Japanese Men Have Smaller Prostate Volumes But Comparable Urinary Flow Rates Relative to American Men: Results of Community Based Studies in 2 Countries

Does Race/Ethnicity Have a Role in a Link Between Lower Urinary Tract Symptoms and Metabolic Syndrome?

Metabolic syndrome (MS) is a highly prevalent disease related to the risk of cardiovascular disease and diabetes. A large body of evidence has suggested a link between MS and the components of MS with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) complex. The pathogenesis of MS is complex and not fully understood. Furthermore, recent results from epidemiological studies, including multiple Asian reports, have not been consistent. The risk of BPH is lower in Asian men compared with white men and the prevalence of MS varies by race and ethnicity. An elevated risk of Type 2 diabetes mellitus, hypertension, and dyslipidaemia is closely related to MS and is observed in Asian men even if their body mass index is low. However, the role of race and ethnic disparity in the link between MS and LUTS secondary to BPH is not elucidated. It has been suggested that the pathogenesis of LUTS is multifactorial rather than developing from BPH, which is the traditional concept. Lifestyle and genetic factors may substantially modify the risk of MS and LUTS/BPH. This comprehensive literature review summarises the scientific evidence of the racial/ethnic disparity regarding the association between MS and LUTS/BPH in order to improve current understanding of this controversial issue.

Preoperative administration of chlormadinone acetate reduces blood loss associated with transurethral resection of the prostate: a prospective randomized study

OBJECTIVES

To assess the effects of giving chlormadinone acetate (CMA) before surgery on blood loss associated with transurethral resection of the prostate (TURP), in a prospective randomized controlled study.

PATIENTS AND METHODS

Candidates for TURP among patients with benign prostatic hyperplasia were randomized to either treatment with CMA (CMA+) or not (CMA-). In principle, CMA was started at least 28 days before TURP and continued until just before surgery.

RESULTS

In all, 33 patients in the CMA+ (median duration of treatment 34.5 days) and 38 in the CMA- group were evaluable. The mean blood loss during TURP was less in the CMA+ (237.3 mL) than in the CMA- group (263.1 mL), but the difference was not significant. There was significantly less blood loss per gram of resected prostate tissue in the CMA+ (9.6 mL/g) than in the CMA- group (13.3 mL/g) (P < 0.05). Haematuria on the day of and the day after TURP was also significantly less severe in the CMA+ than in the CMA- group (P < 0.001 and P < 0.05, respectively). The mean microvessel density of resected prostate tissue was significantly less after CMA treatment (P < 0.001).

CONCLUSIONS

CMA given for 1 month before TURP could reduce blood loss to some extent during and after TURP, and this may be related to a decrease in microvessel density.

Doxazosin for benign prostatic hyperplasia: An open-label, baseline-controlled study in Korean general practice

BACKGROUND

Few studies have reported the treatment of benign prostatic hyperplasia (BPH) in Asian patients. We assessed the safety and efficacy of doxazosin, a selective alpha1-adrenoceptor antagonist, in the treatment of Korean patients with symptomatic BPH.

METHODS

Two hundred and ninety-five men, aged 48 years or older with clinical BPH, were enrolled in a 12-week, open-label, baseline-controlled, dose-titration, multicenter study. A 2-week, single-blind, placebo run-in was followed by 10 weeks of doxazosin treatment, initially administered at 1 mg/day, with upward titrations (2, 4, or 8 mg/day) at 2-week intervals. The international prostate symptom score (IPSS) was used to assess efficacy after 4, 6, and 10 weeks of active treatment.

RESULTS

The intent-to-treat (ITT) population comprised 249 patients (mean age 63.6 years). Doxazosin significantly reduced the mean total IPSS by 48%; similarly, the obstructive and irritative subscores were reduced from baseline by 51% and 39%, respectively (P < 0.001 for all scores: Wilcoxon rank sum test). In a subset analysis of 170 normotensive and 78 hypertensive patients, significant reductions in mean systolic and diastolic blood pressures relative to baseline were observed only in the hypertensive subset (P < 0.01). Similar results in mean IPSS were observed in older (> or =65 years, n = 100) and younger (45-64 years, n = 140) patients, as well as between normotensive and hypertensive patients. Thirty-nine patients reported adverse events: The most frequent were dizziness, dyspepsia, asthenia, somnolence, and dry mouth.

CONCLUSIONS

The efficacy and safety of doxazosin treatment for BPH were confirmed in this Asian population. Significant improvements in total IPSS, as well as obstructive and irritative subscores, were observed.