Hepatotoxicidad por tamsulosina / dutasterida: reporte de un caso probable

La tamsulosina y dutasterida son medicamentos ampliamente usados como tratamiento de la hipertrofia benigna de próstata. teniendo un buen perfil de seguridad. Existen escasos reportes de injuria hepática asociado al uso de tamsulosina; sin embargo, no hay reportes de toxicidad hepática por el uso de dutasterida y del uso combinado de tamsulosina/dutasterida. Se presenta el caso de un varón de 64 años quien desarrolla injuria hepática tras el uso combinado de tamsulosina/dutasterida, desarrollando un patrón de daño hepatocelular y clínica de hepatitis aguda. Se realizo descarte de patología hepática viral, autoinmune y enfermedades metabólicas de depósito, así como de patología biliar mediante ecografía abdominal y colangioresonancia. En la evaluación de causalidad, presentó CIOMS-RUCAM: 6 puntos (probable) y Naranjo: 4 puntos (posible). El paciente presentó respuesta clínica y laboratorial luego de suspender el medicamento.

Tamsulosin and dutasteride are drugs widely used to treat benign prostatic hypertrophy. having a good safety profile. There are few reports of liver injury associated with the use of tamsulosin; however, there are no reports of hepatic toxicity from the use of dutasteride and the combined use of tamsulosin/dutasteride. We present the case of a 64-year-old man who developed liver injury after the combined use of tamsulosin/dutasteride, developing a pattern of hepatocellular damage and acute hepatitis symptoms. Viral, autoimmune, and metabolic storage diseases of the liver were ruled out, as well as biliary pathology by means of abdominal ultrasound and resonance cholangiography. In the causality evaluation, CIOMS-RUCAM presented: 6 points (probable) and Naranjo: 4 points (possible). The patient presented a clinical and laboratory response after discontinuing the drug.

Utilidad del antígeno prostático específico total y del índice de antígeno prostático específico libre para detectar cáncer de próstata en el paciente asintomático / Utility of total prostate-specific antigen and free prostate- specific antigen index to detect prostate cancer in the asymptomatic patient

Resumen El antígeno prostático específico (PSA) en circulación se encuentra ligado a la alfa-1-quimiotripsina y una pequeña fracción circula de manera libre (PSAl). Se valoró la utilidad clínica del PSA total (PSAt) y el índice de PSA libre para la detección de cáncer prostático en pacientes asintomáticos. Se cuantificó el PSAt, el PSAl y el índice de PSAl en 364 pacientes estratificados por grupo de edad. La frecuencia de valores anormales de PSAt fue del 8,79% (32/364). El grupo de 50-59 años presentó la mayor incidencia de resultados anormales (19/32). No hubo diferencia estadísticamente significativa entre PSAt y el índice de PSAl (p<0,05). El índice PSAl puede potencializar el valor del PSAt para determinar la presencia o ausencia de cáncer prostático. Un índice superior a 0,24 ng/mL puede ayudar a evitar o posponer la indicación de biopsia, principalmente cuando los valores de PSAt están entre 4 y 10 ng/mL.

Abstract Circulating prostate-specific antigen (PSA) is bound to alpha-1-chymotrypsin and a small fraction is free (PSAl). The clinical utility of the total PSA (PSAt) and the PSAl index for prostate cancer screening in asymptomatic patients was assessed. PSAt, PSAl and the PSAl index were quantified in 364 patients stratified by age group. The frequency of abnormal PSAt values was 8.79% (32/364). The 50-59 year-old group presented the highest incidence of abnormal results (19/32). There was no statistically significant difference between PSAt and the PSAl index (p<0.05). The PSAl index can potentiate the PSAt value to determine the presence or absence of prostate cancer. An index greater than 0.24 ng/mL can help to avoid or postpone the indication for a biopsy, especially when the PSAt values are between 4 and 10 ng/mL.

Resumo O antígeno prostático específico (PSA) em circulação é ligado à alfa-1-quimotripsina e a uma pequena fração circula livremente (PSAl). A utilidade clínica do PSA total (PSAt) e do índice de PSAl livre para o rastreamento do câncer de próstata em pacientes assintomáticos foi avaliada. PSAt, PSAl e o índice de PSAl foram quantificados em 364 pacientes estratificados por faixa etária. A frequência de valores anormais de PSAt foi de 8,79% (32/364). O grupo de 50-59 anos apresentou a maior incidência de resultados anormais (19/32). Não houve diferença estatisticamente significativa entre o PSAt e o índice PSAl (p<0,05). O índice PSAl pode potencializar o valor do PSAt para determinar a presença ou ausência de câncer de próstata. Um índice superior a 0,24 ng/mL pode ajudar a evitar ou adiar a indicação de biópsia, principalmente quando os valores de PSAt estão entre 4 e 10 ng/mL.

A Study of Immunohistochemical Expression of Epidermal Growth Factor Receptor in Prostatic Lesions

Epidermal growth factor receptor (EGFR) is a 170-kDa tyrosine kinase transmembrane glycoprotein expressed in normal tissues in many organs and different types of tumours. In prostate, EGFR is expressed mainly in epithelial cells, phosphorylation of EGFR (pEGFR) which is assessed by immunohistochemical methods could be useful prognostic marker for prostate cancer cases. Tumours may affect the surrounding non-malignant tissue and pEGFR immunoreactivity in the morphologically normal prostate tissue can be used to retrieve prognostic information. In this study the membranous and cytoplasmic expression of EGFR is checked in both the basal and luminal cells. Intensity of the staining and the pattern of the staining were noted in benign, in-situ and malignant lesions and it was found that the staining intensity of the luminal cells increase with a subsequent decreased staining in the basal layer as the lesion progress towards malignancy. Subsequently the staining intensity and patterns were correlated with the Gleason grade for triaging of the cases into different prognostic groups.

Prevalencia de hiperplasia benigna de próstata en mayores de 40 años como causa de insuficiencia renal crónica / Prevalencia of benign prostatic hyperplasia at age 40 as a cause of chronic renal failure

Con el objetivo de determinar la prevalencia de uropatía obstructiva crónica en pacientes mayores de 40 años con insuficiencia renal crónica como consecuencia de hiperplasia benigna de próstata (HBP), se desarrolló un estudio observacional, descriptivo y retrospectivo en una población conformada por todos los pacientes varones mayores de 40 años con insuficiencia renal crónica (IRC) como consecuencia de hipertrofia benigna de próstata, atendidos en el consultorio de Nefrología del Hospital EsSalud “Augusto Hernández Mendoza” de la ciudad de Ica, entre Mayo del 2011 y Abril del 2012; encontrándose que la edad promedio fue 74,3 ±0,9 años, el tiempo promedio de insuficiencia renal crónica fuede 28,8±1,2 meses, 62 (53,4 %) pacientes presentaron comorbilidades, siendo la diabetes mellitus la más frecuente (37; 31,9%), 62 (53,4%) pacientes recibían tratamiento farmacológico, 35 (30,17%) presentaron uropatía obstructiva crónica, con un tiempo de enfermedad promedio de 24,8±2,2 meses, ademas la presencia de diabetes mellitus (6; 16,2%) y la administración de antagonistas de calcio (7; 58,3%) se asociaron a uropatía obstructiva crónica; concluyendo que la uropatía obstructiva crónica es frecuente en el paciente con IRC a consecuencia de HBP y se asocia a diabetes mellitus y tratamiento con antagonistas de calcio. (AU)

In order to determine the prevalence of chronic obstructive uropathy in patients older than 40 years with chronic renal failure as a result of benign prostatic hyperplasia (BPH ) , an observational, descriptive and retrospective study was conducted in a population consisting of all male patients over 40 years with chronic (CRF) renal failure as a result of benign prostatic hypertrophy, served in the office of Nephrology Essalud " Augusto Hernandez Mendoza" Hospital of the city of Ica, between May 2011 and April 2012 , finding that the average age was 74.3 +/- 0.9 years, the average time of chronic renal failure was 28.8 +/- 1.2 months, 62 ( 53-4%) patients had comorbidities , diabetes mellitus being the most frequent ( 37, 31.9%) , 62 ( 53-4%) patients received pharmacological treatment, 35 ( 30.17 %) had chronic obstructive uropathy with a mean disease duration of 24.8 +/- 2.2 months, plus the presence of diabetes mellitus (6 , 16.2% ) and administration of calcium antagonists (7 , 58.3 % ) were associated with chronic obstructive uropathy, concluding that chronic obstructive uropathy is common in patients with CRF as a result of BPH associated with diabetes mellitus and calcium antagonist therapy. (AU)

Clinical effect of suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy / 中国基层医药

Objective To evaluate the safety and efficacy of suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy in basic hospital.Methods The clinical datas of 85 patients with large volume and high-risk benign prostatic hypertrophy for suprapubic transvesial prostatectomy in our hospital were retrospectively analyzed.The operating time,intra-operative blood loss,the mean bladder irrigating time,catheration time,hospital stay and operative complications were observed.The indices such as IPSS,QOL,Omax and PVR were recorded preoperatively,and at 6 and 12 months postoperatively.Results The mean operating time was (63.5 ± 18.2) min,the intra-operative blood loss was (121.3 ± 10.6) ml,the mean bladder irrigating time was (4.2 ±0.6)days,the catheration time was (5.1 ± 1.7) days and the hospital stay was (7.8 ±2.3)days.At 6 and 12 months postoperatively,IPSS,OOL,Omax and PRV were significantly different compared with those preoperatively(all P ＜0.05).There were few complications and great patients satisfaction with the post-operative results.Conclusion suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy has significant advantages of good safety,simple operation,reliable efficacy in basic hospital.It is an effective and alternative method.

Predicting Outcome of Trial of Voiding Without Catheter in Acute Urinary Retention with Intravesical Prostatic Protrusion

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.

A clinical research of transurethral plasmakinetic resection of prostate for benign prostatic hyperpla-sia / 中国医师杂志

Objective To investigate clinical efficacy and safety and complications of transurethral plasmakinetic resection of prostate ( PKRP) for benign prostatic hyperplasia ( BPH) .Methods Totally 186 BPH patients were underwent PKRP .Comparison of clinical parameters before and after operation .Results Following-up at 3 and 6 months after the operation showed that international prostate symptom score ( IP-SS),quality of life(QQL),residual urine volume(RUV) scores increased and maximal urinary flow rate ( Qmax) scores decreased .The incidence of complications was 8.2%.Conclusion PKRP have efficacy in the treatment of BPH , and PKRP is safer and less complications .

Effect of Prostatectomy on Detrusor Instability Associated with Benigh Prostatic Hyperplasia: 11 Cases

PURPOSE: Detrusor instability is common in men with benign prostatic hypertroplasia(B.P.H.) and known to be reversed in about two thirds of patients after operation. We evaluated the fate of detrusor instability in B.P.H patients after operation. MATERIALS AND METHODS: In 11 patients with urgency or urge incontinence combined with B.P.H., cystometries were performed at baseline and 3 months after operation. RESULTS: Detrusor instability associated with B.P.H was reversed postoperatively in 7 patients (63.6%). CONCLUSIONS: Detrusor instability with urgency or urge incontinence can be managed by operation for B.P.H. This will improve the quality of life for B.P.H. patients.

Cost-effectiveness Analysis of Four Different Drugs for Benign Prostatic Hypertrophy / 中国药房

AIM:To evaluate the economic effectiveness of different therapeutic schemes for benign prostatic hypertrophy METHODS:175 patients with benign prostatic hypertrophy were divided into 4 groups:A,B,C and D They received different drugs,A:tamsulosin(34),B:prostat(45),C:tedenan(46) and D:qiangliexin(50) RESULTS:The costs of A,B,C,D schemes were RMB 492 80,499 52,526 40 and 664 16 yuans,respectively,and the effective ratios were 85 3%,82 2%,80 4% and 80 0%,respectively CONCLUSION:According to the evaluation with pharmacoeconomic cost-effectiveness analysis,A is the best scheme

Effects of Benign Prostatic Diseases on the Level of Serum Prostate Specific Antigen / 대한비뇨기과학회지

PURPOSE: Prostatic specific antigen (PSA) may be elevated in patients with benign prostatic diseases. We evaluated the causes of elevated serum prostatic specific antigen concentration in men without prostatic carcinoma by periodic determination of serum PSA. MATERIALS AND METHODS: From January 1996 to December 2000, of the 85 patients with elevated serum PSA (>4 ng/ml), 53 (62.4%) had clinical evidence of benign prostatic diseases such as BPH or acute prostatic inflammation. In 47 patients serum PSA was measured every 1-4 weeks until the PSA returned to base line level. RESULTS: In 42 (89.4%) patients the serum PSA concentration decreased to less than 4 ng/ml. within 3 months. The recovery rate of serum PSA within 4 weeks was high at 69% (29 of 42). The base line PSA was greater than 4 ng/ml during the follow-up period of 3 months in five patients. An elevation of PSA by acute prostatic inflammation (mean 34.1 40.0ng/ml) was abrupt and significantly greater than by prostatic hyperplasia (12.4 9.4 ng/ml, p=0.026). In patients with BPH, an initial elevation in serum PSA correlated with prostatic volume (r2=0.211, p=0.036), but no significant correlations between prostatic volume and elevated PSA levels were observed in patients with acute prostatic inflammation (r2=0.051, p=0.480). CONCLUSIONS: Benign prostatic hypertrophy and acute prostatic inflammation were main benign causes for serum PSA elevation. Majority of patients with elevated PSA by benign causes returned to base line less than 4 ng/ml in 4 weeks. However in some patients the serum PSA still remained elevated after 4 weeks, who should undergo TRUS guided biopsy of prostate to rule out the presence of malignancy. We recommended to wait at least 6 weeks for a repeat PSA determination.

Comparative evaluation of open surgery and transurethral management for bladder outlet obstruction caused by benign prostatic hyperplasia of small volume / 中华泌尿外科杂志

Objective To evaluate open surgery vs transurethral management for bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH) of small volume. Methods From May 1993 to June 2002,50 patients were surgically treated.Of them 22 underwent open surgery and 28 underwent TURP plus transurethral incision of bladder neck(TUIBN).There was no statistically significant difference between the 2 groups in age,disease course,preoperative prostate weight and the excised prostate weight.All the surgical procedures were conducted by the same urologist.The efficacy of open surgery and TURP plus TUIBN was comparatively evaluated by IPSS,Qmax and post void residual urine volume(PVR) and hospitalization days. Results The IPSS of those undergoing open surgery decreased from 24.6?3.8 of preoperation to 15.2?3.4 of postoperation ,and the Qmax increased from (8.3?2.9)ml/s to (9.5?3.6)ml/s,and the PVR decreased from(220.0?30.0)ml to(90.0?20.0)ml,and the postoperative hospital stay was 14.2 days.The IPSS of the patients undergoing TURP plus TUIBN decreased from 24.9?4.2 to 5.8?2.7,and the Qmax increased from (8.0?3.1)ml/s to (23.2? 3.8)ml/s,and the PVR decreased from(230.0?28.0)ml to(15.0?4.0)ml,and the postoperative hospital stay was 8.5 days.The postoperative improvement was much greater in the patients undergoing TURP plus TUIBN than those undergoing open surgery as assessed by IPSS,Qmax and PVR (all P

5-alpha reductase inhibitor: a new therapeutic option in the treatment of benign prostatic hypertrophy

A placebo-controlled randomized study of 60 patients over 50 years was undertaken to measure the effectiveness of finasteride in the management of BPH. Significant changes in the uterine flow rate, PSA level, mass volume and symptom severity score were noted.

Clinical Results Comparing Transurethral Needle Ablation with Transurethral Resection of Prostate for the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: We compared the outcome of transurethral resection of the prostate (TURP) with that of transurethral needle ablation(TUNA) of the prostate in patient with BPH. MATERIALS AND METHODS: From May 1996 to April 1997, 21 patients were treated with TURP and 25 with TUNA. In TURP group, the mean age was 67.2 years and mean prostatic volume was 52.7ml. In TUNA group, the mean age was 67.2 years and mean prostatic volume was 32.1ml. Assessment parameters were International Prostate Symptom Score(1-PSS), quality of life question, uroflowmetry and complications. Post-treatment morbidity was noted if the patients experienced erectile dysfunction, retrograde ejaculation or urinary incontinence. Patients were examined at 3 months from the day of treatment. RESULTS: At 3 months, the maximum flow rate improved from the mean of 10.2+/- 3.2m1/sec to 20.5+/-10.7m1/sec for the TURP group and 9.3+/-1.9m1/sec to 12.5+/-4.3 for the TUNA group. 1-PSS improved from the mean 22.0+/-7.6 to 6.4+/-4.6 for the TURP group and 21.2+/-6.6 to 13.1+/-6.8 for the TUNA group. Quality of life improved from the mean 3.8)1.6 to 1.3+/-1.0 for the TURP group and 4.3+/-0.9 to 2.9+/-1.1 for the TUNA group. Erectile dysfunction was reported in 43% (9/21) of TURP and 5%(1/20) of TUNA. Retrograde ejaculation was reported in 57%(12/21) and urinary incontinence was in 5%(1/21) of TURP. Retrograde ejaculation and urinary incontinence was not reported with TUNA. The mean operation time, hospital stay and a catheterization time in the TUNA group were 45.4min, 1.2days, 4.4days in comparison with 58.7min, 7.0days, 3.6days in the TURP group. CONCLUSIONS: After TURP and TUNA, there was significant improvement in all clinical parameters. But TURP was more effective in improving maximum flow rate, 1-PSS and quality of life. TUNA, however, produced minimal morbidity with no serious complication. With acceptable low morbidity, TUNA appears to be a safe and effective procedure in the treatment of BPH.

The effects of Intraurethral Stent (Intraurethral Cath) for the Treatment of Benign Prostatic Hypertrophy / 대한비뇨기과학회지

Transurethral resection of Prostate(TURP) is the current optimal therapy for benign prostatic hypertrophy. But in some cases of BPH patients, TURP cannot be performed because the patients have medical disorders not to be operated. Thus several alternatives have been used in the management of BPH patients, especially who had anesthetic contraindications to an operation. We experienced 12 cases of BPH patients applied with Intraurethral Cath(IUC) from April 1991 to September 1995. Eleven patients became able to void after IUC insertion. The maximal flow rates were 5.1 to 15.7 ml/sec and average value was 11.8 ml/sec. Almost all patients showed irritative voiding symptoms such as urgency, urge incontinence, frequency, and dysuria at first. In 7 patients, these symptoms disappeared spontaneously within 2 to 5 days and oxybutynin chloride was used orally in 2 patients. Suprapubic cystostomy was done in three patients because two patients had severe irritative voiding symptoms and one patient had persistent urinary retention. The stent was changed every 3 to 6 months. Stone formation around the device was noted in 2 patients and migration of device into the bladder was found in 2 patients. In 4 patients, TURP was performed when the patient's condition improved enough to be operated under epidural anesthesia. In conclusion, the use of IUC is thought to be a valid, cost effective and safe alternative to TURP in the treatment of highly operative risk patients with benign prostatic hypertrophy.

A Clincal Study of 401 Benign Prostatic Hypertrophy Patients / 대한마취과학회지

Benign prostsatic hypertrophy is a common disease of middle-aged and elderly men that nacessitates surgical resection of ths prostatic gland, and tranaurethral resetion is the second most common surgical procedure in men over the age 65. This geriatric patient population generally carries greater anesthetic risk than the young because of greater prevalenee of coexisting cardiovascular or pulmonary diseases. Futhermore,because transurethral resection carries a number of complications such as bleeding requiring transfusion, TURP syndrome, arrhythmia, hemolysis, coagulopathy, sepsis, bladder perforation, and pulmonary edems, transurethral resection is of concern to anesthesiologists. Thus, we had reviewed clinical records of 40lcases of benign prostatic hypertrophy and performed clinical and statistical analysis according to sge, ASA physical status, preoperative abnormal laboratory findings, combined disesses, anesthetic techniques, resection time of prostate, volume of irrigation fluid, weight of resected prostate, transfusion, intraoperative and postoperative complications. The results were as follows. 1) Of the 401 cases, 175 cases(43.6% ) were 61-70 years of age. 2) The most common ASA physical status was class 2(73.6%). 3) Of the operative methods, most common was TURP(89.5% ). 4) Preoperative cheat X-ray evaluation showed abnormalities in 167 cases(41.6%); 52 cases(31.1% ) had hypertensive heart configuration, 40 cases(24.0% ) had inactive pulmonary tuberculosisnd 39 case(23.4%) had pleural thickening. 5) Preoperative abnormal ECG findings were found in 150 casee(37.4%); 52 cases(34.7 %) had LVH, 43 cases(28.7%) had heart block,and 35 csses(23.3%) had myocardial ische-mia. 6) Preoperative pulmonary function test showed abnormalities in 101 cases(25.2%), most common abnormal finding was small airway obstruction disease(22.8% ). 7) The sssociated diseases were 146 cases(36.4%) snd most commonly associated disease was hypertension(36.3%). 8) The number of epidural anesthesia was performed in 218 cases(54.4%); general anesthesia, in 118(29.4%) and spinal anesthesia,in 65(16.2%). The duration of resection time was less than 1 hour in 315 cases(87.8%). 9) The mean value of the volume of irrigation fluid was 15.6+/-8.2L, and the mean value of weight of resected prostate was 22.4+/-16.9g. 10) Total number of intraoperative complications were 60 cases; 6 cases were ECG abnormalities, 32 cases were bleeding, and 12 csses were intraoperative hypotension. Postoperative complications were bleeding and acute myocardial infarction, but there was no death.

A Clincal Study of 401 Benign Prostatic Hypertrophy Patients / 대한마취과학회지

Benign prostsatic hypertrophy is a common disease of middle-aged and elderly men that nacessitates surgical resection of ths prostatic gland, and tranaurethral resetion is the second most common surgical procedure in men over the age 65. This geriatric patient population generally carries greater anesthetic risk than the young because of greater prevalenee of coexisting cardiovascular or pulmonary diseases. Futhermore,because transurethral resection carries a number of complications such as bleeding requiring transfusion, TURP syndrome, arrhythmia, hemolysis, coagulopathy, sepsis, bladder perforation, and pulmonary edems, transurethral resection is of concern to anesthesiologists. Thus, we had reviewed clinical records of 40lcases of benign prostatic hypertrophy and performed clinical and statistical analysis according to sge, ASA physical status, preoperative abnormal laboratory findings, combined disesses, anesthetic techniques, resection time of prostate, volume of irrigation fluid, weight of resected prostate, transfusion, intraoperative and postoperative complications. The results were as follows. 1) Of the 401 cases, 175 cases(43.6% ) were 61-70 years of age. 2) The most common ASA physical status was class 2(73.6%). 3) Of the operative methods, most common was TURP(89.5% ). 4) Preoperative cheat X-ray evaluation showed abnormalities in 167 cases(41.6%); 52 cases(31.1% ) had hypertensive heart configuration, 40 cases(24.0% ) had inactive pulmonary tuberculosisnd 39 case(23.4%) had pleural thickening. 5) Preoperative abnormal ECG findings were found in 150 casee(37.4%); 52 cases(34.7 %) had LVH, 43 cases(28.7%) had heart block,and 35 csses(23.3%) had myocardial ische-mia. 6) Preoperative pulmonary function test showed abnormalities in 101 cases(25.2%), most common abnormal finding was small airway obstruction disease(22.8% ). 7) The sssociated diseases were 146 cases(36.4%) snd most commonly associated disease was hypertension(36.3%). 8) The number of epidural anesthesia was performed in 218 cases(54.4%); general anesthesia, in 118(29.4%) and spinal anesthesia,in 65(16.2%). The duration of resection time was less than 1 hour in 315 cases(87.8%). 9) The mean value of the volume of irrigation fluid was 15.6+/-8.2L, and the mean value of weight of resected prostate was 22.4+/-16.9g. 10) Total number of intraoperative complications were 60 cases; 6 cases were ECG abnormalities, 32 cases were bleeding, and 12 csses were intraoperative hypotension. Postoperative complications were bleeding and acute myocardial infarction, but there was no death.

Preliminary Results of Terazosin in the Treatment of Benign Prostatic Hypertrophy / 대한비뇨기과학회지

The literature has suggested that alpha-receptor blockade may have therapeutic value in treating the symptoms of patients with benign prostatic hypertrophy. Terazosin is an alpha-1 adrenergic blocking agent approved by the FDA for the treatment of benign prostatic hypertrophy. We treated 30 patients with symptomatic benign prostatic hypertrophy in double- blind fashion using terazosin and placebo. In placebo group, mean total symptom score was decreased from 9.8 to 7.7 (p 0.05). In terazosin group, the symptom score changes in obstructive and irritative were from 6.1 to 3.3 and from 4.5 to 5.9 (p <0.0001), respectively, and changes in maximal and mean urinary flow rates were from symptoms 8.7 to 10.2 and from 4.2 to 5.9, respectively (p<0.0001). There were significant improvements in all parameters in terazosin group when compared with placebo group (p<0.05). It was concluded that terazosin is beneficial for treatment of obstructive symptoms in patients with benign prostatic hypertrophy.

Acupuncture for Benign Prostatic Hypertrophy / 全日本鍼灸学会雑誌

A male patient aged 70 years, diagnosed as the benign prostatic hypertrophy (BPH) stage I, was the subject of this study. The effectiveness of acupuncture was evaluated by uroflowmetry (UFM). The patient received acupuncture treatments once a week for 5 weeks. Disposable needles (0.30mm in diameter), were inserted into bilateral Zhongliao (BL-33) points and rotated manually for 10 minutes. Average flow rate (AFR), maximum flow rate (MFR) and flow curve (FC) were used to evaluate the effectiveness of acupuncture treatment. The AFR before acupuncture, immediately after the treatments and twelve months after the cessation of acupuncture were 3.2ml/s, 11.4ml/s and 2ml/s, respectively. The MFR were 10ml/s, 20ml/s and 10ml/s, respectively. FC was observed as normal pattern during the treatment, but the obstructive pattern were recorded before and after the treatment.<br>Acupuncture treatment to the BL-33 points for BPH was shown to be useful although the effect was not long-lasting.

The clinical value of IVP in BPH / 대한비뇨기과학회지

Routine use of the IVP in preoperative evaluation of patients with obstructive bladder outlet symptoms has been questioned on the basis of the chance of incidental finding in the upper tract and the implication of such findings to management. We studied 220 patients who underwent intravenous pyelography before prostatectomy at Department of Urology, Sanggye Paik Hospital from Oct. 1989 to Jun 1992. Of 220 patients, 183( 83.2% ) showed normal upper tract with cystogram compatible with benign prostatic hyperplasia. Abnormalities were found in 37( 16.8% ) patients but treatment plan was altered in only 5(2.25% ) cases. Most of these abnormalities could be detected on KUB or cystoscopy. Only one(0.45% ) malignancy would have been missed without routine IVP. We conclude that IVP in our opinion should not be performed as a routine procedure in patients with benign prostatic hypertrophy, but only in selected cases.

The effect of prazosin as a first-line therapy for the symptomatic benign prostatichypertrophy / 대한비뇨기과학회지

We evaluated 41 patients with symptomatic benign prostatic hypertrophy who were treated with prazosin alone more than 3 months. Among them, 21 patients( 51.2%) showed improvement of both symptom score and maximal flow rate. There was the similar effectiveness on the patients with acute urinary retention as on the patients without retention. The pretreated prostate volume and prostate specific antigen were not statistically different between the responders and nonresponders.After with drawl of the medication, almost all patients immediately complained of the symptoms worsened again. So, we concluded that the d-blocker can be used as a first-line therapy in selected patients with symptomatic benign prostatic hypertrophy with temporal effect.