Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital

The Effects of Age on Prostatic Responses to Oxytocin and the Effects of Antagonists

Benign prostatic hyperplasia (BPH) is an age-related enlargement of the prostate with urethral obstruction that predominantly affects the middle-aged and older male population, resulting in disruptive lower urinary tract symptoms (LUTS), thus creating a profound impact on an individual's quality of life. The development of LUTS may be linked to overexpression of oxytocin receptors (OXTR), resulting in increased baseline myogenic tone within the prostate. Thus, it is hypothesised that targeting OXTR using oxytocin receptor antagonists (atosiban, cligosiban, and β-Mercapto-β,β-cyclopentamethylenepropionyl1, O-Me-Tyr2, Orn8]-Oxytocin (ßMßßC)), may attenuate myogenic tone within the prostate. Organ bath and immunohistochemistry techniques were conducted on prostate tissue from young and older rats. Our contractility studies demonstrated that atosiban significantly decreased the frequency of spontaneous contractions within the prostate of young rats (**** p < 0.0001), and cligosiban (* p < 0.05), and ßMßßC (**** p < 0.0001) in older rats. Additionally, immunohistochemistry findings revealed that nuclear-specific OXTR was predominantly expressed within the epithelium of the prostate of both young (*** p < 0.001) and older rats (**** p < 0.0001). In conclusion, our findings indicate that oxytocin is a key modulator of prostate contractility, and targeting OXTR is a promising avenue in the development of novel BPH drugs.

The industrial revolution for the management of benign prostate obstruction: worldwide publication trends for surgical and medical therapies over the past two decades

INTRODUCTION

Research for management of benign prostate obstruction (BPO) for adult males remains a cornerstone of urology research. This landscape has witnessed the rise and fall of multiple therapies, both surgical and medical. Our aim was to formally evaluate the publication trends for these interventions over the past 20 years.

MATERIAL AND METHODS

A systematic search was performed in a Cochrane style. Data was analysed using the independent t-test and Pearson's correlation coefficient (SPSS version 24). To observe changes in trends more effectively, data was sub-divided into two time periods: 1997 to 2006 and 2007 to 2016.

RESULTS

Over the past 20 years, 4236 papers have been published concerning for BPO (surgical, n = 2177 and medical, n = 2059). For surgical treatments, these included articles on monopolar transurethral resection of prostate (TURP) (n = 340), bipolar TURP (n = 260), HoLEP (n = 293) and Greenlight laser (n = 395). For medical therapies, these included alpha blockers (848), 5-alpha reductase inhibitors (n = 618) and PDE5I (n = 91). Between the two time periods the change was +18.8% (p = 0.108) for monopolar TURP, +497.1% (<0.001) for bipolar TURP, -54.5% (p <0.001 for prostatic stents and -81.9% (p <0.001) for transurethral microwave therapy (TUMT). There was over 290% rise in number of publications related to BPO laser surgery (p <0.001). For medical interventions, the change was +11.5% (p = 0.397) for alpha blockers, -1.9% (p = 0.867), +49.0%( 0.122) for phytotherapy, +2075% (p <0.001) for PDEI and +2375.0% (p <0.001) for combined alpha blocker and anti-muscarinics.

CONCLUSIONS

Interventions for BPO have undergone a high volume of research. In particular, minimally invasive laser surgeries and combined medical therapies have seen significant expansion.

Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.

Minimally invasive surgical therapies for benign prostatic hypertrophy: The rise in minimally invasive surgical therapies

The prevalence of benign prostatic hypertrophy (BPH) causing bothersome lower urinary tract symptoms increases with our ageing population. Treatment of BPH traditionally begins with medical therapy and surgical intervention is then considered for those whose symptoms progress despite treatment. Minimally invasive surgical therapies have been developed as an intermediary in the treatment of BPH with the aim of decreasing the invasiveness of interventions. These therapies also aim to reduce morbidity and dysfunction related to invasive surgical procedures. Multiple treatment options exist in this group including mechanical and thermo-ablative strategies. Emerging therapies utilizing differing technologies range from the established to the experimental. We review the current literature related to these minimally invasive therapies and the evidence of their effectiveness in treating BPH. The role of minimally invasive surgical therapies in the treatment of BPH is still yet to be strongly defined. Given the experimental nature of many of the modalities, further study is required prior to their recommendation as alternatives to invasive surgical therapy. More mature evidence is required for the analysis of durability of effect of these therapies to make robust conclusions of their effectiveness.