Association between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure: a single-center cross-sectional study

ABSTRACT BACKGROUND: Lower urinary tract symptoms significantly worsen quality of life. The hypothesis that they might lead to serious systolic blood pressure alterations through inducing sympathetic nervous activity has not been studied so far. OBJECTIVES: To investigate the relationship between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure. DESIGN AND SETTING: Cross-sectional single-center study on data from a hospital patient record system. METHODS: We evaluated the medical records of all consecutive patients with benign prostate enlargement-related lower urinary tract symptoms admitted between January 2012 and December 2017. Storage and voiding symptoms were assessed separately. International Prostate Symptom Score, uroflowmetry, postvoiding residual urine volume and systolic blood pressure were recorded. Pearson correlation and linear regression analysis were used. RESULTS: Positive correlations were found between systolic blood pressure and all of the storage symptoms. Among these, urgency had the most significant effect. There were 166 patients (41.4%) with urgency for urination, which increased mean systolic blood pressure from 124.88 mmHg (average value in elevated blood pressure group) to 132.28 mmHg (average value in stage-1 hypertension group). Hesitancy in urinating and feeling of incomplete bladder emptying had weak positive correlations with systolic blood pressure. There was a negative correlation between systolic blood pressure and intermittency of urination. CONCLUSIONS: With increasing numbers of urine storage symptoms, systolic blood pressure also increases, while the opposite occurs for voiding symptoms in patients with benign prostate enlargement. We conjecture that storage symptoms may lead to this increase through inducing sympathetic hyperactivity. Further prospective studies with larger groups are needed to confirm these findings.

Relationship between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with urinary tract symptoms

ABSTRACT Objective: To evaluate correlation between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with lower urinary tract symptoms. Material and Methods: This is a cross sectional study conducted at a university Hospital. Sixty-seven adult male patients>50 years of age were enrolled in the study after signing an informed consent. Qmax and voided volume recorded at uroflowmetry graph and at the same time VPSS were assessed. The education level was assessed in various defined groups. Pearson correlation coefficient was computed for VPSS and Qmax. Results: Mean age was 66.1±10.1 years (median 68). The mean voided volume on uroflowmetry was 268±160mL (median 208) and the mean Qmax was 9.6±4.96mLs/sec (median 9.0). The mean VPSS score was 11.4±2.72 (11.0). In the univariate linear regression analysis there was strong negative (Pearson's) correlation between VPSS and Qmax (r=848, p<0.001). In the multiple linear regression analyses there was a significant correlation between VPSS and Qmax (β-http://www.blogapaixonadosporviagens.com.br/p/caribe.html after adjusting the effect of age, voided volume (V.V) and level of education. Multiple linear regression analysis done for independent variables and results showed that there was no significant correlation between the VPSS and independent factors including age (p=0.27), LOE (p=0.941) and V.V (p=0.082). Conclusion: There is a significant negative correlation between VPSS and Qmax. The VPSS can be used in lieu of IPSS score. Men even with limited educational background can complete VPSS without assistance.

The role of prolactin in prostatic inflammation / O papel da prolactina na inflamação prostática

Several reports have shown that prolactin (PRL) plays a role in prostatic growth, but few studies considered the role of PRL in the process of prostatic inflammation. Young (45 ± 5 days old) and adult (75 ± 5 days old) male Wistar rats were subcutaneously injected daily with domperidone (4.0 mg.kg-1) to maintain high serum PRL levels. The animals were treated for 15, 30, 45 or 60 days. Blood and prostate samples were collected at the end of each treatment for PRL dosage and histological analysis, respectively. Only young animals treated with DOMP for 15 and 30 days displayed inflammatory infiltrate in the prostate. These results confirm literature data in regards to PRL involvement in inducing prostate inflammation. Moreover, it was concluded that young animals are more susceptible then adults to the PRL action concerning prostate inflammation...

A prolactina (PRL) influencia o crescimento prostático, entretanto poucos estudos investigaram o papel da PRL na inflamação prostática. Ratos Wistar jovens (45 ± 5 dias de idade) e adultos (75 ± 5 dias de idade) receberam injeções subcutâneas diárias de domperidona (4,0 mg.kg-1) para manter níveis séricos altos de PRL. Os animais foram tratados por 15, 30, 45 ou 60 dias. Amostras de sangue e próstata foram coletadas ao final dos tratamentos para dosagem de PRL e análise histológica, respectivamente. Apenas os animais jovens tratados com domperidona por 15 e 30 dias apresentaram infiltrado inflamatório na próstata. Esses resultados confirmaram a participação da PRL na indução da inflamação prostática. A conclusão obtida foi que animais jovens são mais susceptíveis à ação da PRL na inflamação da próstata que os adultos...

Correlation between the presence of inguinal hernia and the intensity of lower urinary tract symptoms / Correlação entre a presença de hérnia inguinal e a intensidade dos sintomas do trato urinário inferior

PURPOSE: To verify the correlation between the presence of IH and the intensity of LUTS related to BPH quantified through the International Prostate Symptom Score (IPSS). METHODS: We prospectively selected 52 patients over the age of 55years; Patients were divided into 2 groups. Group 1: composed of 32 patients with IH; Group 2 (control group): composed of 20 patients with no clinical evidence of IH. All patients were assessed using the IPSS, uroflowmetry (Qmax), post-void residual urine volume (PVR) and prostate volume (PV). RESULTS: Groups 1 and 2 presented no difference in PV (p>0.05) and uroflowmetry (Qmax) (p>0.05). There was a statistical significant difference between the PVR mean values between groups 1 and 2. The presence of IH correlated with a higher IPSS score (r=0.38 p<0.05) despite the fact the no difference was detected between the incidence of patients with mild, moderate and severe LUTS in groups 1 and 2. CONCLUSION: Patients with IH present higher IPSS. The role of IPSS as a marker to predict the development of clinical IH still to be determined.

OBJETIVO: Verificar a correlação entre a presença de HI e a intensidade dos STUI quantificados através do escore internacional de sintomas prostáticos (IPSS). MÉTODOS: Foram selecionados prospectivamente 52 pacientes com idade superior a 55 anos; os pacientes foram divididos em 2 grupos. Grupo 1: composto por 32 pacientes portadores de IH, Grupo 2 (grupo controle): composto por 20 pacientes sem evidência clínica de IH. Os parâmetros avaliados foram: sintomas urinários, quantificados através do IPSS; fluxo urinário máximo (Qmax), obtido através da fluxometria livre; resíduo pós miccional (RM) e volume prostático (VP), obtido através do ultrassom transretal. RESULTADOS: Os grupos 1 e 2 não apresentaram diferença significativa em relação ao Qmax e VP (p>0.05). Foi detectada diferença estatística significativa entre em relação ao VR entre os grupos 1 e 2 (p<0.05). A presença de HI se correlacionou com o aumento da intensidade dos STUI (r=0,38; p<0.05). Não foi detectada diferença estatisticamente significativa entre a incidência de pacientes portadores de STUI, leve, moderado ou intenso entre os grupos 1 e 2. CONCLUSÃO: Pacientes portadores de HI apresentam escore de sintomas (IPSS) mais elevados, entretanto o papel dos sintomas urinários como um dos possíveis fatores causadores do aparecimento de HI ainda não foi determinado.

Impact of infection on the secretory capacity of the male accessory glands

INTRODUCTION: Studies that compare the impact of different infectious entities of the male reproductive tract (MRT) on the male accessory gland function are controversial. MATERIAL AND METHODS: Semen analyses of 71 patients with proven infections of the MRT were compared with the results of 40 healthy non-infected volunteers. Patients were divided into 3 groups according to their diagnosis: chronic prostatitis NIH type II (n = 38), chronic epididymitis (n = 12), and chronic urethritis (n = 21). RESULTS: The bacteriological analysis revealed 9 different types of microorganisms, considered to be the etiological agents, isolated in different secretions, including: urine, expressed prostatic secretions, semen and urethral smears: E. Coli (n = 20), Klebsiella (n = 2), Proteus spp. (n = 1), Enterococcus (n = 20), Staphylococcus spp. (n = 1), M. tuberculosis (n = 2), N. gonorrhea (n = 8), Chlamydia tr. (n = 16) and, Ureaplasma urealyticum (n = 1). The infection group had significantly (p < 0.05) lower: semen volume, alpha-glucosidase, fructose, and zinc in seminal plasma and, higher pH than the control group. None of these parameters was sufficiently accurate in the ROC analysis to discriminate between infected and non-infected men. CONCLUSION: Proven bacterial infections of the MRT impact negatively on all the accessory gland function parameters evaluated in semen, suggesting impairment of the secretory capacity of the epididymis, seminal vesicles and prostate. These findings were associated with an infectious related significant increase of semen pH. None of the semen parameters evaluated can be suggested as a diagnostic tool for infection.

Morphometric analysis of the fate of secretory epithelial cells in the ventral lobe of the rat prostate during massive apoptosis

Orchiectomy causes marked, rapid involution of the prostatic secretory epithelium. Concurrently, macrophages, which in normal glands are small and rarely occur at the base of the secretory epithelium, increase in size and number. Apoptotic cells are engulfed by companion epithelial cells and also by macrophages. In secretory cells and macrophages, dense bodies progressively increase in number and store membranes derived from dead cells of the secretory epithelium. In this work, we examined the contributions of the various routes of disposal of demised secretory epithelial cells of the rat prostate, induced to enter in apoptosis by retrieval of androgen. Specifi cally, we sought to determine how much membrane surface area derived from apoptotic cells of the secretory epithelium could be stored in dense bodies, and how these data compared with the disposal of dead cells via the glandular lumen. Glands from unoperated controls (day 0) and from rats examined 12 h and 1, 2, 3, 4, 5, 6, 7, 8, and 9 days after orchiectomy were studied morphometrically. The total membrane surface area of rough and smooth endoplasmic reticulum, Golgi apparatus, mitochondria and vesicles declined from 6.75 x 103 ìm2 in non-castrated rats to 1.12 x 103 ìm2 nine days after castration. Similarly, the total surface area of the secretory epithelium decreased from 10.6 x 1011 ìm2 in non-castrated rats to 0.204 x 1011 ìm2 nine days after castration. Geometrical models revealed that 1 ìm3 of dense body accommodated at least 142 ìm2 of myelin-like membrane surface area. Three to four days after castration, the total volume of intramacrophage dense bodies peaked (~5 x 106 ìm3) and represented 1-2% of the volume of intraepithelial dense bodies (~4 x 108 ìm3). The minimum membrane surface area that could be stored in dense bodies of the secretory epithelium on post-castration days 0, 1, 2, 3, 4 and 9 was 1.4%, 9%, 16%, 23%, 28% and 44%, respectively, of the total membrane surface area of the...

Prostate Shape and Symptom Score in Benign Prostatic Hyperplasia

Prostates of the same volumes were found to have very variable shapes, that is, combinations of variably elongated width, height, and lengths. These were believed to be possible causes of the differences in the severity of both the obstructions and symptoms in the prostates even when their volumes were similar. We measured the transverse (width), anterior-posterior (height) and longitudinal (length) diameters of the prostates and the transition zone, and their calculated volumes using transrectal ultrasonography. To establish the relationship between the International Prostate Symptom Score (IPSS) and each of the dimensional parameters of the transition zone and the total prostate, 105 consecutive patients (mean age 66.43 +/- 9.24 years with a range o6f 46 to 90) who had voiding dysfunctions that were presumably related to BPH were analyzed using the t-test. Patients with conditions other than BPH were excluded. The results were as follows: 1. There was no significant correlation between the IPSS and any prostate volume parameter in the constant prostate volume conditions, because of the small numbers in each group. However, in the analysis of the total number of cases in all the volume categories, a significant correlation was found between the IPSS and some prostate dimensions; i.e., the longitudinal parameters in the total prostates (p < 0.01), and the transverse (p < 0.05) and longitudinal parameters (p < 0.05) in the transition zones. 2. Further investigations of the statistics of these significant parameters showed that prostates that were longer than 4 cm had significantly more severe symptoms than prostates shorter than 4 cm (p < 0.05), and that prostates with a ratio of length in the transition zone to the length in the total prostate ratio that was greater than 0.8 had significantly higher symptom scores than those with lower ratios (p < 0.05). When evaluating patients who have BPH, it is important to consider the shape of prostate. More aggressive treatment may be indicated in cases where the transition zone lengths exceeds 4 cm and the transition zone to total prostate length ratio exceeds 0.8.

El dilema de la andropausia y el reemplazo hormonal en el hombre mayor / The dilemma of andropause and hormone replacement in the aged man

Los niveles de testosterona plasmática disminuyen con el correr de los años, calculándose que en un 20-30 por ciento de los hombres mayores de 60 años tiene valores por debajo de lo normal. Este estado de déficit ha sido denominado PADAM (déficit parcial de andrógenos en hombres de edad, por sus siglas en inglés). Los andrógenos en el adulto actúan sobre varias estructuras, como el hueso, el músculo, la hematopoyesis y la función sexual. La terapia de reemplazo hormonal puede realizarse con medicación oral o inyectable, debiendo valorarse los riesgos potenciales, especialmente sobre la próstata, lo que requiere un estricto monitoreo

Estudo estrutural, morfométrico e topoquímico do destino das células mortas nos epitélios secretores da próstata e da mama induzidos a sofrer apoptose maciça / Morphometric and topochemical studies on the fate of the dead cells in epithelia induced to suffer massive apoptosis

Apresentamos os resultados obtidos em estudos dos epitélios secretores do lobo ventral da próstata de ratos castrados e de glândula mamária de ratas em desmame induzido. Em ambas as glândulas o recrutamento de macrófagos e o destino das células epiteliais secretoras apoptóticas foram analisados näo só com observaçöes qualitativas e morfométricas ao MET mas tambée através de cortes de parafina submetidos à reaçäo para revelar o antígeno ED1, um indicador fiduciável da presença de macrófagos de rato. Ainda em cortes de parafina, uma abordagem de apariçäo de células apoptóticas foi feita usando a reaçäo de TUNEL. Baseados nas observaçöes ao microscópio eletrônico de que corpos apoptóticos dentro de macrófagos säo progressivamente compactados em corpos densos e que os corpos densos intra-epiteliais pareciam ser formados de modo similar, decidimos investigar se há algum fundamento para a suspeita de que a totalidade da área superficial de membranas epiteliais perdidas na apoptose maciça poderia ter sido progressivamente armazenada nos corpos densos dos macrófagos intra-epiteliais e nos corpos densos das células epiteliais

Evaluación clínica de la correlación entre el volumen prostático, el flujo urinario, la edad y el residuo posciccional en 250 pacientes con trastornos miccionales / Clinical evaluation of the correlation between prostatic volume (PV), peak flow rate (PFR), age, and post void residual urine (PVR) in 250 patients with lower urinary tract symptoms (LUTS)

Objetivo: Interpretar clínicamente los resultados de la correlación existente entre los parámetros objetivos que utilizamos en la evaluación de pacientes portadores de síntomas urinarios, en relación con la presencia de HPB. Material y métodos: se evaluó la variación de las relaciones entre el tscto rectal, la flujometría, el volumen prostático, la edad y el residuo, en 250 pacientes con síntomas urinarios. Resultados: El tamaño de la próstata aumentó con la edad, con un brusco incremento en la década de los 50 años (p<0,01), el Qmax fue menor (p<0,01) y el residuo fue más frecuente (p<0,01) cuanto más grande ( o más pesada) fue la próstata; del mismo modo se relacionó el menor flujo con la mayor prevalencia de residuo (p<0,01). mientras que la edad no demostró una influencia significativa (p>0.05) para condicionar estos resultados. Conclusión En los pacientes que consultan por trastornos miccionales en asociación con HPB clínicamente demostrable se observa una correlación estadísticamente significativa entre el mayor tamaño de la misma, un flujo bajo, menor de 10ml/s y la presencia de residuo posmicional clínicamente significativo, independientemente de la edad

Efficacy of transrectal microwave hyperthermia [TRMH] in treatment of abacterial prostatitis

Thirty patients with chronic abacterial prostatitis were randomly divided into two groups [15 cases each]. Group I was given medical treatment in the form of oral minocycline [100 mg] twice daily for three weeks, whereas group II was given the same medical treatment course combined with eight sessions [1-hour each thrice weekly] of TRMH [43 C] to the prostate. The efficacy of the treatment was evaluated by the effect on symptoms, clinical signs, white blood cells [WBCs] in expressed prostatic fluid [EPF], pre- and post-prostatic massage urinalysis and urodynamic measurements [flowmetry]. The results showed marked improvement of the symptoms and signs among group II patients [excellent results in six, good in three, fair in two and poor in four] and less improvement among group I patients [excellent in three, good in three and poor in nine] as assessed clinically. When a comparison was made between the mean difference of pre- and post-treatment values of groups I and II, superior results were detected with the latter. The mean difference of WBCs in EPF among group II was 19 +/- 9.32 compared with 9.2 +/- 8.2 among group I. Post-prostatic massage urinalysis mean difference in group II was 7.2 +/- 1.99, whereas in group I it was 3.1 +/- 3.93. The uroflowmetric studies showed mean difference Q max to be 4.3 +/- 2.63 in group II, whereas in group I it was 2.0 +/- 1.33. From the above data, it was concluded that transrectal microwave hyperthermia improved the outcome of therapy of chronic abacterial prostatitis and provided a potentially effective therapeutic modality for this condition

Precauciones para el anestesiólogo durante la resección transuretral de la próstata / Precautions for the anesthesiologist during trans-urethral resection of the prostate

Cuando hay ruptura de senos venosos o de la cápsula prostática durante la resección transuretral de la próstata, ingresa rápidamente al compartimiento vascula, líquido utilizado durante la irrigación continua, que desencadena sobrehidratación, hemodilución, hiponatremia, hemolisis e insuficiencia renal aguda. El tipo de líquido, la altura y presión de la columna hídrica, el peso del tejido resecado y la duración del tiempo quirúrgico son algunos factores que incrementan la incidencia de desarrollo al síndrome de reacción a la resección transuretral de la próstata, y aunque el anestesiólogo no es el responsable único de esta complicación, debe estar consciente de esta posibilidad para implementar las medidas preventivas y terapéuticas inherentes

Biopsia aspiracion con aguja fina de la prostata / Biopsy - fine needle aspiration of the prostate

El siguiente en un estudio prospectivo que busca comparar un procedimiento diagnóstico como la biopsia transrectal con aguja Tru-cut (Vinsilverman), propendiendo por establecer las ventajas y desventajas de cada procedimiento en cuanto a su precisión en el diagnóstico histológico, su baja morbilidad y su uso en forma repetitiva instaurándolo corno norma en nuestro servicio. Se presenta reporte preliminar en el cual se estudian 10 (diez) pacientes con sospecha clínica de Carcinoma Prostético y a quienes se les practicaron biopsias por aspiración con aguja fina y seguidamente biopsias con aguja Tru-cut con administración de antibioticoterapia pre y post procedimiento. Además practicaron biopsias por aspiración con aguja fina a 10 (diez) pacientes con próstata aumentada de tamaño pero de características clínicas benignas, sin preparación. A todos los pacientes se les practicó hemocultivo post procedimiento. Se hacen observaciones acerca de la técnica del procedimiento y del diagnóstico histológico de acuerdo a la experiencia del patólogo. Los resultados histológicos son similares, la morbilidad demostrada es baja, por lo tanto lo consideramos un método diagnóstico recomendable

Polipos de la uretra prostatica en adultos / Polypos of prostatic urethra in adults

Los pólipos de la uretra prostática pueden presentarse clínicamente como hematuria, hemospermia, obstrucción o disuria; ellos ocurren más frecuentemente de lo sospechado. La presentación clínica, los hallazgos uretrocistoscópicos, patológicos y el tratamiento son revisados. Nosotros informamos 3 casos de pólipos de la uretra prostática, creemos que son benignos y deberán ser resecados como una medida diagnóstica y algunas veces terapéutica

Prognostic importance of prostate-specific antigen in cancer prostate patients

Serum PSA was measured by radioimmunoassay in 52 patients with cancer prostate, 22 patients with regionally confined disease and 30 patients with [stage D2] advanced lesion. The results indicated that there was no significant difference between normal range of serum PSA and the group of patients, remained disease free during follow-up period. On the contrary, patients relapsed after initial treatment showed highly significant elevation of PSA in relation to the normal range [P >0.001]. There was also significant risk between elevated PSA level and disease progression in advanced diseases [stage D2] patients. The results indicate that PSA is a valuable marker in patients with prostate cancer not only diagnostic but also as prognostic indicator

Ausencia funcional de conductos eyaculadores / Functional absence of ejaculatory ducts

Se realizó un estudio retrospectivo de muestras de semen procedentes de 5 159 pacientes que se consultaron por infertilidad en un período de 8 años y 4 meses. En 188 casos se comprobó azoospermia (muestras seminales con ausencia de espermatozoides) y en 23 de los azoospérmicos se presentaron características seminales del síndrome de ausencia funcional de los conductos eyaculadores. Se compararon los valores bioquímicos del plasma seminal (fructosa, fosfatasa ácida, y glicerilfosforilcolina) de los pacientes con las características del síndrome con igual número de normozoospérmicos infértiles y azoospérmicos no obstructivos. Pudo comprobarse diferencia altamente significativa en los 3 indicadores (p < 0,005) entre los pacientes con el sídrome y los otros 2 grupos. Los resultados indican que estas determinaciones bioquímicas son útiles en el diagnóstico del síndrome sin necesidad de utilizar métodos quirúrgicos

Biopsia por aspiracion con aguja fina de la prostata / Prostatic carcinoma diagnosis of the fine needle aspiracion biopsy

De acuerdo con la literatura urológica utilizando la Biopsia por aspiración con aguja fina de la próstata (BACAF), la sensibilidad en el diagnóstico del Ca de próstata es igual o mayor a la tradicional con aguja Tru-cut, sin tener complicaciones ni molestias importantes para el paciente. Se estudiaron 42 pacientes en quienes al tacto rectal se encontró sospecha de malignidad, practicándoles la BACAF y la biopsia con Tru cut en el mismo acto. Se llevó a cabo un muestreo secuencial, comparando de modo doble ciego los resultados de la citología con los de la histología. Se practicaron en total 84 aspiraciones con aguja fina e igual número de BACAF diagnosticando Ca en el 30.9 de los pacientes. En la biopsia con Tru-cut se diagnosticó Ca prostático en el 22.6 por ciento de pacientes siendo negativo en 71.6 por ciento. Con BACAF, se diagnosticó Ca de próstata en el 27.3 por ciento y fue negativo en 38 por ciento. El nivel de correlación en cuanto a positividad fue del 100 por ciento. En la BACAF influye mucho para su éxito la experiencia del Urólogo y del Patólogo, habiendo encontrado material inadecuado en buen número de casos durante la curva de aprendizaje. Sin embargo, la BACAF es una técnica fácil de bajo costo y con pocas molestias

Colesterol y fosfolípidos en el plasma seminal humano antes y después de vasectomía / Cholesterol and phospholipids in seminal plasma before and after vasectomy

Antes y a los 2 y 6 meses después de practicada la vasectomía se evaluaron las alteraciones que pudieran presentar las glándulas del aparato genital masculino en su fisiología y capacidad secretora, mediante el análisis químico de los constituyentes del plasma seminal (colesterol libre, colesterol esterificado y fosfolípidos). El resultado de este análisis químico, indica que la relación de la concentración del colesterol libre con respecto al colesterol esterificado, permanece constante a los seis meses de practicada la vasectomía, no así la concentración de fosfolípidos, la cual disminuye a partir de los dos meses de realizado este procedimiento quirúrgico. Estos hallazgos indican de una manera indirecta las alteraciones en la capacidad secretora que pudieran tener las glándulas genitales debido a este método de anticoncepción masculina.