089 PMCID: PMC5423280 DOI: 10.15171/jrip.2017.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/29/2016] [Indexed: 01/18/2023] Open
Abstract
Introduction: Benign prostatic hyperplasia (BPH) is considered as a major cause of lower urinary tract symptoms (LUTS) in older men and its most common sign is nocturia.
Objectives: This study aimed to determine the effect of the seeds of Peganum harmala compared with tamsulosin on alleviating urinary symptoms in patients with BPH.
Patients and Methods: In this single blind clinical trial study, 90 patients diagnosed with BPH and LUTS, based on international prostate standard survey (IPSS) were divided into three groups. The first group was received oral capsule of P. harmala, the second group was administered tamsulosin with oral P. harmala seed and the third group was received tamsulosin drug and they were evaluated after 4 weeks.
Results: The results showed that the difference between mean scores of IPSS was significant after the intervention (P=0.001). Besides, the mean of IPSS in the three groups was significantly different (P=0.001) (the first group 41.9±5.3, the second group 21.0±4.4 ,the third group 16.5±3.7 respectively). However, after the intervention, patients in the second group had the lowest average on most indicators of IPSS but the difference was only significant about urinary frequency, nocturia and intermittency(P<0.05).
Conclusion: Application of Peganum harmala seed can be useful in reducing urinary symptoms in patients with BPH.
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Alan B, Utangaç M, Göya C, Dağgülli M. Role of Acoustic Radiation Force Impulse (ARFI) Elastography in Determination of Severity of Benign Prostate Hyperplasia. Med Sci Monit 2016; 22:4523-4528. [PMID: 27876713 PMCID: PMC5132425 DOI: 10.12659/msm.898676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study was to investigate the potential contribution of acoustic radiation force impulse (ARFI) elastography to the determination of the severity of benign prostate hypertrophy (BPH) by performing shear wave velocity (SWV) measurements of the prostate using ARFI technology. Material/Methods Sixty BPH patients and 40 healthy volunteers were included in this study. SWV measurements of the prostate were performed by transabdominal ultrasonography (US), both in the BPH patients and control subjects. The BPH patients also underwent uroflowmetry measurements. Using the International Prostate Symptom Score (IPSS), the BPH patients were divided into two subgroups, a mild-to-moderate BPH group and a severe BPH group, to compare SWV values. Results The BPH patients had higher SWV values for the central area of the prostate compared to the control subjects (2.52±0.59 m/s and 1.47±0.42 m/s, p<0.01). The SWV values of the central area of prostate were higher in the severe BPH group compared to the mild-to-moderate BPH group (2.62±0.58 and 2.25±0.55, p=0.02). Conclusions Our ARFI elastography results indicated that the central prostate SWV values of BPH patients were significantly higher relative to those of a healthy control group. The central prostate SWV values increased in proportion to the increased severity of BPH. Measurement of SWV by ARFI technology constitutes a non-invasive alternative to other methods for the determination of BPH severity.
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Affiliation(s)
- Bircan Alan
- Department of Radiology, Dicle University, Medical Faculty, Diyarbakır, Turkey
| | - Mazhar Utangaç
- Department of Neurology, Dicle University, Medical Faculty, Diyarbakır, Turkey
| | - Cemil Göya
- Department of Neurology, Dicle University, Medical Faculty, Diyarbakır, Turkey
| | - Mansur Dağgülli
- Department of Neurology, Dicle University, Medical Faculty, Diyarbakır, Turkey
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Huang W, Huang Z, Xiao G, Qin X. Effect of transurethral split of the prostate using a double-columnar balloon catheter for benign prostatic hyperplasia: A single-center experience of 565 consecutive patients. Medicine (Baltimore) 2016; 95:e4657. [PMID: 27749528 PMCID: PMC5059030 DOI: 10.1097/md.0000000000004657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We aimed to evaluate the long-term therapeutic effect of transurethral split of the prostate (TUSP) with a newly improved double-columnar balloon catheter on patients with benign prostatic hyperplasia (BPH).Total 565 BPH patients (mean age 73.6 years, range 46-94 years) who underwent TUSP surgery between January 2006 and January 2015 were included. Patient's baseline characteristics, prostate size, PSA, preoperative and postoperative maximum urinary flow rate (Qmax), postvoid residual (PVR), international prostate symptoms score (IPSS) and quality of life (QOL) score, perioperative data and postoperative complications were recorded.The mean preoperative prostates size was 48.6 ± 8.2 mL (range 33-230 mL), and the PSA level was 0.8 to 18.6 ng/mL. The mean duration of TUSP procedure from the catheter localization to the split of capsula prostatica was ∼10 minutes. After surgery, the mean Qmax increased from 5.2 ± 1.4 to 12.8 ± 2.2 mL/s (P < 0.001). Patients had improved mean PVR, QOL score, and IPSS after TUSP (76 ± 8 vs 20 ± 8.5 mL, 4.6 ± 0.2 vs 1.4 ± 0.3, and 20.2 ± 4.4 vs 6.6 ± 1.1, respectively, all P < 0.001). Until September 2014, 328 patients were successfully followed up for a long-term period of 38 to 99 months. There was no other case of recurrence with dysuria despite 2 recurrent cases.The TUSP with a double-columnar balloons catheter was a safe and long-term efficient treatment for BPH, with minimal invasion, short operative time, few postoperative complications, and low recurrence rate.
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Affiliation(s)
- Weiguo Huang
- Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
- Correspondence: Weiguo Huang, Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No.321 Zhongshan Road, Nanjing, Jiangsu, 210008, China (e-mail: )
| | | | - Guofeng Xiao
- Nanjing Suangwei Biotechnology Co., Ltd, Nanjing, China
| | - Xiang Qin
- Nanjing Suangwei Biotechnology Co., Ltd, Nanjing, China
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DerSarkissian M, Xiao Y, Duh MS, Lefebvre P, Swensen AR, Bell CF. Comparing Clinical and Economic Outcomes Associated with Early Initiation of Combination Therapy of an Alpha Blocker and Dutasteride or Finasteride in Men with Benign Prostatic Hyperplasia in the United States. J Manag Care Spec Pharm 2016; 22:1204-14. [PMID: 27668569 PMCID: PMC10397950 DOI: 10.18553/jmcp.2016.22.10.1204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common disease in men that is characterized by lower urinary tract symptoms. Pharmacologic treatment with alpha blockers (ABs) and 5-alpha reductase inhibitors (5ARIs) is recommended to alleviate symptoms, prevent disease progression that can lead to complications, and reduce health care costs. OBJECTIVE To compare clinical, economic, and health care resource utilization outcomes among BPH patients treated with early continuous combination AB and 5ARI therapy (dutasteride vs. finasteride) using administrative claims data from the United States. METHODS A retrospective analysis of administrative claims data from 2003-2013 was conducted to compare outcomes between patients with claims for early combination therapy with dutasteride + AB and patients with claims for early finasteride + AB. The study population included males aged older than 50 years with at least 1 medical claim with a diagnosis of BPH and pharmacy dispensing for AB and 5ARI therapies. Outcomes included acute urinary retention (AUR), prostate-related surgery, clinical progression, medical and pharmacy costs, and health care resource utilization. Inverse probability of treatment (IPT) weighted Cox proportional hazards, linear, and Poisson regression models were used to assess the association between outcomes and early combination therapy as appropriate. RESULTS A total of 2,778 patients were included in the early finasteride + AB treatment cohort, and 4,125 patients were included in the early dutasteride + AB cohort. Dutasteride users were younger than finasteride users (mean age: 64.8 vs. 67.5 years, P < 0.001) and had a greater mean number of urologist visits (10.7 vs. 7.9, P < 0.001) during baseline. After adjusting for confounding using IPT weighting, no statistically significant difference was observed between dutasteride and finasteride for AUR (hazard ratio [HR] = 0.845, 95% CI = 0.660-1.070, P = 0.1643), prostate-related surgery (HR = 0.806, 95% CI = 0.568-1.171, P = 0.2525), and clinical progression (HR = 0.834, 95% CI = 0.663-1.043, P = 0.1122). While dutasteride was associated with higher pharmacy costs per month (adjusted monthly cost difference = $79, 95% CI = $45-$105), total all-cause medical costs were not significantly different between the 2 cohorts (adjusted monthly cost difference = -$44, 95% CI = -$110-$22). CONCLUSIONS Clinical and economic outcomes were similar between the early dutasteride + AB and early finasteride + AB cohorts, with no statistically significant differences detected. DISCLOSURES Funding for this study was provided by GlaxoSmithKline (HO-14-15325 and AVO110072). Bell and Swensen are employees of GlaxoSmithKline. DerSarkissian, Xiao, Duh, and Lefebvre are employed by Analysis Group, a consulting company that received research grants from GlaxoSmithKline to conduct this study. Study concept and design were contributed by Bell, Swensen, Lefebvre, and Duh. Bell and Duh acquired the data. DerSarkissian and Xiao performed the statistical analysis and interpreted the data along with Lefebvre, Duh, and Bell. DerSarkissian and Bell drafted the manuscript. All authors contributed equally to critically revising the manuscript and providing final approval of the submitted manuscript.
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Srivilai J, Khorana N, Waranuch N, Wisuitiprot W, Suphrom N, Suksamrarn A, Ingkaninan K. Germacrene Analogs are Anti-androgenic on Androgen-dependent Cells. Nat Prod Commun 2016. [DOI: 10.1177/1934578x1601100906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anti-androgenic drugs are treatments for androgen-related disorders such as benign prostatic hyperplasia, acne, hirsutism, and androgenic alopecia. Germacrone (1), a sesquiterpene isolated from hexane extracts of Curcuma aeruginosa Roxb. rhizome, is an androgen inhibitor of steroid 5-alpha reductase in-vitro. Here, we used the similarity of germacrone's α,ß-unsaturated carbonyl to testosterone's α,ß-unsaturated carbonyl to find germacrene analogs obtained from this plant and by semi-synthesis that might be more potent steroid 5-alpha reductase inhibitors. 8-Hydroxy germacrene B (4) was ~13-fold more potent than its parent, 1 and the most potent (IC50, 0.15±0.022 mM) among 9 compounds tested. The conformation of its cyclodecadiene ring and the α,ß-unsaturated ketone/hydroxy in the germacrene molecule might be crucial role for its anti-androgen activity. Moreover, 1 and 4 showed mild cytotoxic effect on prostate cancer cells. Neither compound was cytotoxic towards human dermal papilla cells at 100 μg/mL. We show that this SAR strategy created promising anti-androgenics for androgen dependent disorders and may create further analogues with further improvements in selectivity and clinical efficacy.
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Affiliation(s)
- Jukkarin Srivilai
- Bioscreening Unit, Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences and Center of Excellence for Innovation in Chemistry, Naresuan University, Phitsanulok 65000, Thailand
| | - Nantaka Khorana
- Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences and Center of Excellence for Innovation in Chemistry, Naresuan University, Phitsanulok 65000, Thailand
| | - Neti Waranuch
- Cosmetic and Natural Product Research Center, Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Center of Excellence for Innovation in Chemistry, Naresuan University, Phitsanulok 65000, Thailand
| | - Wudtichai Wisuitiprot
- Department of Thai Traditional Medicines, Sirindhorn College of Public Health, Phitsanulok, Thailand
| | - Nungruthai Suphrom
- Department of Chemistry, Faculty of Science, Naresuan University, Phitsanulok 65000, Thailand
| | - Apichart Suksamrarn
- Department of Chemistry, Faculty of Science, Ramkhamhaeng University, Bangkok 10240, Thailand
| | - Kornkanok Ingkaninan
- Bioscreening Unit, Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences and Center of Excellence for Innovation in Chemistry, Naresuan University, Phitsanulok 65000, Thailand
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Macey MR, Raynor MC. Medical and Surgical Treatment Modalities for Lower Urinary Tract Symptoms in the Male Patient Secondary to Benign Prostatic Hyperplasia: A Review. Semin Intervent Radiol 2016; 33:217-23. [PMID: 27582609 DOI: 10.1055/s-0036-1586142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is one of the most common ailments affecting aging men. Symptoms typically associated with BPH include weak stream, hesitancy, urgency, frequency, and nocturia. More serious complications of BPH include urinary retention, gross hematuria, bladder calculi, recurrent urinary tract infection, obstructive uropathy, and renal failure. Evaluation of BPH includes a detailed history, objective assessment of urinary symptoms with validated questionnaires, and measurement of bladder function parameters, including uroflowmetry and postvoid residual. In general, treatment of LUTS associated with BPH is based on the effect of the symptoms on quality of life (QOL) and include medical therapy aimed at reducing outlet obstruction or decreasing the size of the prostate. If medical therapy fails or is contraindicated, various surgical options exist. As the elderly population continues to grow, the management of BPH will become more common and important in maintaining patient's QOL.
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Affiliation(s)
- Matthew Ryan Macey
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mathew C Raynor
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Kreutzwiser D, Tseng A. Drug interactions between antiretrovirals and drugs used to treat benign prostatic hyperplasia/lower urinary tract symptoms. Expert Opin Drug Metab Toxicol 2016; 12:1211-24. [PMID: 27376653 DOI: 10.1080/17425255.2016.1209483] [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] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Significant advances in antiretroviral (ARV) therapy have transformed HIV into a chronic manageable disease. Co-morbidities associated with aging, such as benign prostatic hyperplasia (BPH), are becoming increasingly prevalent in the HIV-infected population. The pharmacological treatment of BPH involves medications mainly metabolized by CYP 450 enzymes, while many ARVs have inducing or inhibiting effects on the CYP 450 system. Consequently, there is potential for significant pharmacokinetic (PK) interactions between these two classes of medications. AREAS COVERED This article reviews the pharmacology and metabolism of selected BPH drug therapies and ARVs, in addition to highlighting potential interactions between these two drug categories. The authors also present PK evidence of interactions from available clinical trials, product monographs and international conference abstracts. Potentially significant drug interactions are summarized and strategies for management are discussed. EXPERT OPINION Drugs most likely to interact with BPH medications include protease inhibitors, the non-nucleoside reverse transcriptase inhibitors efavirenz, nevirapine, etravirine, and the cobicistat-boosted integrase inhibitor elvitegravir. Clinically significant PK interactions with BPH medications and dolutegravir, raltegravir, rilpivirine, or the investigational agent doravirine do not appear to exist. Clinicians working with HIV-infected individuals need to recognize the potential for interactions involving BPH and ARV treatments to ensure effective and safe drug therapy use.
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Affiliation(s)
- Denise Kreutzwiser
- a Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.,b Chronic Viral Illness Service, McGill University Health Centre , Montreal , Quebec , Canada.,c Immunodeficiency Clinic, Toronto General Hospital , University Health Network , Toronto , Ontario , Canada
| | - Alice Tseng
- a Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.,c Immunodeficiency Clinic, Toronto General Hospital , University Health Network , Toronto , Ontario , Canada
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Cakir OO, Podlasek CA, Wood D, McKenna KE, McVary KT. Effect of Onabotulinum Toxin A on Substance P and Receptor Neurokinin 1 in the Rat Ventral Prostate. ANDROLOGY : OPEN ACCESS 2016; 4. [PMID: 27144785 DOI: 10.4172/2167-0250.1000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The objective of this work is to examine if sensory innervation impacts lower urinary tract symptoms (LUTS). Onabotulinum toxin A (BoNTA) has been used for the treatment of overactive and neurogenic bladder and as a treatment for LUTS secondary to benign prostatic hyperplasia (BPH). The mechanism of how BoNTA impacts LUTS/BPH is unclear. In rats, BoNTA injection causes prostate denervation, apoptosis and atrophy. In clinical trials reduced prostate size and LUTS are observed inconsistently, suggesting a neurologic component. We will examine if BoNTA treatment inhibits substance P production in sensory nerve fibers in the rat prostate. METHODS Twenty Sprague Dawley rats were divided into four groups including 1X PBS (control, n=6), 2.5 units Onabotulinum toxin A (BoNTA, n=6), 5 units BoNTA (n=6) injected into both lobes of the ventral prostate (VP) and sham surgery (n=2). Rats were Euthanized after one week. Substance P and its receptor neurokinin 1 localization and quantification were performed by counting the number of stained neurons and nerve bundles, by semi-quantitative immunohistochemical analysis and by western analysis. RESULTS Substance P was localized in neuronal axons and bundles in the stroma of the VP but not in the epithelium. Receptor neurokinin 1 was identified in neuronal bundles of the stroma and in columnar epithelium of the VP ducts. Substance P decreased ~90% after BoNTA treatment (p=0.0001) while receptor neurokinin 1 did not change by IHC (p=0.213) or Western (p=0.3675). CONCLUSIONS BoNTA treatment decreases substance P in the rat VP.
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Affiliation(s)
- Omer Onur Cakir
- Department of Urology, Bagcilar Research and Training Hospital, Bagcilar, Istanbul, Turkey
| | - Carol A Podlasek
- Department of Urology, Physiology and Bioengineering, University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Douglas Wood
- Department of Urology, Bagcilar Research and Training Hospital, Bagcilar, Istanbul, Turkey
| | - Kevin E McKenna
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL 62794, USA
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Jin BH, Yoo BW, Oh ES, Yang S, Jung J, Park MS. Pharmacokinetics and safety profiles of tadalafil/tamsulosin HCl fixed-dose combination capsule under fasted and fed condition in healthy volunteers. Transl Clin Pharmacol 2016. [DOI: 10.12793/tcp.2016.24.4.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Byung Hak Jin
- Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon 21983, Korea
- Department of Clinical Pharmacology and Clinical Trials Center, Severance Hospital, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Byung Won Yoo
- Department of Clinical Pharmacology and Clinical Trials Center, Severance Hospital, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Eun Sil Oh
- Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon 21983, Korea
| | - Seungwon Yang
- Department of Pharmacy, College of Pharmacy, Yonsei University, Incheon 21983, Korea
- Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Korea
| | - Jina Jung
- Clinical Research Team, Hanmi Pharmaceutical Co.,Ltd., Seoul 05545, Korea
| | - Min Soo Park
- Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon 21983, Korea
- Department of Clinical Pharmacology and Clinical Trials Center, Severance Hospital, College of Medicine, Yonsei University, Seoul 03722, Korea
- Department of Pediatrics, College of Medicine, Yonsei University, Seoul 03722, Korea
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Roy A, Singh A, Sidhu DS, Jindal RP, Malhotra M, Kaur H. New Visual Prostate Symptom Score versus International Prostate Symptom Score in Men with Lower Urinary Tract Symptoms: A Prospective Comparision in Indian Rural Population. Niger J Surg 2016; 22:111-117. [PMID: 27843276 PMCID: PMC5013737 DOI: 10.4103/1117-6806.189002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Benign prostrate hyperplasia (BPH) is a leading source of healthcare problem in aging men around the world including India. Both International Prostate Symptom Score (IPSS) and New Visual Prostate Symptom Score (VPSS) are used to assess the lower urinary tracts symptoms (LUTSs) in men. The present study was planned to compare these two scores, IPSS and VPSS in Indian rural men prospectively and their efficacy was compared with urodynamic evaluation of the patients. Materials and Methods: With Institutional Ethical Committee approval, this study was conducted on 100 patients having LUTS and BPH after obtaining written informed consent. Patients’ educational status was noted. All the patients were requested to complete the IPSS and VPSS questionnaire, and they were correlated. The urodynamic study was performed on all the patients with uroflowmeter. Two parameters of uroflowmetry, Qmax (maximum urine flow rate expressed in ml/s) and Qavrg (average urine flow rate expressed in ml/s) were measured and correlated. Results: Most of the patients (55%) in this study were uneducated. Out of 100 patients, 83% were able to fill the VPSS questionnaire without assistance as compared to only 40% patients in IPSS questionnaire (Z = 6.557, P < 0.001). There was a positive correlation between IPSS and VPSS total score in this study (r = 0.453 and P ≤ 0.001). It was noticed that IPSS Question 2 for frequency of urination had a positive correlation with VPSS Question 1 (day time frequency of urination) r = 0.645 (P = 0.000). Similarly, IPSS Question 7 for night frequency when compared with VPSS Question 2 (nocturia); the value for r was found to be 0.536 (P = 0.000). The IPSS Question 5 for straining when compared to the VPSS Question 3, i.e., the question for the strength of stream during micturition; the positive correlation was found to be 0.266 (P = 0.007). There was a negative correlation between IPSS total score and Qavrg with value − 0.368 (P = 0.000) and between IPSS total score and Qmax of − 0.433 (P = 0.000). A negative correlation is also noted between VPSS total score and Qavrg of value 0.497 (P = 0.000) and VPSS total score and Qmax of value − 0.719 (P = 0.000). Conclusion: VPSS correlates significantly with the IPSS to quantify the LUTS due to BPH. The VPSS can be used instead of the IPSS for the assessment of symptom severity in men with LUTS, who are illiterate or have limited education.
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Affiliation(s)
- Ashutosh Roy
- Department of Surgery, Adesh Institute of Medical Sciences, Bathinda, India
| | - Amandeep Singh
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Darshan Singh Sidhu
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - R P Jindal
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Mishi Malhotra
- Department of Medicine, Adesh Institute of Medical Sciences, Bathinda, India
| | - Haramritpal Kaur
- Department of Anaesthesia and Intensive Care, GGS Medical College and Hospital, Faridkot, Punjab, India
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Mankowski C, Ikenwilo D, Heidenreich S, Ryan M, Nazir J, Newman C, Watson V. Men's preferences for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia: a discrete choice experiment. Patient Prefer Adherence 2016; 10:2407-2417. [PMID: 27920507 PMCID: PMC5125770 DOI: 10.2147/ppa.s112161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To explore and quantify men's preferences and willingness to pay (WTP) for attributes of medications for lower urinary tract symptoms associated with benign prostatic hyperplasia using a discrete choice experiment. SUBJECTS AND METHODS Men in the UK aged ≥45 years with moderate-to-severe lower urinary tract symptoms/benign prostatic hyperplasia (based on self-reported International Prostate Symptom Score ≥8) were recruited. An online discrete choice experiment survey was administered. Eligible men were asked to consider different medication scenarios and select their preferred medication according to seven attributes: daytime and nighttime (nocturia) urinary frequency, urinary urgency, sexual and nonsexual side effects, number of tablets/day, and cost/month. A mixed-logit model was used to estimate preferences and WTP for medication attributes. RESULTS In all, 247 men completed the survey. Men were willing to trade-off symptom improvements and treatment side effects. Men preferred medications that reduced urinary urgency and reduced day- and nighttime urinary frequency. Men preferred medications without side effects (base-case level), but did not care about the number of tablets per day. WTP for symptomatic improvement was £25.33/month for reduced urgency (urge incontinence to mild urgency), and £6.65/month and £1.39/month for each unit reduction in night- and daytime urination frequency, respectively. The sexual and nonsexual side effects reduced WTP by up to £30.07/month. There was significant heterogeneity in preferences for most attributes, except for reduced urinary urgency from urge incontinence to mild urgency and no fluid during ejaculation (dry orgasm). CONCLUSION To compensate for side effects, a medicine for lower urinary tract symptoms/benign prostatic hyperplasia must provide a combination of benefits, such as reduced urgency of urination plus reduced nighttime and/or reduced daytime urination.
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Affiliation(s)
- Colette Mankowski
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
- Correspondence: Colette Mankowski, Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, 2000 Hillswood Drive, Chertsey, Surrey KT16 0PS, UK, Tel +44 78 8194 0638, Email
| | - Divine Ikenwilo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jameel Nazir
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
| | - Cathy Newman
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Egan KB, Burnett AL, McVary KT, Ni X, Suh M, Wong DG, Rosen RC. The Co-occurring Syndrome—Coexisting Erectile Dysfunction and Benign Prostatic Hyperplasia and Their Clinical Correlates in Aging Men: Results From the National Health and Nutrition Examination Survey. Urology 2015. [DOI: 10.1016/j.urology.2015.04.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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