1
|
Abid A, Piperdi H, Babar M, Loloi J, Moutwakil A, Azhar U, Maria P, Small A. Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: A systematic review. Prostate 2024; 84:895-908. [PMID: 38656693 DOI: 10.1002/pros.24717] [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: 01/12/2024] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Geriatric patients, prone to adverse events (AEs) and low compliance with drugs, may benefit from minimally invasive surgical therapies (MISTs) for managing benign prostatic hyperplasia (BPH). We evaluated the efficacy, safety, and procedural characteristics of MISTs in geriatric patients with BPH. METHODS PubMed/MEDLINE database was systematically searched for relevant articles through October 1, 2023. Eligible studies focused on geriatric patients (≥65 years) with BPH who were treated with MISTs and evaluated follow-up surgical, micturition, and/or sexual outcomes. Studies were included if there was separate reporting for age subgroups ≥65 years, or if the mean age minus standard deviation was ≥65 years, or if the first quartile was ≥65 years. RESULTS Out of 292 screened studies, 32 (N = 3972 patients) met inclusion criteria and assessed prostatic artery embolization (PAE), Rezum, GreenLight, holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), diode laser enucleation of the prostate (DiLEP), and Aquablation. Except for Rezum, all MISTs required a planned overnight stay. While PAE and Rezum could be performed under local anesthesia, the other MISTs needed general or spinal anesthesia. Postoperative catheterization duration was longest for PAE (median 14 days) and Rezum (21 days) and shortest for GreenLight (1.9 days). At 12 months postoperatively, all MISTs exhibited significant percent changes in International Prostate Symptom Score (median -69.9%) and quality of life (median -72.5%). Clavien-Dindo Grade 1 AEs ranged widely, with PAE (5.8%-36.8%), Rezum (0%-62.1%), and GreenLight (0%-67.6%) having the largest range, and HoLEP (0%-9.5%), ThuLEP (2%-6.9%), and DiLEP (5%-17.5%) having the smallest. PAE, Rezum, DiLEP, and Aquablation reported no significant changes in the International Index of Erectile Function. CONCLUSIONS Although all the MISTs reviewed in this study effectively treat BPH in geriatric patients, differences in procedural characteristics and safety profiles across MISTs were considerable. Physicians should use shared decision-making processes, considering risks and patient characteristics, when choosing a suitable treatment option for their patients.
Collapse
Affiliation(s)
- Ahmad Abid
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Huzaifa Piperdi
- Touro College of Osteopathic Medicine, New York, New York, USA
| | - Mustufa Babar
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Umair Azhar
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Pedro Maria
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Alexander Small
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
2
|
Winograd J, Venishetty N, Codelia-Anjum A, Bhojani N, Elterman D, Zorn KC, Te A, Chughtai B. Emerging drugs for the treatment of benign prostatic hyperplasia: a 2023 update. Expert Opin Emerg Drugs 2024:1-13. [PMID: 38841744 DOI: 10.1080/14728214.2024.2363213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is a condition that affects over 50% of men as they enter their fifth decade of life, often leading to lower urinary tract symptoms (LUTS). Primary treatment options include alpha blockers, 5-alpha reductase inhibitors, and phosphodiesterase-5 inhibitors. However, these medications can have some side effects, and there is a noticeable dearth of information addressing the long-term use of these medications. Thus, the exploration of all treatment modalities helps ensure patients receive personalized and effective care. Consequently, the primary objective of this review is to identify potential emerging medications for the treatment of BPH. AREAS COVERED We conducted an extensive review of articles discussing pharmacotherapy for BPH spanning the last 15 years. Our information gathering process involved Scopus, PubMed-MEDLINE, Cochrane, Wiley Online Library Google Scholar, ClinicalTrials.gov, and the PharmaProjects database. This approach ensures that readers gain an in-depth knowledge of the existing therapeutic agents as well as promising avenues for managing BPH. EXPERT OPINION BPH treatment targets a patient's specific constellation of symptoms. Therefore, a broad knowledge base encompassing various treatment options is paramount in ensuring optimal treatment. Looking forward, the emphasis on personalization promises to reshape the landscape of BPH treatment and improve patient outcomes.
Collapse
Affiliation(s)
- Joshua Winograd
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech Health Sciences Center, El Paso, TX, USA
| | | | - Naeem Bhojani
- Division of Urology, University of Montreal, Montreal, Québec, Canada
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Kevin C Zorn
- Division of Urology, University of Montreal, Montreal, Québec, Canada
| | - Alexis Te
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
3
|
Almusafer M, Narayan Y, Nnorom I, Karna S, Katsouri A, Russo GI, Morgado A, Symeonidis EN, Buchholz N, Papatsoris A, Tsampoukas G. Exploring pharmacological interventions in benign prostate hyperplasia: the role of cost-effectiveness analysis in daily practice and future directions. Expert Opin Pharmacother 2024; 25:907-914. [PMID: 38828638 DOI: 10.1080/14656566.2024.2362272] [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] [Received: 01/28/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Benign Prostate Hyperplasia (BPH) significantly impacts men's health and quality of life, with its prevalence rising with age. This review critically examines the cost-effectiveness of pharmacological interventions for BPH to optimize patient outcomes and healthcare resource utilization. AREAS COVERED This review explores the integration of cost-effectiveness analysis (CEA) into clinical practice, balancing clinical efficacy with economic efficiency in BPH management. We performed a critical literature search, including recent studies on the economic evaluation of BPH treatments, focusing on pharmacotherapies such as alpha-blockers and 5-alpha reductase inhibitors. Additionally, we discussed the concept of CEA and evaluated the role of medicinal reconciliation and the avoidance of polypharmacy in favor of optimal BPH treatment. EXPERT OPINION Cost-effectiveness analysis is crucial for evaluating BPH treatments, with evidence suggesting a shift towards surgical interventions may offer greater long-term economic benefits. However, these models must be applied cautiously, considering clinical evidence and patient preferences to ensure equitable and patient-centric healthcare.
Collapse
Affiliation(s)
- Murtadha Almusafer
- Scientific Office, U-merge Ltd, London, UK
- Department of Urology, University of Basrah, Basrah, Iraq
| | | | - Ijeoma Nnorom
- Department of Urology, Homerton Healthcare NHS Foundation Trust, Homerton, UK
| | - Sourabh Karna
- Department of Urology, Milton Keynes University Hospital, Milton Keynes, UK
| | | | | | - Afonso Morgado
- Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Evangelos N Symeonidis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Athanasios Papatsoris
- Scientific Office, U-merge Ltd, London, UK
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsampoukas
- Scientific Office, U-merge Ltd, London, UK
- Department of Urology, Homerton Healthcare NHS Foundation Trust, Homerton, UK
| |
Collapse
|
4
|
Lee DY, Kam SC. The Need for Prospective Cohort Study of the Association between Lower Urinary Tract Symptoms and Cognitive Decline in Elderly Individuals. World J Mens Health 2023; 41:974-975. [PMID: 36792092 PMCID: PMC10523111 DOI: 10.5534/wjmh.220187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/28/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Dong Yun Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, Korea.
| |
Collapse
|
5
|
Park DJ, Kwon SY, Seo YJ, Byun HJ, Lee KS. Changes of resistance indices after medication in benign prostatic hyperplasia: a prospective study. Prostate Int 2023; 11:139-144. [PMID: 37745908 PMCID: PMC10513904 DOI: 10.1016/j.prnil.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
Background This study aimed to determine the relationship between resistive indices (RIs) and changes in prostate size after medical treatment in patients with benign prostatic hyperplasia (BPH). Methods A total of 86 patients with BPH were included in the study, excluding 42 patients with a total prostate volume (TPV) of <30 cc or taking α1-adrenergic blockers and 5α-reductase inhibitors (5ARI) before study participation. Therefore, the data for 44 patients were analyzed. All patients were treated with α1-adrenergic blockers and 5ARIs. The variables examined were prostate-specific antigen, International Prostate Symptom Score, quality of life score, maximal urinary flow rate, residual urine volume, TPV, transition zone volume, and RIs of the urethral artery and left and right capsular arteries. These variables were assessed at baseline and after 3 and 6 months of treatment. Results The mean TPV was 43.5 ± 10.9 and decreased to 35.2 ± 11.5 and 33.9 ± 9.8 after 3 and 6 months of treatment, respectively (p < 0.001). The mean RI of the urethral artery, right capsular artery, and left capsular artery at pretreatment did not decrease significantly. However, comparing the baseline with 3-month data, TPV at 3 months/TPV at baseline was significantly correlated with RI changes in the left capsular artery (r = 758; P < 0.001). Conclusion In patients with BPH, α1-adrenergic blocker and 5ARI medications for 3 and 6 months did not result in a significant reduction in the RI of the urethral artery and both capsular arteries. Larger scale, prospective studies are needed to evaluate the relationship between TPV and RI reductions.
Collapse
Affiliation(s)
- Dong Jin Park
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Se Yun Kwon
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young Jin Seo
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hye Jin Byun
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Seop Lee
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
6
|
Soliman MG, Al-Ghadeer MR, Al-Shabaan HR, Al-Hamrani AH, AlGhadeer HA. Evaluation of intermittent tamsulosin in treating symptomatic patients with benign prostatic hyperplasia. Urol Ann 2023; 15:43-47. [PMID: 37006221 PMCID: PMC10062509 DOI: 10.4103/ua.ua_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/19/2022] [Indexed: 04/04/2023] Open
Abstract
Purpose The purpose of this study is to evaluate and assess the effect of intermittent tamsulosin treatment as a trial to increase the drug safety (in terms of reducing the drug side effects, particularly retrograde ejaculation) while maintaining the effect in reducing the symptoms and assess its impact on the patients' quality of life. Materials and Methods Patients who enrolled in this study were suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and were using 0.4 mg tamsulosin daily to relieve their symptoms but complained of ejaculatory problems. A baseline assessment involves medical history and evaluation of ejaculatory function abdominopelvic ultrasound, postvoid residual volume (PVR) estimation, the International Prostate Symptom Score (IPSS), quality of life assessed using global satisfaction, vital signs, physical examination including digital rectal examination, and renal function. During the study, patients consented to take 0.4 mg tamsulosin intermittently every other day and to proceed with their sexual activities on the days they did not take the drug in. Baseline assessment was repeated and recorded after 3 months from starting the treatment. The adverse effects and compliance were analyzed in all patients. Results Twenty-five patients had a mean baseline IPSS of 6.6 ± 1 and baseline PVR of 87.6 ± 15.1 ml. At the 3rd month, the mean PVR was 100.4 ± 15.1 ml and the mean IPSS was 7.3 ± 1.1. Moreover, 20 out of the total number of 25 patients (80%) reported improvement in their ejaculation. All our 20 patients who showed improvement in their ejaculatory function are either satisfied or very satisfied (4 or 5), in regard to the global satisfaction rate. Conclusion Intermittent tamsulosin therapy (0.4 mg/every other day) is well-tolerated and shows a potential advantage in recovery in patients who suffer from LUTS/BPH and complaining from abnormal ejaculation, especially absent ejaculate. Although there was a significant change in PVR and IPSS after using intermittent tamsulosin therapy. Most patients show a higher overall satisfaction with the treatment compared to the standard dose (0.4 mg/daily). A study on a larger scale is still needed to confirm our results.
Collapse
Affiliation(s)
- Mohamed G. Soliman
- Department of Urology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mohammed R. Al-Ghadeer
- Department of Urology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | - Amer H. Al-Hamrani
- Department of Family Medicine, AlAhsa Health Cluster, Al-Ahsa, Saudi Arabia
| | | |
Collapse
|
7
|
Shin D, Zhu GQ, Tian WJ, Ahn ST, Jeon SH, Cho HJ, Ha US, Hong SH, Lee JY, Kim SW, Moon DG, Bae WJ. Quisqualis indica extract for men with lower urinary tract symptoms: A randomized, double-blind, placebo-controlled trial. Investig Clin Urol 2023; 64:20-30. [PMID: 36629062 PMCID: PMC9834572 DOI: 10.4111/icu.20220290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/08/2022] [Accepted: 11/27/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of Quisqualis indica in men with moderate lower urinary tract symptoms (LUTS). MATERIALS AND METHODS A total of 135 subjects with International Prostate Symptom Score (IPSS) of 8-19 were randomized in 2 centers from June 2018 to April 2019. Patients were assigned into one of the three groups: a low-dose group (LG, 1,000 mg Q. indica), a high-dose group (HG, 2,000 mg Q. indica) or a placebo group (PG). The primary endpoint was the change of IPSS at the end of treatment from baseline. Secondary end points included the changes of prostate specific antigen, testosterone, dihydrotestosterone, maximum urinary flow rate (Qmax), postvoid residual volume (PVR) and International Index of Erectile Function-5 (IIEF-5), with drug safety. RESULTS 113 patients were able to finish the study. Compared to the PG, total IPSS in the LG and the HG was significantly improved at 6 weeks and 12 weeks. For IPSS subscores, LG showed improvements in all except for urgency and quality of life at 6 weeks. HG showed improvements in incomplete emptying and frequency at 6 weeks and 12 weeks along with improvements in intermittency, straining, and quality of life at 12 weeks. For IIEF-5 subscores, orgasmic function and overall satisfaction improved in HG when compared to PG at 12 weeks. Lastly, increase of Qmax and decrease of PVR was observed at 6 weeks in LG. CONCLUSIONS 12-week treatment with Q. indica has a therapeutic effect and is well tolerated in patients with LUTS.
Collapse
Affiliation(s)
- Dongho Shin
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Guan Qun Zhu
- Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wen Jie Tian
- Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seung Hwan Jeon
- Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Integrative Medicine Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
8
|
Kayigil Ö, Altay Y, Okulu E. A new diagnostic definition for patients with lower urinary tract symptoms evaluated by corpus cavernosum electromyography: 'Pelvic autonomic dysfunction'. Andrologia 2022; 54:e14626. [PMID: 36285558 DOI: 10.1111/and.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022] Open
Abstract
This study investigates the use of corpus cavernosum electromyography (CC-EMG) recording as a diagnostic tool for identifying the presence of pelvic autonomic dysfunction (PAD) in patients with LUTS and concurrent ED. Fifty patients were included in the study, and the electromyographic and urodynamic findings were compared. The 50% relaxation degree was accepted as a threshold value for PAD. According to relaxation degree in CC-EMG recordings, patients were grouped as; Group 1 (with PAD) = 23 patients with a relaxation degree of less than 50%. Group 2 (without PAD) = 27 patients with a relaxation degree greater than 50%. The mean age of the patients was 58 ± 3.2 (50-71) years. The comparison of the urodynamic parameters and transrectal ultrasound revealed that the postvoiding residual urine volume (PVR) (p = 0.0007), P det Qmax (p = 0.0005), and P det compliance (0.003) values were statistically significantly lower in Group 2. The mean IIEF-5 and IIEF-15 scores of the patients in Group 1 were 2.5 ± 0.7 and 8.1 ± 1.1 respectively. In Group 2, mean IIEF-5 and IIEF-15 scores were 7.2 ± 2.9, and 17.2 ± 3.5 (p: 0.00023 and p: 0.0009). The mean I-PSS score was 22.8 ± 3 in Group 1 and 16 ± 2.3 in Group 2 (p = 0.001). The mean relaxation degree (RD) in Group I was 30.73 ± 6.8%, and in Group 2 was 66.3 ± 5.1%. The mean amplitude values of the patients in Group I were 261.41 ± 112.97 before papaverine injection, and in Group 2 were 246 ± 101.28 respectively. The inter-group difference was statistically significant (p < 0.05). The mean amplitude value of the patients in Group I after papaverine injection was 182.73 ± 60.71, and in Group 2, that value was 83.2 ± 29.19. The inter-group difference was also significant (p < 0.05). Increased electrical bursts and decreased relaxation responses on CC-EMG indirectly indicated an increase in the contractility of the bladder sphincter. Therefore, we concluded that CC-EMG could be a diagnostic tool for PAD and cavernous autonomic dysfunction.
Collapse
Affiliation(s)
- Önder Kayigil
- Faculty of Medicine, The Urology Clinics of Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Yucel Altay
- The Urology Clinics of Ergani State Hospital, Diyarbakir, Turkey
| | - Emrah Okulu
- Faculty of Medicine, The Urology Clinics of Ankara City Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| |
Collapse
|
9
|
Park S, Lee KS, Choi M, Lee M. Factors associated with quality of life in patients with benign prostatic hyperplasia, 2009-2016. Medicine (Baltimore) 2022; 101:e30091. [PMID: 36086750 PMCID: PMC9512327 DOI: 10.1097/md.0000000000030091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
This study analyzed the factors affecting the health-related quality of life of patients with benign prostatic hyperplasia (BPH) according to age. We also aimed to determine appropriate strategies to improve their quality of life. Data from the Korea Health Panel Survey (2009-2016) were used in this study. A total of 3806 patients with BPH were divided into 2 groups: younger adults (aged under 65 years) and older adults (aged over 65 years). In addition, a logistic regression analysis was conducted to identify factors affecting the quality of life of young and older patients with BPH. In younger adult patients with BPH, the higher the level of education, the higher the quality of life by a factor of 1.379, and the more intense the physical activity, the lower the quality of life by a factor of 0.791. Also, the longer the sitting time, the lower the quality of life by a factor of 0.765. In contrast, for older adult patients with BPH, the quality of life improved by factors of 1.601 and 2.921, respectively, for health insurance and higher income level. In addition, it was found that the quality of life decreased by a factor of 0.754 in patients who drink alcohol. In order to improve the quality of life of the middle-aged adult population with BPH, it is necessary to reduce sitting time through constant physical activity. Moreover, the cost of medical care should be reduced and the quality of life increased through reductions in surgical treatment, as the burden of medical expenses will degrade the quality of life for older adults.
Collapse
Affiliation(s)
- Sewon Park
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Kyu-Sung Lee
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mankyu Choi
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
| | - Munjae Lee
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
- Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea
| |
Collapse
|
10
|
Kim SH, Ock M, Jo MW, Park S. Estimation of utility weights for prostate-related health states in Korea. J Prev Med Public Health 2022; 55:243-252. [PMID: 35677998 PMCID: PMC9201095 DOI: 10.3961/jpmph.21.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Seon-Ha Kim
- Department of Nursing, Dankook University, Cheonan,
Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul,
Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan,
Korea
| |
Collapse
|
11
|
Asare GA, Sule DS, Oblitey JN, Ntiforo R, Asiedu B, Amoah BY, Lamptey EL, Afriyie DK, Botwe BO. High degree of prostate related LUTS in a prospective cross-sectional community study in Ghana (Mamprobi). Heliyon 2021; 7:e08391. [PMID: 34825094 PMCID: PMC8605080 DOI: 10.1016/j.heliyon.2021.e08391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/17/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022] Open
Abstract
Background Changing voiding patterns, volume and frequency, may sometimes be mistaken for anxiety, stress or increase in fluid consumption. In the aging male population, the commencement of lower urinary tract symptoms (LUTS) may be silent and perceived as “normal” and unrelated to Benign prostatic enlargement (BPE). The purpose of the study was to determine the prevalence of apparently “silent LUTS” (perceived asymptomatic LUTS) in men in a Ghanaian Community as well as its underlying risk factors. Methods One hundred and eleven (111) men (40–70 years) were recruited from a community in Ghana. The International Prostate Symptoms Score (IPSS) questionnaire (administered in the local language and English) and ultrasonographic imaging of the prostate volume (PV) were utlized to collect data. IPSS score >7 plus PV > 30 cm3 was definitive of lower urinary tract symptoms. Eighty-one (81) participants were classified “LUTS Negative” (LN) and 30, “LUTS Positive” (LP). Risk factors i.e., cholesterol (CHOL), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), very low-density lipoprotein (VLDL), coronary risk (CR), BMI and Blood Pressure were also determined. Results The prevalence of LUTS using only IPSS definition alone was 42.3%. However, IPSS in combination with Prostate Volume gave a prevalence of 27.0%. LN subjects had enlarged prostate (41.98%) and LP, 100%. Quality of life (QoL) was better in the LUTS Negative than LUTS Positive group (p < 0.001). In the univariant analysis coronary risk, triglyceride and VLDL contributed to LUTS (p = 0.023, 0.22, 0.22, respectively). In a multivariant analysis HDL-C (p = 0.027), BMI (p = 0.047) and triglyceride (p = 0.019) significantly contributed to LUTS. Conclusions The prevalence of LUTS (42.3%) is high. Components of Metabolic Syndrome- HDL-C, BMI, and coronary risk were associated with LUTS. This emphasizes the need for community education.
Collapse
Affiliation(s)
- George A. Asare
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
- Corresponding author.
| | - Derick S. Sule
- Department of Radiography, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
| | - Jared N. Oblitey
- Department of Radiography, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
| | - Reese Ntiforo
- Department of Radiography, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
| | - Bernice Asiedu
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
| | - Brodrick Y. Amoah
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
| | - Emmanuel L. Lamptey
- Department of Radiography, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
| | - Daniel K. Afriyie
- Department of Pharmacy, Ghana Police Hospital, Cantonments, Accra, Ghana
| | - Benard Ohene Botwe
- Department of Radiography, School of Biomedical & Allied Health Sciences (SBAHS), University of Ghana, P. O Box KB 143, Korle Bu Campus, Ghana
- Corresponding author.
| |
Collapse
|
12
|
Amelioration of testosterone-induced benign prostatic hyperplasia using febuxostat in rats: The role of VEGF/TGFβ and iNOS/COX-2. Eur J Pharmacol 2020; 889:173631. [PMID: 33031799 DOI: 10.1016/j.ejphar.2020.173631] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/23/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023]
Abstract
Benign prostatic hyperplasia (BPH) is a common male disorder. Febuxostat is a non-purine, selective inhibitor of xanthine oxidase (XO), which has a strong antioxidant capacity and pleiotropic pharmacological properties. This study's objective was to explore the potential ameliorative effects of febuxostat against testosterone-induced BPH in rats. Febuxostat (10 mg/kg/day, per os [p.o.]) prevented increased prostate index levels, serum levels of prostate-specific antigen (PSA), and testosterone levels compared to animals treated with testosterone alone, when administered for 28 days. Histological examination indicated that febuxostat dramatically ameliorated pathological changes in the prostate architecture compared to the testosterone group. Similarly, febuxostat markedly improved testosterone-induced oxidative stress by inhibiting the increase in lipid peroxide and nitrite content, and by reducing the level of depletion of reduced glutathione (GSH) and superoxide dismutase (SOD) activity, which significantly reduced the prostate content of pro-inflammatory cytokines, including tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6). Furthermore, febuxostat significantly reduced the prostatic content, both in terms of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) messenger ribonucleic acid (mRNA) levels, and of protein levels. Moreover, compared to the testosterone group, febuxostat's beneficial effects prevented the increase in growth factors, comprising vascular endothelial cell growth factor A (VEGF-A) and transforming growth factor beta (TGF-β) protein levels. Its ameliorating effects were equal to those of finasteride, which is the most widely used remedy for BPH. In conclusion, this study provides novel evidence that febuxostat experimentally attenuates testosterone-induced BPH in rats, at least in part by inhibiting iNOS/COX-2 and VEGF/TGF-β pathways.
Collapse
|
13
|
Smith DK, Hasanali SL, Wang J, Kallifatidis G, Morera DS, Jordan AR, Terris MK, Klaassen Z, Bollag R, Lokeshwar VB, Lokeshwar BL. Promotion of epithelial hyperplasia by interleukin-8-CXCR axis in human prostate. Prostate 2020; 80:938-949. [PMID: 32542667 PMCID: PMC8327464 DOI: 10.1002/pros.24026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical manifestation of benign prostatic hyperplasia (BPH) is causally linked to the inflammatory microenvironment and proliferation of epithelial and stromal cells in the prostate transitional zone. The CXC-chemokine interleukin-8 (IL-8) contributes to inflammation. We evaluated the expression of inflammatory cytokines in clinical specimens, primary cultures, and prostatic lineage cell lines. We investigated whether IL-8 via its receptor system (IL-8 axis) promotes BPH. METHODS The messenger RNA and protein expression of chemokines, including components of the IL-8 axis, were measured in normal prostate (NP; n = 7) and BPH (n = 21), urine (n = 24) specimens, primary cultures, prostatic lineage epithelial cell lines (NHPrE1, BHPrE1, BPH-1), and normal prostate cells (RWPE-1). The functional role of the IL-8 axis in prostate epithelial cell growth was evaluated by CRISPR/Cas9 gene editing. The effect of a combination with two natural compounds, oleanolic acid (OA) and ursolic acid (UA), was evaluated on the expression of the IL-8 axis and epithelial cell growth. RESULTS Among the 19 inflammatory chemokines and chemokine receptors we analyzed, levels of IL-8 and its receptors (CXCR1, CXCR2), as well as, of CXCR7, a receptor for CXCL12, were 5- to 25-fold elevated in BPH tissues when compared to NP tissues (P ≤ .001). Urinary IL-8 levels were threefold to sixfold elevated in BPH patients, but not in asymptomatic males and females with lower urinary tract symptoms (P ≤ .004). The expression of the IL-8 axis components was confined to the prostate luminal epithelial cells in both normal and BPH tissues. However, these components were elevated in BPH-1 and primary explant cultures as compared to RWPE-1, NHPrE1, and BHPrE1 cells. Knockout of CXCR7 reduced IL-8, and CXCR1 expression by 4- to 10-fold and caused greater than or equal to 50% growth inhibition in BPH-1 cells. Low-dose OA + UA combination synergistically inhibited the growth of BPH-1 and BPH primary cultures. In the combination, the drug reduction indices for UA and OA were 16.4 and 7852, respectively, demonstrating that the combination was effective in inhibiting BPH-1 growth at significantly reduced doses of UA or OA alone. CONCLUSION The IL-8 axis is a promotor of BPH pathogenesis. Low-dose OA + UA combination inhibits BPH cell growth by inducing autophagy and reducing IL-8 axis expression in BPH-epithelial cells.
Collapse
Affiliation(s)
- Diandra K. Smith
- Department of Medicine, Georgia Cancer Center, Medical College of Georgia, Augusta, Georgia
| | - Sarrah L. Hasanali
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Jiaojiao Wang
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Georgios Kallifatidis
- Department of Medicine, Georgia Cancer Center, Medical College of Georgia, Augusta, Georgia
- Department of Biological Sciences, College of Science and Mathematics, Augusta University, Augusta, Georgia
- Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia
| | - Daley S. Morera
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Andre R. Jordan
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Martha K. Terris
- Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Roni Bollag
- Department of Pathology, Bio-Repository Alliance of Georgia for Oncology (BRAG-Onc), Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Vinata B. Lokeshwar
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, Georgia
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Bal L. Lokeshwar
- Department of Medicine, Georgia Cancer Center, Medical College of Georgia, Augusta, Georgia
- Research Service, Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| |
Collapse
|
14
|
Lammers HA, Teunissen TAM, Bor H, Smid IS, Lagro-Janssen ALM. No Relationship Between the International Prostate Symptom Score and Post-Void Residual Volume in Primary Care. Res Rep Urol 2020; 12:167-174. [PMID: 32440512 PMCID: PMC7211310 DOI: 10.2147/rru.s241961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/17/2020] [Indexed: 11/27/2022] Open
Abstract
Background Lower urinary tract symptom (LUTS) is a common condition in older men. In accordance with the Dutch College of General Practitioners Guideline “Micturition symptoms in men”, the diagnosis can be made based on a patient’s medical history and a physical examination. GPs lack additional tools in primary care to assess the residual urine volume. A residual volume usually requires a referral to a urologist. We hypothesized that the IPSS screening questionnaire score (measuring the severity of symptoms) might be related to patients’ residual urine volume. The research objective was to examine the relation between the IPSS score and the residual urine volume. Methods In a cross-sectional study, we analysed patients’ IPSS and residual urine volume. Men aged over 50 with LUTS who consulted Dutch primary-care physicians were included. The interventions comprised an IPSS screening and a bladder scan. Data regarding the patients’ residual volume, total IPSS score, single IPSS score, IPSS storage score, and IPSS voiding score were recorded and analysed. We used odds ratios to describe the relation between the IPSS categories associated with the presence of a normal or abnormal (above 100 cc and above 200 cc) residual urine volume. Results A total of 126 patients were included in this study. Patients with higher scores on the overall IPSS, separate IPSS, IPSS storage and IPSS voiding showed no higher odds ratios of having an abnormal residual volume, neither above 100 mL or 200 mL. Conclusion We did not find a relation between the IPSS core to an abnormal residual urine volume in men aged over 50 with LUTS consulting primary-care physicians. Trial Registration This study has been approved by the Central Committee on Research Involving Human Subjects for the Arnhem-Nijmegen Region and is registered with ToetsingOnline under ID number 29822.091.10.
Collapse
Affiliation(s)
- H A Lammers
- Radboudumc, Department of Primary and Community Care/Gender & Women's Health, Nijmegen, the Netherlands
| | - T A M Teunissen
- Radboudumc, Department of Primary and Community Care/Gender & Women's Health, Nijmegen, the Netherlands
| | - H Bor
- Radboudumc, Department of Primary and Community Care/Gender & Women's Health, Nijmegen, the Netherlands
| | - I S Smid
- Radboudumc, Department of Primary and Community Care/Gender & Women's Health, Nijmegen, the Netherlands
| | - A L M Lagro-Janssen
- Radboudumc, Department of Primary and Community Care/Gender & Women's Health, Nijmegen, the Netherlands
| |
Collapse
|
15
|
Nazari F, Shaygannejad V, Mohammadi Sichani M, Mansourian M, Hajhashemi V. The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis. BMC Neurol 2020; 20:24. [PMID: 31952513 PMCID: PMC6966887 DOI: 10.1186/s12883-019-1582-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Most patients with multiple sclerosis (MS) suffer from bladder dysfunction during the course of the disease. This study was conducted to examine the prevalence of these complications among patients with MS. Methods This cross-sectional study was performed on 602 patients with MS who referred to the neurology clinics of Kashani and Alzahra Hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Multistage random cluster sampling was performed and the informed consent form was signed by the subjects. Then, all the data were collected through interviews using the Lower Urinary Tract Symptom Score (LUTSS) developed in accordance with the definitions presented by the International Continence Society (ICS) and the International Prostate Symptom Score (I-PSS) and DASS-21 questionnaire. The data were analyzed using descriptive and inferential statistical tests in SPSS. Results The prevalence rate of lower urinary tract symptoms (LUTS) was 87.6% among all the subjects, with a similar rate among women (88.0%) and men (86.0%). There was a significant difference between men and women in terms of the prevalence of stress urinary incontinence (SUI), intermittent urine flow, hesitancy, straining, and dribbling (P < 0.050). There was no significant difference between women and men in terms of the prevalence of other symptoms (P > 0.050). A significant difference was observed in the degree of LUTS with age, marital status, marriage duration, education, illness duration, clinical course, disability, anxiety, depression, and stress (P< 0.05). Moreover, logistic regression analysis revealed that there was a higher probability of a urinary problems among patients with MS and a high EDSS score [0.67 (0.507–0.903), P = 0.008]. Conclusions A high prevalence of LUTS was found among patients with MS. There was a higher probability of a urinary tract problem among patients with MS and a high EDSS score. Therefore, it is recommended that the health system take the necessary measures regarding timely detection and treatment of LUTS among these patients in order to prevent secondary outcomes and improve the quality of life (QOL) of patients with MS.
Collapse
Affiliation(s)
- Fatemeh Nazari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. .,Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehrdad Mohammadi Sichani
- Isfahan Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology & Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Hajhashemi
- Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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.
| |
Collapse
|
18
|
Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male 2019; 22:12-19. [PMID: 29392976 DOI: 10.1080/13685538.2018.1434772] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is very common in aging men and causes lower urinary tract symptoms (LUTS), which decrease health-related quality of life. A number of evidence suggests that other than ageing, modifiable factors, such as increasing prostate volume, obesity, diet, dyslipidemia, hormonal imbalance, hypertension, metabolic syndrome, alcohol, and smoking, also contribute to the development of BPH and/or LUTS. More recently, erectile dysfunction (ED) has been linked to LUTS/BPH as a part of this syndrome, suggesting that patients with BPH or LUTS easily develop ED, and that LUTS/BPH symptoms often coexist with ED. This article focuses on the epidemiology and risk factors of the combined phenotype LUTS/BPH - ED.
Collapse
Affiliation(s)
- Aldo E Calogero
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Giovanni Burgio
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Rosita A Condorelli
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Rossella Cannarella
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Sandro La Vignera
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| |
Collapse
|
19
|
Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Treatment of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male 2018; 21:272-280. [PMID: 29378485 DOI: 10.1080/13685538.2018.1432586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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
This article summarizes years of challenging research on erectile dysfunction (ED), a condition that has an important social and cultural relevance. Preclinical and clinical research progress has led to new therapeutic approaches to ED in patients with different comorbidities and particularly in those with low urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). These goals were possible only by combined work of specialists and researchers of different and intertwined medical disciplines. Currently, tadalafil (5 mg/d) is the best choice; other phosphodiesterase-5 inhibitors (PDE5i) are not included among options, despite the growing evidence of therapeutic effects. Different regimens of tadalafil may be prescribed based on patient needs, severity of LUTS/BPH - ED profile, and clinical experience. An integrated approach is necessary to choose for a combined therapy with PDE5i and α-blockers following urological and cardiac counseling in terms of outcomes and adverse effects.
Collapse
Affiliation(s)
- Aldo E Calogero
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Giovanni Burgio
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Rosita A Condorelli
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Rossella Cannarella
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| | - Sandro La Vignera
- a Department of Clinical and Experimental Medicine , University of Catania , Catania , Italy
| |
Collapse
|
20
|
Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction: from physiology to clinical aspects. Aging Male 2018; 21:261-271. [PMID: 29374992 DOI: 10.1080/13685538.2018.1430758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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
Erectile dysfunction, prostatic hyperplasia and lower urinary tract symptoms hare important pathogenetic links. Endothelial dysfunction and hormonal alterations represent the main aspects. The present article examines the anatomical, physiological, and pathophysiological characteristics of this association, finalizing the text to an interpretation of the clinical management of these patients based on these functional considerations.
Collapse
Affiliation(s)
- Aldo E Calogero
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Giovanni Burgio
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Rosita A Condorelli
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Rossella Cannarella
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| | - Sandro La Vignera
- a Department of Clinical and Experimental Medicine, Policlinico "G. Rodolico", University of Catania , Catania , Italy
| |
Collapse
|
21
|
Enikeev D, Glybochko P, Rapoport L, Okhunov Z, O'Leary M, Potoldykova N, Sukhanov R, Enikeev M, Laukhtina E, Taratkin M. Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function. BMC Urol 2018; 18:87. [PMID: 30314492 PMCID: PMC6186032 DOI: 10.1186/s12894-018-0400-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022] Open
Abstract
Background The impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP). Methods We performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after. Results A total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001). Conclusions Both TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.
Collapse
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Mitchel O'Leary
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Natalya Potoldykova
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| |
Collapse
|
22
|
Ryu JM, Jang GY, Park D, Woo KS, Kim TM, Jeong HS, Kim DJ. Effect of sorghum ethyl-acetate extract on benign prostatic hyperplasia induced by testosterone in Sprague-Dawley rats. Biosci Biotechnol Biochem 2018; 82:2101-2108. [PMID: 30124113 DOI: 10.1080/09168451.2018.1507721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Benign prostatic hyperplasia (BPH) is commonly observed in men > 50 years worldwide. Phytotherapy is one of the many treatment options. Sorghum (Sorghum bicolor L.) contains various health-improving phytochemicals with antioxidant and inhibitory activities on cell proliferation, both in vitro and in vivo. To confirm the effects of Donganme sorghum ethyl-acetate extract (DSEE) on BPH, we induced BPH in Spragye-Dawley rats using exogenous testosterone. We measured prostate weight, examined prostrates histopathologically, and analyzed mRNAs associated with male hormones and proteins associated with cell proliferation in the prostate. DSEE inhibited weight gain of the prostate; decreased mRNA expressions of androgen receptor and 5α-reductase II; and improved histopathological symptoms, the protein-expressed ratio of Bax/Bcl-2, and the oxidative status of BPH induced by testosterone in SD rats. Therefore, DSEE may have potential as a preventive or therapeutic agent against BPH.
Collapse
Affiliation(s)
- Jae-Myun Ryu
- a Veterinary Medical Center and College of Veterinary Medicine , Chungbuk National University , Cheongju , Korea
| | - Gwi Yeong Jang
- b Department of Herbal Crop Research, National Institute of Horticultural and Herbal Science , Rural Development Administration , Eumseong , Korea
| | - Dongsun Park
- c Department of Biology Education , Korea National University of Education , Cheongju , Korea
| | - Koan Sik Woo
- d Department of Central Area Science, National Institute of Crop Science , Rural Development Administration , Suwon , Korea
| | - Tae Myoung Kim
- a Veterinary Medical Center and College of Veterinary Medicine , Chungbuk National University , Cheongju , Korea
| | - Heon Sang Jeong
- e Department of Food Science and Biotechnology , Chungbuk National University , Cheongju , Korea
| | - Dae Joong Kim
- a Veterinary Medical Center and College of Veterinary Medicine , Chungbuk National University , Cheongju , Korea
| |
Collapse
|
23
|
2-Methoxyestradiol Attenuates Testosterone-Induced Benign Prostate Hyperplasia in Rats through Inhibition of HIF-1 α/TGF- β/Smad2 Axis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:4389484. [PMID: 30154949 PMCID: PMC6093036 DOI: 10.1155/2018/4389484] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/24/2018] [Accepted: 07/09/2018] [Indexed: 12/18/2022]
Abstract
Benign prostatic hyperplasia (BPH) is a common disorder in the male population. 2-Methoxyestradiol (2ME) is an end metabolite of estrogens with pleiotropic pharmacological properties. This study aimed to explore the potential ameliorative effects of 2ME against testosterone-induced BPH in rats. 2-Methoxyestradiol (50 and 100 mg/kg, dissolved in DMSO) prevented the rise in prostatic index and weight in comparison to testosterone-alone-treated animals for 2 weeks. Histological examination indicated that 2ME ameliorated pathological changes in prostate architecture. This was confirmed by the ability of 2ME to decrease the glandular epithelial height when compared to the testosterone group. Also, 2ME improved testosterone-induced oxidative stress as it inhibited the rise in lipid peroxide content and the exhaustion of superoxide dismutase (SOD) activity. The beneficial effects of 2ME against the development of BPH were substantiated by assessing proliferation markers, preventing the rise in cyclin D1 protein expression and enhancing Bax/Bcl2 mRNA ratio. It significantly reduced prostate content of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), nuclear factor κB (NF-κB), and transforming growth factor β (TGF-β). In addition, 2ME reduced hypoxia-inducible factor 1-α (HIF-1α) and phospho-Smad2 (p-Smad2) protein expression compared to the testosterone group. In conclusion, 2ME attenuates experimentally induced BPH by testosterone in rats through, at least partly, inhibition of HIF-1α/TGF-β/Smad2 axis.
Collapse
|
24
|
Low dose daily versus on-demand high dose tadalafil in diabetic patients with erectile and ejaculatory dysfunction. Int J Impot Res 2018; 30:102-107. [PMID: 29795527 DOI: 10.1038/s41443-018-0019-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 11/20/2017] [Accepted: 12/24/2017] [Indexed: 02/07/2023]
Abstract
The aim was to compare the differences between daily 5 mg and on-demand 20 mg tadalafil use in diabetic patients with erectile dysfunction (ED), and the effects of two different tadalafil protocols on ejaculatory and lower urinary tract symptoms (LUTS). Of the 63 diabetic patients with ED, 31 were given 5 mg tadalafil once a day, and 32 were given 20 mg tadalafil on-demand four times a month over three months. Erectile function, erectile hardness, ejaculatory function, and LUTS were assessed at pretreatment, first- and third-month controls. Both tadalafil protocols increased International Index of Erectile Function (IIEF) scores in all patients under 65 years, whereas patients older than 65 years did not benefit. Ejaculatory function, the quality of the hardness of an erection, and LUTS improved in both groups in the study. Tadalafil improved sexual function with acceptable side effects in diabetic men with ED. Both protocols equally improved LUTS and the quality of the erection. Daily use of 5 mg of tadalafil significantly improved the quality of ejaculation and LUTS more than the on-demand use of 20 mg of tadalafil. It may be beneficial to give 5 mg tadalafil daily to patients over 65 years old who do not benefit from treatment with 20 mg of tadalafil or in patients who have LUTS over 65 years old.
Collapse
|
25
|
Vaughan CP, Markland AD, Smith PP, Burgio KL, Kuchel GA. Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome. J Am Geriatr Soc 2018; 66:773-782. [PMID: 29205261 PMCID: PMC5906179 DOI: 10.1111/jgs.15157] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions. The conference provided a forum for discussing current epidemiology, basic science, and clinical and translational research on urinary incontinence in older adults; for identifying gaps in knowledge; and for developing a research agenda to inform future investigative efforts. The conference also promoted networking involving emerging researchers and thought leaders in the field of incontinence, aging, and other fields of research, as well as National Institutes of Health program personnel.
Collapse
Affiliation(s)
- Camille P Vaughan
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Phillip P Smith
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Kathryn L Burgio
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Birmingham/Atlanta, Atlanta, Georgia, Birmingham, Alabama
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| |
Collapse
|
26
|
Kwon SY, Lee KS, Yoo TK, Chung JI, Lee JY, Hong JH, Seo SI, Jung TY, Kwak C, Kang TW, Yun SJ. Comparison of the Effect of Naftopidil 75 mg and Tamsulosin 0.2 mg on the Bladder Storage Symptom With Benign Prostatic Hyperplasia: Prospective, Multi-institutional Study. Urology 2018. [DOI: 10.1016/j.urology.2017.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
27
|
Yang DY, Ko K, Lee SH, Cho JS, Lee SK, Shin TY, Lee WK. Postmicturition Dribble Is Associated with Erectile Dysfunction in Middle-Aged and Older Men with Lower Urinary Tract Symptoms. World J Mens Health 2018; 36:263-270. [PMID: 30168300 PMCID: PMC6119842 DOI: 10.5534/wjmh.180042] [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] [Received: 05/24/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) are correlated with erectile dysfunction (ED), but research on whether postmicturition dribble (PMD) is related to ED is limited. We assessed the correlation between PMD and ED in middle-aged and older Korean men with LUTS. MATERIALS AND METHODS In our prospective, cross-sectional, observational, multicenter study, we enrolled 205 men (age >40 years) with LUTS. LUTS and ED were assessed using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), respectively. PMD was assessed using the Hallym PostMicturition Dribble Questionnaire, Question 1, and the PMD volume was calculated in a paper test. Age, prostate volume, serum prostate-specific antigen, maximum urinary flow rate, and postvoid residual urine were also evaluated. RESULTS There were significant differences in the total and voiding IPSS between men with and without ED (p=0.042 and 0.043, respectively). The Hallym PostMicturition Dribble Questionnaire 1 score was inversely well correlated with the IIEF-5 score (r=-0.388, p<0.001). Also, the PMD volume was inversely correlated with the IIEF-5 score (r=-0.138, p=0.042). ED prevalence increased as the Hallym PostMicturition Dribble Questionnaire 1 score increased (p=0.002). Further, incorporating the Hallym PostMicturition Dribble Questionnaire 1 into the IPSS tended to increase the predictive accuracy of LUTS by 4.2% in ED patients (p=0.082). CONCLUSIONS PMD was significantly correlated with ED and reinforced the relationship between LUTS and ED in middle-aged and older men. PMD might be an important component of the association between LUTS and ED.
Collapse
Affiliation(s)
- Dae Yul Yang
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kyungtae Ko
- Department of Urology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Ho Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Kon Lee
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Tae Young Shin
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Won Ki Lee
- Department of Urology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
| |
Collapse
|
28
|
Won JE, Chu JY, Choi HC, Chen Y, Park HJ, Dueñas HJ. Safety and Effectiveness of Once-Daily Tadalafil (5 mg) Therapy in Korean Men with Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms in a Real-World Clinical Setting: Results from a Post-Marketing Surveillance Study. World J Mens Health 2017; 36:161-170. [PMID: 28879692 PMCID: PMC5924958 DOI: 10.5534/wjmh.17017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/13/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to investigate the safety and effectiveness of tadalafil 5 mg once daily (quaque die [everyday], QD) among Korean men with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) in a real-world clinical setting. Materials and Methods This was a single-country, prospective, observational cohort study in which patients newly prescribed tadalafil 5 mg QD for the treatment of BPH/LUTS were followed-up for 12±2 or 24±2 weeks, or to the last treatment, during post-marketing surveillance. Safety was evaluated in terms of the frequency of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). Effectiveness was assessed by changes in the International Prostate Symptom Score (IPSS) from baseline to each endpoint. Results All patients receiving ≥1 dose of tadalafil 5 mg QD (N=637) were included in the safety population. Two percent of patients (n=13) experienced 15 TEAEs of mild (n=10; 66.7%) or moderate (n=5; 33.3%) severity. No severe TEAEs and no SAEs were reported. Effectiveness evaluations included all patients receiving tadalafil who had both baseline and endpoint observations (12-week, N=265; 24-week, N=44). Compared with baseline, the mean IPSS total score (±standard error) significantly improved by 4.7±0.3 and 6.4±0.7 points at the 12- and 24-week endpoints, respectively (p<0.0001), with significant improvements also observed on the storage, voiding, and quality of life subscores. In total, 69.1% of the patients had a clinically meaningful ≥3-point improvement in the IPSS total score. Conclusions Tadalafil 5 mg QD was well tolerated and effective in Korean men with BPH/LUTS in a real-world clinical setting.
Collapse
Affiliation(s)
| | | | | | - Yun Chen
- Lilly Suzhou Pharmaceutical Company, Shanghai, China
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.
| | | |
Collapse
|
29
|
Thomas D, Chughtai B, Kini M, Te A. Emerging drugs for the treatment of benign prostatic hyperplasia. Expert Opin Emerg Drugs 2017; 22:201-212. [PMID: 28829208 DOI: 10.1080/14728214.2017.1369953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is a common condition affecting over 50% of men as they reach their 5th decade of life. This leads to a number of sequelae such as lower urinary tract symptoms, urinary retention and a decrease in quality of life. Currently, the available treatments for BPH are alpha blockers and 5-alpha reductase inhibitors. Clinical studies have demonstrated these medical options are effective in alleviating a patient's symptoms, however there are a number of side effects. There is a paucity of information regarding long-term use of these medications. The purpose of this review is to identify potential and emerging medications for the treatment of BPH. Areas covered: Articles used in this review were retrieved from Pubmed, Google and through searching the PharmaProjects database over the last 10 years, giving the reader an in-depth knowledge about the current pharmacological agents available and other potential treatments for BPH. Expert opinion: The new paradigm of BPH treatment depends on addressing a patient's specific constellation of symptoms. This allows to tailor therapy of increasing efficacy and reduce adverse events that our patients have by increasing dosage.
Collapse
Affiliation(s)
- Dominique Thomas
- a Department of Urology , Weill Cornell Medicine-New York Presbyterian , New York , NY , USA
| | - Bilal Chughtai
- a Department of Urology , Weill Cornell Medicine-New York Presbyterian , New York , NY , USA
| | - Mitali Kini
- a Department of Urology , Weill Cornell Medicine-New York Presbyterian , New York , NY , USA
| | - Alexis Te
- a Department of Urology , Weill Cornell Medicine-New York Presbyterian , New York , NY , USA
| |
Collapse
|
30
|
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.
Collapse
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.
| |
Collapse
|
31
|
Carbone A, Fuschi A, Al Rawashdah SF, Al Salhi Y, Velotti G, Ripoli A, Autieri D, Palleschi G, Pastore AL. Management of lower urinary tract symptoms associated with benign prostatic hyperplasia in elderly patients with a new diagnostic, therapeutic and care pathway. Int J Clin Pract 2016; 70:734-43. [PMID: 27561366 DOI: 10.1111/ijcp.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/22/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) resulting in lower urinary tract symptoms (LUTS) is a widespread disease that strongly interferes with the quality of life (QoL) of elderly males. It represents a real clinical and socio-economic problem may be due to the lack of a diagnostic, therapeutic and care pathway (DTCP) tool for LUTS/BPH that considers elderly people population in its whole complexity. The aim of this study was to evaluate the clinical effectiveness of the proposed DTCP LUTS/BPH tool. METHODS This prospective study was conducted on 278 patients over 75 years old with non-neurogenic LUTS recruited from February to July 2014 by 10 general practitioners (GP) and two assisted sanitary residences (ASR). Only five GPs and one ASR were provided with the complete DTCP LUTS/BPH tool to create two different groups of patients: group A (138 patients) was treated without the aid of the DTCP; group B (140 patients) was treated according to the DTCP. RESULTS At 1 year of follow-up, the patients of Group B compared with Group A achieved a greater and significant mean reduction in the questionnaires score (International Prostate Symptom Score, Quick prostate test and QoL) linked to a higher increase in the flowmetry parameters (Qmax) and a lower postvoid residual. Furthermore, in Group B compared to Group A, a greater improvement of hydronephrosis, creatinine values and erectile dysfunction (ED) were obtained at 1 year of follow-up. CONCLUSION The encouraging results obtained from this study are significant and support the use of this diagnostic, therapeutic and care tool (DTCP) as the ideal pathway management for elderly men with LUTS associated to BPH and ED. Further studies with greater number of elderly subjects and long-term follow-up are needed to confirm DTCP utility in the clinical management of LUTS/BPH and ED.
Collapse
Affiliation(s)
- Antonio Carbone
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy
- Uroresearch, No Profit Research Investigation in Urology, Latina, Italy
| | - Andrea Fuschi
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy
| | - Samer Fathi Al Rawashdah
- Urolgy Unit, Department of Special Surgery, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Yazan Al Salhi
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy
| | - Gennaro Velotti
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy
| | - Andrea Ripoli
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy
| | - Domenico Autieri
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy
| | - Giovanni Palleschi
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy
- Uroresearch, No Profit Research Investigation in Urology, Latina, Italy
| | - Antonio Luigi Pastore
- Urology Unit, ICOT, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Latina, Italy.
- Uroresearch, No Profit Research Investigation in Urology, Latina, Italy.
| |
Collapse
|
32
|
Clinical Significance of the Resistive Index of Prostatic Blood Flow According to Prostate Size in Benign Prostatic Hyperplasia. Int Neurourol J 2016; 20:75-80. [PMID: 27032561 PMCID: PMC4819154 DOI: 10.5213/inj.1630390.195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/25/2015] [Indexed: 11/16/2022] Open
Abstract
Purpose: The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH). Methods: The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist. Results: The 110 patients were categorized according to IPSS (mild symptoms, 0–7; moderate symptoms, 8–19; and severe symptoms, 20–35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP. Conclusions: RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.
Collapse
|
33
|
Roehrborn CG, Egan KB, Miner MM, Ni X, Wong DG, Rosen RC. Erectile dysfunction and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) combined responders to tadalafil after 12 weeks of treatment. BJU Int 2016; 118:153-60. [DOI: 10.1111/bju.13406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Claus G. Roehrborn
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | | | | | - Xiao Ni
- Global Statistical Sciences and Advanced Analytics; USA
| | | | | |
Collapse
|
34
|
Affiliation(s)
- Du Geon Moon
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
35
|
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]
|
36
|
Haddad A, Jabbour M, Bulbul M. Phosphodiesterase type 5 inhibitors for treating erectile dysfunction and lower urinary tract symptoms secondary to benign prostatic hyperplasia: A comprehensive review. Arab J Urol 2015; 13:155-61. [PMID: 26413339 PMCID: PMC4563010 DOI: 10.1016/j.aju.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/15/2015] [Accepted: 06/10/2015] [Indexed: 01/01/2023] Open
Abstract
Many men have coexistent erectile dysfunction (ED) and lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Phosphodiesterase type 5 (PDE5) inhibitors are effective for treating both of these conditions independently. In this review we summarise the evidence supporting a link between ED and LUTS/BPH, and the results from key clinical studies related to the use of PDE5 inhibitors for treating both conditions. The results from these studies suggest that men who have both ED and LUTS/BPH, and are concerned about their sexual dysfunction, might benefit from single-agent, holistic treatment with a PDE5 inhibitor.
Collapse
Key Words
- 5ARI, 5α-reductase inhibitor
- AE, adverse event
- Benign prostatic hyperplasia
- ED, erectile dysfunction
- EF, erectile function (domain)
- Erectile dysfunction
- IIEF, International Index of Erectile Function
- LUTS
- NO, nitric oxide
- PDE5 inhibitor
- PDE5, phosphodiesterase type 5
- QoL, quality of life
- ROCK, Rho-associated protein kinase
- RhoA, Ras homologue gene family member A
- cGMP, cyclic guanosine monophosphate
Collapse
Affiliation(s)
- Albert Haddad
- Lilly Research Laboratories, Eli Lilly and Company, Dubai, United Arab Emirates
| | - Michel Jabbour
- Division of Urology, Saint Georges Hospital, Balamand University, Achrafieh, Beirut, Lebanon
| | - Muhammad Bulbul
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
37
|
Basu S, Majumder S, Bhowal A, Ghosh A, Naskar S, Nandy S, Mukherjee S, Sinha RK, Basu K, Karmakar D, Banerjee S, Sengupta S. A study of molecular signals deregulating mismatch repair genes in prostate cancer compared to benign prostatic hyperplasia. PLoS One 2015; 10:e0125560. [PMID: 25938433 PMCID: PMC4418837 DOI: 10.1371/journal.pone.0125560] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/24/2015] [Indexed: 12/12/2022] Open
Abstract
Prostate cancer is one of the leading causes of mortality among aging males. There is an unmet requirement of clinically useful biomarkers for early detection of prostate cancer to reduce the liabilities of overtreatment and accompanying morbidity. The present population-based study investigates the factors disrupting expression of multiple functionally related genes of DNA mismatch repair pathway in prostate cancer patients to identify molecular attributes distinguishing adenocarcinoma from benign hyperplasia of prostate. Gene expression was compared between tissue samples from prostate cancer and benign prostatic hyperplasia using real-time-PCR, western blot and immunohistochemistry. Assessment of genotypes of seven single-nucleotide-polymorphisms of three MMR genes was conducted using PCR-coupled RFLP and sequencing. Promoter methylation was interrogated by methylation-specific-PCR and bisulfite-sequencing. Interaction between microRNAs and MMR genes was verified by 3'UTR-based dual luciferase assays. Concurrent reduction of three MMR genes namely hMLH1, hMSH6 and hMSH2 (34-85%, P<0.05) was observed in prostate cancer tissues. hMSH6 polymorphism rs1800932(Pro92Pro) conferred a borderline protection in cancer patients (OR = 0.33, 95% CI = 0.15-0.75). Relative transcript level of hMLH1 was inversely related (r = -0.59, P<0.05) with methylation quotient of its promoter which showed a significantly higher methylation density (P = 0.008, Z = -2.649) in cancer patients. hsa-miR-155, hsa-miR-141 and hsa-miR-21 gene expressions were significantly elevated (66-85%, P<0.05) in tumor specimens and negatively correlated (r = -0.602 to -0.527, P<0.05) with that of MMR genes. hsa-miR-155 & hsa-miR-141 and hsa-miR-155 & hsa-miR-21 were demonstrated to bind to their putative seed sequences in hMLH1 and hMSH6 3’UTRs respectively. Relatively higher expression of DNA methyl-transferases (DNMT1 and DNMT3b) and HIF-1α genes (34-50%, P<0.05) were also detected in tumor tissues. This study provides statistical evidence that MMR deficiency is correlated with hypermethylation of hMLH1 promoter and upregulation of hsa-miR-155, hsa-miR-141 and hsa-miR-21 in prostate cancer. This comparative study reflects that microRNA expression level, particularly hsa-miR-155, exhibits predictive signature of prostate adenocarcinoma.
Collapse
Affiliation(s)
- Sanmitra Basu
- Department of Biochemistry, University of Calcutta, Kolkata, West Bengal, India
| | - Subhadipa Majumder
- Department of Biochemistry, University of Calcutta, Kolkata, West Bengal, India
| | - Ankur Bhowal
- Department of Biochemistry, University of Calcutta, Kolkata, West Bengal, India
| | - Alip Ghosh
- Centre for Liver Research, Institute of Post-Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - Sukla Naskar
- Department of Pathology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Sumit Nandy
- Department of Pathology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Subhabrata Mukherjee
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Rajan Kumar Sinha
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Keya Basu
- Department of Pathology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Dilip Karmakar
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Soma Banerjee
- Centre for Liver Research, Institute of Post-Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - Sanghamitra Sengupta
- Department of Biochemistry, University of Calcutta, Kolkata, West Bengal, India
- * E-mail:
| |
Collapse
|
38
|
Andersson KE, Nomiya M, Yamaguchi O. Chronic Pelvic Ischemia: Contribution to the Pathogenesis of Lower Urinary Tract Symptoms (LUTS): A New Target for Pharmacological Treatment? Low Urin Tract Symptoms 2014; 7:1-8. [PMID: 26663644 DOI: 10.1111/luts.12084] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/30/2014] [Accepted: 10/05/2014] [Indexed: 11/28/2022]
Abstract
The incidence of lower urinary tract symptoms, including overactive bladder (OAB), is continuing to rise, and is associated with a negative impact on quality of life and a heavy economic burden. A major risk factor for OAB is advancing age. The etiology of OAB is multifactorial and appears to involve myogenic, neurogenic, and urotheliogenic factors. In this article, we review the strengthening preclinical evidence supporting the contribution of chronic pelvic ischemia to the pathogenesis of OAB. In animal models, chronic ischemia induced by arterial injury and a high-fat diet upregulates markers of oxidative stress and proinflammatory cytokines in the urothelium and lamina propria, and leads to increased expression of nerve growth factor. These processes result in increased afferent activity and an increased frequency of micturition, reflecting a state of bladder hyperactivity. In severe, prolonged cases, bladder overactivity may develop into underactivity. Antimuscarinic therapies are the mainstay of OAB treatment, but their usefulness is limited by modest efficacy and troublesome side-effects. Our increasing understanding of the contribution of chronic ischemia to OAB is leading toward novel therapeutic options targeting chronic pelvic ischemia and its morphological, functional, and oxidative consequences. Preclinical trials have demonstrated encouraging results with α1 -adrenoreceptor blockade, phosphodiesterase type 5 inhibition, β3 -adrenoreceptor agonism, free radical scavenging, and stem cell therapy, in preventing morphological, biochemical and functional changes induced by chronic bladder ischemia.
Collapse
Affiliation(s)
- Karl-Erik Andersson
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Masanori Nomiya
- Division of Bioengineering and Lower Urinary Tract Diseases Research, Nihon University School of Engineering, Koriyama, Japan
| | - Osamu Yamaguchi
- Division of Bioengineering and Lower Urinary Tract Diseases Research, Nihon University School of Engineering, Koriyama, Japan
| |
Collapse
|
39
|
|
40
|
Bulut S, Ozden C, Aktas BK, Deren T, Tagci S, Gokkaya CS, Baykam MM, Memis A. Effects of medical therapy or surgery on prostatic and bladder resistive indices in patients with benign prostatic hyperplasia. Urol Int 2014; 94:181-6. [PMID: 25139617 DOI: 10.1159/000363581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/12/2014] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Suleyman Bulut
- Urology Clinic, Numune Training and Research Hospital, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|