Observation on clinical effect of fire needling for mild to moderate benign prostatic hyperplasia with kidney yang deficiency / 中国针灸

OBJECTIVE@#To observe the effect of fire needling on prostate symptoms, quality of life, average daily number of nightly urination, urine flow rate and prostat volume in patients with mild to moderate benign prostatic hyperplasia (BPH) of kidney yang deficiency.@*METHODS@#A total of 60 patients with mild to moderate BPH of kidney yang deficiency were randomly divided into an observation group (30 cases, 3 cases dropped off) and a control group (30 cases, 4 cases dropped off). The observation group was treated with fire needling at Guanyuan (CV 4), Shuidao (ST 28) and Qugu (CV 2) twice a week (2-3 d interval between each treatment), continuous treatment for 4 weeks. The control group received lifestyle advice and education, once a week for 4 weeks. In the two groups, the international prostate symptom score (IPSS), the quality of life (QoL) score and the average daily number of nightly urination were observed before treatment, after treatment and during the follow-up of the 4th week; the urinary maximum flow rate (Qmax), the average flow rate (Qave), and the prostate volume were assessed before and after treatment in the two groups. The safety was observed in the observation group.@*RESULTS@#After treatment and during follow-up, the IPSS scores, QoL scores, and the average daily number of nightly urination in the observation group were decreased compared with those before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, there was no significant difference in Qmax, Qave and prostate volume between the two groups and within the each group (P>0.05). There were no fire needling-related adverse reactions, and no obvious abnormality was found in urine routine and coagulation function tests before and after treatment in the observation group.@*CONCLUSION@#Fire needling can improve lower urinary tract symptoms and quality of life, reduce frequency of nightly urination in patients with mild to moderate BPH of kidney yang deficiency, and has good safety.

Exploration of the diagnosis and treatment for benign prostatic hyperplasia with acupuncture based on jingjin theory / 中国针灸

Benign prostatic hyperplasia is caused by kidney deficiency and impaired qi transformation of the urinary bladder and is manifested by the stagnation of essence chamber. Based on jingjin (muscle region of meridian, sinew/fascia) theory and taking the visceral membrane as the principal, acupuncture is delivered at sinew/fascia to promote qi circulation, resolve stasis and open the orifice. Guided by CT, the needle is inserted at Zhongji (CV 3), the front-mu point of the urinary bladder, and then goes to the prostatic capsule, meaning "the disease of zang organ is treated by needling the front-mu point". In treatment of benign prostatic hyperplasia, this acupuncture therapy stimulates the different layers of fascia, by which, the defensive qi on the exterior is regulated and "essence orifice" in the interior is adjusted so that the urination can be promoted.

Endourology and benign prostatic hyperplasia in COVID-19 pandemic

ABSTRACT The new disease COVID-19 pandemic has completely modified our lifestyle, changing our personal habits and daily activities and strongly our professional activity. Following World Health Organization (WHO) and health care authorities around the World recommendations, all elective surgeries from benign diagnose procedures must be postponed and imperatively continue working on emergent and oncological urgent pathologies. Surgical elective treatment of benign prostatic hyperplasia (BPH) is not considered as a priority. During BPH endoscopic surgeries, urine and blood are mixed with the irrigation liquid implying a risk of viral presence. Furthermore, a steam and smoke bubble is being accumulated inside the bladder implying the risk of splashing and aerosols. The risks of other viral infections have been identified during endourological procedures and they are related to splashing events. Several studies observed 33-100% of splashing on goggles. All BPH endoscopic procedures must be postponed. In case of complete urinary obstruction, this event can be adequately treated by urethral or suprapubic catheter under local anesthesia. As soon as local COVID-19 prevalence decreases, endourological procedures could be restarted. As protocols are being validating around the World to redeem elective surgeries, a symptomatic obstructed patient could be operated knowing his COVID-19 status with a molecular PCR, a cleaned epidemiological interview with a normal preoperative protocol. If patient is COVID-19+, surgery must be delayed until complete recovery, because mortality could increase as Lei from Wuhan describes. Informed consent must include risks of complications related to COVID-19 disease. Surgery must be performed by an experienced surgeon in order to avoid increase of operating time and risks of complications. Surgical approach of BPH must be considered depending on availability of disposable material, infrastructure, and the epidemiological COVID-19 status of your area. The main aim is patients and healthcare staff safety.

Validez de la ecografía pélvica en la detección de hipertrofia prostática para el tratamiento quirúrgico / Validity of pelvic ultrasound in the detection of prostatic hypertrophy for surgical treatment

Objetivo: Determinar la validez de la ecografía pélvica en la detección de Hipertrofia Prostática en la Clínica San Marcos basándose en su sensibilidad, especificidad y Valor Predictivo Positivo (VPP). Material y Métodos: Se utilizó como instrumento de investigación la Historia Clínica de los pacientes y una ficha de recolección de datos validado a través de juicio de expertos. Se trabajó con una muestra de 60 pacientes. Resultados: La sensibilidad de la ecografía pélvica en la detección de hipertrofia prostática para el tratamiento quirúrgico fue de 96,49%, la especificidad fue de 0,00% y el VPP fue de 94,08%, utilizando con referencia el reporte operatorio. Conclusiones: La ecografía pélvica es de alto valor en la detección de Hipertrofia Prostática, según el reporte operatorio en la Clínica San Marcos. (AU)

Objective: To determine the validity of the pelvic ultrasound in detection of Prostatic Hypertrophy in San Marcos Clinic based on their sensitivity, specificity and posive predictive value (PPV). Material and Methods: We used as a research tool the medical history of the patients and a data collection sheet validated through expert judgment. We worked with a sample of 60 patients. Results: The sensitivity of pelvic ultrasound in detecting prostatic hypertrophy for surgical treatment was 96.49%, specificity was 0.00% and the VPP was 94.08%, using the surgery report as reference. Conclusions: pelvic ultrasound is of high value in detecting Prostatic hypertrophy, according operative in San Marcos Clinic report. (AU)

Estabilidad del D-004 ingrediente activo en frascos de polietileno de alta densidad / Stability of D-004 active ingredient in high density polyethylene flasks

Introducción: el D-004 es un ingrediente farmacéutico activo obtenido de los frutos de la palma real cubana (Roystonea regia), compuesto fundamentalmente por una mezcla de ácidos grasos libres entre 8 y 18 átomos de carbono, con potencialidades en el tratamiento de la hiperplasia prostática benigna. Objetivo: determinar la vida útil del D‒004 en frascos de polietileno de alta densidad en las zonas climáticas IV y II. Métodos: muestras de tres lotes pilotos de D-004, envasadas en frascos blancos de polietileno de alta densidad y protegidos por cajas de cartón, se colocaron en las condiciones de las zonas climáticas IV (30 ºC/70 % HR) y II (25 ºC/60 % HR). Se determinaron las características organolépticas y los contenidos de material insaponificable, ácidos grasos y microbiológicos desde el tiempo inicial hasta los 36 meses, y se determinaron gráficamente los tiempos de vida útil en ambas zonas. Resultados: en las dos zonas climáticas el D‒004 cumplió con los parámetros de estabilidad evaluados durante los primeros 33 meses, pero a los 36 meses el contenido de ácidos fue inferior al límite establecido en varias de las muestras. Los análisis de regresión permitieron determinar tiempos de vida útil del D‒004 en las zonas IV y II. Conclusiones: se demostró que el ingrediente activo D‒004 que se obtuvo a escala piloto, se envasa en frascos de polietileno de alta densidad y protegido por un envase secundario (caja de cartón), presenta una vida útil de 30 y 32 meses en las zonas climáticas IV y II, respectivamente(AU)

Introduction: D­004 is a pharmaceutical active ingredient obtained from the Cuban royal palm fruits (Roystonea regia), mainly composed by a mixture of free fatty acids between 8 and 18 carbon atoms, potentially useful to treat benign prostatic hyperplasia. Objective: to determine the shelf life of D­004 in high-density polyethylene flasks in climatic zones IV and II. Methods: samples of three pilot batches of D­004, packed in white high-density polyethylene flasks and protected by cardboard boxes, were placed under conditions of the climatic zones IV (30 ºC/70 % RH) and II (25 ºC / 60 % RH). Organoleptic characteristics and unsaponifiable matter, fatty acids and microbiological contents were determined from the initial time till 36 months, and shelf lives were graphically determined in both zones. Results: in the two climatic zones, the D­004 fulfilled the tested stability parameters during the first 33 months, but at the month 36th, the acid content in several samples was lower than the set limit. The regression analyses allowed determining the shelf lives of D­004 in climatic zones IV and II. Conclusions: it was demonstrated that the active ingredient D­004, obtained at pilot scale, packed in high density polyethylene flasks and protected by a secondary container (cardboard box), exhibits a shelf life of 30 and 32 months in the climatic zones IV and II, respectively(AU)

Carcinogenicidad del D-004 en ratas Srague Dawley: informe parcial a los 18 meses / Carcinogenicity of D-004 in Sprague Dawley rats: a partial report at 18 months

INTRODUCCIÓN. el D-004, extracto lipídico del fruto de Roystonea regia (palma real), constituido por una mezcla reproducible de ácidos grasos -principalmente oleico, palmítico, láurico y mirístico- ha mostrado ser efectivo en modelos experimentales de hiperplasia prostática. OBJETIVO. resumir los resultados parciales (18 meses) del estudio de carcinogenicidad por exposición repetida y prolongada del D-004 en ratas Sprague Dawley, el cual culminará al concluir el tiempo establecido (24 meses). MÉTODOS. ratas Sprague Dawley de uno y otro sexo fueron distribuidas aleatoriamente en cuatro grupos (50 ratas/sexo/grupo): uno control de vehículo y tres tratados con D-004 (500, 1000 y 1500 mg/kg, respectivamente). Los tratamientos se administraron oralmente por intubación gástrica. Este reporte incluye los resultados de peso corporal, observaciones clínicas, mortalidad y frecuencia de aparición de tumores hasta ese momento (18 meses). RESULTADOS. la frecuencia de mortalidad es baja: en los grupos tratados fue de un 8,3 % por un 9 % en los controles. No se evidencia una disminución en el tiempo de supervivencia y las observaciones diarias no revelaron signos indicativos de toxicidad atribuibles al tratamiento. Además, el momento de aparición de tumores y la frecuencia de estos en los animales tratados y en los controles fueron estadísticamente similares en ambos sexos. CONCLUSIONES. en conclusión, la administración oral de D-004 (500-1500 mg/kg) a las ratas no mostró, durante los primeros 18 meses del estudio, evidencias de toxicidad o carcinogenicidad temprana relacionadas con el tratamiento

INTRODUCTION: D-004, a lipid extract from royal palm (Roystonea regia) fruit constituted by a reproducible mixture of fatty acids, mainly oleic, palmitic, lauric and myristic, has shown to be effective in experimental models of prostate hyperplasia. OBJECTIVE: summarize the partial results (18 months) of the study on carcinogenicity by repeated and long-term exposure of Sprague Dawley rats to D-004, to be completed in the planned period of 24 months. METHODS: sprague Dawley rats of both sexes were randomly distributed into four groups (50 rats / sex / group): one group was the vehicle control and three were treated with D-004 (500, 1000 and 1500 mg/kg, respectively). Treatments were administered orally by gastric intubation. This report includes the results obtained so far (18 months) concerning body weight, clinical observations, mortality and frequency of appearance of tumors. RESULTS: mortality is low: 8.3% in treatment groups and 9% in controls. A reduction in survival time was not observed, and daily observations did not reveal any signs of toxicity attributable to the treatment. The time of appearance and the frequency of tumors in treated animals and controls were statistically similar in both sexes. CONCLUSIONS: oral administration of D-004 (500­1500 mg/kg) to rats during the first 18 months of the study did not show any evidence of early carcinogenicity or toxicity associated with the treatment.

Informe de evaluación rápida de tecnología sobre seguridad y efectividad del láser verde para hiperplasia benigna de próstata / Rapid evaluation report of technology on safety and effectiveness of the green laser for benign prostatic hyperplasia

La HBP es el tumor benigno más frecuente del varón. La edad de comienzo es entre la cuarta y la quinta década de vida. El crecimiento de la próstata es lento o inexistente hasta los 30 años cuando empieza a aumentar de tamaño; este crecimiento en más marcado desde los 50 años. La prevalencia de hiperplasia benigna de próstata, histológicamente identificable, es del 50% para varones entre 50-60 años de edad, del 70% entre 61-70 años y llega al 90% para los hombres entre los 80 y 90 años. Aproximadamente el 50% de los hombres con evidencia microscópica de HPB muestran un agrandamiento visible de la glándula y aproximadamente la mitad de estos desarrollarán síntomas clínicos de prostatismo. Así la prevalencia de síntomas urinarios de tracto inferior moderados o severos (Índice de síntomas de la Asociación Americana de Urología (AUA) > 7) en Estados Unidos es de 26% durante la quinta década de vida, del 33% en la sexta, del 41% en la séptima y del 46% a partir de los 80 años. Como resultado de la utilización del láser verde se observó resultados favorables en pacientes con hiperplasia benigna de próstata. La vaporización fotoselectiva de la próstata con láser ha demostrado reducir el tiempo de ingreso hospitalario, la duración del sondaje vesical y la necesidad de transfusiones de sangre, comparada frente a la resección transuretral de próstata. Se recomienda cubrir con generación de evidencia y con restricciones.(AU)

The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia

Objective Prostatic artery embolization (PAE) for the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) is believed to be a safe procedure with a low risk of adverse side effects. Artery embolization is a viable treatment option in patients who are refractory to the classic noninvasive treatments. Knowledge of the histological characteristics of prostate tissue following the procedure is still limited. In this study, we describe the microscopic aspects of the prostate following PAE for BPH. Materials and Methods Two patients underwent transurethral resections of the prostate (TURP) after PAE. Embolizations were performed under local anesthesia with an initial pelvic angiography to evaluate the iliac vessels and the prostate arteries using a 2.8 French microcatheter. The prostate was embolized with 300-500µm Microspheres (Embosphere®), using complete blood stasis as the end point. The prostate tissues were analyzed histologically to characterize the effects of the embolization. Results The embolic material within the prostate tissue was easily identified as homogeneous, bright eosin-red spheroids filling the vessel lumens. Ischemic necrosis surrounded or not by chronic inflammatory reactions containing macrophages were considered as a result of the artery embolization. Also, some aspects related to the healing process were observed being fibrotic nodules surrounded by glands with squamous metaplasia of the epithelial lining the most important. In the remaining sections, due to the precocious surgical intervention, the classic findings of BPH were still present with the glandular and stromal hyperplasia associated with nonspecific chronic prostatitis. Conclusions This is the first description of prostate histology in BPH patients treated by PAE, a new procedure that is being used increasingly as a therapeutic intervention. The recognition of the changes caused by this new modality of treatment has ...

Cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia in the Brazilian public health system

OBJECTIVE: To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH) under Brazilian public health system perspective (Unified Health System - "Sistema Único de Saúde (SUS)"). MATERIAL AND METHODS: A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR), the treatment and the evolution of these patients in public hospitals. A model of economic analysis(Markov) predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate) related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70). RESULTS: The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$449.78) and R$ 579.57 (US$ 340.92) per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs) was R$ 4.130 (US$ 2.429) per episode of AUR avoided and R$ 2.735 (US$ 1.609) per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918) per AUR episodes avoided and R$ 11.980 (US$ 7.047) per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results. CONCLUSIONS: These findings suggest that the treatment of BPH with finasteride is cost-effective compared to placebo in the Brazilian public health system perspective.

Diagnóstico e tratamento da hiperplasia benigna da próstata / Diagnosis and treatment of benign prostatic hyperplasia

A hiperplasia benigna da próstata (HBP) é uma condição muito prevalente em homens a partir dos 40 anos, atingindo mais da metade da população masculina na sétima década e a quase totalidade na oitava década. Os sintomas a ela relacionados podem causar grande prejuízo à qualidade de vida desses pacientes. O objetivo da presente revisão é resumir a literatura atual sobre a patologia, focando na sua epidemiologia, diagnóstico e manejo. A avaliação inicial do paciente com HBP deve compreender a anamnese com aplicação do escore de sintomas prostáticos (IPSS), exame físico com toque retal, avaliação laboratorial (PSA sérico, exame de urina e função renal), além de métodos de imagem e urodinâmica para casos selecionados. O tratamento inicial para casos leves e moderados é medicamentoso, com o uso de alfa-bloqueadores ou inibidores da 5-alfaredutase, ou ainda a combinação desses. Pacientes que não respondem ao tratamento medicamentoso, com sintomas graves, ou que desenvolvem complicações da HBP devem ser considerados para tratamento cirúrgico. Este consiste em cirurgia aberta para próstatas de grande volume, ressecção transuretral para próstatas menores, além de outros tratamentos invasivos pouco disponíveis ou indisponíveis no nosso meio. O tratamento expectante para casos leves deve ser lembrado. Em conclusão, a HBP é doença com alta prevalência, cujo tratamento deve ser individualizado e instituído antes do surgimento de complicações maiores

Benign prostatic hyperplasia (BPH) is a very prevalent condition in men after 40 years of age, affecting more than half the male population in the seventh decade, and almost all in the eighth decade of life. The related symptoms can cause great damage to the quality of life of these patients. The purpose of this review is to summarize the current literature on the disease, focusing on epidemiology, diagnosis, and management. The initial evaluation of patients with BPH must include anamnesis with scoring of prostatic symptoms (IPSS), physical examination with digital rectal examination, laboratory evaluation (serum PSA, urinalysis and renal function), and imaging and urodynamics for selected cases. The initial treatment for mild to moderate cases is drug-based, using alpha blockers or 5-alpha-reductase inhibitors, or a combination of these. Patients who do respond to drug treatment, with severe symptoms, or who develop complications of BPH should be considered for surgical treatment. This consists in open surgery for large-volume prostates, transurethral resection for smaller prostates, and other invasive treatments little or unavailable in our community. The expectant treatment for mild cases should be considered. In conclusion, BPH is a highly prevalent disease whose treatment should be individualized and started before the onset of major complications

Hiperplasia benigna da próstata / Benign prostatic hyperplasia

A hiperplasia benigna da próstata (HPB) e o adenocarcinoma da próstata (CaP) possuem elevada prevalência em homens acima dos 50 anos. As duas patologias possuem forte caráter hereditário, sendo que na HPB a intensidade dos sinais clínicos determina, na maioria das vezes, a necessidade e o tipo de tratamento a ser instituído. Já no CaP a detecção precoce é fundamental para a cura do paciente e a doença localizada, normalmente, não produza sintomas. Há várias opções de tratamento para ambas as patologias, dependendo do quadro clínico do paciente, a simples observação vigilante, o tratamento medicamentoso e os procedimentos cirúrgicos. O prognóstico da doença depende da fase em que é detectada, sendo necessária orientação para realização de exames periódicos.

Photoselective vaporization combined with bipolar transurethral resection for the treatment of large prostate adenoma in high-risk patients

To evaluate the safety and effectiveness of the combined photoselective vaporization of the prostate [PVP] and bipolar transurethral resection of the prostate [TURP] in high-risk symptomatic patients with large prostates. Between January 2007 and January 2010, a prospective study was performed in Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, China. One hundred and one patients presenting with various kinds of systematic diseases, and with an American Society of anesthesiologists score of 3 or greater underwent PVP plus bipolar TURP for severe lower urinary tract symptoms due to benign prostatic hyperplasia with prostatic volume greater than 80 ml. The international Prostate Symptom Score [IPSS] and quality-of-life questionnaire [IPPS-QoL], maximum flow rates [Qmax], postvoid urine residues [PVR], and MRI prostatic volumes were recorded. Perioperative data, functional outcome, and complications were evaluated. Patients were reassessed at 3, 6, and 12 months. The mean operation time was 68.5 +/- 23.9 minutes. The mean pre-and post-operative prostate volumes were 102.2 +/- 33.1 ml and 40.4 +/- 15.6 ml. No severe complications were observed. Significant differences in IPSS,Qmax, and PVR values were recorded within the follow-up period. The results of our study show that PVP plus bipolar TURP have an excellent efficiency and low morbidity in high-risk patients with large prostates

Outcome of transurethral resection of prostate in clinical benign prostatic hyperplasia

Benign prostatic hyperplasia [BPH] is a condition in which the prostate gland becomes enlarged. Some men with enlarged prostate glands may experience symptoms while some may have few symptoms. Symptomatic improvement determines the successful outcome of surgical procedure of TURP for clinical BPH patients. Objectives of this study were to assess the outcome of transurethral resection of prostate [TURP] in clinical BPH with the help of International Prostate Symptom Score [IPSS]. This was descriptive case series study conducted at the Department of Urology, Liaquat University of Medical and Health Sciences, Jamshoro from November 2009 to April 2010. All patients who underwent TURP for clinical BPH were included in the study. Their preoperative IPSS was done by asking irritative and obstructive symptoms. IPSS was calculated for patients who presented with urinary retention by asking lower urinary tract symptoms before urinary retention. Each symptom carried a score of 0-5, and the total score was 35. After the TURP, IPSS was calculated on 1[st] follow-up visit after 6 weeks and 2[nd] follow-up visit after 12 weeks. Outcome, was considered favourable if there was mild grade [IPSS <7] on [12]th week after TRUP. Total of 70 patients of clinical BPH were included in study. Mean age of the patients was 63.1 +/- 3.0 yrs. Outcome of transurethral resection of prostate was found to be favourable in 81.4% after 6 weeks in 1st follow-up visit and in 62 [88.6%] patients after 12 weeks in second follow-up visit. Preoperatively mean IPSS was 22.5 and postoperatively mean IPSS was 6.5. TURP is an effective and gold standard surgical treatment option in the clinical BPH patients

Prevalence of benign prostatic hyperplasia in general practice and practical approach of the Tunisian general practitioner [Prevapt study]

Benign prostatic hyperplasia [BPH] is one of the most common conditions associated with ageing in men. BPH presents as lower urinary tract symptoms [LUTS]. The aim of this study is to assess the prevalence of LUTS suggestive of BPH in 50 years or older men in general medicine and to evaluate the management of these patients by general practitioners. This cross-sectional, prospective, multi-centre epidemiological survey, included all men with an IPSS [international prostatic symptoms score] > 8. The management by general practitioners was analysed including complementary examinations and treatment. Among 4602 outpatients recruited by 88 general practitioners, 434 patients had an IPSS > 8 and were included in the study. The prevalence of LUTS/ BPH was 16.1%. The prevalence showed a linear increase with age. The prevalence was 7% at the age 50-59 years, 17.4% at the age 60-69 years and 33.4% in 70 years and over men. LUTS were the main reason of consulting general practitioner in 45.4% of cases. 72.6% of patients were with moderate symptoms [IPSS 8-19] and 26.4% of patients were with severe symptoms [IPSS 20-35]. Quality-of-life score was 0-2 in 10.3% of patients, 3-4 in 52.2% of patients and 5-6 in 37.5% of cases. The management by general practitioner was then a watchful waiting in 14.7% of cases, to refer the patient to an urologist in 13.7% of cases, to ask for complementary examinations in 71.6% of cases and to treat in 73.4% of cases. Only 37.4% of patients with suspect prostate malignancy were referred to the urologist. In cases of treatment alpha blocker was the treatment choice in 77% of the cases. LUTS/ BPH are frequent in Tunisia. It occurs in one third of men over 60 years and one fifth of men over 70 years. With the progressive ageing of Tunisian population, this pathology may constitute a public health problem. It is therefore urgent to elaborate recommendations concerning the management of this disease, specifying the role to play by the urologist and the general practitioner

Láser KTP (verde) para la vaporización fotoselectiva del adenoma prostático obstructivo: una evaluación independiente / KTP Laser (green) for photoselective vaporization of the obstructive prostatic adenoma: an independent evaluation

La vaporización fotoselectiva del adenoma prostático es una técnica poco invasiva, que consiste en la vaporización y remoción del tejido usando el láser verde KTP, con una potencia de 80W. El propósito de este trabajo es informar nuestra experiencia con el uso de esta técnica. Material y Métodos: Se realizó fotovaporización selectiva con láser KTP a 18 pacientes, portadores de uropatía obstructiva baja secundaria a HNBP, entre noviembre de 2005 y abril de 2006, en el Hospital Militar de Santiago. Se registraron las características pre operatorias y los resultados post operatorios y complicaciones. Resultados: El volumen prostático promedio fue de 51 cc (rango 24 a 78). El tiempo operatorio promedio fue de 83 minutos (rango 40 a 120). Dieciséis pacientes quedaron sin sonda Foley antes de las 24 horas. El promedio del score AUA preoperatorio fue de 22 y disminuyó a 11,4 a los 30 días. El flujo máximo promedio en el pre operatorio fue de 9 ml/seg y aumentó a 18,2, 22,1, 22,5, 25,3 y 27,2 ml/seg al día 1, 7, 14, 21 y 30 respectivamente. Las complicaciones no fueron de gravedad e incluyeron demora en el retiro de la sonda Foley (11,1 por ciento), disuria (16,6 por ciento) y hematuria tardía (11,1 por ciento). Conclusiones: La vaporización fotoselectiva del adenoma prostático con láser KTP es una técnica segura, fácil de aprender, con buenos resultados funcionales a corto plazo y con bajo riesgo de complicaciones.

Prostatic adenoma photoselective vaporization is a low invasive technique. It is a tissue vaporization and removal using green KTP laser, under 80W power. The purpose of this work was to report our experience with this technique. Material and Methods: Selective photovaporization with KTP laser to 18 patients, carriers of secondary low obstructive uropathy HNBP, was carried out from November, 2005 to April 2006, in Hospital Militar of Santiago. Pre-operation characteristics and post- operation results and complications were registered. Results: The prostatic volume average was 51cc (range 24 to 78). Average operation time was 83 minutes (range 40 to 120). The Foley catheter was removed from sixteen patients before 24 hours. The AUA preoperation average score was 22, and on the 30th day it diminished to 11.4. The maximum average in the pre-operation was 9 ml/sec and it increased to 18.2, 22.1, 22.5, 25.3 and 27.2 ml/sec. at the 1st, 7th, 14th, 21st, and 30th day, respectively. Complications were not serious. They included delay in the removal of Foley catheter (11.1%), dysuria (16.6%) and late hematuria (11.1%) Conclusions: Prostatic adenoma photoselective vaporization with KTP laser is a safe, easy to learn technique, with good functional results at the short term and with low risk of complications.

Sonablate-500 transrectal high-intensity focused ultrasound (HIFU) for benign prostatic hyperplasia patients / 华中科技大学学报（医学）（英德文版）

To evaluate the safety and efficacy of transrectal high-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH), serial studies were conducted in 150 BPH patients before and 30 min, 1, 2, 6 and 12 month(s) after Sonablate-500 HIFU treatment. A silicon-coated indwelling 16F latex catheter was placed during the determination of the therapy zone. Preoperative and postoperative evaluations were made by using the international prostate symptom score (IPSS), quality of life (QOL), uroflowmetric findings and transrectal ultrasound, and incidence of complications. The cystourethrography was done in 23 patients within 1 year postoperatively. The results showed that after HIFU treatment, IPSS and QOL scores were significantly decreased at 1, 2, 6 and 12 month(s) (P<0.01). Maximum urine flow rate (6.0 to 17.2 mL/s, P<0.01), PVR (75.0 to 30.3, P<0.01) and prostatic volume (65.0 to 38.1 mL, P<0.05) were significantly improved 12 months after the operation. Recurrent urinary retention (n=2) and urethrorectal fistula (n=1) occurred at the 15(th) postoperative day. The duration of the HIFU prostate ablation was 25-90 min. The mean time for an indwelling catheter was 3-19 days. These data demonstrate that treatment of BPH with Sonablate-500 HIFU is safe and effective.

Hiperplasia prostática benigna: actualización en su terapia farmacológica / Benign prostate hyperplasia: update in its pharmacological therapy

La hiperplasia prostática benigna es un problema de salud molesto y relativamente frecuente en los hombres. La siguiente nota es una actualización sobre el beneficio de la evidencia existente para su tratamiento con los bloqueantes de los receptores alfa o alfa bloqueantes y con los inhibidores de al 5 alfa reductasa.

Hiperplasia prostática benigna na terceira idade / Benign prostatic hyperplasia

A hiperplasia prostática benigna (HPB) é uma condição tão freqüente na população masculina geriátrica que sua presença pode ser considerada como um achado normal. São as seqüelas ou complicações da HPB que vão ditar a necessidade de tratamento do paciente. As mais freqüentes são: sintomas miccionais, infecção urinária, hematúria e obstrução urinária. Nos últimos anos surgiram várias opções de tratamento para HPB, incluindo medicamentos e alternativas cirúrgicas menos agressivas. Entretanto, a ressecção transuretral da próstata (RTUP) ainda é considerada o padrão-ouro com a qual outras formas de tratamento devem ser comparadas em termos de eficácia(au)