Protective Role of 4-(4-Hydroxy-3-methoxyphenyl)-2-Butanone on Prostatic Cells Hyperplasia of Rats and Human, 5α-reductase Inhibition Pathway.

BACKGROUND: Prostate gland is an exocrine gland that could be affected by various pathological conditions. Benign prostatic hyperplasia (BPH) is an age-dependent medical condition caused by increased activity of 5α-reductase enzyme (5α-R). Medical treatment by finasteride is considered during treatment, but it has unavoidable side effects. Hence, there is an increasing need to use natural ingredients for BPH treatment. Gingerol oil (ginger extract) is transferred by heating into zingerone. Recent studies reported the effect of zingerone on prostate cancer cells. AIMS AND OBJECTIVES: The aim of the present research is to investigate the protective effect of zingerone against BPH. MATERIALS AND METHODS: Sixty male Albino Wistar rats were divided into three groups: control group, prostatic hyperplasia group treated with saline, and prostatic hyperplasia group treated with zingerone (PH-Z-G). At day 28, all rats were sacrificed, epididymis and prostate samples were collected for histopathological examination and Western blotting for androgen receptors (ARs) proteins and steroid 5 alpha-reductase 1 (SRD5A1). Human RWPE-1 prostatic cell line was assessed for viability and cycle after treated with zingerone 500 µg/day for 10 days. RESULTS: PH-S group showed significant (P < 0.05) thickening of connective tissue septa associated with narrowing of acinar lumen. PH-Z group showed regain of the normal histological feature. SRD5A1 and AR expression was significantly (P < 0.05) reduced in PH-Z group in comparison with PH-S group. Cell line proliferation was significantly reduced after application of zingerone with G2/M cell cycle arrest. CONCLUSION: Our results showed that natural herbal zingerone decreased the prostatic tissue levels of (5α reductase and AR) in rat BPH model, which could be a promising herbal medicine for BPH treatment. Further human clinical trials are required.

Perioperative use of cyproterone acetate with transurethral resection of large prostate: preliminary results.

PURPOSE: To assess the impact of short-term treatment with cyproterone acetate (CPA) on intraoperative and early postoperative complications of transurethral resection of relatively large prostate. PATIENTS AND METHODS: We recruited patients with prostate size of 60-90 g and randomized them into two equal groups. The first one had 50 mg of CPA orally twice a day (bds) for 2 weeks before the operation and maintained it for an extra week postoperatively. The other group received placebo. All patients underwent monopolar transurethral prostatectomy (M-TURP) and the prostatic chips were stained for CD34 specific for nascent blood vessels. RESULTS: Ninety-five patients were included. Mean patient age was 60.88±2.5 years and mean prostate size was 72.76±7.21 g. CPA was well tolerated with no serious adverse effects. The mean resection time and the mean weight of the resected tissue were comparable between the two groups. Intraoperative blood loss, fluid absorption, and blood loss per gram of resected tissue (259.47±78.27 mL, 787.38±300.56 mL, and 14.87±4.02 mL/g and 327.25±98.97 mL, 937.4±350.2 mL, and 17.08±5.55 mL/g, respectively) were significantly lower in the treatment group (p<0.05). In addition, excessive postoperative bleeding was encountered in one case in the treatment group and in seven in the control (p<0.05). Finally, the histopathological study revealed that the mean microvessel density in each of the suburethral portion and the hyperplastic nodules of the prostate was significantly lower in the CPA group (p<0.001). CONCLUSION: The perioperative use of CPA with M-TURP of a relatively large prostate may help in decreasing the perioperative bleeding and fluid absorption that usually take place during this procedure.

Does the type of urinary diversion affect the result of distal hypospadias repair? A prospective randomized trial.

PURPOSE: The purpose of this review is to evaluate different techniques in urinary diversion and urethral stenting in hypospadias surgery. PATIENTS AND METHODS: The surgical procedure included 192 tubularized incised plate (TIP) repairs for distal penile hypospadias. The patients were prospectively randomized into three groups: In group A, a urethral catheter was used as a stent and for diversion of urine (63 patients); in group B we use no urethral stenting (63 patients), only a suprapubic catheter; and in group C we use a suprapubic diversion and we put a small catheter in the anterior urethra only (66 patients). The urethral catheter was removed in group A at the 6th-7th postoperative day and in group C the urethral stent was removed at the 3rd-4th postoperative day. The suprapubic catheter was removed in both groups B and C at the 7th-9th postoperative day. All patients received an injection of antibiotics in the morning of the operation and daily until the day of catheter removal. All of the operations were performed by the same surgeon. RESULTS: The mean ages of our patients were 3, 5, and 5 years in groups A, B, and C, respectively. The mean hospital stay was 5 days (3-8). Follow-up ranged from 8 to 48 months (mean of 21.5 ± 10.1 months). Bladder spasm was observed in 33% of our patients in group A while there were no cases of spasm in the other two groups with a statistically significant difference (p < 0.05). Fistula was reported in eight patients (12.7%) of our urethral catheter group A, while it was observed in three patients (2.3%) of our suprapubic diversion groups B and C with a statistically significant difference between the two groups (p < 0.05). Meatal stenosis was reported in eight patients in group B (12.7%; nonstented group) versus three patients of both groups A and C (2.4%; stented groups) with a statistically significant difference (p < 0.05). CONCLUSION: Suprapubic diversion is an important step in hypospadias repair as it provides a better success rate with a significantly lower rate of occurrence of fistula. However, the addition of a stent in the anterior urethra to suprapubic diversion avoids the development of meatal stenosis and also avoids the bladder spasm observed with a urethral catheter.