Benign Prostatic Hyperplasia: Rapid Evidence Review.

Lower urinary tract symptoms from benign prostatic hyperplasia affect 25% of U.S. men, nearly one-half of whom have at least moderate symptoms. Sedentary lifestyle, hypertension, and diabetes mellitus increase risk of symptoms. Evaluation is focused on determining severity of symptoms and therapy to improve symptoms. Rectal examination has limited accuracy in evaluating prostate size. Transrectal ultrasonography is preferred to verify size when starting 5-alpha reductase therapy or considering surgery. Serum prostate-specific antigen testing is not recommended in routine evaluation of lower urinary tract symptoms, and shared decision-making should be used for cancer screening decisions. The International Prostate Symptom Score is the best way to track symptoms. Self-management methods, including limiting evening fluid intake, reducing caffeine and alcohol intake, toilet and bladder training, pelvic floor exercises, and mindfulness techniques, can improve symptoms. Although saw palmetto is not effective, the herbal treatments Pygeum africanum and beta-sitosterol may be effective. Primary medical treatment involves alpha blockers or phosphodiesterase-5 inhibitors. Alpha blockers offer rapid benefit and can be used for acute urinary retention. Combining alpha blockers and phosphodiesterase-5 inhibitors is not beneficial. For uncontrolled symptoms, 5-alpha reductase inhibitors should be started if the prostate volume is 30 mL or greater by ultrasonography. 5-Alpha reductase inhibitors take up to one year to be fully beneficial and are more effective when taken with alpha blockers. Only 1% of patients with lower urinary tract symptoms require surgery. Although transurethral resection of the prostate improves symptoms, many less invasive options with varying effectiveness can be considered.

Direct Measurement of Tissue Oxygenation in Neonates via Resonance Raman Spectroscopy: A Pilot Study.

BACKGROUND: The ability to monitor tissue oxygenation in neonates remains a challenge due to limited blood supply and the reliance on invasive procedures. Resonance Raman spectroscopy noninvasively measures tissue oxygenation (RRS-StO2). Peripheral tissue oxygenation using this novel technology has not been described in neonates. OBJECTIVES: To examine the relationship between short-term RRS-StO2 measurements and central venous saturation (ScvO2) and pulse oximetry (SpO2) in preterm and term neonates. METHODS: Ninety-seven term neonates had buccal and plantar RRS-StO2 measurements performed. In 15 preterm neonates, similar measurements were obtained in conjunction with ScvO2 in the first week of life. Simultaneous SpO2 and heart rate were also recorded. RESULTS: In healthy neonates, buccal RRS-StO2 values negatively correlated with the day of life. No correlation existed between buccal and plantar RRS-StO2 values and ScvO2 or SpO2. Greater intra-patient plantar RRS-StO2 variability was seen in preterm neonates with increasing respiratory support. CONCLUSIONS: Neonatal RRS-StO2 measurements are feasible short term but do not correlate with ScvO2 and SpO2. Healthy neonates had greater differences and variability in RRS-StO2 values, illustrating an evolving microcirculation not detected with pulse oximetry. Greater RRS-StO2 variability in sick neonates requiring respiratory support may indicate microcirculatory instability despite being within target SpO2 ranges. Further study is needed to establish if RRS-StO2 monitoring is an accurate representation of tissue oxygenation.