Current role of treatment in men with lower urinary tract symptoms combined with overactive bladder

Can bladder neck thickness on magnetic resonance imaging (MRI) predict early outcomes after anatomic enucleation of the prostate (AEEP) in benign prostatic hyperplasia patients with small-volume prostate?

AIM

We aimed to evaluate whether preoperative bladder neck thickness (BNT) measured by magnetic resonance imaging (MRI) can guide surgical decisions in benign prostatic hyperplasia (BPH) and primary bladder neck obstruction (PBNO) patients with a small volume (≤30 mL).

MATERIALS AND METHODS

The clinical data of 403 patients were retrospectively collected. The Kappa consistency test was used to compare subjective (IPSS-voiding) and objective (Qmax) postoperative outcomes. Multivariable logistic regression identified predictors of the consistency between postoperative objective and subjective evaluations. The receiver operating characteristic (ROC) curve was utilised to identify the optimal preoperative BNT (preop-BNT) cut-off value for predicting residual obstruction.

RESULTS

The Kappa consistency test revealed a significant difference between IPSS-voiding and Qmax improvements (P < 0.001). Multivariable logistic regression identified intravesical prostatic protrusion (IPP), prostate urethral angle (PUA), and preop-BNT as independent factors influencing postoperative outcome consistency. Among 51 PBNO patients confirmed by prostate MRI and urodynamic examination to have residual postoperative obstruction, multivariable logistic regression analysis showed that preop-BNT was an independent risk factor and PUA was an independent protective factor. ROC analysis determined the optimal preop-BNT cut-off value to be 7.50 mm for predicting residual obstruction.

CONCLUSION

PBNO results in a significant difference between postoperative objective evaluation and subjective evaluation improvement in many of these BPH patients with small-volume prostate. Preop-BNT is a valuable indicator for guiding surgical decisions in these patients. Measuring BNT can help determine whether to preserve or incise the bladder neck during anatomic enucleation of the prostate (AEEP), leading to better postoperative outcomes.

Relationship of age, prostate-specific antigen, and prostate volume in Indonesian men with benign prostatic hyperplasia

BACKGROUND

To investigate the relationship between age, prostate specific antigen (PSA), and prostate volume (PV) in Indonesian men with histologically proven benign prostatic hyperplasia.

METHODS

Data were generated from our BPH database from June 1994 until December 2013. Subjects were men with a minimum age of 40 years with chief complaint of LUTS or urinary retention, diagnosed with BPH. All patients underwent TRUS-guided prostate biopsy. Patients with PSA level >10 ng/mL were excluded from the study to exclude the possibility of occult prostate cancer. PV was measured with TRUS. Appropriate statistical tests were employed for data analysis.

RESULTS

In all, 1638 patients were enrolled in our study. There was a statistically significant difference in PSA (P = 0.03) and PV (P < 0.0001) between age groups. Overall correlation between age, PSA, and PV were: i). Age and PV (r = 0.12, P < 0.0001); ii). Age and PSA (r = 0.07, P = 0.008); iii). PSA and PV (r = 0.26, P < 0.0001). Subgroup analysis in terms of indwelling catheter use versus without: i). Age 66.09 ± 8 years versus 65.38 ± 7.66 years (P = 0.158); ii). PSA 4.93 ± 2.62 ng/mL versus 4.68 ± 2.82 ng/mL (P = 0.038); iii). PV 47.58 ± 21.33 mL versus 41.43 ± 20.55 mL (P < 0.0001). Correlation between age, PSA, and PV in patients were similar in patients with and without indwelling catheter.

CONCLUSION

In Indonesian men with biopsy-proven BPH, both PV and PSA increased with ageing. Prostate volume was significantly correlated with PSA. Even though the results were weaker, these results are consistent with results in other sets of population. The results vary between different countries and thus, ethnicities. Indonesia is a populous a sociocultural and ethnically diverse country. Therefore, aside from PSA, age, and PV, when investigating men with BPH, ethnicity may also need to be taken into account.

Blockade of Androgen Markers Using a Novel Betasitosterol, Thioctic Acid and Carnitine-containing Compound in Prostate and Hair Follicle Cell-based Assays

Androgenetic alopecia (AGA) affects approximately 70% of men and 40% of women in an age-dependent manner and is partially mediated by androgen hormones. Benign prostatic hyperplasia (BPH) similarly affects 50% of the male population, rising by 10% each decade. Finasteride inhibits 5-alpha reductase (5AR) and is used to treat both disorders, despite offering limited clinical benefits accompanied by significant adverse side effects. Building on our previous work demonstrating the efficacy of naturally derived 5AR inhibitors (such as stigmasterol and beta sitosterol), we hypothesize that targeting 5AR as well as inflammatory pathways may yield improved efficacy in AGA and BPH. Here we address these dual pathomechanisms by examining the potency of a novel composition using in vitro assays of representative cell lines for AGA (hair follicle dermal papilla cells) and BPH (LNCaP prostate cells), respectively. Exposure of cells to the novel test composition down-regulated mRNA expression profiles characteristic of both disease processes, which outperformed finasteride. Changes in mRNA expression were corroborated at the protein level as assessed by western blotting. These studies provide proof of concept that novel, naturally derived compositions simultaneously targeting 5AR and inflammatory mediators may represent a rational approach to treating AGA and BPH. Copyright © 2016 John Wiley & Sons, Ltd.

Drug therapy of overactive bladder--what is coming next?

After the approval and introduction of mirabegron, tadalafil, and botulinum toxin A for treatment of lower urinary tract symptoms/overactive bladder, focus of interest has been on their place in therapy versus the previous gold standard, antimuscarinics. However, since these agents also have limitations there has been increasing interest in what is coming next - what is in the pipeline? Despite progress in our knowledge of different factors involved in both peripheral and central modulation of lower urinary tract dysfunction, there are few innovations in the pipe-line. Most developments concern modifications of existing principles (antimuscarinics, β₃-receptor agonists, botulinum toxin A). However, there are several new and old targets/drugs of potential interest for further development, such as the purinergic and cannabinoid systems and the different members of the transient receptor potential channel family. However, even if there seems to be good rationale for further development of these principles, further exploration of their involvement in lower urinary tract function/dysfunction is necessary.

PATTERN OF OVERACTIVE BLADDER IN SOUTHEAST NIGERIA

BACKGROUND

Overactive bladder is a distressing condition characterized by the syndrome of uncontrollable urgency, day time frequency, nocturia with or without urgency urinary incontinence.

AIM

To determine the pattern of overactive bladder in two tertiary health institutions in South-East Nigeria.

STUDY DESIGN

The study is prospective.

SETTING

Federal Teaching Hospital, Abakaliki and Niger Foundation Hospital and Diagnostic centre Enugu in southeastern Nigeria.

METHOD

The study involved 383 patients who were diagnosed with overactive bladder in the two hospitals during the study period. Their demographics, clinical feature, management options and outcome were analyzed.Tolterodine was the anticholinegic used to treat the syndrome while the underlying pathology was treated accordingly.

RESULT

There were 383 patients out of which 363 (94.8%) patients were males while 20 (5.2%) patients were females with the age range of 37yrs to103yrs with a mean of 63.4yrs. A total of 313 (81.7%) patients had prostatic disease (benign prostatic hyperplasia and cancer of the prostate), while 99 (25.8%) patients had diabetes mellitus. Among the 313(82 %) with prostate disease, two hundred and eighty nine (75.5%) had benign prostatic hyperplasia while twenty four (6.3%) had cancer of the prostate. Urgency, urinary incontinence and fecal incontinence were observed simultaneously in 133 (34.7%) patients during the episode of involuntary painful bladder contraction. In 271 (71%) patients, the overactive bladder was treated with Tolterodine alone and management of the underlying pathology with resolution of symptoms. Few patients benefitted from behavioral therapy.

CONCLUSION

Overactive bladder in this environment is associated commonly with prostate diseases with urgency of urine, urine and fecal incontinence but responds well to anticholinergic.