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1.
Urologe A ; 59(1): 65-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31741004

RESUMO

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Feminino , Alemanha , Humanos
3.
Urologe A ; 58(3): 271-283, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30790005

RESUMO

BACKGROUND: Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is the fourth most common and the fifth most costly disease in men aged 50 years or older. Despite the high prevalence of LUTS/BPH in clinical practice and evidence-based guideline recommendations, there are still plenty of misconceptions on the terminology and pathophysiology of the disease, leading to false assumptions and malpractice. OBJECTIVES: Listing of commonly used false assumptions and clarification of the correct terminology and pathophysiology. MATERIALS AND METHODS: Critical reflection of 12 selected fake news based on PubMed search. RESULTS: Average prostate weight in healthy men is 20 g but varies between 8-40 g. The BPH-disease does not progress in stages; therefore, the BPH-classifications according Alken or Vahlensieck should not be used anymore. There is only a weak and inconsistent relationship between bladder outlet obstruction (BOO) and prostate size, diverticula/pseudo-diverticula, postvoid residual, urinary retention or renal insufficiency, which is too unreliable for BOO-diagnosis in the individual patient. Urethro-cystoscopy with grading of the degrees of occlusion of the prostatic urethra and bladder trabeculation is insufficient for BOO-diagnosis. There is no clinically relevant reduction of BOO with licensed BPH-drugs and no convincing data that prostate resection (TURP) has to be complete until the surgical capsule in order to obtain optimal results. CONCLUSIONS: The reasons for the persistent use of wrong terminology and pathophysiology are diverse. One reason is lack of implementation of evidence-based guidelines into clinical practice due to lack of knowledge, individual beliefs, costs, availability and reimbursement policies. Another reason is the increasing focus on oncology, coupled with underrepresented education and training on BPH.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Obstrução do Colo da Bexiga Urinária , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia
4.
Urologe A ; 58(3): 238-247, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30796463

RESUMO

BACKGROUND: Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) is the most common condition affecting the lower urinary tract of men. Evidence-based assessment is the basis for an ideal treatment approach. OBJECTIVES: To provide an overview of the current status of diagnostic measures for LUTS/BPH. MATERIALS AND METHODS: Descriptive review of the literature on the diagnosis of LUTS/BPH. RESULTS: A medical history inquiring about LUTS/BPH symptoms and burden as well as a standardized and validated symptom questionnaire such as the International Prostate Symptom Score (IPSS) are the basis of the assessment. A physical examination including a rectal exam and the ultrasonography of the lower and upper urinary tract are also part of the basic diagnostic workup. Prostate size is ideally measured by transrectal ultrasound. Serum prostate-specific antigen measurement may help to estimate the prostate size and the risk fo progression. It can also be helpful in the detection of prostate cancer. Urine dipstick or sediment is used to exclude urinary tract infection, hematuria, or glucosuria. Voiding dysfunction can be detected by uroflowmetry. In addition to the aforementioned examinations, further tests such as frequency-voiding charts, multichannel urodynamic evaluation, measurement of detrusor wall thickness and X­ray imaging of the upper urinary tract as well as a cystoscopy may be offered if needed. CONCLUSIONS: Diagnostics of LUTS/BPH consist of basic exams as well as optional exams and can be used to assess the progression risk, to identify complications and to offer the ideal treatment.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Cistoscopia , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Masculino , Hiperplasia Prostática/diagnóstico , Bexiga Urinária , Urodinâmica
7.
Clin Exp Immunol ; 185(1): 107-18, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26990855

RESUMO

Besides mobilizing stem cells into the periphery, granulocyte colony-stimulating factor (G-CSF) has been shown to influence various types of innate and adaptive immune cells. For example, it impairs the effector function of cytotoxic T lymphocytes (CTLs). It is assumed that this effect is mediated indirectly by monocytes, regulatory T cells and immunomodulatory cytokines influenced by G-CSF. In this study, isolated G-CSF-treated CD8(+) T cells were stimulated antigen-dependently with peptide-major histocompatibility complex (pMHC)-coupled artificial antigen-presenting cells (aAPCs) or stimulated antigen-independently with anti-CD3/CD28 stimulator beads. By measuring the changes in interferon (IFN)-γ and granzyme B expression at the mRNA and protein level, we showed for the first time that G-CSF has a direct effect on CD8(+) CTLs, which was confirmed based on the reduced production of IFN-γ and granzyme B by the cytotoxic T cell line TALL-104 after G-CSF treatment. By investigating further elements affected by G-CSF in CTLs from stem cell donors and untreated controls, we found a decreased phosphorylation of extracellular-regulated kinase (ERK)1/2, lymphocyte-specific protein tyrosine kinase (Lck) and CD3ζ after G-CSF treatment. Additionally, miRNA-155 and activation marker expression levels were reduced. In summary, our results show that G-CSF directly influences the effector function of cytotoxic CD8(+) T cells and affects various elements of T cell activation.


Assuntos
Células Apresentadoras de Antígenos/efeitos dos fármacos , Fator Estimulador de Colônias de Granulócitos/farmacologia , Ativação Linfocitária/efeitos dos fármacos , Linfócitos T Citotóxicos/efeitos dos fármacos , Linfócitos T Reguladores/efeitos dos fármacos , Células Apresentadoras de Antígenos/citologia , Células Apresentadoras de Antígenos/imunologia , Antígenos CD28/genética , Antígenos CD28/imunologia , Complexo CD3/genética , Complexo CD3/imunologia , Comunicação Celular/efeitos dos fármacos , Comunicação Celular/imunologia , Linhagem Celular Tumoral , Técnicas de Cocultura , Regulação da Expressão Gênica , Granzimas/antagonistas & inibidores , Granzimas/genética , Granzimas/imunologia , Humanos , Interferon gama/antagonistas & inibidores , Interferon gama/genética , Interferon gama/imunologia , Proteína Tirosina Quinase p56(lck) Linfócito-Específica/genética , Proteína Tirosina Quinase p56(lck) Linfócito-Específica/imunologia , MicroRNAs/genética , MicroRNAs/imunologia , Proteína Quinase 1 Ativada por Mitógeno/genética , Proteína Quinase 1 Ativada por Mitógeno/imunologia , Proteína Quinase 3 Ativada por Mitógeno/genética , Proteína Quinase 3 Ativada por Mitógeno/imunologia , Cultura Primária de Células , RNA Mensageiro/genética , RNA Mensageiro/imunologia , Transdução de Sinais , Linfócitos T Citotóxicos/citologia , Linfócitos T Citotóxicos/imunologia , Linfócitos T Reguladores/citologia , Linfócitos T Reguladores/imunologia
8.
Urologe A ; 55(2): 184-94, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26518303

RESUMO

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.


Assuntos
Terapia Comportamental/normas , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Conduta Expectante/normas , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Fitoterapia/normas , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normas
9.
Urologe A ; 55(2): 195-207, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26518304

RESUMO

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.


Assuntos
Guias de Prática Clínica como Assunto , Prostatectomia/normas , Hiperplasia Prostática/terapia , Stents , Obstrução do Colo da Bexiga Urinária/prevenção & controle , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Prostatectomia/métodos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normas
10.
Urologe A ; 55(1): 81-94; quiz 95-6, 2016 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-26676726

RESUMO

The pharmacological treatment of benign prostatic hyperplasia (BPH) is indicated when men suffer from lower urinary tract symptoms (LUTS) but there are no absolute indications for prostate surgery or severe bladder outlet obstruction. Phytotherapy can be used in men with mild to moderate LUTS and alpha-blockers can quickly and effectively decrease the LUTS and symptomatic disease progression. Phosphodiesterase type 5 inhibitors (PDE5-I) are an alternative to alpha-blockers when men experience bothersome side effects from alpha-blockers or erectile dysfunction. If patients predominantly have bladder storage symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination of alpha-blocker plus muscarinic receptor antagonist is more efficacious in reducing LUTS than the single drugs alone. The 5 alpha-reductase inhibitors (5ARI) can significantly decrease LUTS and disease progression (e.g. acute urinary retention and need for prostate surgery) in men with larger prostates (> 30-40 ml). The combination of 5ARI plus alpha-blocker can reduce LUTS and disease progression more effectively than drug monotherapy. Combination therapy with PDE5-I (tadalafil) plus 5ARI (finasteride) reduces LUTS more substantially than 5ARI alone and, additionally, PDE5-Is reduce the sexual side effects during 5ARI treatment.


Assuntos
Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Inibidores da Fosfodiesterase 5/uso terapêutico , Fitoterapia/métodos , Hiperplasia Prostática/tratamento farmacológico , Inibidores de 5-alfa Redutase/efeitos adversos , Antagonistas Adrenérgicos alfa/efeitos adversos , Antagonistas Colinérgicos/efeitos adversos , Quimioterapia Combinada/métodos , Medicina Baseada em Evidências , Humanos , Masculino , Inibidores da Fosfodiesterase 5/efeitos adversos , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento
11.
Int J Clin Pract ; 69(12): 1496-507, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26299520

RESUMO

PURPOSE: The influence of cardiovascular risk factors/comorbidities on response to oral once-daily tadalafil 5 mg was explored in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). METHODS: This post hoc analysis pooled data from four double-blind studies in which 1498 men with > 6-mo history of LUTS/BPH were randomised and received either once-daily placebo (n = 746) or tadalafil 5 mg (n = 752) for 12 weeks. Descriptive statistics were reported for changes in total International Prostate Symptom Score (IPSS), IPSS voiding and storage subscores, and IPSS quality-of-life (QoL) index. Treatment group differences by baseline clinical and cardiovascular factors and medical therapies were examined using analysis of covariance. RESULTS: Tadalafil was effective in men with LUTS/BPH and cardiovascular risk factors/comorbidities except for patients receiving > 1 antihypertensive medication. Placebo-adjusted least squares (LS) mean improvements in total IPSS were -1.2 (95% CI: -2.5 to -0.0) in men taking > 1 antihypertensive medication vs. -3.3 (95% CI: -4.4 to -2.1) in men taking one medication (interaction p = 0.020). In addition, placebo-adjusted LS mean improvements in total IPSS were -0.2 (95% CI, -2.1 to 1.7) in men who reported use of diuretics vs. -2.8 (95% CI, -3.7 to -1.9) in men who reported taking other antihypertensive medications vs. -2.3 (95% CI, -3.2 to -1.5) in men who reported not using any antihypertensive drug (p-value for interaction = 0.053). CONCLUSIONS: Once-daily tadalafil 5 mg improved LUTS/BPH, regardless of severity, in men with coexisting cardiovascular risk factors/comorbidities, except for patients with history of > 1 drug for arterial hypertension. Use of diuretics may contribute to patients' perception of a negated efficacy of tadalafil on LUTS/BPH. Comorbidities should be considered when choosing the optimal medicine to treat men with LUTS/BPH.


Assuntos
Doenças Cardiovasculares/complicações , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Inibidores da Fosfodiesterase 5/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Tadalafila/administração & dosagem , Vasodilatadores/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Método Duplo-Cego , Esquema de Medicação , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Urologe A ; 54(6): 887-99; quiz 900, 2015 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-26081822

RESUMO

Stress urinary incontinence in men is predominantly iatrogenic whereby radical prostatectomy is the most common cause with persistent stress urinary incontinence rates varying between 10 % and 25 %. The first line therapy for postoperative male stress urinary incontinence is physiotherapy, especially pelvic floor muscle rehabilitation. If conservative treatment fails to show sufficient improvement, surgical therapy is recommended. Several treatment options are currently available for the surgical treatment of male stress urinary incontinence including artificial sphincters, adjustable and functional sling systems, bulking agents and implantable balloon systems.


Assuntos
Terapia por Exercício/métodos , Prostatectomia/efeitos adversos , Slings Suburetrais , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Esfíncter Urinário Artificial , Medicina Baseada em Evidências , Humanos , Masculino , Resultado do Tratamento
13.
Drugs Aging ; 31(6): 425-39, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24811735

RESUMO

Several studies have highlighted a strong association between benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) and erectile dysfunction (ED), particularly in elderly men. Many epidemiological trials, such as in vitro and in vivo studies, have reported the emerging role of metabolic syndrome, including abdominal obesity, impaired glucose metabolism, hypertriglyceridemia, low high-density lipoprotein cholesterol, and hypertension, in the development and progression of urinary and sexual symptoms. Moreover, many authors have focused their studies on the identification of all the shared pathogenetic mechanisms of LUTS/BPH and ED, including alteration of cyclic guanosine monophosphate and RhoA-ROCK pathways or vascular and neurogenic dysfunction. All these are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Therefore, several trials have recently been designed to evaluate the role of PDE5-Is alone or in combination with conventional treatment for BPH, such as α-adrenergic blockers, in men affected by LUTS/BPH, with or without ED. Different PDE5-Is are in clinical use worldwide and currently six of them are licensed for the oral treatment of ED. All these compounds differ in pharmacokinetic factors, with influence on drug action, and subsequently in the overall safety and efficacy profile.


Assuntos
Disfunção Erétil/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Antagonistas Adrenérgicos alfa/administração & dosagem , Antagonistas Adrenérgicos alfa/efeitos adversos , Antagonistas Adrenérgicos alfa/uso terapêutico , Ensaios Clínicos como Assunto , Quimioterapia Combinada , Disfunção Erétil/complicações , Disfunção Erétil/imunologia , Humanos , Masculino , Inibidores da Fosfodiesterase 5/administração & dosagem , Inibidores da Fosfodiesterase 5/efeitos adversos , Inibidores da Fosfodiesterase 5/farmacocinética , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/complicações , Hiperplasia Prostática/imunologia , Qualidade de Vida , Resultado do Tratamento
14.
Curr Bladder Dysfunct Rep ; 8(2): 150-159, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23888186

RESUMO

Epidemiologic data in adult men exhibit a strong relationship between erectile dysfunction (ED) and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), indicating that men affected by ED should also be investigated for LUTS/BPH and those presenting with storage or voiding LUTS should be investigated for co-morbid ED. Common pathophysiolgical mechanisms underlying both LUTS/BPH and ED, including alteration of NO/cGMP or RhoA/Rho-kinase signaling and/or vascular or neurogenic dysfunction, are potential targets for proposed phosphodiesterase type 5 inhibitors (PDE5-Is). Several randomized controlled trials and only a few reviews including all commercially available PDE5-Is demonstrated the safety and efficacy of these drugs in the improvement of erectile function and urinary symptoms, in patients affected either by ED, LUTS, or both conditions.

15.
Z Gerontol Geriatr ; 46(5): 456-64, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23619707

RESUMO

A multidisciplinary German expert group met in 2012 to discuss the current status and prospects of health care of geriatric patients with urinary incontinence in Germany. The purpose of this position paper is to raise awareness among health care providers for the challenges associated with adequate management of urinary incontinence in frail elderly. The experts agree that a multidisciplinary collaboration is essential for the successful treatment of urinary incontinence symptoms which are often associated with loss of autonomy and social isolation. For most geriatric patients, usually the general practitioner is the first contact when seeking help. Hence, the general practitioner plays a crucial role in the coordination of diagnosis and treatment. The involved health care providers should have adequate education and training in their respective disciplines and should be networked allowing quick turnaround times. Non-pharmacological treatments (e.g. behavioural interventions) should have been tried before any pharmacotherapy is initiated. If pharmacological treatment of urinary incontinence involves the use of anticholinergic agents, cognitive performance should be monitored regularly. If indicated, anticholinergic agents with a documented efficacy and safety profile, explicitly assessed in the elderly population, should be preferred.


Assuntos
Terapia Comportamental/métodos , Antagonistas Colinérgicos/uso terapêutico , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/normas , Incontinência Urinária/diagnóstico , Incontinência Urinária/terapia , Urologia/normas , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Avaliação Geriátrica/métodos , Alemanha , Humanos , Masculino
16.
Urologe A ; 52(3): 354-8, 2013 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-23435646

RESUMO

Intraprostatic injection therapy is a minimally invasive treatment of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and could be a therapeutic alternative in increasingly older and co-morbid patients. Nowadays only botulinum neurotoxin A (BoNT/A), absolute ethanol, NX-1207 and PRX302 are of relevance but none of these substances has yet been authorized for treatment use (off-label use). There have been only three randomized, placebo-controlled trials (RCTs) for BoNT/A, whereas none exist for ethanol and the results of existing studies are inconsistent and without convincing proof of efficacy. NX-1207 is a protein with selective pro-apoptotic properties and non-inferiority compared to finasteride has been demonstrated. PRX302 is a modified proaerolysin that can be activated by prostate-specific antigen and is therefore (prostate) cell-specific. Safety and efficacy are well documented; however, intraprostatic injection therapy should presently only be performed in clinical trials, irrespective of the substance used.


Assuntos
Toxinas Bacterianas/administração & dosagem , Toxinas Botulínicas Tipo A/administração & dosagem , Etanol/administração & dosagem , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/prevenção & controle , Proteínas Citotóxicas Formadoras de Poros/administração & dosagem , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Humanos , Injeções Intralesionais , Sintomas do Trato Urinário Inferior/diagnóstico , Masculino , Hiperplasia Prostática/diagnóstico
18.
Urologe A ; 51(12): 1674-82, 2012 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-23160605

RESUMO

In some countries plant extracts have belonged to the most popular drugs for the treatment of the benign prostatic syndrome (BPS) for decades; however, only few of the large number of published studies meet the criteria of the WHO benign prostatic hyperplasia (BPH) consensus conference. The few placebo-controlled long-term (study period >6 months) studies suggest a positive effect of some extracts (saw palmetto fruit, ß-sitosterol, urtica, rye grass and a saw palmetto/urtica combination) on lower urinary tract symptoms (LUTS), urinary flow rate, post-void residual volume but effects on prostate volume or prostate-specific antigen (PSA) were only inconsistently demonstrable. To date no study has proven an effect on disease progression, such as acute urinary retention or need for surgical interventions. Due to the controversial data various extraction techniques and compositions of various products, neither American, European, British nor German BPH guidelines recommend plant extracts for the indication BPS although some placebo-controlled trials provided encouraging data. Further prospective studies according to WHO standards are required to determine the role of plant extracts for the management of BPS. For the indication of prostate cancer (PCa) plant extracts have been evaluated for disease prevention and management of several tumor stages but none of these studies have provided convincing evidence that plant extracts are superior to placebo and none of the Pica guidelines have recommended their use.Based on current knowledge plant extracts can never supplement evidence-based PCa management and should be used only in addition to the standard treatment. There is no scientific evidence for the use of dietary supplementation with high doses of vitamins or selenium-containing products.


Assuntos
Antineoplásicos/uso terapêutico , Medicina Baseada em Evidências , Fitoterapia/estatística & dados numéricos , Extratos Vegetais/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Neoplasias da Próstata/tratamento farmacológico , Comorbidade , Humanos , Masculino , Efeito Placebo , Prevalência , Hiperplasia Prostática/epidemiologia , Neoplasias da Próstata/epidemiologia , Resultado do Tratamento
19.
Urologe A ; 50(10): 1257-8, 1260-4, 2011 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-21901570

RESUMO

Histological benign prostatic hyperplasia (BPH) and the BPH disease are frequent, lead to a reduction of quality of life, are both progressive and potentially associated with complications in the lower and upper urinary tract. A PubMed/MEDLINE search was conducted for the years 1990 to 2011. This article summarizes known selective measures of primary and secondary disease prevention.Measures of primary disease prevention aim to inhibit histological BPH and the development of clinically relevant BPH. Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5α-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH. Selective measures of secondary prevention aim to inhibit disease progression and BPH-associated complications. The regular and long-term use of α1-blockers reduces lower urinary tract symptoms (LUTS) and inhibits symptomatic disease progression but cannot prevent BPH-associated complications (e.g. urinary retention or need for prostate surgery). 5α-Reductase inhibitors can reduce the probability of symptomatic disease progression, urinary retention or need for surgery but the combination of α1-blocker and 5α-reductase inhibitor is more efficacious than either monotherapy. Especially older men with enlarged prostates (>40 cm(3)) and elevated serum PSA concentration (>1.6 µg/l) profit from measures of secondary disease prevention.For primary disease prevention, data quality is low and early treatment with 5α-reductase inhibitors is not been approved. For secondary disease prevention, men with risk factors of disease progression should use a treatment containing 5α-reductase inhibitors. Despite several epidemiological and clinical investigations on BPH disease progression no official programme exists in Germany for disease prevention.


Assuntos
Prevenção Primária , Hiperplasia Prostática/prevenção & controle , Prevenção Secundária , Progressão da Doença , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/prevenção & controle , Masculino , Hiperplasia Prostática/etiologia , Fatores de Risco , Retenção Urinária/etiologia , Retenção Urinária/prevenção & controle
20.
Int J Impot Res ; 23(5): 206-12, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21697861

RESUMO

The clitoris contributes to the normal female sexual response cycle. A significance of cyclic guanosine monophosphate (GMP) has been assumed in the control of clitoral vascular smooth muscle. As only a few investigations on the physiology of the vascular and non-vascular clitoral tissue have been carried out, knowledge on the mechanisms controlling this particular female genital organ is still vague. It has been suggested that human clitoral corpus cavernosum smooth muscle is regulated by nitric oxide (NO)/cyclic GMP and related key enzymes, such as NO synthases (NOSs) and the phosphodiesterase type 5 (PDE5). The present study evaluated in the human clitoris, by means of immunohistochemistry, the expression and distribution of key enzymes of the cyclic GMP pathway, such as the endothelial NOS, PDE2, PDE11 and cyclic GMP-dependent protein kinase type I (cGKI) in relation to the PDE5. Immunohistochemistry revealed the presence of PDE2, PDE5 and cGKI in the smooth muscle wall of blood vessels transversing the supepithelial and stromal space. Immunosignals specific for PDE2 were also identified in interstitial-like cells located in the basal epithelial layer. Staining for PDE11A was observed in single nerve trunks located in the clitoral stroma. The results are in favor of a role of the cyclic GMP signaling in the control of clitoral blood flow. It seems likely that PDE2 and PDE11 are also involved in the mechanism of local (neuro)transmission in the clitoris.


Assuntos
Clitóris/enzimologia , Proteínas Quinases Dependentes de GMP Cíclico/metabolismo , GMP Cíclico/metabolismo , Nucleotídeo Cíclico Fosfodiesterase do Tipo 5/metabolismo , Óxido Nítrico Sintase Tipo III/metabolismo , Adolescente , Adulto , Nucleotídeo Cíclico Fosfodiesterase do Tipo 2/metabolismo , Nucleotídeo Cíclico Fosfodiesterase do Tipo 5/química , Feminino , Humanos , Imuno-Histoquímica , Sistemas do Segundo Mensageiro , Vimentina/metabolismo , Adulto Jovem
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