Body mass index predicts failure of surgical management in benign prostatic hyperplasia

The association between body mass index and testosterone deficiency in aging Chinese men with benign prostatic hyperplasia: results from a cross-sectional study

BACKGROUND AND OBJECTIVES

Evidence has supported obesity as a risk factor for both benign prostate hyperplasia (BPH) and hypogonadism. In this paper, we performed a retrospective study and discussed the prevalence of testosterone deficiency (TD) and its relationship to body mass index (BMI) in aging Chinese men with BPH who have surgical intervention.

MATERIAL AND METHODS

We reviewed the clinical data by age, BMI, medical history, serum prostate-specific antigen (PSA) levels, serum total testosterone (TT) levels, biochemical analysis, and transrectal ultrasound. BMI and other variables were considered to be independent variables in an effort to evaluate any potential associations between these factors and TD status using non-adjusted and multivariate-adjusted regression models.

RESULTS

Of the 795 BPH participants, 27.2% (216) patients had TD. After adjusting for all potential covariates, there was a similar J-shaped relationship between BMI and TD, with an inflection point of 19.2 kg/m². The effect sizes and the confidence intervals on the left and right sides of this inflection point were 0.6 (0.4-1.0) (p = .043) and 1.2 (1.1-1.3) (p < .001), respectively.

CONCLUSION

Nearly one-third of the aging Chinese BPH patients had TD in this study. The association between BMI and TD is not simple. A J-shaped curve correlation was detected. BMI was positively correlated with TD when it was over 19.2 kg/m² and inversely correlated with TD when it was below 19.2 kg/m². Long-term prospective studies are needed to confirm these findings.

Laser Therapy for Bladder Outlet Obstruction: A Prospective Analysis of All Patients Receiving Treatment with the GreenLight XPS 180-Watt Laser System after Introduction at a Single Center

OBJECTIVE

The objective was to assess and publish our first experiences with the GreenLight XPS™ 180-watt laser in men suffering from bladder outlet obstruction.

PATIENTS AND METHODS

From January 2013 to February 2014, the results of 142 patients were analyzed prospectively at a single center. Indications for disobstruction were in line with current EAU guidelines, but independent of the underlying causes of obstruction. Assessments were made of the prostate size, International Prostate Symptom Score (IPSS), postvoid residual (PVR) and maximum urinary flow (Qmax). Intraoperative data such as lasing time, surgery time, applied energy and blood transfusions were recorded. Reinterventions and complications were evaluated.

RESULTS

The average prostate volume was 29.6 ml (2-82). The average surgery time was 50 min (13-157). Qmax increased by an average of 20.2 ml/s (p < 0.05). On average, PVR was reduced by 162 ml (p < 0.05).

CONCLUSION

The GreenLight XPS™ 180-watt laser is an effective treatment option for bladder outlet obstruction with a low perioperative complications rate, and it shows results comparable with transurethral resection of the prostate. Even multimorbid patients and patients with long-term catheter requirements may be treated due to its high safety profile and reliable results.

Effects of medical therapy or surgery on prostatic and bladder resistive indices in patients with benign prostatic hyperplasia

INTRODUCTION

The effects of medical therapy or surgery on bladder and prostatic resistive indices (RIs) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) were evaluated in the present study.

PATIENTS AND METHODS

A total of 124 consecutive LUTS/BPH patients who were candidates for medical therapy (alfuzosin 10 mg once daily, n=66) or surgery (transurethral prostatectomy (TUR-P), n=58) were prospectively included. Baseline assessment of patients was performed with the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and prostatic and bladder RIs measured using power Doppler imaging (PDI). All patients were re-evaluated 3 months after treatment measuring the same parameters.

RESULTS

Following medical therapy, mean IPSS (17.2±5.1 vs. 8.3±5.3, p=0.0001), postvoiding residual (PVR) urine (80.0±80.5 vs. 40.3±38.6, p=0.0001), and prostatic RI (0.73±0.1 vs. 0.70±0.1, p=0.0001) were decreased, Qmax (13.7±4.2 vs. 16.9±5.9, p=0.0001) was increased, and bladder RI remained unchanged (0.70±0.1 vs. 0.70±0.1, p=0.68). Mean IPSS (25.3±5.6 vs. 6.0±4.5, p=0.0001), PVR urine volume (134.5±115.5 vs. 35.7±25.9, p=0.0001), and prostatic (0.78±0.1 vs. 0.67±0.04, p=0.0001) and bladder RIs (0.72±0.1 vs. 0.64±0.04, p=0.005) were decreased, and Qmax (8.0±4.5 vs. 17.2±8.2, p=0.0001) was increased after TUR-P.

CONCLUSIONS

Our results demonstrated that TUR-P decreased both prostatic and bladder RIs, while α-blocker therapy did not change bladder RI in the early posttreatment period in LUTS/BPH patients.