Prostatic inflammation: a potential treatment target for male LUTS due to benign prostatic obstruction.

BACKGROUND: The purpose of this narrative review is to evaluate the role of prostatic inflammation as a treatment target for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) and provide an update on the available therapies. METHODS: An extensive literature search was conducted for studies on established and investigational treatments with anti-inflammatory mechanism of action that has been assessed for the management of male LUTS due to BPO. RESULTS: Data on phosphodiesterase 5 inhibitors, nonsteroidal anti-inflammatory drugs, vitamin D3 receptor analogs, phytotherapy, statins, and lifestyle changes have been reviewed and analyzed. Preclinical evidence has shown the anti-inflammatory effect of these treatments on prostate. However, there is a wide variation in the degree of mature of each therapy. In addition, there are significant differences between the studies in terms of design, number of patients, and duration of follow-up. CONCLUSIONS: Several drugs classes have been investigated for their impact on prostatic inflammation and improvement of male LUTS. The reviewed data support the rationale for use of agents that may alter and improve the inflammatory environment in the prostate in men with LUTS, but further high-quality long-term studies are required for the exact positioning of the new drugs in daily practice.

Green light laser (KTP, 80 W) for the treatment of benign prostatic hyperplasia.

AIM: An attractive alternative for the management of benign prostate hyperplasia (BPH) is the use of 80 W potassium titanyl phosphate (KTP). We evaluated the efficacy and safety of this procedure in patients with bladder outlet obstruction (BOO). METHODS: A total of 171 patients with obstructive BPH underwent the 80 W potassium-titanyl-phosphate laser procedures. Preoperatively the international prostate symptom score (IPSS), the maximal urinary flow rate (Qmax), prostate volume and the post-void residual urine volume (PVR) were determined. Perioperative complications and postoperative blood loss, hospitalization, catheterization time, Qmax and PVR were also assessed. RESULTS: From the 171 patients, who underwent KTP laser procedure, 143 have been evaluated. The mean preoperative prostate volume was 43.9+/-17.1 (15-76). Eighty-nine patients (62.2%) were on chronic oral anticoagulant therapy (Coumarin or Aspirin 100). The mean applied energy was 170+/-65 kJ (100-275). There was no significant blood loss or fluid absorption during the KTP procedure. The mean Qmax values preoperatively and postoperatively were 3.4+/-4.3 and 16.3+/-7.3, respectively. PVR decreased from 74+/-47.7 mL preoperatively, to 16.6+/-21.5 mL postoperatively. Catheteriza-tion time was 1.4+/-0.8 days (0-5). CONCLUSION: KTP laser for the prostate represents a safe and effective treatment for patients with BPH. The procedure has a low rate of postoperative complications. It can be used for high risk patients especially for them who are receiving oral anticoagulation therapy.

Pain level and anal discomfort during transrectal ultrasound for guided prostate biopsy. Does intrarectal administration of local anesthetic before periprostatic anesthesia makes any difference?

AIM: The aim of this study was to evaluate the anal discomfort and pain level, during transrectal ultrasound probe insertion and before the periprostatic anesthesia in young patients (<65 years of age). METHODS: This study enrolled 147 patients, who underwent prostate biopsy and were divided in two groups: 74 patients received perianal local anesthesia with lidocaine cream 2% (first group), while 73 received only lubricant gel as perianal local anesthesia (second group) prior the insertion of ultrasound probe. Patients in both groups received periprostatic anesthesia. Pain and discomfort due to the probe and due to the biopsy were estimated with visual analogue scale. Patients' characteristics, complications, and surgical data were analyzed for both groups. RESULTS: No serious intraoperative and postoperative complications were noted in both groups. The mean pain score for pain and anal discomfort was 1.7 and 5.7 for the first and second group, respectively. During biopsy, patients in the first group reported also less pain but there was no significant difference. CONCLUSIONS: The intrarectal introduction of lidocaine cream 2% can significantly reduce anal discomfort and pain before the probe insertion for ultrasound guided biopsies in young patients. Considering that these patients could undergo repeated biopsies, a higher level of local anesthesia is desired.