Serum luteinizing hormone concentration is significantly associated with recovery of urinary function after radical prostatectomy.

OBJECTIVE: To perform a longitudinal investigation of the correlation between functional recovery and sex hormone concentrations after radical prostatectomy (RP). PATIENTS AND METHODS: A total of 72 consecutive patients undergoing RP between January 2012 and June 2013 were prospectively included and serially followed after surgery for comparative analysis. Their luteinizing hormone (LH) and total testosterone (TT) concentrations were measured before surgery and 3 and 12 months after surgery. They also filled out a health-related quality of life questionnaire before and at 1, 3, 6 and 12 months after surgery. RESULTS: The mean LH concentration increased from 4.28 U/L at baseline to 5.53 U/L at 3 months and remained high at 12 months after RP (both P < 0.001). There were no significant changes in the TT concentration after RP. LH at baseline was negatively correlated with the urinary function (UF) score at 3 and 12 months after RP (P = 0.030 and 0.032, respectively). After RP, subjects with high baseline LH (n = 37) were more likely than those with low LH concentrations to report lower UF scores (P = 0.014). Multivariate analysis of variance in an interaction of time × LH concentration for UF scores indicated a significant relationship between changes in UF score and LH concentration (P = 0.004). CONCLUSIONS: Radical prostatectomy affects sex hormones by increasing LH concentrations, while TT concentrations remain stable after surgery. Baseline LH concentrations are significantly associated with the recovery of urinary outcomes after RP.

Significance of histological prostatitis in patients with urinary retention and underlying benign prostatic hyperplasia or adenocarcinoma of the prostate.

OBJECTIVE: To compare the clinical features of patients having urinary retention and benign prostatic hyperplasia (BPH) with those having adenocarcinoma of the prostate (ACP) and to evaluate the significance of histological prostatitis. PATIENTS AND METHODS: The clinical data and histopathology reports of patients with retention admitted to Tygerberg Hospital between September 1998 and June 2007 were evaluated. Statistical analysis was performed with Student's t-test, Mann-Whitney test and Fisher's exact test where appropriate and P < 0.05 was considered to indicate statistical significance. RESULTS: Prostatic histology was available in 405 patients, 204 with BPH and 201 with ACP. Comparing those with BPH and those with ACP showed statistically significant differences in mean age (69.5 vs 71.9 years), serum prostate-specific antigen (PSA) level (18.6 vs 899.5 ng/mL) and histological prostatitis (48 vs 25%) but not duration of catheterization, prostate volume or urinary tract infection (UTI). Comparing those with BPH only and those with BPH plus prostatitis showed significant differences in mean age (71.9 vs 67.1 year) and PSA level (14.6 vs 22.8 ng/mL) but not prostate volume, UTI or duration of catheterization. Comparing those with ACP only and those with ACP plus prostatitis showed significant differences in stage T4 cancer (68.1 vs 35.4%) and PSA level (1123.4 vs 232.4 ng/mL) but not age, prostate volume, UTI or duration of catheterization. CONCLUSIONS: Histological prostatitis was almost twice as common in patients with urinary retention associated with underlying BPH than in patients with ACP, but there was no significant difference in the duration of catheterization, prostatic volume or presence of UTI, suggesting that histological prostatitis more often contributes to the development of retention in patients with underlying BPH than in those with ACP. In patients with BPH, histological prostatitis was associated with urinary retention at a significantly younger age and with higher serum PSA levels. In patients with ACP, histological prostatitis was associated with urinary retention at an earlier stage of cancer.

Photoselective vaporization of the prostate using the 120-W lithium triborate laser in enlarged prostates (>120 cc).

UNLABELLED: OBJECTIVE • To evaluate experience with high power LBO laser for large prostates PATIENTS AND METHODS: • Prospective database of 288 men treated with PVP from November 2006-2009 • 33 men identified to have transrectal ultrasound measured prostate size >120 cc • All but 9 men not in urinary retention or on anticoagulant medications • Average ASA Score 2.25 (range 1-4) with 11 having an ASA Score of 3 or more RESULTS: • Mean operating time and laser time 109 and 86 minutes respectively • IPSS, QoL and Qmax changes from baseline to 3 months for those not in retention were 24 to 8.6, 5.0 to 1.8 and 7.5 mL/s to 19.6 mL/s respectively • Post void residual in these men fell from a mean of 235 mL to 88 mL • Average fall in PSA was 38% for 22 men with paired PSA data • Post operative urinary retention in 4 men resolved. 2 late onset clot urinary retention CONCLUSION: • Early results demonstrate PVP to be safe and efficacious on early follow up in a high risk group of patients with significantly enlarged prostates, anticoagulation and urinary retention.

Can bedside ultrasound assist in determining whether serum creatinine is elevated in cases of acute urinary retention?

BACKGROUND: There are no guidelines to determine which patients with acute urinary retention (AUR) require blood testing (i.e., serum creatinine) to assess for renal failure. OBJECTIVE: To determine if hydronephrosis on bedside ultrasound correlates with an abnormal serum creatinine (Cr) level in cases of AUR. METHODS: This was a prospective, observational study of subjects clinically diagnosed with AUR at two associated urban academic centers from October 2004 through August 2006. Emergency physicians completed a data form and performed a bedside ultrasound to determine the presence or absence of hydronephrosis. The data collected included suspected cause of AUR, amount of urinary output after Foley insertion, and blood test results. Follow-up was obtained by telephone and electronic medical record for 1 month. Standard statistics were employed. RESULTS: Among 96 enrolled subjects with AUR, 43 had a serum Cr level obtained on the initial visit, and 10 (23%; 95% confidence interval [CI] 11-36) of these had an elevated Cr (10% [95% CI 4-16] of the study cohort). The test characteristics of hydronephrosis on bedside ultrasound to detect elevation in Cr were a sensitivity, specificity, positive predictive value, and negative predictive value of 70%, 67%, 39%, and 88%, respectively. CONCLUSION: In cases of AUR, the prevalence of elevated creatinine is high, and hydronephrosis based on bedside ultrasonography does not correlate with elevation in creatinine.

Effect of Climatic Parameters on Acute Urinary Retention Incidence.

OBJECTIVES: We investigated the effect of daily climatic parameters on spontaneous acute urinary retention (sAUR) and evaluated the risk factors for refractory/recurrent AUR. METHODS: A total of 4194 patients older than 40 years were diagnosed with AUR in the emergency department at Gangnam Severance Hospital, Seoul, from January 2007 to May 2016. To evaluate climatic parameters at sAUR onset, we included individuals living in the area around the hospital. We excluded patients with fever, who did not return to the hospital after the AUR episode or with AUR occurring within 2 weeks following admission for surgery or chemotherapy. RESULTS: Among 818 patients living in the two districts around the hospital, winter and October had the highest seasonal and monthly rates of sAUR development, respectively, and sAUR incidence increased with age. Daily temperature range and mean wind speed were significant risk factors for sAUR development. Several daily climatic parameters had seasonal effects on sAUR incidence. Over a mean follow-up of 0.98 years, 122 patients (14.9%) developed refractory/recurrent AUR. Transitional zone index (TZI; HR = 1.03; P = 0.002) and prostate-specific antigen (PSA) at the time of sAUR (HR = 1.01; P = 0.030) were significant predictors of refractory/recurrent AUR. Benign prostate hyperplasia medication and transurethral prostatectomy after sAUR were not risk factors for refractory/recurrent AUR. CONCLUSIONS: Cold temperature provoked sAUR in patients with higher age and International Prostate Symptom Score. Patients with higher TZI and PSA level at the time of sAUR had a greater risk of developing refractory/recurrent AUR.

Treatment of benign prostatic hyperplasia by occlusion of the impaired urogenital venous system - first experience.

PURPOSE: To effect regression of benign prostatic hyperplasia (BPH), Gat et al. (Andrologia 2008) proposed to occlude incompetent spermatic veins to reduce increased hydrostatic pressure on the prostatic venous plexus and prevent reflux with androgen rich blood from the testicles. Our aim was to implement this treatment strategy in clinical practice and to report about first results. METHODS: Embolization of the spermatic veins was performed in 30 patients with BPH. In 16 patients, we obtained follow-up data from at least 6 months. The sonographic transabdominal prostatic volume, prostate-specific antigen (PSA) and peripheral total testosterone levels were determined before and 6 months after the intervention. Subjective symptomatology was assessed using standardized questionnaires (International Prostate Symptom Score [IPSS] and Quality of Life score [QoL]) before and 6 months after the procedure. RESULTS: The age of all treated patients was 46 - 77 years. The age of the 16 patients who received follow-up was 51 - 77 years. IPSS (median 18 [IQR 20.75 - 14.50] vs. 9 [IQR 11.00 - 7.25], p < 0.0001) and QoL score (4 [IQR 5 - 3] vs. 2 [IQR 3 - 1], p < 0.001) were significantly decreased 6 months after the intervention. The subjective improvement of symptoms did not correspond with prostatic volumes, which did not change significantly (54.31 ±â€Š30.90 vs. 50.50 ±â€Š29.26 ml, p = n. s.). 4/16 patients had a measurable post-void urine volume, which decreased in two patients 6 months after the procedure, remained unchanged in one patient, and was no longer detectable in one patient. 4 of the 11 had a sonographically detectable varicocele before the intervention, and one patient had a trabeculated bladder. Both the peripheral total testosterone levels (4.55 ±â€Š1.27 vs. 3.93 ±â€Š1.00 ng/ml; p = n. s.) and PSA levels (3.74 ±â€Š2.83 vs. 4.06 ±â€Š3.34 ng/ml; p = n. s.) showed no significant differences. CONCLUSION: Interventional occlusion of the spermatic veins in patients with BPH is a feasible outpatient procedure with a low complication rate. Intermediate results are satisfactory. Mid- and long-term results and pathophysiologic mechanisms need to be further elucidated.

Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group.

OBJECTIVES: Prostate-specific antigen (PSA) is produced exclusively in the prostate gland and is currently the most useful clinical marker for the detection of prostate cancer. In this report, we examine whether serum PSA is also a predictor of important benign prostatic hyperplasia (BPH)-related outcomes, acute urinary retention (AUR), and the need for BPH-related surgery. METHODS: Three thousand forty men were treated with either placebo or finasteride in a double-blind, randomized study of 4-year duration. Serum PSA was measured at baseline, and baseline prostate volume was measured in a 10% subset of 312 men. Probabilities and cumulative incidences of AUR and BPH-related surgery, as well as reduction in risk of events with finasteride, were calculated for the entire patient population, stratified by treatment assignment, baseline serum PSA, and prostate volume. RESULTS: The risk of either needing BPH-related surgery or developing AUR ranged from 8.9% to 22.0% during the 4 years in placebo-treated patients stratified by increasing prostate volume and from 7.8% to 19.9% when stratified by increasing serum PSA. In comparison with symptom scores, flow rates, and residual urine volume, receiver operating characteristic curve analyses showed that serum PSA and prostate volume were the most powerful predictors of spontaneous AUR in placebo-treated patients (area under the curve 0.70 and 0.81, respectively). Finasteride treatment reduced the relative risk of needing surgery or developing AUR by 50% to 74% and by 43% to 60% when stratified by increasing prostate volume and serum PSA, respectively. CONCLUSIONS: Serum PSA and prostate volume are powerful predictors of the risk of AUR and the need for BPH-related surgery in men with BPH. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makers in predicting the risk of BPH-related outcomes and choosing therapy for BPH.

The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigen concentration.

PSA remains an immensely valuable tool in the diagnosis of prostate adenocarcinoma. Factors such as prostatitis, urinary retention, ejaculation, and inpatient versus outpatient measurement, however, may have a profound effect on the serum PSA concentration. Furthermore, prostate biopsy and TURP result in an increase in the serum PSA value that resolves in 4 to 6 weeks. It is imperative that these factors be taken into account to interpret serum PSA values, to optimize the diagnostic utility of the PSA test.

The effect of urethral catheterisation on serum prostate- specific antigen levels in male patients with acute urinary retention.

Urethral catheterisation is often used in acute urinary retention (AUR). In this study, we aimed to evaluate the effect of urethral catheterisation on serum prostate-specific antigen (PSA) levels in men with AUR. Our study subjects comprised 35 men with a mean age of 63.7 +/- 7.35 years (range 55 - 80) who presented with AUR at our department between March 1999 and June 2000. Patients were randomly divided into two groups; 18 patients underwent urethral catheterisation in the first group (catheterisation group), while 17 underwent suprapubic percutaneous cystostomy in the second group (cystostomy group). Serum PSA levels before manipulation, and 2 and 12 hours and 7 days after treatment were determined. The change in median PSA values after manipulation was statistically significant in the catheterisation group (p < 0.05), but not in the cystostomy group (p > 0.05). The change in serum PSA was not clinically important in any of the patients. These results suggested that urethral catheterisation did not cause a significant alteration in serum PSA in men with AUR retention.

Lower urinary tract symptoms and benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is an important cause of lower urinary tract symptoms (LUTS). However, many other causes, including smooth muscle dysfunction and neurological factors may contribute to these symptoms, and accurate diagnosis is imperative before invasive treatments are chosen. Careful recording of symptoms, giving emphasis on how they interfere with the patient's quality of life, as well as the use of properly selected tests, constitutes the mainstay of making a correct diagnosis. Men with mild or moderate symptoms not experiencing complications are ideal candidates for medical treatment. For the rest with persistent symptoms or complications such as infection, bleeding, chronic retention or renal impairment further investigation and more invasive forms of treatment need to be considered. We review the patho-physiology of the disease, and current approaches and management of this common problem.

[The effect of acute urinary retention on serum prostate specific antigen concentration].

OBJECTIVES: To study the effect of acute urinary retention on the serum prostate-specific antigen (PSA) concentration. METHODS: Blood samples from 34 benign prostatic hyperplasia (BPH) patients with acute urinary retention were drawn immediately before suprapubic cystomy and 48 hours after relief of urinary retention. Serum PSA concentrations were measured with radioimmunoassay. RESULTS: The mean serum PSA levels of BPH patients with acute urinary retention was (24.6 +/- 16.1) micrograms/L (range from 2.6 micrograms/L to 45.8 micrograms/L). Forty-eight hours after relief of urinary retention, the mean serum PSA levels declined to (9.4 +/- 6.3) micrograms/L (range from 1.7 micrograms/L to 16.6 micrograms/L). The difference was significant (P < 0.01). CONCLUSIONS: Acute urinary retention could dramatically increase the serum PSA value of patients with BPH. After relief of the urinary retention, the patients had a great than 50% decreased of PSA values.

Prostate biopsy in patients with long-term use of indwelling bladder catheter: what is the rationale?

OBJECTIVE: Acute urinary retention (AUR) is expected to occur in 2% to 39% men with benign prostatic hyperplasia. To date, no study has elucidated the effect of long-term use of indwelling bladder catheter on serum prostate specific antigen (PSA) levels and on the incidence of prostate cancer (CaP). The aim of the present study is to analyze the incidence of CaP in patients with long-term use of indwelling bladder catheter and determine some practice patterns on this issue. MATERIALS AND METHODS: The study comprised a retrospective analysis of data from 1,651 patients who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy from July 2004 to June 2009. Among these patients, 198 (12%) were using an indwelling bladder catheter during the biopsy for at least 1 month. The incidence of CaP was recorded according to total PSA levels. Other variables such patient age, free/total PSA rate, PSA density, prostate volume, and duration of catheter use was also analyzed. Men with a digital rectal examination suspicious for cancer were not considered for analysis. RESULTS: Median patient age was 71 years (37 to 89 years). Overall, 25% of patients presented a CaP diagnosis. CaP incidence according to the PSA levels was 0%, 18.9%, 24.5%, and 40.6% for patients with PSA ≤4.0, 4.1-10.0, 10.1-20.0, and >20.0 ng/ml, respectively. When prostate volume was analyzed together, we demonstrated that only 1 (2.4%) patient with PSA below 10.0 ng/ml and prostate volume >60 g had CaP. Median total PSA, PSA density, and prostate volume were statistically different between patients with and without CaP. CONCLUSIONS: Prostate biopsy should not be indicated for all patients with diagnosis of BPH and AUR who present an elevated PSA level. Patients with PSA below 10.0 ng/ml, and prostate volume >60 g should only undergo biopsy in selected cases. Patients with PSA >20.0 ng/ml and a prostate volume ≤60 g are at higher risk of CaP diagnosis.

A novel case of a raised testosterone and LH in a young man.

A 19 year old male attended his GP with a history of "fluid retention", lack of libido and erectile dysfunction. He was found to have a high serum testosterone, and a raised luteinising hormone. After further investigations, the patient admitted to taking a supplement called ActivaTe Xtreme, obtained from an internet source, to address his low libido. ActivaTe Xtreme contains active ingredients which increase serum testosterone levels by several independent mechanisms that are not associated with luteinising hormone suppression. Urine analyses for synthetic anabolic steroids were negative, and urinary testosterone, epitestosterone and other androgens were normal. This biochemical pattern is not the same as that seen with anabolic steroids (i.e. raised testosterone, suppressed luteinising hormone and abnormal urine steroid profile). The issue of self medication with performance enhancing compounds needs to be carefully considered in order to avoid expensive and invasive investigations, missing an underlying pathology or misdiagnosing a patient. This case also raises the spectre of yet another "performance enhancing" product that may cause difficulty for those trying to ensure that sport remains on a "hormonally" equal basis.

Definition of at-risk patients: baseline variables.

Benign prostatic hyperplasia (BPH) represents a significant burden in ageing men due to frequently associated lower urinary tract symptoms (LUTS), which may impair their quality of life. Some men will have progressive disease, mainly characterized by symptom deterioration of > or = 4 points on the International Prostate Symptom Score, but also by the occurrence of acute urinary retention (AUR) and BPH-related surgery. Identifying those at risk of unfavourable outcomes is important to optimize their management. Community-based longitudinal studies provide excellent data on the natural history of BPH. Baseline variables such as age, severe LUTS, low peak flow rate, high postvoid residual urine volume (PVR), enlarged prostate and high serum prostate-specific antigen (PSA) levels, have been identified as risk factors for AUR and BPH-related surgery in such studies. Placebo arms of controlled studies have more limited value for assessing the natural history, due to strong selection criteria which generate a regression to the mean artefact and narrow the applicability to the general population. Nevertheless, in these controlled studies, baseline serum PSA level and to a lesser extent prostate size consistently predicted the risk of AUR and BPH-related surgery. Conversely, quantitative variables such as baseline symptom severity and peak flow rate behaved paradoxically, probably as a consequence of strict inclusion criteria, resulting regression to the mean, and 'ceiling' effects. Results from the Medical Therapy of Prostatic Symptoms study and the Alfuzosin Long-Term Efficacy and Safety Study also suggest that using the PVR in clinical practice needs to be reconsidered as a predictor of BPH progression. Further research is needed to clarify the role of chronic inflammation in the process of BPH progression.

Efficacy of PSA in the detection of carcinoma of the prostate in patients presenting with acute urinary retention.

OBJECTIVES: A temporary elevation in serum-prostate specific antigen (PSA) levels has been reported in association with acute urinary retention. In spite of this, it is not uncommon for clinicians to assay PSA at the time a patient presents with acute urinary retention. We sought to evaluate whether this practice can be justified. PATIENTS AND METHOD: Fifty-four patients, aged between 55 and 89 years, who presented to a single institution with acute urinary retention were studied. A PSA assay was performed on admission and a record made of the prostatic size as assessed by digital rectal examination. All patients underwent a trial without catheter, those that failed to void underwent prostatic surgery whilst all others were followed up as outpatients. RESULTS: Five patients were found to have prostatic carcinoma, three following transurethral resection of the prostate (TURP) and two following needle biopsy, performed because of persistent elevation of the PSA. A significant elevation in the PSA was associated with acute urinary retention, with only 15 (28%) patients having a PSA of 4.0 ng/ml or less. This elevation reduced the sensitivity of PSA in detecting carcinoma of the prostate; even with a cut-off of 20 ng/ml, the positive predictive value of the test was only 21%. CONCLUSIONS: A PSA assay should not be performed at the time of presentation with acute urinary retention as it may lead to unnecessary investigations and anxiety for the patient. For those in whom a PSA assay is desirable a delay of 2 weeks should be allowed prior to sampling, as the half-life of PSA is known to be 2-3 days.

[Changes of serum total PSA and free PSA in patients with prostate carcinoma and benign prostate hyperplasia].

BACKGROUND & OBJECTIVE: Total prostate-specific antigen (TPSA) is considered the best marker in diagnosis of carcinoma of prostate (Pca), and FPSA (free prostate specific antigen)/TPSA can improve its specificity in diagnosis of PCa. This study was designed to compare the level of serum TPSA and FPSA/TPSA between PCa and benign prostate hyperplasia (BPH) patients, providing reference for diagnosis of PCa. METHODS: Values of serum TPSA and FPSA of 66 BPH cases, 29 BPH with acute urinary retention (AUR) cases, 22 PCa cases were determined by enzyme linked immunosorbent assay (ELISA). The differences of serum TPSA and FPSA/TPSA of the three groups were compared and analyzed. RESULTS: There were significant differences of serum TPSA concentration among the three groups (P< 0.05), when the serum TPSA in the patients with BPH, BPH and AUR, PCa were 4.1+/-1.39 microg/L, 15.5+/-3.34 microg/L, 55+/-13.5 microg/L, respectively. Serum TPSA concentration overlapped in the three groups especially in AUR group when the TPSA level in the three groups were less than 4.0 microg/L, 4.0-10.0 microg/L, and more than 10.0 microg/L. There was no significant difference between BPH group and AUR group when the FPSA/ TPSA of BPH group was 0.32+/-0.13, AUR group was 0.30+/-0.09 (P >0.05). However, there were significant differences between BPH and Pca group, between AUR and PCa group when the FPSA/TPSA of Pca group was 0.11+/-0.05 (P< 0.05). FPSA/TPSA level also overlapped in these three groups when FPSA/TPSA level was less than 0.15, 0.15-0.25, and more than 0.25. CONCLUSIONS: The serum TPSA and the level of FPSA/TPSA overlapped in these three groups. They can only be regarded clinically as reference index.

Prostate volume and serum prostate-specific antigen as predictors of acute urinary retention. Combined experience from three large multinational placebo-controlled trials.

OBJECTIVES: We evaluated prostate volume and prostate-specific antigen (PSA) as predictors of acute urinary retention (AUR) in men with benign prostatic enlargement (BPE). METHODS: Data were pooled from 3 identical 2-year, multinational, multicenter, non-US, placebo-controlled finasteride trials in 4,222 men with BPE and no evidence of prostate cancer. RESULTS: The 2-year incidence of spontaneous AUR was higher in placebo patients with enlarged prostates (4.2% in men with prostate volume > or =40 ml vs. 1.6% in the <40 ml group) and higher PSA levels (3.9% in men with PSA > or =1.4 ng/ml vs. 0.5% in the <1.4 ng/ml group) at baseline. Finasteride reduced AUR incidence by 61% in men with larger prostates, by 63% in men with higher PSA levels, and by 47% in men with smaller prostates, compared with placebo. CONCLUSIONS: BPE patients with larger prostate volumes, higher PSA levels and no evidence of prostate cancer have an increased risk of developing AUR and therefore derive the greatest benefit from the risk reduction seen with finasteride therapy.

Bladder catheterization and a plasma prostate-specific antigen in patients with benign prostatic hyperplasia and complete urine retention.

Nineteen men with BPH (benign prostatic hyperplasia) were studied who had up to 6 months prior to complete urine retention PSA levels measured (PSA I). Subsequent PSA levels were obtained at 2 weeks post catheterization upon catheter removal (PSA II) and at 4 (PSA III) and 6 weeks post catheterization (PSA IV). Analysed were 18 mean PSA values [ng/ml] (as one patient was found to have prostatic cancer and his data were discarded): PSA I - 6.46, PSA II - 14.26, PSA III - 9.83 and PSA IV - 7.47. Initial data suggest that the irritation of the adenoma by the catheter may cause PSA levels to rise.

[The mechanism of the action of local transrectal hyperthermia in treating prostatic adenoma]. / Mekhanizm deistviia lokal'noi transrektal'noi gipertermii v lechenii adenomy prostaty.

Local transrectal hyperthermia (LTH) was used to treat 139 patients with prostatic adenoma aged 54-86 if they did not demand urgent surgery. LTH mechanism of action was studied by blood rheology, immunity characteristics, prostatic tissue gentamycin concentrations, morphological alterations after hyperthermia followed by TUR and adenomectomy. Clinical evaluation covered dysuria dynamics, uroflowmetry values, quantitation of residual urine and measurement of the prostate. The patients combined adenoma with chronic prostatitis, acute urine retention, cystostomy fistula (43, 22 and 16 patients, respectively). A microwave electromagnetic hyperthermia unit "Yakhta-4M" made in Russia (434 MHz, 200 W) heated the prostate to 43-44 degrees C. Two procedures a week of 60 min duration were performed within 3-5 weeks. LTH results in reduced blood viscosity, has no effect on blood coagulation, enhances neutrophil phagocytic function inhibiting their metabolic activity without affecting humoral immunity, raises 2-fold gentamycin concentrations in the prostatic tissue compared to blood and urine levels. Histologically, LTH does not alter prostatic parenchyma, but induces structural shifts in the muscular and connective tissue of the stroma producing stabilizing action on acinar epithelium. Clinical picture was characterized by subjective improvement in 72% of those treated, by urination recovery in 70% of the patients. 73% of the latter experienced cystostomy drainage which rid them of the fistula without operation. In general, mechanism of LTH action is brought to improvement of microcirculation, enhancement of cellular phagocytosis with a tendency to prostatic tissue sclerosing and stabilization of growth of the glandular tissue.