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1.
Niger Postgrad Med J ; 27(1): 49-53, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32003362

RESUMO

Background: Androgen deprivation therapy (ADT) is accepted as the first-line treatment of advanced prostate cancer. This study sets out to determine the outcomes of ADT in reducing lower urinary tract symptoms (LUTS) in patients with advanced prostate cancer and also to determine the quality of life (QoL) of the patients. Patients and Methods: This was a prospective study carried out at Jos University Teaching Hospital. All consecutive patients who had LUTS due to advanced prostate cancer were recruited into the study. All patients completed the international prostate symptom score (IPSS) questionnaire, including QoL assessment. Post-void residual (PVR) urine, maximum flow rate (Qmax), prostate specific antigen and total prostate volume (TPV) were assessed. The parameters before and at 12 months were compared. Results: Data from 65 patients were analysed. The mean age of the patients was 68.5 ± 8.67 years with an age range of 46-85 years. Four (6.2%) had mild LUTS before AD, and their symptoms remained mild at 12 months of ADT. Twenty-two (33.9%) patients had moderate urinary symptoms. Of this, 10 (18.5%) patients had symptomatic improvement at 12 months of ADT. Of 39 (60%) patients who presented with severe LUTS, 21 (32.3%) had improvement at 12 months of ADT. Before ADT and at 12 months of ADT, the mean IPSS score, mean TPV, Qmax, PVR and mean QoL score were 23 ± 8.8 and 15 ± 8.8 (P < 0.0001); 79.7 ± 51.4 and 73.4 ± 34.3 (P = 0.212); 8.0 ± 4.7 and 11.2 ± 4.4 (<0.001); 209.8 ± 127.8 and 163 ± 111.4 (<0.001); 4.23 ± 1.2 and 3.24 ± 1.2 (P < 0.001), respectively. Of the 39 patients (60%) with severe urinary symptoms, 18 (27.7%) of patients had urethral catheterization for either acute or chronic urinary retention before ADT. At 12 months on ADT, eight patients (12.3.7%) were still on catheter due to failed attempts at trial without catheter. Conclusion: ADT significantly improves urodynamic parameters, IPSS score and IPSS-related QoL. There remains a subset of patients, in whom LUTS persist with negative effects on QoL.


Assuntos
Antagonistas de Androgênios , Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Neoplasias da Próstata , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Androgênios/uso terapêutico , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Nigéria , Estudos Prospectivos , Hiperplasia Prostática/complicações , Neoplasias da Próstata/complicações , Neoplasias da Próstata/tratamento farmacológico , Qualidade de Vida
2.
Medicine (Baltimore) ; 99(4): e18802, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977871

RESUMO

BACKGROUND: We conducted a meta-analysis to assess the efficacy and safety of mirabegron on overactive bladder (OAB) induced by benign prostatic hyperplasia (BPH) in men receiving tamsulosin therapy. METHODS: We performed the analysis by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The databases including MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were retrieved to get information regarding randomized controlled trials of mirabegron on OAB induced by BPH in men receiving tamsulosin therapy. We also searched the references of included literatures. RESULTS: Three randomized controlled trials containing a total of 1317 BPH patients were included in the analysis. Co-primary efficacy end points: the mean number of micturitions per day [the mean difference (MD) = -0.27, 95% confidence interval (CI): -0.46 to -0.09, P = .004], the urgency episodes per day (the MD = -0.50, 95% CI: -0.77 to -0.22, P = .0004), the total OAB symptom score (the MD = -0.69, 95% CI: -1.00 to -0.38, P < .0001), and mean volume voided (the MD = 10.76, 95% CI: 4.87-16.64, P = .0003) indicated that mirabegron was effective in treating OAB induced by BPH in men receiving tamsulosin therapy. Safety assessments that included treatment-emergent adverse events (odds ratio = 0.88, 95% CI: 0.68-1.13, P = .31) indicated that mirabegron was well tolerated with the exception of post-void residual urine volume (MD = 12.02, 95% CI: 6.01-18.04, P < .0001). CONCLUSIONS: This analysis demonstrates that mirabegron is an effective and safe treatment for OAB symptoms induced by BPH in men receiving tamsulosin therapy with a low occurrence of side effects. Besides, we should be aware that the administration of mirabegron might have the risk of increasing post-void residual urine volume.


Assuntos
Agonistas de Receptores Adrenérgicos beta 3/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Acetanilidas , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Humanos , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Tansulosina/uso terapêutico , Tiazóis , Resultado do Tratamento , Bexiga Urinária Hiperativa/etiologia
3.
Medicine (Baltimore) ; 99(4): e18918, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977907

RESUMO

BACKGROUND: Benign prostatic enlargement (BPE) causes discomfort in daily life, including lower urinary tract symptoms (LUTSs) caused by the enlarged prostate, and requires long-term management as a chronic, irreversible disease. To improve LUTS, certain complementary therapies have been used with or without doctors' directions. Conventional treatments and complementary therapies tend to be combined unsystematically, depending on patient preference; thus, research for safe and efficient combination therapy is warranted. METHODS: Twenty-nine participants were randomly assigned to an integrative group (IG, n = 15) or a conventional group (CG, n = 14). The IG received moxibustion (twice weekly for 4 weeks, at the acupuncture points SP6, LR3, and CV4) and conventional medication for 4 weeks, followed by conventional medication alone for 8 weeks. The CG received conventional medication alone for 12 weeks. The outcome measures were International Prostate Symptom Score (IPSS), patient's global impression of changes (PGIC), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and frequency-volume chart. RESULTS: Total IPSS (IG, -2.4 ±â€Š4.2; CG, 0.9 ±â€Š4.0; P = .039), PGIC-A (IG, 3.5 ±â€Š1.0; CG, 2.2 ±â€Š1.0; P = .001), and PGIC-B (IG, 3.5 ±â€Š0.1; CG, 4.7 ±â€Š0.6; P = .004) were significantly improved in the IG compared with the CG, 4 weeks after baseline. Among the IPSS items, incomplete emptying (IG, -0.6 ±â€Š0.7; CG, 0.4 ±â€Š1.2; P = .019), straining (IG, -0.6 ±â€Š0.8; CG, 0.2 ±â€Š1.2; P = .046), and nocturia (IG, -0.8 ±â€Š1.4; CG, 0.1 ±â€Š1.0; P = .045) showed significant differences. The Qmax and PVR volume did not differ significantly at 12 weeks after the baseline. CONCLUSION: Moxibustion can be considered an adjunct therapy to improve LUTS in BPE patients. A full-sized randomized controlled trial would be feasible with comparator modifications and an extended study period. The study design should include a placebo group and narrow the eligibility to subjects who do not respond well to conventional treatments.


Assuntos
Sintomas do Trato Urinário Inferior/terapia , Moxibustão/métodos , Hiperplasia Prostática/complicações , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Resultado do Tratamento
4.
Urology ; 136: 196-201, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790785

RESUMO

OBJECTIVE: To compare outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms secondary to benign prostate hyperplasia using 3 different laser fibers and 2 different laser energy modes. MATERIALS AND METHODS: This is a review of a clinic registry of men with lower urinary tract symptoms secondary to benign prostate hyperplasia who underwent HoLEP between August 2018 and January 2019. Patients were assigned to group 1 (50 patients), group 2 (50 patients), and group 3 (50 patients) based on the HoLEP being completed with either a Slimline 550µm, Slimline 1000µm, or MOSES 550 µm laser, respectively. The groups were compared using SSPS for ANOVA comparison of means and multivariate logistic regression. RESULTS: Ten patients who underwent concomitant stone surgery (2 PCNL, 8 ureteroscopy , 3 bilateral cases) and 11 patients had bladder stones removed; ancillary procedures did not significantly differ between groups(P = .2). Prostate enucleation times differed significantly (22.5 + 7.3, 16.4 + 6.9, 18.1 + 8.6 minutes P ≤.001) between groups. However, statistical significance was lost once enucleation time was indexed against enucleated tissue weight. Time to achieve hemostasis (minutes) was statistically different between groups (10.6 + 6.1, 7.7 + 5.2, 6.3 + 4.8 P <.001). This difference in hemostatic time was maintained on multilogistic regression demonstrating that MOSES laser enucleation was associated with a 3.9-minute decrease time to achieve hemostasis after enucleation compared to Slimline 550 HoLEP (P <.001). CONCLUSION: Our findings suggest that modulated pulsed laser energy can improve hemostasis during the enucleation phase of a HoLEP resulting in shorter Operating Room times.


Assuntos
Terapia a Laser/instrumentação , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Estudos Retrospectivos
5.
Urology ; 136: 212-217, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31734349

RESUMO

OBJECTIVE: To present outcomes for prostatic artery embolization (PAE) to treat urinary retention and gross prostatic hematuria in nonindex benign prostatic hyperplasia patients. MATERIALS AND METHODS: Seventy-five patients undergoing PAE from December 2013 to August 2018 (age = 77.5 ± 8.6, age-adjusted Charlson comorbidity index = 4.6 ± 2.0, prostate volume = 224 mL ± 135 mL) for retention (n = 46) and/or gross prostatic hematuria (n = 55) were retrospectively reviewed. Twenty-six patients had both problems. Urinary retention patients (UR, n = 46, catheterization = 162.4 ± 148.1 days) underwent voiding trials 1-2 months post-PAE, with International Prostate Symptom Score (IPSS), Quality of Life (QoL), and postvoid residual (PVR) recorded at 3, 6, 12, 24, and 36 months. Pre- and post-PAE hematuria-related visits were compared for gross hematuria patients (GH, n = 39), as were transfusion rates for severe hematuria patients requiring bladder irrigation (SH, n = 16). Ninety-day adverse event tabulation used Clavien-Dindo classification. RESULTS: Three months post-PAE, 33/38(87%) UR patients were catheter-free (IPSS = 8.9 ± 5.3, QoL = 1.6 ± 1.7, PVR = 158 mL ± 207 mL). Results were similar at 6 months (catheter-free = 26/28(93%), IPSS = 6.5 ± 4.4, QoL = 1.1 ± 0.9, PVR = 149 mL ± 139 mL), 12 months (catheter-free = 19/20(95%), IPSS = 4.7 ± 4.8, QoL = 0.6 ± 0.9, PVR = 125 mL ± 176 mL), 24 months (catheter-free = 11/12(92%), IPSS = 4.4 ± 3.0, QoL = 0.9 ± 0.8, PVR = 66 mL ± 68 mL), and 36 months (catheter-free = 5/6(83%), IPSS = 5.8 ± 3.8, QoL = 0.8 ± 1.0, PVR =99 mL ± 71 mL). Out of 37, 34(92%) GH patients remained hematuria-free at 483 ± 137 days, with 22 hematuria-related visits pre-PAE vs none post-PAE. Hematuria resolved <48 hours post-PAE in 14/16(87.5%) SH patients, with 36 blood units transfused pre-PAE, 4 units transfused <48 hours post-PAE, and none thereafter. Subsequently, 13/16(81%) remained hematuria-free at 500 ± 501 days; 2/16(13%) required fulguration; 1/16(6%) developed bladder tumor. There were 2 deaths <30 days post-PAE, and 8(11%) Grade-II urinary infections. CONCLUSION: PAE provided safe, effective, and durable treatment for retention and gross hematuria in nonindex benign prostatic hyperplasia patients.


Assuntos
Embolização Terapêutica , Hematúria/etiologia , Hematúria/terapia , Próstata/irrigação sanguínea , Doenças Prostáticas/etiologia , Doenças Prostáticas/terapia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Retenção Urinária/etiologia , Retenção Urinária/terapia , Idoso , Idoso de 80 Anos ou mais , Artérias , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
6.
J Urol ; 203(1): 171-178, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31430232

RESUMO

PURPOSE: Our current understanding of recent trends in the management of lower urinary tract symptoms associated with benign prostatic hyperplasia is incomplete, particularly in younger men. The 2018 Urologic Diseases in America Project attempted to fill this gap by analyzing multiple large administrative claims databases which include men of all ages and permit longitudinal followup. To our knowledge we report these findings for the first time in the scientific literature. MATERIALS AND METHODS: The 2 data sources used in this study included the de-identified Optum® Clinformatics® Data Mart database for men 40 to 64 years old and the Medicare 5% Sample for men 65 years old or older. To assess trends in lower urinary tract symptoms/benign prostatic hyperplasia related medication prescriptions and surgical procedures from 2004 to 2013 we created annual cross-sectional cohorts and a longitudinal cohort of patients with incident lower urinary tract symptoms/benign prostatic hyperplasia and 5 years of followup. RESULTS: The use of medications related to lower urinary tract symptoms/benign prostatic hyperplasia increased with age, particularly among men 40 to 60 years old. While medication use increased with time, surgical procedures decreased. Increasing age correlated with a higher rate of surgical procedures in the longitudinal cohort. Younger men were more likely to elect treatments of lower urinary tract symptoms/benign prostatic hyperplasia which reportedly optimize sexual function. CONCLUSIONS: Medication use increased and surgery decreased during the study period. Treatment approaches to lower urinary tract symptoms/benign prostatic hyperplasia varied greatly by patient age. While the minority of men in the fifth and sixth decades of life required treatment, a sharp increase in treatment use was seen between these decades. Younger men were more likely to elect less invasive surgical options. Future studies of lower urinary tract symptoms/benign prostatic hyperplasia should focus on age specific treatment selection.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Hiperplasia Prostática/complicações , Adulto , Fatores Etários , Idoso , Estudos Transversais , Humanos , Estudos Longitudinais , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Medicare , Pessoa de Meia-Idade , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Estados Unidos
8.
Urologiia ; (5): 156-160, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808653

RESUMO

In the treatment of lower urinary tract in combination with benign prostatic hyperplasia, alpha-blockers are most often prescribed, but in certain cases, the appointment of 5-reductase inhibitors is justified. This article analyzes relevant studies of recent years regarding the validity of the use of dutasteride (Gardium) 0.5 mg per day. Dutasteride can effectively reduce the total score of IPSS to 30%. It increases a volumetric urine flow rate 2-3 ml/sec, significantly reduces the chance of acute urinary retention in 70-88% in various studies, and reduces the frequency of hospitalization by 66%. Dutasteride also increases the likelihood of timely diagnosis of prostate cancer by 23%. Erectile dysfunction is a common side effect, serving as a reason for refusal of therapy is erectile dysfunction, which occurs in 16% of cases, and the probability of which is the highest in the first months during conservative therapy.


Assuntos
Inibidores de 5-alfa Redutase/administração & dosagem , Dutasterida/administração & dosagem , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Hiperplasia Prostática/complicações , Inibidores de 5-alfa Redutase/uso terapêutico , Dutasterida/uso terapêutico , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/microbiologia , Masculino , Resultado do Tratamento , Retenção Urinária/prevenção & controle
9.
Medicine (Baltimore) ; 98(45): e17848, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702643

RESUMO

BACKGROUND: Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) are one of the most common conditions seen in middle-aged and elderly men and threaten their quality of life. Since conventional pharmacotherapy for LUTS/BPH can lead to sexual side effects, herbal therapies are widely used as complementary and alternative treatments worldwide. HT080 is an herbal extract of Cinnamomum cassia and Rosa Laevigata, both of which have been used to treat symptoms typically associated with BPH in traditional Asian medicine. The aims of this trial are to assess whether HT080 can alleviate LUTS/BPH in middle-aged and elderly men, and to investigate the safety of HT080. METHODS/DESIGN: A double-blind, randomized, placebo-controlled, two-arm parallel group trial will be conducted in men with moderate LUTS/BPH. A total of 100 eligible men aged 40 to 75 years with an International Prostate Symptom Score of 8 to 19 will be randomized in a 1:1 ratio and receive either HT080 (500 mg) or placebo twice a day for 12 weeks. All participants will be evaluated for efficacy and safety at baseline and weeks 6 and 12. The primary endpoint is the change in International Prostate Symptom Score between baseline and week 12. The secondary efficacy variables are uroflowmetry parameters (maximal urinary flow rate and post-void residual volume), serum prostate-specific antigen, testosterone, and dihydrotestosterone levels, the International Index of Erectile Function score, and participant-reported global response assessment scores. The safety assessments include adverse events, laboratory tests results, vital signs, and physical examination. DISCUSSION: This is a first-in human trial designed to investigate the efficacy and safety of HT080 among middle-aged and elderly men with LUTS/BPH. This prospective study with a double-blind randomized design will provide high-quality evidence supporting the use of HT080 for LUTS/BPH. TRIAL REGISTRATION: Korean Clinical Research Information Service (KCT0004286) Registered September 6, 2019.


Assuntos
Cinnamomum aromaticum/química , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Rosa/química , Adulto , Idoso , Método Duplo-Cego , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Medicina Tradicional Coreana , Pessoa de Meia-Idade , Extratos Vegetais/efeitos adversos , Estudos Prospectivos , Hiperplasia Prostática/complicações , Resultado do Tratamento
10.
Nihon Yakurigaku Zasshi ; 154(5): 250-254, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31735753

RESUMO

Benign prostatic hyperplasia/benign prostatic enlargement (BPH/BPE) is a common proliferative disease, and giving rise to associate with lower urinary tract symptoms (LUTS). However, the pathogenesis is not well clarified, and thought to be multifactorial. There are some lines of evidence that impairment in the blood supply of the lower urinary tract causes development of BPH/BPE. Clinical data showed an association between the development of BPH/BPE and atherosclerotic disease such as hypertension, diabetes and hyperlipidemia. The spontaneously hypertensive rat (SHR) has been used as model of genetic hypertension. SHR also shows decreased blood flow and hyperplastic morphological abnormalities in the ventral prostate. Our previous studies demonstrated that chronic treatment with vasodilative drugs nicorandil (ATP sensitive potassium channel opener) and silodosin (alpha1 adrenoceptor antagonist) increased blood flow and suppressed the growth factor and morphological abnormalities in the SHR ventral prostate. These data suggested that prostatic blood flow could be therapeutic targets for BPH/LUTS.


Assuntos
Próstata/irrigação sanguínea , Hiperplasia Prostática/tratamento farmacológico , Vasodilatadores/uso terapêutico , Animais , Hipertensão/complicações , Indóis/uso terapêutico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Nicorandil/uso terapêutico , Próstata/fisiopatologia , Hiperplasia Prostática/complicações , Ratos , Ratos Endogâmicos SHR
11.
Nihon Yakurigaku Zasshi ; 154(5): 265-269, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31735756

RESUMO

As Japan enters into an aging society, aged patients with chief complaint of lower urinary tract symptoms (LUTS) have increased. The most common cause of LUTS in men older than 50 years is benign prostatic hyperplasia (BPH). In particular, LUTS associated with overactive bladder (OAB) symptoms was reported to have a significant negative impact on patient quality of life (QOL). In clinical practice, monotherapy with α1-blockers or PDE5 inhibitors is widely employed for the initial management of BPH accompanied by OAB (BPH/OAB). However, storage symptoms may persist in some patients. In patients with residual OAB symptoms despite α1-blocker or PDE5 inhibitor monotherapy, the addition of an anticholinergic agent or a ß3-adrenergic receptor (ß3-AR) agonist is recommended by the BPH guidelines. Although both agents have been shown to effectively improve OAB symptoms and bladder storage functions, it remains unclear which type of add-on therapy, anticholinergic agents or ß3-AR agonists, is most effective for alleviating OAB symptoms and storage functions. Recently, detrusor underactivity (DU) is also considered to be a common cause of non-neurogenic LUTS in men. DU has been reported to be present in 9%-48% of men undergoing urodynamic evaluation for non-neurogenic LUTS. DU can lead to adverse health effects, in addition to significant burden and decreased QOL. Thus, development of a safe and effective treatment for patients with LUTS induced by DU is an urgent issue at present. In this paper, we will introduce most recent findings of curative drugs for LUTS, especially BPH/OAB and DU in clinical practice.


Assuntos
Sintomas do Trato Urinário Inferior/tratamento farmacológico , Hiperplasia Prostática/complicações , Bexiga Urinária Hiperativa/complicações , Humanos , Japão , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Qualidade de Vida
12.
Transplant Proc ; 51(9): 2921-2926, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31627917

RESUMO

BACKGROUND: With the aging of recipients of renal transplantation (RT) one of the emerging issues is the incidence of low urinary tract symptoms (LUTS), which may have negative consequences on the graft survival and function. The aim of our study was to assess the influence of LUTS and the treatment with transurethral resection of the prostate (TURP) on the outcome of RT. MATERIALS AND METHODS: We collected data from men over 55 who underwent RT at our center from January 2007 to December 2016. We analyzed the incidence of LUTS; the rate of treatment with TURP; the eGFR (estimated glomerular filtration rate) at 6 months and 1, 3, and 5 years from transplantation; and graft survival. RESULTS: Fifty-five patients out of 268 experienced LUTS, and 19 of them had a bladder outlet obstruction (BOO). Patients experiencing BOO had a significantly higher hazard ratio (HR) of graft failure (HR 5.7, CI 1.56-21.4) compared to the other recipients. Of the 18 patients treated with TURP, 10 received the procedure within 6 months from the LUTS onset. They had a significantly absolute eGFR improvement at 6 months from the intervention (+14.25 mL/min ± 8.10) compared to the patients treated later (-8.4 mL/min ± 14.43). DISCUSSION: We showed the negative effects of LUTS on kidney graft function and survival. Although TURP is the standard therapy for such an issue, the best timing for it still has to be defined. Our experience supports the need for an early treatment of the LUTS for promoting the outcome of the RT.


Assuntos
Transplante de Rim , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Idoso , Sobrevivência de Enxerto , Humanos , Transplante de Rim/efeitos adversos , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/epidemiologia , Obstrução do Colo da Bexiga Urinária/epidemiologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
13.
Med Arch ; 73(2): 81-86, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391692

RESUMO

Aim: To determine the discriminatory power of penile urethral compression-release index (PCRI), clinical prostate score (CLIPS) and bladder outlet obstruction index 2 (BOON2) for the detection of bladder outlet obstruction (BOO), and the associated bladder abnormality in patients with benign prostatic enlargement (BPE). Material and methods: In study was included of 135 patients with proven BPE underwent urodynamic measurement (UDM) and PCR maneuver. PCR Index was calculated following the formula: (Qs-Qss)/Qss x 100(%). CLIPS score was calculated based on non-invasive variables (prostate volume, maximal urinary flow, residual urine and voided volume), while BOON2 was calculated using the formula intravesical prostate protrusion (IPP)-3 x Qmax-0.2 x mean voided volume. UDM results were plotted on Schaefer and URA nomograms. Results: A comparative analysis was made using ROC curves. The area under the curve (AUC) for PCRI is 0.85 (PTP 91.3%), while AUC for CLIPS and BOON2 is 0.8 (PTP 77.6%) and 0.82 (PTP 74.5%), respectively. PCRI with the cut-off point of 96% clearly distinguishes obstructed patients with normocontractile detrusor and the presence of detrusor overactivity (DO), versus those unobstructed. CLIPS (>10) shows good BOO prediction, but without the possibility of distinguishing between detrusor contractility grade and the occurrence of DO. BOON2 has shown that impaired contractility has influence on this number in obstructed patients. Conclusion: PCRI is a very good noninvasive urodynamic test for a group-wise detection of BOO in patients with BPE and associated bladder co-morbidities; it is therefore superior in comparison with to CLIPS or BOON2.


Assuntos
Hiperplasia Prostática/fisiopatologia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Técnicas de Diagnóstico Urológico , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Pênis , Próstata/patologia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/patologia , Medição de Risco , Uretra , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Urodinâmica
14.
Curr Urol Rep ; 20(10): 58, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31468204

RESUMO

PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) and sexual health have common links. Medical and surgical treatments for LUTS can significantly affect various domains of sexual health including erectile function, ejaculatory function, and libido. This review summarizes recent findings. RECENT FINDINGS: Current literature demonstrates a strong association between LUTS, sexual health, and metabolic syndrome. The role of miRNA is also being investigated. Combination medical therapy with phosphodiesterase 5 inhibitors (PDE5-I) shows promise but needs further investigation. Newer surgical therapies for benign prostatic hyperplasia (BPH) aim to preserve sexual function without sacrificing efficacy and durability. Although we are beginning to acknowledge the link between LUTS and sexual health, a better understanding of the underlying biochemistry is needed. Only then can more effective therapies be developed. Further prospective studies should focus on the long-term durability and safety of treatments for both conditions.


Assuntos
Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/terapia , Síndrome Metabólica/complicações , Saúde Sexual , Ejaculação , Humanos , Libido , Masculino , Síndrome Metabólica/cirurgia , Ereção Peniana , Inibidores da Fosfodiesterase 5/uso terapêutico , Estudos Prospectivos , Hiperplasia Prostática/complicações
16.
Urologia ; 86(3): 115-121, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282310

RESUMO

Male lower urinary tract symptoms are frequently due to benign prostatic enlargement. Medical therapy is strongly recommended in patients with moderate to severe symptoms. Lower urinary tract symptoms may require a different medical approach using drugs with different mechanisms of action. Alpha-1 blockers, muscarinic receptor antagonists and phosphodiesterase type 5 inhibitors are the most frequently used drugs. 5-Alpha reductase inhibitors are commonly prescribed to reduce prostate volume and to prevent benign prostatic hyperplasia progression. Currently, medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement can be tailored according to different symptom characteristics and severity, and to different patient comorbidities and preferences. For this reason, the decision-making process should be based on an accurate patient counselling with detailed clarification of potential benefits and, above all, potential side effects of different drugs. This non-systematic review of the literature presents an update of the current options for medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement, helping urologists in the decision-making and counselling process.


Assuntos
Hiperplasia Prostática/tratamento farmacológico , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Humanos , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/complicações
17.
Clin Lab ; 65(7)2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31307183

RESUMO

BACKGROUND: Prostate cancer is considered the most prevalent cancer among men. Recent studies suggest that sex-ually transmissible infections (STIs) may be related to prostate carcinogenesis. Therefore, the aim of this study was to investigate whether STI pathogens (Atopobium vaginae (ATO), Neisseria gonorrhoeae (NG), Chlamydia tra-chomatis (CT), Treponema pallidum (TP), Ureaplasma urealyticum (UU), Gardnerella vaginalis (GV), Herpes Sim-plex Virus (HSV), Cytomegalovirus (CMV), Human herpesvirus (HHV), Human papillomavirus (HPV), and Tricho-monas vaginalis (TV)) presence in prostate tissues are associated with the risk of prostate cancer. METHODS: Paraffin-embedded prostate tissues obtained from patients with hyperplasia and prostate cancer were extracted. Determination of infectious microorganisms of interest was done by quantitative TaqMan real-time PCR assay. RESULTS: STI DNA was detected in 53/243 (21.8%) of the prostate tissues samples (ATO 3.7%, UU 2.88%, GV 2.46%, HSV-2 2.05%, CT 2.05%, CMV 1.64%, NG 1.64%, TP 1.64%, HHV-8 1.23%, HPV 1.23%, and TV 1.23%.) The statistical analysis revealed significant correlation between prevalence of Gardnerella vaginalis (GV) and Herpes Simplex Virus (HSV-2) between hyperplasia and cancerous groups (p = 0.02), respectively. CONCLUSIONS: No statistically significant difference was observed in the prevalence of most candidate infectious or-ganisms between hyperplasia and cancerous groups except for GV and HSV-2. It appears that inflammation in the prostate gland is more associated with prostate hyperplasia than prostate cancer. According to the role of in-fectious microorganisms in induction of chronic inflammation, we cannot exclude the importance of these patho-gens in progression of cancer. More studies are required to explore the associations of cancer with different infec-tious organisms.


Assuntos
Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Doenças Sexualmente Transmissíveis/complicações , Idoso , Chlamydia trachomatis/genética , Chlamydia trachomatis/patogenicidade , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/patogenicidade , Papillomaviridae/genética , Papillomaviridae/patogenicidade , Próstata/microbiologia , Próstata/parasitologia , Próstata/virologia , Hiperplasia Prostática/complicações , Neoplasias da Próstata/complicações , Trichomonas vaginalis/genética , Trichomonas vaginalis/patogenicidade , Virulência/genética
18.
Curr Urol Rep ; 20(8): 47, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31278441

RESUMO

INTRODUCTION: In the last decade, there has been a growing interest in minimally invasive treatment for benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS). In this field, one of the options currently available is the temporary implantable nitinol device (iTIND) (Medi-Tate®; Medi-Tate Ltd., Or Akiva, Israel). PURPOSE OF THE WORK: To review the recent data available in the literature regarding the role of the first-generation (TIND) and second-generation (iTIND) devices for the management of BPH with LUTS, especially focusing on follow-up of functional outcomes. EVIDENCE ACQUISITION: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were screened for clinical trials on this topic. EVIDENCE SYNTHESIS: Literature evidences regarding implantation of TIND and iTIND for PBH with LUTS are limited. There are only three studies available, one with a medium-term follow-up. The results of these studies suggested that both the TIND and iTIND implantations are safe, effective, and well-tolerated procedures, allowing spare ejaculation in sexually active patients. CONCLUSIONS: Current evidences emphasize that the temporary implantable nitinol devices are promising alternatives to the standard minimally invasive surgical options for BPH-related LUTS. Further studies are needed to confirm the effectiveness over a long-term follow-up.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Hiperplasia Prostática/cirurgia , Stents , Ligas , Materiais Biocompatíveis , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Hiperplasia Prostática/complicações , Implantação de Prótese
19.
Urology ; 132: 164-169, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279692

RESUMO

OBJECTIVE: To evaluate the impact of photoselective vaporization of the prostate (PVP) on erectile function (EF) utilizing a 160W GreenLight laser system with up to 36 months of follow-up in men with lower urinary tract symptoms caused by benign prostatic hyperplasia. METHODS: A prospectively maintained database of patients who underwent GreenLight PVP was retrospectively reviewed. International Index of Erectile Function-5 (IIEF-5) questionnaire was used to assess EF. In total, 265 sexually active patients who underwent 160W GreenLight laser PVP were identified and divided into Group A with baseline IIEF-5 <19 and group B with baseline IIEF-5 ≥19. IIEF-5, International Prostate Symptom Score, quality of life, postvoid residual, and Qmax were recorded preoperatively, perioperatively, and at follow-up after 1, 3, 6, 12, 24, and 36 months. Recorded data were analyzed statistically using t- and χ2 tests. RESULTS: The preoperative and perioperative data of the 2 groups were comparable. Significant improvements in International Prostate Symptom Score, Qmax, quality of life, and postvoid residual were observed in both groups at every follow-up visit throughout the 36 months with no significant difference between the groups. EF was sustained postoperatively compared with the baseline in the whole study population. In Group A (preoperative IIEF-5 <19), EF was significantly improved at 1 month and 12 month (P= .02 and P= .002). CONCLUSION: In patients undergoing PVP by 160W GreenLight laser for lower urinary tract symptoms secondary to benign prostatic hyperplasia, no significant detrimental effect was observed in the EF at up to 3 years of follow-up. However, in patients with preoperative erectile dysfunction (ED), we showed a significant improvement.


Assuntos
Sintomas do Trato Urinário Inferior/cirurgia , Ereção Peniana , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Idoso , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Período Pós-Operatório , Hiperplasia Prostática/complicações , Estudos Retrospectivos , Resultado do Tratamento
20.
Curr Urol Rep ; 20(8): 46, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31227924

RESUMO

PURPOSE OF REVIEW: To explore the potential applicability of a novel, heat-free, and robotically controlled ablative therapy for surgical management of benign prostatic enlargement. RECENT FINDINGS: With the emergence of new technology to provide personalized care and overcome the complications associated with options such as TURP, holmium laser enucleation of the prostate, GreenLight laser, or simple prostatectomy, Aquablation has been studied across a variety of prostate volumes. The functional outcome of Aquablation seems to be uncompromised by prostate volume. The sexual profile seems superior to TURP and the risk of retrograde ejaculation is lower. The robotic system provides a reproducible ablation, independent of prostate volume, without requiring extensive training for performing the procedure. The mean ablation time in the prostate as large as 150 ml does not exceed 9.1 min, and the blood transfusion rates do not seem to be higher than open prostatectomy.


Assuntos
Técnicas de Ablação/métodos , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Humanos , Hidroterapia/métodos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/complicações
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