Does transurethral microwave thermotherapy (TUMT) affect emission of semen?

UNLABELLED: In the patient's choice of treatment for symptomatic BPH today, more importance has become attached to disturbances in sexual function as a side-effect. This study concerns analyses of semen after TUMT. MATERIAL AND METHODS: TUMT was performed with Prostatron, Prostasoft 2.0. Fourteen men were able to provide semen specimens for this study. One sample was collected before and one three to seven months after TUMT. The analyses of semen included determinations of volume, sperm number, sperm morphology and secretory contribution of seminal vesicular and prostatic fluid. RESULTS: One of the fourteen men could not provide a post-TUMT specimen, despite normal erection. One patient developed pain in the perineum/prostate region post-TUMT when ejaculating and showed azoospermia after the treatment. In analysing the whole group, no statistically significant differences were found between pre- and post-TUMT specimens, regarding semen emission (semen volume, total sperm number, total fructose and zinc) or sperm morphology.

Transurethral microwave thermotherapy for benign prostatic hyperplasia: clinical outcome after 4 years.

PURPOSE: We describe long-term results of transurethral microwave thermotherapy. We determined pretreatment variables favorable for the outcome. MATERIALS AND METHODS: We followed for 4 years 187 patients treated with Prostatron software 2.0.* Preoperative evaluations consisted of score, cystoscopy, transrectal ultrasonography, urine flow and residual volume measurements. Followup examinations with score and urodynamics were performed for 4 years after transurethral microwave thermotherapy. Kaplan-Meier plots and logistic regression were used for statistical analyses. RESULTS: A decrease in the number of satisfied patients was noted from 62% at 1 year after transurethral microwave thermotherapy to 23% at 4 years. Initial decrease in score and increase in urine flow were followed by increase in score and decrease in flow at the 4-year followup of the 56 patients who had not received supplementary benign prostatic hyperplasia (BPH) treatment. The Kaplan-Meier analysis estimated the median time for need of supplementary BPH treatment to be 45 months. Pretreatment urine flow greater than 10 ml. per second and an irritative score less than 5 were the only factors related to a favorable outcome. Prostate volume or energy delivered to the prostate did not influence the result. CONCLUSIONS: Four years after transurethral microwave thermotherapy 23% of the initially treated group were satisfied with the result. Two-thirds had received supplementary BPH treatment. Preoperatively less obstructed patients and those with low initial irritative scores responded more favorably to transurethral microwave thermotherapy treatment.

Transurethral microwave thermotherapy in symptomatic benign prostatic hyperplasia: a possible association between androgen status and treatment result?

BACKGROUND: Nothing is yet known of possible endocrine effects of transurethral microwave thermotherapy (TUMT) or of possible influence of endocrine status on the result of thermotherapy. METHODS: Serum levels of testosterone (T), SHBG, estradiol, LH, and PSH were measured in 48 men with BPH before and 2-3 months after TUMT (Prostatron, Prostasoft 2.0; Technomed International, Lyon, France). Assessment of results was based on the patients' own estimations. RESULTS: The treatment did not alter hormone levels. Patients who reported response after 12 months (n = 21) had significantly lower outset levels of calculated free testosterone (fT) than in the nonresponders (n = 27). In the patients aged < 70 years (n = 13), both the fT and T values were lower than in the nonresponders (n = 15). There was no age difference between responders and nonresponders. CONCLUSIONS: TUMT did not influence hormone levels. These observations suggest that androgen status may influence the final result of treatment.

Effect of transurethral microwave thermotherapy. An evaluation with MR imaging.

PURPOSE: To detect morphological changes in the prostate, as depicted with MR imaging, in order to clarify the effects of transurethral microwave thermotherapy (TUMT). MATERIAL AND METHODS: Twenty patients with prostatism and a prostatic volume of 30-71 cm3 underwent MR examination before, the day after, and 6 months after treatment. TUMT was carried out with a Prostatron. A method to detect oedematous changes on heavily T2-weighted MR images was developed and used as an indicator of morphological changes. RESULTS: The study showed some correlation (r=0.59) between the energy given at TUMT and an increased T2 signal. All patients with increased T2 signal except one were found among those who received the highest amount of energy to the prostate. Of 8 patients, 6 showed a symptomatic response to the treatment and 2 did not. There was a weak statistical correlation (r=0.41) between treatment response and increased T2 signal. CONCLUSION: The study does not support the view that TUMT leads to significant necrosis in the prostate with loss of tissue and retraction. We theorize that the response to TUMT may be caused by a denervation of the prostate.

Transurethral microwave thermotherapy. A comparison between clinical outcome and morphologic effects assessed by urethrography.

PURPOSE: To detect possible morphologic changes in the urethra in an attempt to clarify the effects of thermotherapy (TUMT). MATERIAL AND METHODS: Eighteen patients with symptomatic disturbance in micturition and a prostatic volume of 14-133 cm3 underwent voiding cystourethrogram and retrograde urethrogram before and 6 and 12 months after treatment. TUMT treatment was carried out with a Prostatron unit. RESULTS: No correlation was found between subjective improvement in symptoms and morphologic changes of the urethra. There were more responders among patients who received a high microwave effect. CONCLUSION: We conclude that there is no evidence to support the view that TUMT leads to significant necrosis in the prostrate with loss of tissue and retraction. Our results support the view that TUMT causes denervation of the prostate.

Transurethral microwave thermotherapy of benign prostatic hyperplasia: do any pretreatment conditions predict the result?

OBJECTIVES: To investigate the long-term effect of transurethral microwave thermotherapy (TUMT) treatment and find possible predictors of a favourable outcome. METHODS: Men with symptomatic benign prostatic hyperplasia (BPH) (n = 339) were examined before undergoing TUMT. The pretreatment evaluation included two or more of the following: cystoscopy, ultrasonic examination of the prostate, urine flow rate, residual urine volume and Madsen symptom score. The urodynamic measurements and Madsen score were repeated after 3, 6 and 12 months. Six different groups, based on pretreatment examinations or energy given during TUMT, were analysed. RESULTS: The Madsen score was significantly reduced and the score reduction was similar in all groups. Residual urine did not change significantly and flow rate increased only marginally. At 12 months, 56% of the men were satisfied with the treatment result, 29% had received additional treatment because of insufficient relief symptoms, while the remaining 15% were not satisfied but decided not to undergo further treatment at present. CONCLUSION: The reduction in the Madsen score remained stable during 1-year follow-up. None of the investigated pretreatment findings were predictive of a favourable treatment result. Since TUMT did not increase peak urinary flow significantly, men with BPH symptoms and unobstructed micturition appear to be the most suitable group for treatment. This group of men showed the same symptomatic improvement as the other investigated groups.

Adrenaline, cyclic AMP and potassium during general anaesthesia with and without epidural analgesia.

Twenty patients undergoing abdominal surgery under general anaesthesia were studied to determine whether beta 2-adrenergic receptor sensitivity and adrenaline-induced hypokalaemia are related to preceding adrenergic stress. Half of the patients were given epidural analgesia with bupivacaine-adrenaline before starting surgery and then a booster dose after 60 min of surgery. The others were given only the epidural dose of bupivacaine-adrenaline at 60 min. Despite marked increases in the plasma adrenaline concentration after the intra-operative epidural dose, there was no decrease in the serum potassium concentration in either group. In the patients who received only the 60 min dose, the plasma adrenaline concentrations increased more, but the plasma level of cyclic AMP (a marker for beta 2-stimulation) increased similarly, which suggests that beta 2-adrenoceptor responsiveness was somewhat reduced. After the intraoperative bupivacaine-adrenaline, the T wave amplitude decreased, but neither U waves nor tachycardia developed. In conclusion, adrenergic stimulation during surgery does not decrease the serum potassium concentration, regardless of whether the surgical stress response has been modified by epidural analgesia. This lack of a hypokalaemic effect might be partly due to reduced responsiveness of beta 2-adrenoceptors to adrenaline.

The human renal 25-hydroxyvitamin D3-1 alpha-hydroxylase: properties studied by isotope-dilution mass spectrometry.

The renal 25-hydroxyvitamin D3-1 alpha-hydroxylase activity has been measured in normal human kidney cortex, using a highly specific assay based on isotope-dilution mass spectrometry. The cortex was obtained from kidneys removed due to renal tumours. The subcellular distribution of 25-hydroxyvitamin D3-1 alpha-hydroxylase activity was studied. Enzyme activity was only observed in the mitochondrial fraction. Mitochondria from non-tumourous kidney cortex had a Vmax of 0.17 +/- 0.02 pmol min-1 mg-1 protein and the apparent Km was in the range of 14 mumol l-1. There was a tendency to a higher 25-hydroxyvitamin D3-1 alpha-hydroxylase activity in preparations from male kidney (0.21 +/- 0.03 pmol min-1 mg-1 protein) than female (0.12 +/- 0.02, P less than 0.05). A significant inverse correlation between serum phosphate and 25-hydroxyvitamin D3-1 alpha-hydroxylase activity was found. No correlation was observed between enzyme activity and serum levels of 1,25-dihydroxyvitamin D (total and free index), PTH, total calcium or ionized calcium. The results indicate that there is a sex difference in human 25-hydroxyvitamin D3-1 alpha-hydroxylase activity similar to the one observed in laboratory animals. Furthermore, the data support the hypothesis that serum phosphate is a major regulator of 1,25-dihydroxyvitamin D3 production in man.

Effects of orchidectomy and different modes of high dose estrogen treatment on circulating "free" and total 1,25-dihydroxyvitamin D in patients with prostatic cancer.

Serum levels of total 1,25-dihydroxyvitamin D (1,25(OH)2D), vitamin D binding protein (DBP), sex hormone binding globulin (SHBG), testosterone, estradiol 17 beta (E2) and the "free" 1,25(OH)2D index were measured before and during treatment in prostatic cancer patients treated by orchidectomy (n = 15), with combined i.m. polyestradiol phosphate (PEP) + oral ethinyl estradiol (EE) (n = 10) and with i.m. PEP only for 3 months, followed by addition of oral EE (n = 9). Total concentrations of 1,25(OH)2D and DBP were unaffected by orchidectomy and treatment with i.m. PEP only, but were significantly elevated during treatment including oral EE. SHBG levels were unaffected by orchidectomy, slightly increased by i.m. PEP only and greatly increased by oral EE. The free 1,25(OH)2D index was slightly elevated by treatment including oral EE. Evidence was obtained that the increase in 1,25(OH)2D levels observed during oral estrogen treatment was secondary to the estrogen-augmented increase in DBP and not a result of an estrogen-stimulated synthesis of 1,25(OH)2D. Furthermore, the stimulatory effect of estrogen on DBP concentrations seemed to be dependent on the route of administration of the hormone.

Absorption of a pharmacological dose of vitamin D3 from two different lipid vehicles in man: comparison of peanut oil and a medium chain triglyceride.

The absorption of a pharmacological dose of vitamin D3 from two different lipid vehicles, peanut oil, containing long chain fatty acids, and a medium chain triglyceride was compared. Serial measurements of the serum concentration of vitamin D3 after dosage were made. The serum levels of 25-hydroxyvitamin D3, the major circulating vitamin D3 metabolite, were also determined. The analytical methods used were based on HPLC. In the fasting state, the serum levels of vitamin D3 were significantly higher after administration in peanut oil than after administration in the medium chain triglyceride. When the vitamin D3 dose was ingested together with food no difference between the two formulations was observed. Only small inter-formulation differences in serum 25-hydroxyvitamin D3 levels were detected. The results indicate that the presence of long chain fatty acids facilitates the absorption of vitamin D3.

Effect of calcium intake on serum levels of 25-hydroxyvitamin D3.

The effects of high calcium intake on vitamin D metabolism were investigated. To the normal diet of 14 healthy men, 2 g calcium were added daily for 6-7 weeks. The mean serum concentration of 25-hydroxyvitamin D3 increased from 73 +/- 7 to 94 +/- 6 nmol l-1 (P less than 0.05, Student's unpaired t-test; P less than 0.01, paired t-test) in the subjects receiving calcium, whereas there was only a minimal increase, from 67 +/- 5 to 71 +/- 4 nmol l-1 in a control group on a normal diet. At the end of the study the difference between the test group and the controls was highly significant (P less than 0.005). The calcium loading caused a statistically significant depression of the serum levels of 1,25-dihydroxyvitamin D. The results obtained are in agreement with previous studies in rats and indicate that calcium intake is of some importance for the serum level of 25-hydroxyvitamin D3. The findings are discussed in relation to our previous finding that there is a relationship between high 25-hydroxyvitamin D3 levels and hypercalciuria in renal-stone formers.

Irrigating fluid absorption and blood loss during transurethral resection of the prostate studied with a regular interval monitoring (RIM) method.

A method for the study of physiological events during transurethral resection of the prostate (TUR) is described. Measurements of volumetric irrigating fluid balance, blood loss, central venous pressure (CVP) as well as blood haemoglobin and serum levels of sodium and glycine were performed at 10-min intervals. This regular interval monitoring (RIM) method offers the possibility to retrospectively correlate changes that occur during TUR at discrete time intervals. In 20 patients undergoing TUR, irrigating fluid absorption occurred throughout the procedure although the risk of having an absorption increased 30 min after surgery commenced. Increase of blood loss coincided with intravascular but not with extravascular absorptions. If there was a rapid massive intravascular absorption of about 500 ml/10 min, the CVP increased greater than 2 mmHg. The total intraoperative blood loss was not greater in patients with large absorption volumes. RIM will detect absorption greater than the urine excretion in any given period of time. If absorption occurs during a limited time of the TUR, RIM allows a partial correction for the urinary excretion in the volumetric fluid balance.

Changes in intravesical pressure during irrigating fluid absorption in transurethral prostatic surgery.

Continuous recording of intravesical pressure (IVP) and incremental volumetric measurements of irrigating fluid absorption were performed during 37 transurethral resections of the prostate (TUR). Absorption which resulted in concomitant dilutional changes in peripheral blood, indicating intravascular absorption, was associated with prolongation of the time required to increase the IVP. There was an inverse relation between the change in maximum IVP and the rate of irrigating fluid absorption. Absorption that did not result in concomitant dilutional changes in peripheral blood, indicating extravascular absorption, was associated with similar changes in IVP parameters but the critical pressure for absorption was lower.

Factors influencing the osmolality and the concentrations of blood haemoglobin and electrolytes during transurethral resection of the prostate.

Twenty patients undergoing transurethral resection of the prostate (TUR) were followed every 10 min intraoperatively as well as 1 and 2 h postoperatively with measurements of blood haemoglobin concentration (B-Hb), serum sodium (S-Na), serum potassium (S-K), serum osmolality (S-osmol), blood loss, central venous pressure and volumetric determination of the irrigating fluid absorption. Changes in B-Hb correlated well with the sum of acetated Ringer solution given and intravascular irrigating fluid absorption. A transient decrease in S-Na of 1-4 mmol/l followed absorptions less than 300 ml. With larger intravascular absorptions, three stages of dilutive changes in S-Na and B-Hb are described. Extravascular absorptions resulted in mild blood parameter changes at various times after their occurrence. Absorption of irrigating fluid was associated with an increase in S-K. S-osmol decreased in conjunction with some absorptions, although the irrigating fluid was isotonic. Postoperative analyses of blood parameters gave only limited information about intraoperative complications. The only consistent pattern was associated with intravascular irrigating fluid absorption.

Three commercial kits and one liquid-chromatographic method evaluated for determining 25-hydroxyvitamin D3 in serum.

The accuracy of three commercial kit methods and one liquid-chromatographic (HPLC) method for determining 25-hydroxyvitamin D3 in serum was evaluated by using isotope dilution-mass spectrometry as a reference technique. The kit methods were based on radioimmunoassay and radioreceptor assay. Serum samples were analyzed from male and female volunteers, some of whom had been exposed to ultraviolet B light or given vitamin D3 orally. Results obtained with the three commercial kits were less accurate than those by HPLC. The agreement between the HPLC method and the comparison method was relatively good: r = 0.99; slope = 1.23; intercept = -2.9 micrograms/L. We conclude that methods based on HPLC should be preferred in routine clinical work and that the accuracy of the three commercial kits tested is not sufficient for their intended use.

On the regulatory importance of 1,25-dihydroxyvitamin D3 and dietary calcium on serum levels of 25-hydroxyvitamin D3 in rats.

The serum level of 25-hydroxyvitamin D3 in rats was found to vary with the dietary intake of calcium. An increase in the dietary intake of calcium was found to be associated with an increase in the concentration of 25-hydroxyvitamin D3 and a decrease in the concentration of 1,25-dihydroxyvitamin D in serum. Intraperitoneal administration of 1,25-dihydroxyvitamin D3 was found to depress the serum concentration of 25-hydroxyvitamin D3 in rats on both medium and high calcium diets. These changes in the serum levels of 25-hydroxyvitamin D3 were not associated with statistically significant changes in the activity of mitochondrial vitamin D3 25-hydroxylase in the liver. Possible mechanisms for the regulation of the level of circulating 25-hydroxyvitamin D3 in serum are discussed.

Proposed criteria for identifying hyperabsorbers among normocalcaemic renal stone formers.

Normocalcaemic male stone formers (n = 138), 31-51 years of age, were divided into a hypercalciuric group (n = 80), with calcium excretions exceeding 7.0 mmol/24 h, and a normocalciuric group (n = 58), with calcium excretions of 7.0 mmol/24 h or less. The hypercalciuric group of patients was further subdivided using two previously published methods for identifying hyperabsorbers--one based on fasting urinary calcium/creatinine ratios and renal threshold phosphate concentrations, Jongen and the other method based on an oral calcium load test, Pak et al. The first method identified 37 patients and the second method 12 patients as hyperabsorbers. However, of the latter 12 patients only 8 were identified as hyperabsorbers using the first method of classification. It is thus evident that the two methods used for subclassification may give surprisingly different results. In order to obtain better congruence, the consequences of changing the defining limits in the two different methods were investigated. On the basis of the results obtained a new model for identification of hyperabsorbers is presented and discussed. With these new selection criteria (TmPO4/GFR greater than or equal to 0.75, urinary fasting molar calcium/creatinine ratio less than 0.40, and an increase in urinary molar calcium/creatinine ratio after calcium load greater than or equal to 0.20), 27 of the hypercalciuric patients were identified as hyperabsorbers. This group included 23 of Jongen's 37 and all of Pak's 12 hyperabsorbers. No patient not identified as a hyperabsorber according to either Jongen's or Pak's method were found in this group. The suggested model for identifying hyperabsorbers seems to be practical at least in studies on the relation between hypercalciuria and metabolism of vitamin D3.

Studies on the relationship between vitamin D3 status and urinary excretion of calcium in healthy subjects: effects of increased levels of 25-hydroxyvitamin D3.

The metabolic consequences of a rapid increase in vitamin D status in healthy subjects were investigated. Circulating levels of 25-hydroxyvitamin D3 were increased by 224% in 12 healthy men by giving oral vitamin D3 for 7 weeks and by 200% in 15 healthy women by UVB irradiation for 7 weeks. No statistically significant effects on the serum levels of calcium, phosphate, creatinine, urate, albumin, PTH, basal urinary excretion of calcium, fasting urinary excretion of cAMP, or urinary excretion of calcium after calcium load tests were observed with the unpaired t-test. With the paired t-test the small stimulatory effects (about 25%) on basal urinary excretion of calcium became statistically significant in both experiments. The ratio between calcium and creatinine in fasting urine was significantly elevated following UVB irradiation (from 0.11 +/- 0.02 to 0.21 +/- 0.04, p less than 0.025 unpaired t-test, p less than 0.02 paired t-test) but not after oral intake of vitamin D3. The level of 1,25-dihydroxyvitamin D in serum was not affected to a statistically significant degree by oral vitamin D3, whereas there was a slight decrease from 48 +/- 3 to 39 +/- 3 pmol/l following UVB irradiation. It is concluded that an increase in the concentration of 25-hydroxyvitamin D3 up to about 125 nmol/l has small and negligible effects on calcium homeostasis in healthy subjects. This finding is discussed in relation to our previous finding that hypercalciuric renal stone formers have elevated serum levels of 25-hydroxyvitamin D3 as compared with normocalciuric stone formers and healthy subjects.

25-Hydroxylase activity in subcellular fractions from human liver. Evidence for different rates of mitochondrial hydroxylation of vitamin D2 and D3.

25-Hydroxylation of vitamin D2 and D3 was studied in subcellular fractions from human liver, using a technique based on isotope dilution-mass spectrometry. The mitochondrial fraction fortified with isocitrate catalysed 25-hydroxylation of vitamin D3 at a rate of about 10 pmol/mg protein X min. Under the same conditions, the rate of 25-hydroxylation of vitamin D2 was less than 2 pmol/mg protein X min. Crude microsomes fortified with NADPH catalysed 25-hydroxylation of vitamin D3 to a very low extent, and this activity was not linear with the amount of microsomal protein. A higher rate of conversion was obtained with a partially purified cytochrome P-450 fraction in the presence of NADPH-cytochrome P-450 reductase and NADPH. This fraction also catalysed 25-hydroxylation of 1 alpha-hydroxyvitamin D3 and 5 beta-cholestane-3 alpha, 7 alpha, 12 alpha-triol. 25-Hydroxylation of vitamin D2 could not be detected, neither with crude microsomes, nor with the microsomal cytochrome P-450 fraction. Since the assay for 25-hydroxyvitamin D2 was less sensitive than that for 25-hydroxyvitamin D3, these experiments do not rule out the presence of some 25-hydroxylase activity towards vitamin D2 in the microsomes. The results are discussed in relation to previous work in which a lower toxicity has been reported for vitamin D2 than for vitamin D3 in some mammalian species.