Benign Prostate Hyperplasia

Objective: To help students, residents, and general practitioners to improve the technique, skills, and reproducibility of their prostate examination. Methods: We developed a comprehensive guideline outlining prostate anatomy, indications, patient preparation, positioning, technique, findings, and limitations of this ancient art of urological evaluation. Results: The prostate exam was the first diagnostic test used for prostate cancer screening and other urological conditions. Although several alternative procedures have been developed in the past century, the prostate exam is still an important part of genital-pelvic evaluation because of its simplicity, cost and time effectiveness, and relatively minimal patient discomfort experienced. Conclusion: With an aging population and increasing incidence of prostate diseases, it is imperative that healthcare professionals possess the knowledge, skills, and attitudes to make the prostate exam a routine part of a complete physical examination.

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with α-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with α-blockers or 5α-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5 ng/ ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with α-blockers, or the sixth month with 5α-reductase inhibitors, will be referred to urology. Patients will also be referred to ACTAS UROLÓGICAS ESPAÑOLAS www.elsevier.es/actasuro actas urol esp. 2010;34(1):24-34 actas urol esp. 2010;34(1):24-34

Previous studies have detected high levels of matrix metalloproteinases (MMPs) in metastatic prostate cancer. In this study, we recruited 40 patients with prostate cancer (PCa): 20 presented organ-confined carcinoma and 20 had metastatic cancer. We also recruited 40 subjects for control groups, 20 with benign prostate hyperplasia (BPH) and 20 healthy males with similar characteristics. All of the patients were monitored at the beginning (time 0) and after 90 days. We analyzed the plasma concentrations of MMP-2, MMP-9, MMP-13, TIMP-1 and the enzyme activity of MMP-2 and MMP-9,using specific ELISA tests. The plasma concentrations of MMP-2, MMP-9 and MMP-13 were higher in PCa patients with metastasis than in the other groups, and in these patients decreased markedly after therapy began. For MMP-2 and MMP-9, greater differences were observed in enzyme activity than in plasma concentrations. TIMP-1 was reduced in PCa patients with metastasis, even if the intergroup differences were not statistically significant. Our results suggest that the plasma concentration and activity of MMPs, in association with PSA determination, could play a role in diagnosis, monitoring therapy and evaluating malignant progression in PCa.

Abstract
Introduction: Prolonged urethral catheterization can cause retained catheter
Key Words: Retained catheter; bladder stone; prostate
Case: 70 years old with BPH, with retained catheter due to huge stone, he had extraction of the stone and prostatectomy.
Discussion: our patient presented with six months prolonged catheterization and Argarwal et al reported 3 months.
Conclusion: retained catheter can be caused by stone around the tip of the catheter.

Purpose: Obesity has been implicated in the etiology of benign and malignant prostatic growth due to its influence on metabolic and endocrine changes. Because obesity is an important determinant of serum levels of insulin and leptin (the product of the obesity gene Ob), we investigated the role of obesity and serum levels of insulin and leptin in benign prostatic hyperplasia (BPH) etiology. Materials and Methods: Fasting serum levels of insulin and leptin as well as the body mass index, a measure of overall obesity, and waist-to-hip ratio, an indicator of abdominal obesity, were determined in 200 men newly diagnosed with BPH who were hospitalized for surgery and in 302 randomly selected healthy male subjects from the population in Shanghai, China. Results: A higher waist-to-hip ratio and higher serum insulin were significantly associated with an increased risk of BPH. Relative to men in the lowest waist-to-hip ratio quartile (less than 0.856) those in the highest quartile (greater than 0.923) were at 2.4-fold risk (odds ratio 2.42, 95% confidence interval [CI] 1.34 to 4.37, test for trend p ϭ 0.01). Similarly relative to men in the lowest quartile of insulin (less than 5.87 U. per ml.) those in the highest quartile (greater than 9.76 U. per ml.) were at significantly increased risk (odds ratio 2.47, 95% CI 1.35 to 4.54, test for trend p ϭ 0.009). The effect of insulin on BPH risk was more pronounced in men in low and middle tertiles of the waist-to-hip ratio (odds ratios comparing high to low insulin tertiles 2.8 and 2.7, respectively), while among men in the highest waist-to-hip ratio tertile insulin was not significantly associated with BPH risk. In contrast, we found no significant odds ratio comparing the highest to lowest quartiles of leptin (odds ratio 0.62, 95% CI 0.33 to 1.17) or body mass index (odds ratio 1.64, 95% CI 0.96 to 2.81). Conclusions: Our results suggest that abdominal obesity and increasing serum insulin, and possibly overall obesity but not serum leptin are associated with a higher risk of BPH. Further prospective and laboratory studies are needed to confirm these results and elucidate the underlying mechanisms.

Purpose: To determine the effects of therapy with Urtica dioica for symptomatic relief of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Material and Methods: A 6-month, double-blind, placebo-controlled, randomized, partial crossover, comparative trial of Urtica dioica with placebo in 620 patients was conducted. Patients were evaluated using the International Prostate Symptom Score (IPSS), the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), Serum Pros-tatic-Specific Antigen (PSA), testosterone levels, and prostate size. At the end of the 6-month trial, unblinding revealed that patients who initially received the placebo were switched to Urtica dioica. Both groups continued the medication up to 18 months. Results: Five hundred fifty-eight patients (90%) completed the study (287/305, 91% in the Urtica dioica group, and 271/315, 86% in the placebo group). By intention-to-treat analysis, at the end of the 6-month trial, 232 (81%) of 287 patients in the Urtica dioica group reported improved LUTS compared with 43 (16%) of 271 patients in the placebo group (P < 0.001). Both IPSS and Qmax showed greater improvement with drugs than with placebo. The IPSS went from 19.8 down to 11.8 with Urtica

The aim of the study was to propose an eccentricity parameter (EP)-based correction to the ellipsoid formula to improve the evaluation of the prostate volume defined by transabdominal ultrasonography (TAUS) at different stages of benign prostatic ...

Objective: To investigate associations between prostate cancer and sexually transmitted diseases (STDs), prostatitis, benign prostatic hyperplasia (BPH), and vasectomy in a population-based case-control study in Wayne County, Michigan, among African American and white men aged 50-74 years. Methods: Incident prostate cancer cases (n ¼ 700) from 1996-1998 were identified from the Metropolitan Detroit Cancer Surveillance System. Controls (n ¼ 604) were identified through random digit dialing and Medicare recipient lists, and frequency matched to cases on age and race. History of potential prostate cancer risk factors was ascertained through in-person interview. Results: Prostate cancer was not associated with STD or vasectomy history. History of prostatitis was associated with prostate cancer among all subjects (odds ratio [OR] ¼ 1.8, 95% confidence interval [CI]: 1.1, 2.9) and in African American men (OR ¼ 2.2, 95% CI: 1.1, 4.6). History of BPH was associated with prostate cancer among all subjects (OR ¼ 2.4, 95% CI: 1.8, 3.3); significant associations were observed in both African American (OR ¼ 2.7, 95% CI: 1.6, 4.4) and white (OR ¼ 2.3, 95% CI: 1.5, 3.4) men. Conclusions: Among all subjects, prostate cancer was associated with prostatitis and BPH history, but not with STD or vasectomy history. Prevention efforts could be enhanced if inflammatory or infectious etiologies are found to be of importance in the subsequent development of prostate cancer.

Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes—strategies—biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: “diagnostic TURP”; “elevated PSA”; and “prostate biopsy”. Furthermore, subsequent reference search was executed on retrieved articles.

The use of dietary supplements for treating a wide range of health conditions has grown rapidly in the United States. In the field of men&#39;s health, the most common dietary supplement used is an extract of the berry of the saw palmetto plant, with which men commonly self-medicate in order to treat lower urinary tract symptoms. Throughout the past two decades, substantial literature has emerged examining the biologic and clinical effects of saw palmetto extracts. Several lines of evidence suggest that saw palmetto may exert physiologic effects consistent with a beneficial clinical effect on the mechanisms of benign prostatic hyperplasia. Although most clinical studies tend to suggest a modest efficacy benefit of saw palmetto, more recent studies are less consistent and the precise clinical value of saw palmetto for treating lower urinary tract symptoms remains undefined. Overall, there appear to be few safety concerns with short-term use of this herbal medicine, although large-sca...

Purpose: To determine the effects of therapy with Urtica dioica for symptomatic relief of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Material and Methods: A 6-month, double-blind, placebo-controlled, randomized, partial crossover, comparative trial of Urtica dioica with placebo in 620 patients was conducted. Patients were evaluated using the International Prostate Symptom Score (IPSS), the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), Serum Pros-tatic-Specific Antigen (PSA), testosterone levels, and prostate size. At the end of the 6-month trial, unblinding revealed that patients who initially received the placebo were switched to Urtica dioica. Both groups continued the medication up to 18 months. Results: Five hundred fifty-eight patients (90%) completed the study (287/305, 91% in the Urtica dioica group, and 271/315, 86% in the placebo group). By intention-to-treat analysis, at the end of the 6-month trial, 232 (81%) of 287 patients in the Urtica dioica group reported improved LUTS compared with 43 (16%) of 271 patients in the placebo group (P < 0.001). Both IPSS and Qmax showed greater improvement with drugs than with placebo. The IPSS went from 19.8 down to 11.8 with Urtica

Background: Laser vaporisation of the prostate has had a considerable impact in recent years. In an attempt to achieve tissue vaporisation with bipolar highfrequency generators, plasma vaporisation was recently introduced. Objective: To provide the first clinical information on bipolar plasma vaporisation of the prostate for patients with lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO). Design, setting, and participants: Thirty patients were included in this prospective bicentre study. Intervention: All patients underwent bipolar plasma vaporisation with a novel electrode (Olympus Winter & Ibe GmbH, Hamburg, Germany). Measurements: International Prostate Symptom Score (IPSS), bother score, maximum flow rate (Q max ), and postvoid residual were evaluated at baseline and at the time of discharge as well as at 1, 3, and 6 mo after the intervention. Results and limitations: Mean preoperative prostate volume was 59 AE 32 ml (range: 30-170), and mean operating time was 61 AE 26 min (range: 20-140). Besides one reoperation (conventional transurethral prostatectomy) due to persistent obstruction, no major complication occurred intra-or postoperatively and no blood transfusion was required. Catheterisation time averaged . Transient mild to moderate dysuria was noted in four patients (13%). At 1, 3, and 6 mo, Q max increased from 6.6 AE 2.7 ml/s preoperative to 17.3 AE 4.7 ml/s ( p < 0.01), 18.5 AE 4.6 ml/s ( p < 0.01), and 18.1 AE 5.0 ml/s ( p < 0.01), respectively. The IPSS decreased from 20.8 AE 3.6 to 10.4 AE 3.5 ( p < 0.01), 8.2 AE 2.9 ( p < 0.01), and 8.1 AE 3.1 ( p < 0.01), respectively. These data represent a small nonrandomised study cohort with limited follow-up. Conclusions: Our initial experience indicates that bipolar plasma vaporisation might be a safe and effective treatment option for patients with LUTS due to BOO. To define the potential role of this novel technique, randomised trials with longer follow-up are mandatory.

Study Type – Therapy (RCT) Level of Evidence 1bStudy Type – Therapy (RCT) Level of Evidence 1bOBJECTIVETo evaluate the efficiency, safety and short-term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis-PVP), and to compare it to the standard TUR of the prostate (TURP).To evaluate the efficiency, safety and short-term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis-PVP), and to compare it to the standard TUR of the prostate (TURP).PATIENTS AND METHODSIn all, 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), with a maximum urinary flow rate (Qmax) of <10 mL/s, an International Prostate Symptom Score (IPSS) of >19 and prostate volume of 30–80 mL were enrolled in this prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, health-related quality of life (HRQL) score, Qmax and postvoid residual urine volume (PVR).In all, 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), with a maximum urinary flow rate (Qmax) of <10 mL/s, an International Prostate Symptom Score (IPSS) of >19 and prostate volume of 30–80 mL were enrolled in this prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, health-related quality of life (HRQL) score, Qmax and postvoid residual urine volume (PVR).RESULTSPatients from both series had similar preoperative characteristics. TURis-PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis-PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P < 0.05). At the 1, 3 and 6 months follow-ups, improvements in the variables measured were better in the TURis-PVP group: the IPSS was 4.4 vs 8.3 and the Qmax was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Qmax was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Qmax was 21.8 vs 19.3 mL/s at 6 months (All P < 0.05).Patients from both series had similar preoperative characteristics. TURis-PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis-PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P < 0.05). At the 1, 3 and 6 months follow-ups, improvements in the variables measured were better in the TURis-PVP group: the IPSS was 4.4 vs 8.3 and the Qmax was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Qmax was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Qmax was 21.8 vs 19.3 mL/s at 6 months (All P < 0.05).CONCLUSIONSTURis-PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short-term results and complication rates compared with monopolar TURP.TURis-PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short-term results and complication rates compared with monopolar TURP.

Adrenergic receptors (ARs) are a class of proteins belonging to the G protein- coupled receptor family. Pharmacological and molecular studies allowed dividing ARs into three different categories: α1, α2 and β. In this review, we focused on α1 ARs and α1 AR antagonists, since α1 ARs play an important role in the pathophysiology of a number of uri- nary tract

Prolonged, sustained or extended release systems, release the active ingredient slowly than conventional dosage forms similarly administered. Tamsulosin is a selective, potent and competitive α 1 -adrenoreceptor antagonist. It has a greater affinity for the α 1A -receptor subtype and is indicated to treat uretheral stone symptoms associated with benign prostatic hyperplasia. In the present work, attempt was made to develop an once daily sustained release matrix tablet of Tamsulosin hydrochloride. Hydroxy propyl methyl cellulose was used as a hydrophilic matrix polymer. The formulation showed acceptable pharmacotechnical properties and HPLC assay requirements. The present work also involves application of Higuchi's equation, Drug release kinetics, Korsmeyer's and Hixsen-crowell plots. In vitro drug release studies indicated a sustained release pattern.

The use of dietary supplements for various ailments enjoys unprecedented popularity. As part of this trend, Sabal serrulata (saw palmetto) constitutes the complementary treatment of choice with regard to prostate health. In homeopathy, Sabal serrulata is commonly prescribed for prostate problems ranging from benign prostatic hyperplasia to prostate cancer. The authors&amp;amp;amp;#39; work assessed the antiproliferative effects of homeopathic preparations of Sabal serrulata, Thuja occidentalis, and Conium maculatum, in vivo, on nude mouse xenografts, and in vitro, on PC-3 and DU-145 human prostate cancer as well as MDA-MB-231 human breast cancer cell lines. Treatment with Sabal serrulata in vitro resulted in a 33% decrease of PC-3 cell proliferation at 72 hours and a 23% reduction of DU-145 cell proliferation at 24 hours (P&amp;amp;amp;lt;.01). The difference in reduction is likely due to the specific doubling time of each cell line. No effect was observed on MDA-MB-231 human breast cancer cells. Thuja occidentalis and Conium maculatum did not have any effect on human prostate cancer cell proliferation. In vivo, prostate tumor xenograft size was significantly reduced in Sabal serrulata-treated mice compared to untreated controls (P=.012). No effect was observed on breast tumor growth. Our study clearly demonstrates a biologic response to homeopathic treatment as manifested by cell proliferation and tumor growth. This biologic effect was (i)significantly stronger to Sabal serrulata than to controls and (ii)specific to human prostate cancer. Sabal serrulata should thus be further investigated as a specific homeopathic remedy for prostate pathology.

Since its introduction in the late 1970s for the treatment of strabismus and blepharospasm, botulinum toxin (BoNT) has been increasingly used in the interventional treatment of several other disorders characterized by excessive or inappropriate muscle contractions. Over the years, the number of primary clinical publications has grown exponentially, and still continues to increase. It has been shown that BoNT blocks cholinergic nerve endings in the autonomic nervous system but does not block nonadrenergic non-cholinergic responses mediated by nitric oxide (NO).

Heavy metals accumulate in various tissues and are associated with increases in today's biggest killers: cardiovascular disease and cancer. Reducing these heavy metals from the body has been a challenge to modern day medicine. With the advent of intravenous EDTA chelation, it was possible to remove heavy metals, but this invasive method of heavy metal removal is burdensome and expensive. This review examines the rectal suppository method of chelating and removing toxic metals from the circulation and deposits in tissue storage sites. In preclinical experiments CaNa 2 EDTA (Detoxamin) rectal suppositories were compared to intravenous (IV) administration of C14-labeled calcium disodium ethylenediaminetetraacetate (CaNA 2 EDTA) in order to evaluate the absorption, brain and prostate tissue distribution, and excretion in rats. The absolute bioavailability of CaNa 2 EDTA in blood following rectal dosing was 36.3% of the IV doses route, which confirmed that rectal dosing is an efficient method for delivering EDTA to tissues. Following IV or rectal dosing of C14 labeled CaNa 2 EDTA, the ratio of radioactive EDTA in tissues compared to blood, showed negligible brain localization. However, prostate tissues were found to have a mean ratio of 3.69 via the IV and 13.6 for the rectal route. The half-life of IV administration was found to be approximately 1.5 hours whereas the half-life of rectal administration was over 8 hours. The total recovery of C14 EDTA expressed as percent of administered EDTA IV and rectally was a mean of 47.3% and 30.3%, respectively at eight hours. The suppository formulation of CaNa 2 EDTA was well absorbed; delivering high levels of EDTA to the tissues, prostate in particular (3.5-fold increase over IV administration). In human subjects, adult men with chronic prostatitis and with benign prostate hyperplasia and/or prostate cancer and prostate calculi were treated in an outpatient setting with tetracycline and EDTA suppositories (Detoxamin) for 90 days, and their symptoms and lab results were analyzed. Using the NIH Chronic Prostatitis Symptom Index, statistically significant post-treatment mean reductions in symptoms and pain were found, along with a significant improvement in mean quality of life. Use of the International Prostate Symptom Score also indicated significant reductions in 5/7 symptom categories and significant reduction of mean overall scores. Analysis of blood and stool post-treatment indicated significant changes in mobilized, secreted cations (cadmium, copper, boron, lead, molybdenum, magnesium, and calcium). The blood cholesterol/high density lipoprotein ratio was also significantly decreased. Use of rectal suppositories has proved to be an innovative, effective and simple approach, saving time and money for the patient, and its efficacy and safety have been validated in pre-clinical and clinical studies.

Erectile dysfunction (ED) has multifactor pathogenesis, with neurological, vascular, endocrinological and psychogenic components described. However, about 50-85% of ED population report the presence of one or more comorbidities i.e. hypertension, diabetes, cardiovascular disease, dyslipidemia which all impair endothelial function and, erection is a basically vascular event that necessitates an intact endothelium to occur. Hence, ED may be mostly considered as the clinical manifestation of a disease affecting penile circulation as a part of a generalized vascular disorder due to atherosclerosis. Orally active drugs, i.e. phosphodiesterase type-5 inhibitors (PDE5-i), are a group of on-demand drugs licensed for ED treatment and appear to offer advantages over past therapies in terms of ease of administration and cost, and they are now widely advocated as first-line therapy. The recent discovery that chronic not on-demand administration of these drugs may improve erectile and endothelial response in men previously unresponding to on-demand regimes, opens a new scenario in the treatment of men with ED and comorbidities. Finally, the recent approval of PDE5-i sildenafil for the treatment of pulmonary arterial hypertension represents the new challenge for these class of drugs. Aim of this article will be to provide an update on the pathophysiology of ED and how to use of different available PDE5-i in approaching sexual dysfunctional men, pointing out on their characteristic of efficacy and safety and different indications in special subpopulations.

RESUMO: O objetivo deste trabalho foi avaliar a utilização de fi toterápicos a base de saw palmetto na terapia sintomática da hiperplasia benigna da próstata (HBP) por médicos urologistas da cidade de Porto Alegre. Consistiu em um estudo transversal, exploratório, por meio de entrevista semi-estruturada aplicada a urologistas de Porto Alegre. A amostra foi obtida utilizando catálogo do plano de saúde UNIMED-Porto Alegre. A randomização foi realizada através de sistemática aleatória, sendo sorteados trinta e cinco médicos, dos quais 21 foram selecionados para realização da pesquisa através de questionário. Todos os urologistas entrevistados avaliam e tratam pacientes com hiperplasia benigna da próstata. O saw palmetto não foi citado como terapia medicamentosa de 1ª ou 2ª escolhas no tratamento da HBP. O grupo farmacológico mais freqüentemente utilizado para o tratamento da HBP foi ∝-bloqueadores. Mais da metade dos médicos entrevistados relata ter conhecimento sobre a utilização do saw palmetto, principalmente através de artigos científi cos. Os resultados indicam que o saw palmetto não é prescrito pelos urologistas em Porto Alegre, todavia a maior parte destes profi ssionais tem conhecimento sobre sua utilização.

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation represents the latest refinement of holmium:YAG surgical treatment for benign prostatic hyperplasia (BPH). Utilizing this technique, even the largest of glands can be effectively treated with minimal morbidity. The learning curve remains an obstacle, preventing more widespread adoption of this procedure. This paper provides an outline of the HoLEP technique as is currently used at two centers in hopes of easing the initial learning curve. TECHNICAL CONSIDERATIONS: Detailed descriptions of the major steps of the HoLEP procedure are provided with attention to critical steps such as identification of the surgical capsule, median and lateral lobe enucleation, and morcellation of enucleated tissue. CONCLUSIONS: HoLEP is a promising alternative for the surgical treatment of BPH which allows complete removal of intact lobes of the prostate. Obstruction is relieved immediately with superior...

Objective: To compare the efficacy of the lipido-sterolic extract of Serenoa repens, Permixon, to that of the α–blocker, tamsulosin, in the treatment of severe low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH).Methods: In a 12-month, double-blind, randomized study that showed equivalent efficacy of Permixon 320mg/day and tamsulosin 0.4mg/day (“PERMAL study”), 685 BPH patients with IPSS ≥10 had been

Objectives. To evaluate the effects of finasteride, a specific type II 5-alpha-reductase inhibitor, on symptoms of benign prostatic hyperplasia, prostate volume, and urinary flow during a 7 to 8-year period. Methods. A total of 190 men with symptomatic benign prostatic hyperplasia and enlarged prostates entered one of two Phase II double-blind 3 to 6-month studies. Of these, 156 patients continued taking open-label finasteride, and more than 70 patients completed 7 to 8 years of treatment. The symptoms were scored using a patient self-administered modified Boyarsky symptom questionnaire. Prostate volume was measured by magnetic resonance imaging or ultrasonography, and the maximal urinary flow rate was assessed noninvasively. Results. Treatment with finasteride for 7 to 8 years led to sustained improvement in symptoms, reduction in prostate volume (28% from baseline), and increased urinary flow (median 2.5 mL/s from baseline). Decreases in dihydrotestosterone (86%) and prostate-specific antigen (54%) levels were also maintained. Long-term finasteride treatment was safe and generally well tolerated. Conclusions. Long-term treatment with finasteride was well tolerated and resulted in durable symptom relief and improvement in prostate volume and urinary flow. UROLOGY 60: 1040-1044, 2002. © 2002,

Objectives. To evaluate the incidence and resolution of sexual adverse experiences (AEs) in men with benign prostatic hyperplasia treated with finasteride 5 mg compared with placebo. Methods. The Proscar Long-term Efficacy and Safety Study (PLESS) was a 4-year, randomized, doubleblind, placebo-controlled trial assessing the efficacy and safety of finasteride 5 mg in 3040 men, aged 45 to 78 years, with symptomatic benign prostatic hyperplasia, enlarged prostates, and no evidence of prostate cancer. Patients completed a questionnaire at screening regarding their history of sexual dysfunction. During treatment, spontaneously self-reported sexual AEs were recorded. Results. At screening, 46% of patients in each treatment group reported some history of sexual dysfunction. During year 1 of the study, 15% of finasteride-treated patients and 7% of placebo-treated patients had sexual AEs that were considered drug related by the investigator (P Ͻ0.001). During years 2 to 4, no between-group difference was noted in the incidence of new sexual AEs (7% in each group). The drug-related sexual AE profile for finasteride was similar for men with or without a history of sexual dysfunction. Sexual AEs resolved while continuing therapy in 12% of finasteride patients and 19% of placebo patients. Only 4% of finasteride and 2% of placebo patients discontinued the study because of sexual AEs. In men who discontinued with a sexual AE, 50% and 41% experienced resolution of their sexual AE after discontinuing finasteride or placebo therapy, respectively. Conclusions. Compared with placebo, men treated with finasteride experienced new drug-related sexual AEs with an increased incidence only during the first year of therapy. UROLOGY 61: 579-584, 2003. B enign prostatic hyperplasia (BPH) can have a significant impact on a patient's health-related quality of life, including sexual function. Recent community-based studies have demonstrated an increased occurrence of sexual dysfunction in men that is associated with age 1 and symptomatic BPH, 2,3 with erectile dysfunction reported in more than 50% of men having the disease. 3,4 Finasteride,

Objective: While the lipido-sterolic extract of Serenoa repens (LSESr)ÐPermixon 1 Ðhas been shown to have an equivalent ef®cacy to ®nasteride in patients with benign prostatic hyperplasia (BPH), to date, there has been no valid comparison of phytotherapy with a-blockers. The aim of this study was to assess the equivalent ef®cacy of Permixon and tamsulosin. Methods: Eight hundred and eleven men with symptomatic BPH (I-PSS ! 10) were recruited in 11 European countries for a 12-month, double-blind randomized trial. After a 4-week run-in period, 704 patients were randomly assigned to either tamsulosin 0.4 mg/day (N 354) or Permixon 320 mg/day (N 350). I-PSS, QoL and Q max were evaluated at baseline and periodically for 1 year. Prostate volume and serum prostate-speci®c antigen (PSA) were measured at selection and at endpoint. The endpoint analysis was performed on the per-protocol population of 542 patients (tamsulosin: N 273; Permixon: N 269). Results: At 12 months, I-PSS decreased by 4.4 in each group and no differences were observed in either irritative or obstructive symptom improvements. The increase in Q max was similar in both treatment groups (1.8 ml/s Permixon, 1.9 ml/s tamsulosin). PSA remained stable while prostate volume decreased slightly in the Permixon-treated patients. The two compounds were well tolerated, however, ejaculation disorders occurred more frequently in the tamsulosin group. Conclusion: This study demonstrates that Permixon and tamsulosin are equivalent in the medical treatment of lower urinary tract symptoms in men with BPH, during and up to 12 months of therapy. #

Context: A new formulation of tamsulosin for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) has been developed. This formulation uses the proprietary oral controlled absorption system (OCAS 1 ) technology which has the potential to better control the release during passage of the gastrointestinal tract including the colon and which may be devoid of a food effect. This study describes the characteristics of the tamsulosin OCAS formulation with respect to single and multiple dose human pharmacokinetics (PK). Methods: The single dose PK of three tamsulosin OCAS 0.4 mg formulations (S2, S3 and S4) in comparison with tamsulosin modified release (MR) 0.4 mg capsules were analysed in 12 young healthy volunteers in a 4-way crossover study to allow selection of a candidate for further development.

Benign prostatic hyperplasia (BPH) is the noncancerous proliferation of the prostate gland associated with benign prostatic obstruction and lower urinary tract symptoms (LUTS) such as frequency, hesitancy, urgency, etc. Its prevalence increases with age affecting around 70% by the age of 70 years. High activity of 5␣-reductase enzyme in humans results in excessive dihydrotestosterone levels in peripheral tissues and hence suppression of androgen action by 5␣-reductase inhibitors is a logical treatment for BPH as they inhibit the conversion of testosterone to dihydrotestosterone. Finasteride (13) was the first steroidal 5␣reductase inhibitor approved by U.S. Food and Drug Administration (USFDA). In human it decreases the prostatic DHT level by 70-90% and reduces the prostatic size. Dutasteride (27) another related analogue has been approved in 2002. Unlike Finasteride, Dutasteride is a competitive inhibitor of both 5␣-reductase type I and type II isozymes, reduced DHT levels >90% following 1 year of oral administration. A number of classes of non-steroidal inhibitors of 5␣-reductase have also been synthesized generally by removing one or more rings from the azasteroidal structure or by an early non-steroidal lead (ONO-3805) (261). In this review all categories of inhibitors of 5␣-reductase have been covered.

Objectives. To evaluate the efficacy and tolerability of the selective alpha 1 -adrenergic antagonist doxazosin and the 5-alpha-reductase inhibitor finasteride, alone and in combination, for the symptomatic treatment of benign prostatic hyperplasia. Methods. In a prospective, double-blind, placebo-controlled trial, 1095 men aged 50 to 80 years were randomized to treatment for 52 weeks with doxazosin, finasteride, the combination of doxazosin and finasteride, or placebo. The dose of finasteride (or its matched placebo) was 5 mg/day. Doxazosin (or its matched placebo) was initiated at 1 mg/day, and titrated up to a maximum of 8 mg/day over approximately 10 weeks according to the response of the maximal urinary flow rate (Qmax) and International Prostate Symptom Score (IPSS). The IPSS and Qmax were assessed at baseline and at weeks 10, 14, 26, 39, and 52 or at the endpoint.

Preoperative intra-individual variation for determinations of prostate-specific antigen and prostatic acid phosphatase concentrations, 15-30% in 92 patients with benign prostatic hyperplasia, limits the diagnostic usefulness of both tumor markers. In benign prostatic hyperplasia (214 patients), concentrations of these tumor markers increased in the initial postoperative period. Prostatic acid phosphatase concentration then decreased by the third postoperative day. Prostate-specific antigen concentration remained above normal in the first postoperative week but had decreased by 42 days. In prostatic carcinoma (46 patients), the concentrations of these tumor markers did not increase postoperatively. During the first week, the concentrations of prostatic acid phosphatase began to fall, but prostate-specific antigen showed a decrease only at 42 days. After orchidectomy (11 patients), the concentrations of both markers had decreased by five days. Concentrations of prostate-specific antigen but not of prostatic acid phosphatase were significantly increased in patients with metastases at 42 days postoperatively.