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1.
Arch Esp Urol ; 73(8): 675-681, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-33025912

RESUMO

Greenlight laser prostate vaporization is considered a valid alternative to transurethral prostate resection (TURP) for patient with LUTS due to BPH. The current review highlights the current evidence on greenlight technique and current state of-the-art. We will review clinically relevant concerns such as size limitation, economic issues and same-day surgery options. We will also describe technological improvements overtime and its relationship with current vaporization practices.CURRENT SITUATION: Based on clinical trial Goliath, Greenlight 180W vaporization showed non-inferiority to TURP and similar mid-term functional outcomes. A benefit towards length of hospital stay, similar complication rate (below 80% at 2 years). The current laser generators (higher potency) are able to provide an ablative effect on tissue that is associated to a shorter operative time. The major advantage of greenlight laser is the same day discharge, with a low readmission rates. Greenlightlaser is more cost-effective than TURP. CONCLUSIONS: Green light laser remains as an alternativevalid option despite the technological improvementsin the field.


Assuntos
Terapia a Laser , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Duração da Cirurgia , Hiperplasia Prostática/cirurgia
2.
Arch Esp Urol ; 73(8): 682-688, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025913

RESUMO

Thulium lasers operate at wavelengths between1940-2013 nm either in a continuous wave or in a pulsed mode, which enables smooth incisions with fast vaporization or effective laser lithotripsy for urolithiasis. Thulium laser enucleation is a minimally invasive and size-independent treatment for benign prostatic hyperplasia (BPH) with excellent long-term results. Since its introduction, several modifications in the technology and surgical techniques have been proposed such as vaporesection, vaporization and enucleation with regard to BPH treatment. Recent developments in the thulium laser technology include the introduction of a super pulsed thulium fiberlaser.  This technique delivers the laser energy through anactive fiber with an absorption maximum in water at awavelength of 1940 µm. Preclinical studies showed asignificantly higher stone fragmentation rate in differentex vivo models compared to the Ho:YAG laser. Another innovative thulium laser that works, as a hybrid laser has yet not been tested clinically, however, will soon be introduced. With the introduction of both new thulium lasers as novel devices, the armamentarium in the field of endourology for lithotripsy and enucleation increases. We here present different thulium lasers and surgical techniques that are possible to perform with each device including the reasons and advantages of each modification.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Litotripsia a Laser , Hiperplasia Prostática , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia , Túlio
3.
Arch Esp Urol ; 73(8): 699-708, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-33025915

RESUMO

OBJECTIVE: Prostate enucleation is becoming more relevant within BPH treatment. Nowadays is probably the gold standard for enucleation. Several studies have shown holmium laser as the most frequently used safe and efficient energy source. The long learning curve remains as its major drawback. The current review aims to describe step to step technique at our institutionand describing the rational for its use. METHODS: A detailed description on our  step-to-step Holep technique is provided. We focused on the main differences with other techniques already described highlighting the largest experience reported. RESULTS: None of the published series has shown better results in terms of functional, safety and less complications outcomes on the short and long term. No differences are shown in terms of intraoperative/postoperative blood loss, reoperations, capsular perforations or urethral strictures. Our techniques provides shorter surgical length and improved efficiency than blocking and trilobular techniques. The rates of early continence are 4% vs5-40%. Lastly, improvement in morcellator devices delivered no complications related to that part of the surgery. CONCLUSIONS: Holep is the gold standard technique for prostate enucleation. It provides improved functional and safety outcomes than with other techniques. A standardized and optimized technique is mandatory.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Estreitamento Uretral , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia
4.
Arch Esp Urol ; 73(8): 745-752, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025919

RESUMO

OBJECTIVE: To assess current efficacyand safety of low power HoLEP (Holmium Laser Enucleationof the Prostate) for the treatment of obstructingand symptomatic prostatic adenomas and to identify themechanisms supporting the related clinical advantages. METHODS: A systematic review was conducted usingrelevant databases (Ovid Medline, PubMed, Scopusand Web of Sciences), employing ("low power" OR"high power") AND ("HoLEP" OR "holmium laser enucleationof the prostate") as search terms. Inherent publicationswere selected according to the Preferred ReportingItems for Systematic Reviews and Meta-analyses (PRISMA)guidelines. Additionally, the reference lists of theselected papers were checked manually. RESULTS: We included any kind of study (n=15) dealingwith low power HoLEP because of the scarcity of the resultsobtained with the bibliographic search. Low powerHoLEP seems to be fully comparable to the traditionalhigh power HoLEP in terms of feasibility, efficacy andsafety. An additional clinical advantage of the low powerapproach might be the reduced incidence of postoperativedysuria, with limited intensity and duration, possiblydue to the decreased amount of energy delivered tothe capsular plane with a less aggressive modality, conjugatedwith appropriate technical enucleative choices.The physical rationale of low power HoLEP is discussed. CONCLUSIONS: Low power HoLEP is feasible, safeand effective, and might play a not exclusive role in thereduction of incidence, intensity and duration of postoperative dysuria.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia , Resultado do Tratamento
5.
Arch Esp Urol ; 73(8): 689-698, 2020 10.
Artigo em Espanhol | MEDLINE | ID: mdl-33025914

RESUMO

Endoscopic enucleation of the prostate was first described by Hiraoka in 1986, using a monopolar resectoscope. His contribution was largely ignored until Gilling and Fraundorfer published their three-lobe enucleation technique with the Holmium laser in 1998 ,that ended establishing itself as a reliable option for the treatment of HBP, backed by ample scientific evidence. Later on, enucleation performed with other lasers, as well as bipolar energy, have shown concordance in their clinical results. As a result, the term AEEP (anatomic endoscopic enucleation of the prostate) emerged to encompass all these techniques. During the last few years there have been significant advances in two areas: first, technology, with the development of pulse modulation for Holmium generators (MOSES) as well as high-speed morcellators. Second, the development of new surgical techniques that recognize the importance of the early release of the sphincter from the apex of the adenoma during the operation as well as the careful preservation of the external sphincter's mucosa, to avoid early stress incontinence. In this paper,we review the recent evolution of both technology and surgical technique. AEEP has been risen to a new level, reducing operative time significantly, usually under one hour, and radically reducing the incidence of early temporary stress incontinence, and maybe also facilitating the learning curve of AEEP.


Assuntos
Lasers de Estado Sólido , Hiperplasia Prostática , Endoscopia/instrumentação , Humanos , Desenvolvimento Industrial , Lasers de Estado Sólido/uso terapêutico , Masculino , Prostatectomia , Hiperplasia Prostática/cirurgia
6.
Hinyokika Kiyo ; 66(8): 259-264, 2020 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-32882122

RESUMO

Five mg tadalafil was administered once-daily to 48 patients for 6 months. Their International Prostatic Symptoms Score (IPSS), Overactive Bladder Symptoms Score (OABSS), Sexual Health Inventory for Men (SHIM), post-voided residual (PVR) volume, free testosterone (FT) level, prostate-specific antigen level, and highly sensitive C-reactive protein (hsCRP) value obtained before and 6 months after the treatment were analyzed. The treatment significantly improved the IPSS, OABSS, SHIM score, and PVR volume (P<0.05), and significantly increased the mean FT level from 6.68 to 7.10 pg/ml ; P<0.05. We observed no significant changes in the hsCRP value and PSA level. However, elevated FT values were noted in 25 (52.1%) patients 6 months after the treatment (FT-increased group). Compared with the non-FT-increased group, the FT-increased group had markedly lower baseline FT value and higher prostatic volume. In both groups, IPSS and OABSS improved considerably. Moreover, the PVR volume, SHIM score, and hsCRP value markedly improved in the FT-increased group (P<0.05). Thus, 5 mg tadalafil administered oncedaily improved IPSS, OABSS, and erectile function, and increased the FT value, in hypogonadal patients with lower urinary tract symptoms. Furthermore, the hsCRP value declined considerably in patients with posttreatment elevated FT level.


Assuntos
Disfunção Erétil , Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Proteína C-Reativa , Humanos , Masculino , Inibidores da Fosfodiesterase 5 , Tadalafila , Testosterona , Resultado do Tratamento
7.
Hinyokika Kiyo ; 66(9): 289-292, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32993272

RESUMO

We retrospectively investigated the clinical course of α1 blocker discontinuation in patients who had lower urinary tract symptoms with benign prostate hypertrophy (LUTS/BPH) and received combination therapy ofdutasteride and α1 blocker. Among the patients with LUTS/BPH who had been receiving combination therapy, those who wished to reduce the number ofprescribed drugs and discontinue the use of α1 blocker because ofsymptom improvement were recruited in this study. Symptom scores including International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS), parameters ofuroflowmetry and prostate volume (PV) were evaluated at the time of α 1 blocker discontinuation. Twenty-two patients discontinued the use of α 1 blocker. The mean PV at the time of α 1 blocker discontinuation was 43.2 ml, and the mean duration ofcombination therapy was 39.4 months. In 11 (50%) patients, dutasteride monotherapy without α1 blocker was maintained for a mean follow-up of 10.5 months (9-12 months) after α1 blocker discontinuation (Non-resumption group). In the other 11 patients (50%), α1 blocker was resumed because ofthe patient's request to resume the use of α1 blocker (Resumption group). The mean length ofdutasteride monotherapy was 4. 5 months (1-8 months) in the resumption group. Compared with the non-resumption group, IPSS total score and storage sub-score ofIPSS at the time of α1 blocker discontinuation were significantly higher in the resumption group. Based on the ROC curve, IPSS total score <16, IPSS voiding/storage symptom score <7, OABSS <7 and PV 54 ml or more at the time of α1 blocker discontinuation were predictors ofnon-resumption of α1 blocker. These results suggest that if LUTS is controlled by a long-term combination therapy ofdutasteride and α1 blocker and still PV is large enough, α1 blocker can be discontinued.


Assuntos
Sintomas do Trato Urinário Inferior/tratamento farmacológico , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Quimioterapia Combinada , Dutasterida/uso terapêutico , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
Arch Esp Urol ; 73(7): 573-581, 2020 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-32886072

RESUMO

OBJECTIVE: In the Spanish health system, General Practitioners (GPs) play a key role in regulating the flow of patients to hospital care. Most of patients with BPH can be managed through out the evolution of the disease exclusively by the GPs.  METHODS: A pre-experimental study was carried outin two periods, before (pre-test) and after (post-test) of the dissemination of a management protocol for patients with BPH. The protocol was trialled in the health area of Villarrobledo and included all referrals to the urology clinic for BPH from Primary Care. We analyzed the appropriate referrals according with the criteria set for thin the protocol and compared the complementary tests through statistical study (descriptive, a bivariate, multivariate analysis and rate calculation) using version 21of the SPSS. RESULTS: Referral rate decreased after the application of the protocol but did not increase the rate of appropriated referrals. Patients referred after setting forth protocol by GPs that assisted to the education program were younger. There were referred less patients with elevated PSA and more patients with clinical progression. These GPs used less test to achieve diagnosis. The GPs whodid not attend were significantly younger, mainly women, with no previous specific training in BPH and without a full time GP position. CONCLUSIONS: The implementation of a protocol has reduced the referral rate, but it has not improved the appropriate referrals. More research is required to understand the determinants of inequalities in referral from primary care.


Assuntos
Hiperplasia Prostática/complicações , Urologia , Feminino , Humanos , Masculino , Atenção Primária à Saúde , Encaminhamento e Consulta
9.
Life Sci ; 259: 118380, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32898524

RESUMO

AIMS: Benign prostatic hyperplasia (BPH) is a progressive disease, which severely affects men's health. Here, we sought to analyze the functions and mechanism of action of the tripartite motif protein 52 (TRIM52), a novel prostate basal cell biomarker in BPH. MATERIALS AND METHODS: Immunohistochemistry assay was performed in sectioned human BPH tissues, BPH-1 cells, and prostate RWPE-1 cells, to detect the expressions of TRIM52 and NF-κB. Western blotting and qRT-PCR analyses were conducted to measure the relative protein and mRNA expression levels, respectively. Further, lentiviral transfection was performed in BPH-1 and RWPE-1 cells to study the overexpression and siRNA knockdown of TRIM52. Dual-luciferase reporter assay was applied to evaluate the relationship between NF-κB and TRIM52. Furthermore, CCK-8 assay and flow cytometry were employed to analyze cell proliferation and apoptosis. KEY FINDINGS: TRIM52 and NF-κB levels were elevated in BPH tissues, and TRIM52 expression positively correlated with NF-κB expression. TRIM52 silencing suppressed the growth of BPH-1 cells and decreased the promoter activity of NF-κB. Moreover, the NF-κB inhibitor, pyrrolidine dithiocarbamate (PDTC), suppressed TRIM52-induced proliferation of RWPE-1 cells and inhibited NF-κB promoter activity in oeTRIM52 transfected RWPE-1 cells. Silencing TRIM52 also inhibited TRAF2 ubiquitination in BPH-1 cells. Further, NF-κB promoter activity in siNC transfected cells was enhanced by the recombinant protein TNF-α and inhibited by siTRIM52. SIGNIFICANCE: TRIM52 accelerated the growth of BPH-1 cells by upregulating NF-κB, and TRIM52 could promote TRAF2 ubiquitination. These findings might contribute to the understanding of the biological functions and action mechanisms of TRIM52 in BPH.


Assuntos
NF-kappa B/metabolismo , Hiperplasia Prostática/metabolismo , Fator 2 Associado a Receptor de TNF/metabolismo , Proteínas com Motivo Tripartido/metabolismo , Western Blotting , Progressão da Doença , Citometria de Fluxo , Humanos , Masculino , Hiperplasia Prostática/patologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ubiquitinação
10.
Niger J Clin Pract ; 23(9): 1215-1220, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913159

RESUMO

Background: Benign Prostatic Hypertrophy [BPH] is associated with voiding dysfunctions. Urodynamic study is the gold standard for diagnosis of voiding dysfunctions but is invasive. Bladder wall thickness (BWT), post-void urine residue (PVR), and bladder emptying efficiency (BEE) are noninvasive predictors of voiding dysfunction. Objective: To study the relationship among BWT, PVR, and BEE in BPH. Subjects and Methods: A hospital-based cross-sectional prospective study of new BPH patients at Nnamdi Azikiwe University Teaching Hospital, Nnewi. The participants had abdominal ultrasonography measurement of anterior BWT (at bladder volume ≥200 mls), prostate volume (PV), and PVR using Prosound SSD3500 (Aloka Co Ltd, Tokyo, Japan) with an abdominal probe frequency of 3.5 MHz. Then the BEE was calculated. The anterior BWT was divided into two groups: <5 mm and ≥5 mm. The data were analyzed using SPSS version 20. Pearson's correlation was used to assess correlation and the differences between the means of the two groups of BWT were compared by Mann-Whitney test. A P- Value <0.05 was considered significant. Results: Seventy seven men with a mean age of 66.66 ± 10.74 years were included in the study. Sixty one percent had symptoms lasting >12 months. The average anterior BWT, PBV, PVR, BEE, PV, and PSA were 4.55 ± 1.02 mm, 260.98 ± 57.44 mls, 58.36 ± 52.94 mls, 77.98 ± 17.37%, 66.31 ± 46.38 mls, and 8.04 ± 5.97 ng/ml, respectively. There was a significant positive correlation between BWT and duration of symptoms (P = 0.044) and a significant negative correlation between BWT and BEE (P = 0.005). An insignificant positive correlation was found between BWT and PVR (P = 0.255). Fifty four (70.1%) had BWT <5 mm and 29.9% had BWT ≥5 mm. The mean IPSS (P = 0.000), PV (P = 0.032) and PVR (P = 0.020) were significantly higher in the ≥5 mm group. The ≥5 mm group also had a significantly lower BEE (P = 0.002). Conclusion: Voiding dysfunction was more severe in patients with BWT of 5 mm or more. There was a positive, but insignificant, correlation between anterior BWT and PVR and a significant negative correlation between BWT and BEE.


Assuntos
Hiperplasia Prostática/patologia , Ultrassonografia/métodos , Bexiga Urinária/diagnóstico por imagem , Retenção Urinária , Transtornos Urinários/patologia , Idoso , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Liso/anatomia & histologia , Músculo Liso/diagnóstico por imagem , Músculo Liso/patologia , Nigéria , Estudos Prospectivos , Hiperplasia Prostática/complicações , Bexiga Urinária/anatomia & histologia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/diagnóstico por imagem , Transtornos Urinários/etiologia , Urodinâmica
11.
Hinyokika Kiyo ; 66(9): 323-326, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988171

RESUMO

An 82-year-old man visited our department with a chief complaint of penile pain and swelling. He was receiving maintenance dialysis for chronic renal failure and was catheterized because of urinary retention associated with prostatic hypertrophy. The penis was reddened with swelling extending to the root and marked tenderness. Blood tests indicated inflammation and imaging revealed an abscess with emphysematous changes in the cavernous region of the penis. The diagnosis was purulent penile cavernitis. His symptoms improved after decompression with incision and drainage. There has been no recurrence of the abscess in the 4 months since treatment.


Assuntos
Enfisema , Hiperplasia Prostática , Retenção Urinária , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Humanos , Masculino , Pênis
12.
Medicine (Baltimore) ; 99(36): e22006, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899049

RESUMO

BACKGROUND: Benign prostatic hyperplasia (BPH) is a disease of the urinary system. It is common in middle-aged and elderly men. Moxibustion is widely used to manage BPH and the associated lower urinary tract symptoms, but there is still lack of systematic review of moxibusiton for BPH. So the aim of this review is to comprehensively evaluate the effectiveness and safety of moxibustion in the treatment of BPH. METHODS: The following 8 electronic databases including PubMed (1966-2020), EMbase (1980-2020), the Cochrane Library, Web of Science (1900-2020), China National Knowledge Infrastructure Database (1979-2020), WanFang Database (1998-2020), Chinese Scientific Journal Database (1989-2020), and Chinese Biomedical Literature Database (1979-2020) will be searched. No language restrictions will be used. Researchers will retrieve databases, identify trials, extract data, and evaluate the quality of eligible randomized controlled trials, independently. The outcomes will include: total effective rate, the American Urologic Association Symptom Score, International Prostate Symptom Score, urinary flow rate (measured in mL/s), changes in prostate size (measured in cc), quality of life, side effects and adverse events. The quality of methodology and evidence will be rated by using the Cochrane risk-of-bias assessment tool and grading of recommendations, assessment, development, and evaluation tool, respectively. Data synthesis will be presented by the manager of the Cochrane Collaboration's RevMan 5.3.0. RESULTS: We will show the results of this study in a peer-reviewed journal. CONCLUSIONS: The findings will provide credible clinical evidence of moxibustion treatment for BPH. PROSPERO REGISTRATION NUMBER: CRD42020190630.


Assuntos
Moxibustão , Hiperplasia Prostática/terapia , Humanos , Masculino , Metanálise como Assunto , Revisões Sistemáticas como Assunto
13.
Medicine (Baltimore) ; 99(37): e22082, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925747

RESUMO

INTRODUCTION: Diabetes insipidus can be a common cause of polyuria and hydronephrosis in the kidneys. However, there is few reported case of urinary obstruction induced nephrogenic diabetes insipidus. PATIENT CONCERNS: A 60-year-old Chinese man came to our hospital with the complaints of polydipsia and polyuria for 1 month. His examination showed chronic kidney disease stage III with eGFR of 48.274 ml/min, and the plasma osmolality was 338.00 mOsm/(kg·H2O) with a urinary osmolality of 163.00 mOsm/(kg·H2O). Moreover, imagological examination of the urinary system showed benign prostatic hyperplasia and hydronephrosis. DIAGNOSIS: He was considered with benign prostatic hyperplasia induced ureter hydronephrosis and nephrogenic diabetes insipidus. INTERVENTIONS: He got the transurethral resection of the prostate to alleviate urinary retention. OUTCOMES: After that, the urine output gradually decreased, and the administered hydrochlorothiazide was stopped due to the improved renal function. CONCLUSION: Our study presents a case of nephrogenic diabetes insipidus caused by urinary obstruction. Differential diagnoses for diabetes insipidus as well as the relationship between nephrogenic diabetes insipidus and urinary obstruction are also considered in this study.


Assuntos
Diabetes Insípido Nefrogênico/etiologia , Hiperplasia Prostática/complicações , Obstrução Ureteral/complicações , Antidiuréticos/uso terapêutico , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido Nefrogênico/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Poliúria/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Obstrução Ureteral/etiologia
14.
Medicine (Baltimore) ; 99(30): e21365, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791742

RESUMO

BACKGROUND: Water vapor thermal therapy (WVTT) is a minimally invasive procedure for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). There are no known systematic reviews reporting the effectiveness and safety of this increasingly common BPH therapy. METHODS: We performed a systematic review and meta-analysis of studies utilizing WVTT for symptomatic BPH. The international prostate symptom score (IPSS), IPSS-quality of life (IPSS-QOL), BPH impact index (BPHII), and maximum flow rate (Qmax) were calculated as the weighted mean difference relative to baseline and reported in minimal clinically important difference (MCID) units. MCID thresholds were -3 for IPSS, -0.5 for IPSS-QOL, -0.5 for BPHII, and 2 mL/s for Qmax. The surgical retreatment rate was calculated using life-table methods. RESULTS: We identified 5 cohorts treated with WVTT from 4 studies (514 patients; 40% with median lobe obstruction) with 2 years median follow-up (range: 6 months to 4 years). The IPSS, IPSS-QOL, BPHII, and Qmax significantly improved at all intervals between 3 months and 4 years; this benefit ranged from 3.3 to 3.8 MCID units for IPSS, 3.9 to 4.6 MCID units for IPSS-QOL, 6.8 to 8.2 MCID units for BPHII, and 1.5 to 3.0 MCID units for Qmax. The surgical retreatment rate was 7.0% at 4 years of follow-up data. Most adverse events were nonserious and transient; dysuria, urinary retention, and urinary tract infection were most common. No cases of de novo erectile dysfunction occurred. CONCLUSIONS: WVTT provided improvement in BPH symptoms that exceeded established MCID thresholds, preserved sexual function, and was associated with low surgical retreatment rates over 4 years.


Assuntos
Técnicas de Ablação , Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/complicações , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Vapor
16.
PLoS One ; 15(8): e0236879, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790676

RESUMO

Benign prostatic hyperplasia (BPH) is a progressive pathological condition associated with proliferation of prostatic tissues, prostate enlargement, and lower-urinary tract symptoms. However, the mechanism underlying the pathogenesis of BPH is unclear. The aim of this study was to investigate the protective effects of a combination of Stauntonia hexaphylla and Cornus officinalis (SC extract) on a testosterone propionate (TP)-induced BPH model. The effect of SC extract was examined in a TP-induced human prostate adenocarcinoma cell line. Male Sprague-Dawley rats were randomly divided into 5 groups (n = 6) for in vivo experiments. To induce BPH, all rats, except those in the control group, were administered daily with subcutaneous injections of TP (5 mg/kg) and orally treated with appropriate phosphate buffered saline/drugs (finasteride/saw palmetto/SC extract) for 4 consecutive weeks. SC extract significantly downregulated the androgen receptor (AR), prostate specific antigen (PSA), and 5α-reductase type 2 in TP-induced BPH in vitro. In in vivo experiments, SC extract significantly reduced prostate weight, size, serum testosterone, and dihydrotestosterone (DHT) levels. Histologically, SC extract markedly recovered TP-induced abnormalities and reduced prostatic hyperplasia, thereby improving the histo-architecture of TP-induced BPH rats. SC extract also significantly downregulated AR and PSA expression, as assayed using immunoblotting. Immunostaining revealed that SC extract markedly reduced the 5α-reductase type 2 and significantly downregulated the expression of proliferating cell nuclear antigen. In addition, immunoblotting of B-cell lymphoma 2 (Bcl-2) family proteins indicated that SC extract significantly downregulated anti-apoptotic Bcl-2 and markedly upregulated pro-apoptotic B cell lymphoma-associated X (Bax) expression. Furthermore, SC treatment significantly decreased the Bcl-2/Bax ratio, indicating induced prostate cell apoptosis in TP-induced BPH rats. Thus, our findings demonstrated that SC extract protects against BPH by inhibiting 5α-reductase type 2 and inducing prostate cell apoptosis. Therefore, SC extract might be useful in the clinical treatment of BPH.


Assuntos
Apoptose/efeitos dos fármacos , Colestenona 5 alfa-Redutase/química , Extratos Vegetais/farmacologia , Hiperplasia Prostática/prevenção & controle , Substâncias Protetoras/uso terapêutico , Inibidores de 5-alfa Redutase/química , Inibidores de 5-alfa Redutase/farmacologia , Inibidores de 5-alfa Redutase/uso terapêutico , Animais , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Colestenona 5 alfa-Redutase/metabolismo , Cornus/química , Cornus/metabolismo , Regulação para Baixo/efeitos dos fármacos , Humanos , Masculino , Extratos Vegetais/química , Extratos Vegetais/uso terapêutico , Folhas de Planta/química , Folhas de Planta/metabolismo , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/etiologia , Substâncias Protetoras/farmacologia , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ranunculales/química , Ranunculales/metabolismo , Ratos , Ratos Sprague-Dawley , Propionato de Testosterona/efeitos adversos
17.
Niger Postgrad Med J ; 27(3): 242-247, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687126

RESUMO

Giant prostatic enlargement often referred to as giant prostatic hyperplasia (GPH) is a rare condition described as a massive prostatic enlargement >500 g. Up until now, the total number of GPH reported worldwide in medical literature is < 30. To the best of our knowledge, only one case of a giant prostate has been reported in Nigeria. We report a case of a giant prostatic enlargement treated by open simple retropubic prostatectomy in a 73-year-old man who was suffering from lower urinary tract symptoms and persistent visible (gross) haematuria necessitating repeated blood transfusions. Transrectal ultrasound (TRUS) scan revealed a markedly enlarged prostate measuring 565 ml with a suspicious nodule and prostate-specific antigen level of 48.5 ng/ml. He had a 20-core TRUS-guided prostatic biopsy which showed benign prostatic hyperplasia. We performed a retropubic open simple prostatectomy for complete enucleation of the adenoma. Specimen weighed 512.5 g with dimensions of 17 cm × 16 cm and a volume of 528 ml. Histological examination showed prostatic fibromuscular hyperplasia with a focus of adenocarcinoma. The patient had an uneventful post-operative recovery and was discharged within a week post-surgery. Urethral catheter was removed after 2 weeks with satisfactory outcome.


Assuntos
Hematúria/etiologia , Prostatectomia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/cirurgia , Retenção Urinária/etiologia , Adenoma , Idoso , Humanos , Masculino , Nigéria , Próstata/patologia , Hiperplasia Prostática/patologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores
19.
Chirurgia (Bucur) ; 115(3): 307-313, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614285

RESUMO

Transurethral resection of the prostate (TURP) is still considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), but new methods like bipolar TURP became a real treatment alternative. Bipolar resection presents many option for the effective resection of the prostate: the most similar with m-TURP is represented by the loop resection, then transurethral vaporisation of the prostate (B-TUVP) which is derived from plasmakinetic B-TURP and the enucleation, which is among open prosta tectomy or holmium laser, the first choice of surgical treatment in men with a substantially enlarged prostate and moderate-to-severe LUTS. There was no statistical difference observed between M-TURP and B-TURP in the parameters of surgery time, catheterization time, PSA drop, peak flow improvement (Qmax), occurrence of urinary retention, and IPSS and quality of life (QoL) scores. On the other hand, B-TURP proved to be superior to M-TURP in relation to hospitalization time, blood transfusion rate, post-TURP syndrome, serum sodium rate and lower occurrence of urethral stenosis. when is about the cost of the procedure, a meta-analysis on 24 from the most relevant publications in the last 20 years, revealed that the TURis system demon strates equivalent efficacy versus MTURP, In conclusion, it could be observed nowadays that bipolar-TURP represents a viable alternative to M-TURP in patients with moderate to-severe LUTS secondary to BPO, with similar efficacy but lower peri-operative morbidity.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Resultado do Tratamento
20.
Br J Radiol ; 93(1114): 20200484, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32706988

RESUMO

With increasing evidence to support prostate artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH)-induced lower urinary tract symptoms (LUTS), Interventional Radiologists have begun to play an important role in the management of these patients. One area of knowledge needed when developing a PAE practice is knowledge of prostate-specific antigen (PSA) and other biomarkers utilized to detect prostate cancer in this population and what role they should play in the work up and follow-up of patients presenting with presumed BPH-induced LUTS. Furthermore, understanding how to evaluate presumed BPH-induced LUTS and stratify the risk of prostate cancer is an important skill to develop. The goal of this review is to provide Interventional Radiologists who have begun or aim to begin a PAE practice with the information they need to know regarding PSA levels and prostate cancer risk stratification for this patient population.


Assuntos
Biomarcadores Tumorais/sangue , Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/terapia , Radiografia Intervencionista , Humanos , Masculino , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico por imagem
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