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2.
Urologe A ; 59(10): 1195-1203, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32880664

RESUMO

Multimorbid older men are increasingly more common in daily practice and present a challenge because they are often affected by lower urinary tract symptoms (LUTS) and age-associated benign prostatic hyperplasia (BPH). In order to identify possible risks in diagnostics, therapy and counselling at an early stage, screening for functional deficits or risk factors with standardized procedures is helpful. An initial screening with subsequent assessment of everyday skills using the Barthel Index, Timed up & Go Test, and a cognitive test are recommended. If frailty syndrome is detected, it should be taken into account during the pre-, peri-, and postoperative management, as it may indicate increased morbidity and mortality. Noninvasive methods for reducing the prostate volume without anesthesia can be a therapy option in older multimorbid patients, and with individual planning and consideration of risk factors, up to 70% of individuals become symptom-free. However, there is currently no gold standard for this vulnerable patient group. Number of medications and concomitant diseases and higher need for help are per se risk factors for unsatisfactory results after transurethral resection of the prostate (TURP) or laser vaporization. With drug therapy, concomitant medications and their interactions, especially in the cytochrome system, an existing multimorbidity and adherence to therapy must be taken into account. Combination therapies may complement each other and may bridge the time until surgery. Minimally invasive methods that can be performed without general anesthesia are suitable for geriatric patients, especially those with recurrent retention. Studies with the Rezüm® system (NxThera Inc., Maple Grove, MN, USA) and UroLift® (NeoTract Inc., Pleasanton, CA, USA) show that about 70% of patients can be relieved from the permanent catheter.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Idoso , Idoso Fragilizado , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/terapia , Resultado do Tratamento
4.
Ther Umsch ; 77(2): 53-56, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32633228

RESUMO

Diagnosis and Minimal Invasive Treatment of Benign Prostatic Hyperplasia Abstract. Benign prostatic hyperplasia (BPH) is a common condition in men aged 50 - 60 years with a prevalence of about 50 %. After failure of conservative treatment, the standard treatment of BPH is transurethral resection of the prostate (TURP). However, over the last years prostatic artery embolization (PAE) emerged as a minimal invasive alternative to treat lower urinary tract symptoms. After patient assessment by MRI and CT of the prostate to rule out possible contraindications of PAE, the procedure can be performed in an outpatient setting under local anesthesia by an interventional radiologist. Especially for frail patients and / or patients with special risks regarding surgery / anesthesia, PAE may be an alternative to TURP with fewer complications.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/terapia , Ressecção Transuretral da Próstata , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Arch Esp Urol ; 73(5): 405-412, 2020 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-32538810

RESUMO

OBJECTIVES: The pandemic caused by the new SARS / Cov-2 Coronavirus represents an unprecedented scenario in modern medicine that affects many aspects of daily healthcare. Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has a high prevalence and is related to high consumption of health resources. For this reason, we performed a revision of the management of LUTS and HBP during and after COVID-19 pandemic. MATERIAL AND METHODS: A group of experts in benign prostatic hyperplasia from different regions of Spain were selected to design a strategy to reorganize the management of benign prostatic hyperplasia and lower urinary tract symptoms during the pandemic. A comprehensive review of the literature was undertaken and a set of recommendations are generated. RESULTS: Recommendations for the management of LUTS-BPH during and after the SARS/CoV2 coronavirus pandemic outbreak consist of promoting telemedicine and developing joint protocols with Primary Care Attention .Clear diagnostic and treatment criteria and referral criteria must be established. Referral of patients for risk complications such as kidney failure, recurrent hematuria and obstructive uropathy are a priority. Surgeries due to BPH are generally potentially delayed until phases I and II of the pandemic, in which the percentage of hospitalized patients with COVID-19 does not exceed 25%, and it is necessary to determine COVID19 negativity. The surgical technique that associates the least complications and the shortest stay should be selected. CONCLUSIONS: The diagnosis and prescription of treatment for BPH during the COVID-19 pandemic should be based on telemedicine and joint protocols for primary care attention and urology. Elective surgical treatment can be delayed until we are in phases I or II, individualizing the surgical and anaesthetic technique of choice to minimize risks.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Hiperplasia Prostática , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pneumonia Viral/epidemiologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia , Encaminhamento e Consulta , Espanha
6.
Lab Med ; 51(3): 243-251, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374392

RESUMO

OBJECTIVES: To find suitable biomarkers for diagnosis of prostate cancer (PC) in serum and saliva; also, to evaluate the diagnostic efficacy of saliva in patients with PC. METHODS: This case-control study included 20 patients with PC and 20 patients with benign prostatic hyperplasia (BPH). Blood and saliva were collected from the participants and centrifuged. Serum and supernatant saliva were used for biochemical analysis. We evaluated serum and salivary levels of urea, creatinine, prostate-specific antigen (PSA), creatine kinase BB (CK-BB), zinc, ß-2 microglobulin (B2M), and melatonin. Also, we used Mann-Whitney U testing, Spearman correlation coefficients, and receiver operating characteristic (ROC) analysis to evaluate the data. RESULTS: Serum and salivary concentrations of urea, creatinine, PSA, CK-BB, zinc, and B2M were significantly higher in patients with PC, compared with the BPH group (P <.05). However, serum and salivary concentrations of melatonin were significantly lower in patients with PC, compared with BPH group (P <.05). In both groups, salivary concentrations of all markers were lower (P <.05), compared with those values in serum. We observed positive correlation between serum and salivary concentrations of all markers studied (P <.05). CONCLUSION: From the data, we conclude that investigation using saliva specimens is a noninvasive, simple, and effective tool for screening of biochemical parameters.


Assuntos
Biomarcadores/metabolismo , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico , Saliva/metabolismo , Estudos de Casos e Controles , Creatina Quinase Forma BB/metabolismo , Creatinina/metabolismo , Regulação para Baixo , Humanos , Irã (Geográfico) , Masculino , Melatonina/metabolismo , Pessoa de Meia-Idade , Antígeno Prostático Específico/metabolismo , Soro/metabolismo , Regulação para Cima , Ureia/metabolismo , Microglobulina beta-2/metabolismo
7.
Medicine (Baltimore) ; 99(15): e19678, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282720

RESUMO

BACKGROUND: Benign prostatic hyperplasia (BPH) is a medical condition that affects the quality of life by causing lower urinary tract symptoms (LUTS) in 40% to 70% of men aged ≥60 years. Medication treatment is primarily recommended for patients with BPH if their symptom score based on the International Prostate Symptom score (IPSS) is above the moderate level. However, electroacupuncture (EA) and electronic moxibustion (EM), one of the most recent complementary and alternative treatments, are suggested as adjuvant treatments in the improvement of LUTS caused by BPH with respect to the limitations of medication treatments, such as side effects or no improvement in LUTS despite treatment. Therefore, this study aimed to evaluate the effectiveness and safety of EA and its cotreatment with EM for the improvement of LUTS in patients diagnosed with BPH using an alpha blocker but with moderate symptoms on the basis of IPSS. METHODS/DESIGN: This protocol is a 2-arm parallel-design, randomized, controlled assessor-blinded clinical trial. Seventy-eight patients diagnosed with BPH are randomized to one of the following groups: [EA and its cotreatment with EM + alpha blocker group] and [alpha blocker group]. [EA and its cotreatment with EM + alpha blocker group] continues to use the previously prescribed alpha blocker and visits the study institution 3 times a week for 6 weeks to receive the cotreatment of EA and EM. [Alpha blocker group] continues to use the previously prescribed alpha blocker for 6 weeks. To evaluate the effectiveness of the EA and its cotreatment with EM, the followings are measured: total score of the IPSS, IPSS quality of life assessment, EuroQol-Five dimension, maximum and average urinary flow rate (Qmax and Qave), and prostate size at the baseline, 3rd, 6th, and 12th weeks. The primary effectiveness endpoint measures the average change in the total score of the IPSS at the 6th week. Side effects are recorded at each visit. DISCUSSION: The results of this study are expected to provide useful information on the effectiveness and safety of the EA and its cotreatment with EM for patients with BPH with regard to the improvements in LUTS. TRIAL REGISTRATION: Clinical Research Information Service of Republic of Korea (CRIS-KCT0004411), October 31, 2019.


Assuntos
Eletroacupuntura/métodos , Sintomas do Trato Urinário Inferior/psicologia , Moxibustão/métodos , Hiperplasia Prostática/terapia , Antagonistas Adrenérgicos alfa/uso terapêutico , Idoso , Algoritmos , Terapia Combinada , Eletroacupuntura/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Moxibustão/efeitos adversos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/patologia , Qualidade de Vida , República da Coreia/epidemiologia , Segurança , Resultado do Tratamento
8.
Isr Med Assoc J ; 22(4): 241-243, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286028

RESUMO

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.


Assuntos
Cistoscopia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Uretra/diagnóstico por imagem , Estreitamento Uretral/diagnóstico , Urografia/métodos , Idoso , Estudos de Coortes , Cistografia/métodos , Seguimentos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/cirurgia
9.
Urologe A ; 59(5): 544-549, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32274543

RESUMO

The diagnosis and treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement plays an important role in daily urological practice. Therefore, a targeted and resource-saving approach is essential. A rational base-line work-up of our patients provides the necessary information for obtaining the diagnosis and only needs to be expanded in individual cases. In addition to drug therapy, the modification of lifestyle and the possibility of watchful waiting must not be underestimated. Simple measures such as a timed fluid intake, double micturition in the case of residual urine development, but also bladder reconditioning can significantly improve the quality of life of our patients. Regarding surgical treatment, laser procedures have found their way into many departments and have established themselves in daily routine as a reference procedure in addition to transurethral resection of the prostate (TUR-P) and simple open prostatectomy. New, minimally invasive procedures-such as prostatic artery embolization (PAE), the Rezum™- (NxThera Inc., Maple-Grove, MN, USA) or the Aquabeam® (Procept, Redwood City, CA, USA) procedure, but also nonablative procedures such as iTind© (TIND, Medi-Tate, Or Akiva, Israel) or Urolift® (Neotract Inc., Pleasanton, CA, USA)-offer new treatment options to those affected, with the potential to maintain patient's sexual function. As a result, individual risk assessment and advice on the advantages and disadvantages of all available treatment options-even more than today-will be an important part of LUTS treatment. An individual approach, similar to that used in the treatment of oncological disease, will become standard also in the treatment of benign prostatic syndrome.


Assuntos
Embolização Terapêutica , Sintomas do Trato Urinário Inferior/terapia , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/terapia , Ressecção Transuretral da Próstata/normas , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatologia , Qualidade de Vida , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(1): 73-79, 2020 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-32131943

RESUMO

Objective To explore the value of trans-rectal shear wave elastic mode combined with elastic modulus in the diagnosis of prostate cancer and establish a new method for the evaluation of prostate with trans-rectal shear wave elastography(SWE). Methods The typical findings of trans-rectal ultrasound(US)and SWE in 79 patients with prostate cancer(n=41)and benign prostatic hyperplasia(BPH)(n=38)confirmed by surgery or US-guided biopsy were analyzed retrospectively.Their diagnostic value were evaluated with the pathological results as the golden standards. Results Three or more malignant features detected by conventional trans-rectal US(χ 2=42.5,P<0.001)and asymmetrical SWE mode(χ 2=54.2,P<0.001)showed statistically significant difference in prostate cancer and BPH groups.The elastic modulus of Emean and Emax in the prostate cancer group were(92.8±21.5)and(114.2±29.8)kPa,which were significantly higher than those in the BPH group [(56.7±14.0)(t=-8.8,P<0.001)and(68.4±17.2)kPa(t=-8.3,P<0.001)].The receiver-operating characteristic(ROC)curve with Logistic regression showed that the elastic model combined elastic modulus had the largest area under ROC curve and the highest diagnosis efficiency of prostate cancer,with the cutoff value of 0.45.The diagnosis sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of the combination were 95.1%,89.5%,90.7%,94.4%,and 92.4%,respectively. Conclusion Combination of SWE mode and elastic modulus is more valuable than elastic modulus alone in the diagnosis of prostate cancer.


Assuntos
Módulo de Elasticidade , Técnicas de Imagem por Elasticidade , Neoplasias da Próstata/diagnóstico , Humanos , Masculino , Hiperplasia Prostática/diagnóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
J Bone Joint Surg Am ; 102(7): 543-549, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32079872

RESUMO

BACKGROUND: Male patients undergoing total joint arthroplasty have a higher risk of periprosthetic joint infection (PJI) compared with female patients. The exact reason for this finding is not well known. This study aimed to determine if patients with symptomatic benign prostatic hyperplasia (BPH) are at increased risk of PJI. METHODS: A total of 12,902 male patients who underwent primary or revision total joint arthroplasty from January 2006 to April 2017 were retrospectively identified. The mean patient age was 62.47 years and the mean patient body mass index was 30.1 kg/m. The majority of patients were Caucasian or African American. Most surgical procedures involved the hip joints (57.8%) and were primary arthroplasties (86%). Of these patients, 386 (3%) had symptomatic BPH. Among this group, 250 patients with symptomatic BPH were identified and were matched in an approximate 1:3 ratio with 708 control patients. Using the International Consensus Meeting criteria, patients who developed PJI were identified. RESULTS: The PJI rate was 7.9% in the symptomatic BPH group and 2.8% in the control group. Multivariate regression analysis in unmatched groups showed that symptomatic BPH was a strong independent risk factor for PJI. After matching for variables related to outcomes, symptomatic BPH remained a significant risk factor for PJI (p = 0.01). CONCLUSIONS: Patients with symptomatic BPH had a higher risk of PJI compared with the control patients. This may partly explain the higher rate of PJI that is seen in male patients. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia de Substituição/efeitos adversos , Hiperplasia Prostática/complicações , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Adulto Jovem
12.
Indian J Pathol Microbiol ; 63(Supplement): S34-S40, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32108624

RESUMO

Background: Recently, we publish two case reports about association of nonspecific granulomatous prostatitis (NSGP) and eosinophilic metaplasia (EM) in benign prostatic epithelium. There is no investigation of large series of this association in medical literature. Aim of the current study is to investigate the frequency of association of NSGP and prostatic EM in a large series of cases and their relationship with the basic prostate pathology: benign prostatic hyperplasia (BPH), National Institutes of Health-category IV prostatitis (so-called histologic prostatitis (HP)), and prostatic adenocarcinoma (PCa). Materials and Methods: A retrospective record review for NSGP was performed on a total of 2366 prostatic specimens of all types of material. All cases of NSGP were reviewed for the presence of EM, BPH, and HP. NSGP with EM-cases and control cases with high grade PCa with endocrine differentiation (so-called Paneth cell-like changes) were evaluated immunohistochemically. Results: NSGP was found in nine cases (0.38%). EM was detected in benign perigranulomatous secretory epithelial cells in 100% of cases with NSGP and were closely associated with BPH and HP. Immunohistochemically, in 55.5% of cases with EM, there was weak focal apical false-positive staining for p504s. Conclusion: EM is a very common lesion in NSGP and reflects histologically a nonspecific cellular response, connected with repeated inflammation, in close relation with BPH and HP. We speculate that EM might serve as a morphological precursor of the immunologic phase of NSGP. This constant morphological finding could facilitate the histopathological differential diagnosis of NSGP with other types of granulomatous prostatitis and high grade PCa with or without endocrine differentiation.


Assuntos
Eosinofilia , Epitélio/patologia , Granuloma/diagnóstico , Granuloma/fisiopatologia , Prostatite/diagnóstico , Prostatite/fisiopatologia , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Diagnóstico Diferencial , Técnicas Histológicas , Humanos , Masculino , Metaplasia/diagnóstico , Metaplasia/patologia , Pessoa de Meia-Idade , Celulas de Paneth , Próstata/citologia , Próstata/patologia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/fisiopatologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/fisiopatologia , Estudos Retrospectivos
13.
Neurourol Urodyn ; 39(4): 1115-1123, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32110842

RESUMO

AIMS: The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE). METHODS: A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H2 O. A nomogram was developed based on the multivariable logistic regression model. RESULTS: Overall 448 patients with a mean age of 66 ± 11 years were enrolled. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30-0-66; P = .001) and Qmax (OR: 0.75 per mL/s; 95% CI, 0.70-0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer-Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%. CONCLUSIONS: According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Nomogramas , Hiperplasia Prostática/diagnóstico , Bexiga Inativa/diagnóstico , Bexiga Urinária/diagnóstico por imagem , Urodinâmica/fisiologia , Idoso , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contração Muscular , Estudos Prospectivos , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Ultrassonografia , Bexiga Urinária/fisiopatologia , Bexiga Inativa/diagnóstico por imagem , Bexiga Inativa/fisiopatologia
14.
Clin Lab ; 66(1)2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013356

RESUMO

BACKGROUND: Increased evidence suggested the important role of microRNAs (miRNAs) in the tumorigenesis of prostate cancer (PCa). The aberrant expression of miRNA (miR)-374b-5p has been observed in various types of cancers. The purpose of the current study was to evaluate the relationship between miR-374b-5p expression levels and PCa and to assess the feasibility of using peripheral blood miR-374b-5p as a potential non-invasive biomarker for PCa. METHODS: Total RNA was isolated from the whole-blood samples of 42 PCa patients whole-blood samples, 42 benign prostatic hyperplasia (BPH) patients, and 42 healthy controls (HC). The expression of miR-374b-5p was assessed by reverse transcription quantitative polymerase chain reaction. Normalized data were subjected to the receiver operating characteristic (ROC) and Kaplan-Meier analysis. RESULTS: The expression of peripheral blood miR-374b-5p was significantly higher in PCa patients than in HC individuals and patients with BPH (p < 0.001). Upregulation of miR-374b-5p was observed to be related to certain parameters, including Gleason score > 7 (p < 0.001), and PSA > 20 ng/mL (p < 0.01). To further evaluate the role of miR-374b-5p in patients with PCa, ROC analysis was carried out. Our data showed that peripheral blood miR-374b-5p could screen PCa patients from HC individuals (area under the curve (AUC), 0.851; 95% CI, 0.766 - 0.936; p < 0.001) and patients with BPH (AUC, 0.831; 95% CI, 0.742 - 0.920; p < 0.001). CONCLUSIONS: Increased miR-374b-5p expression in peripheral blood may serve as a potential biomarker to distinguish PCa patients from healthy controls and BPH patients.


Assuntos
MicroRNAs/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Hiperplasia Prostática/sangue , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/epidemiologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/epidemiologia
15.
Aging (Albany NY) ; 12(2): 1888-1898, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31991402

RESUMO

This study compared the surgical outcomes of the 120-W Thulium laser (Vela™ XL) enucleation of the prostate and bipolar transurethral resection of the prostate (TURP) in terms of efficacy, safety, and improvements of quality of life (QoL) in patients with benign prostate hyperplasia (BPH). Records were obtained from January 2014 to September 2018 for selected patients with symptomatic BPH who underwent 120-W Thulium laser (Vela™XL) prostate enucleation and bipolar TURP in our institution. All the patients selected met the surgical criteria for TURP and had received medical treatment for at least 3 months. Patients were excluded if their ECOG performance status was >1, if they had active malignant disease, of if they had a history of prostate surgery or reconstruction surgery of the urinary system. Patients decided which treatment option would be performed. Both the procedures were conducted by a single surgeon. Clinical outcomes such as changes in the International Prostate Symptom Score (IPSS) score, urodynamic parameters, drug consumption, pain scores, and QoL were evaluated. The rate of urinary tract infection, recatheterization, additional analgesic requirement, return to the emergency department for treatment, and other surgical complications was analyzed and compared between the two cohorts. A total of 276 patients met the inclusion criteria. Among them, 141 patients received bipolar TURP, where as 135 decided to receive laser vaporesection. No significant difference was observed in age, PSA level, prostate volume, and comorbidities between the two cohorts. Pre-operative (pre-op) urodynamic parameters were also identical, except that the laser surgery group had a higher rate of admission with a urinary catheter (24.4% vs. 14.2%, p=0.044). The operating time was longer in the laser surgery group (79.3 minutes vs. 62.4 minutes, p<0.001). However, enucleation using the Thulium laser was superior to bipolar TURP in terms of post-operative (post-op) pain status, including the numeric rating scale of pain, rate of additional narcotic use, and oral analgesic requirement. Compared with bipolar TURP, laser enucleation achieved a higher improvement in the QoL score at post-op follow-up at 2 weeks and 3 months. Nevertheless, the complication rate, changes in IPSS score, Qmax, and post-op medication-free survival were statistically identical in the two cohorts. Our data revealed that compared with bipolar TURP, 120-W Thulium laser (Vela™ XL) enucleation of the prostate achieved lower post-op pain and higher improvement in the short-term QoL of patients after surgery.


Assuntos
Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/epidemiologia , Qualidade de Vida , Inquéritos e Questionários , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento
16.
Minerva Urol Nefrol ; 72(2): 135-143, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31920062

RESUMO

INTRODUCTION: Prostate specific antigen and Prostate specific antigen-density are used for the initial evaluation of patient with LUTS due to benign prostatic enlargement in order to discriminate between benign conditions and prostate cancer. Conversely, the role of these markers during the follow up of benign prostatic enlargement patients is still unclear. The aim of our study is to evaluate the role of prostate specific antigen and prostate specific antigen density as outcome parameter for both medical and surgical treatment in patients with male LUTS. EVIDENCE ACQUISITION: We performed a systematic review and meta-analysis based on data from clinical trials evaluating the clinical effect of medical or surgical therapy on LUTS/benign prostatic enlargement. Meta-regression analyses were done to evaluate the effects of several factors on IPSS score improvement. EVIDENCE SYNTHESIS: We selected 12 studies out of 433, including data on 1959 patients. Both medical and surgical treatment lead to a significant reduction of PSA levels as compared to baseline (P<0.001). However, after medical treatment, lower PSA values are associated with more significant improvements in lower urinary tract symptoms as measured with the IPSS, while after surgery (P<0.05), the recovery of urinary function does not correlate with the decline in PSA values (P=0.59). After medical treatment, the improvement in LUTS correlate with a decline of PSAD, while the opposite holds true in men treated with surgery (both: P<0.001). CONCLUSIONS: PSAD may represent an objective treatment outcome parameter and should be evaluated during the follow up of men treated for LUTS due to BPE as marker of treatment response.


Assuntos
Biomarcadores/análise , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Antígeno Prostático Específico/análise , Procedimentos Cirúrgicos Urológicos/métodos , Antineoplásicos/uso terapêutico , Humanos , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento
17.
World J Urol ; 38(1): 167-173, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30963229

RESUMO

AIM: To assess efficacy and safety of monopolar enucleation of the prostate (MEP) and to compare it with the current treatment standard for medium-sized prostates, < 80 cc, transurethral resection of the prostate (TURP). METHODS: A prospective analysis patients undergoing a surgical procedure for their diagnosis of BPH (benign prostatic hyperplasia) (IPSS > 20, Qmax < 10; prostate volume < 80 cc) was performed. IPSS, Qmax were assessed preoperatively, at 6 and 12 months postoperatively. The complications were classified according to the modified Clavien-Dindo grading system. RESULTS: A total of 134 patients were included in the study: 70 underwent MEP and 64 - TURP for BPH (mean prostate volumes were comparable with p = 0.163). The mean surgery time was 44 min in the TURP group and 48.2 min in the MEP group, (p = 0.026). Catheterization time for MEP was 1.7 and 3.2 days for TURP (p < 0.001). Hospital stay for MEP was 3.2 days vs. 4.8 days for TURP (p < 0.001). Both techniques shown comparable efficiency in benign prostatic obstruction relief with IPSS drop in MEP from 23.1 to 5.9 and in TURP group from 22.8 to 7.3, whereas Qmax increased from 8.2 to 20.5 after MEP and from 8.3 and 19.9 after TURP. Urinary incontinence rate after catheter removal in TURP group was 9.0% and 7.8% in MEP group, at 1 year follow-up, it was 1.4% and 3.1% in MEP and TURP, respectively (p = 0.466). CONCLUSIONS: Our experience demonstrated that MEP is an effective and safe BPH treatment option combining the efficacy of endoscopic enucleation techniques and accessibility of conventional TURP.


Assuntos
Próstata/patologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Tamanho do Órgão , Período Pós-Operatório , Estudos Prospectivos , Prostatectomia/métodos , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento
19.
Reprod Domest Anim ; 55(3): 283-292, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31885111

RESUMO

Benign prostatic hyperplasia (BPH) is an age-dependent primarily non-inflammatory enlargement of the accessory gland in the intact dog. The aim of the present study was to control a previously raised suspicion of a breed-related higher incidence of BPH in dogs of the Rhodesian Ridgeback breed. For this, 18 Labrador Retrievers/LR and 20 Rhodesian Ridgebacks/RR were assigned to the age groups 18-24 months (n = 12), 25-48 months (n = 13) and 49-72 months (n = 13). Prostate gland status was determined by rectal palpation, B-mode ultrasound, calculation of the prostate gland volume and semen analysis regarding haemospermia and was classified according to blood plasma concentrations of canine prostate-specific arginine esterase (CPSE) (normal ≤ 60 ng/ml, increased ≥ 61 ng/ml; Pinheiro et al., 2017). Concentrations of testosterone, 5α-dihydrotestosterone and estradiol were analysed in peripheral blood serum or plasma for detecting breed-specific conditions regarding the endocrine metabolism. Prostatic volume was significantly larger in RR irrespective of the CPSE status. In RR, BPH occurred more frequently and started at an earlier age compared with the LR. Breed-related specificities in steroid metabolism in the RR were indicated by correlations of 5α-dihydrotestosterone and estradiol with age and of testosterone with prostate gland volume. Although the incidence of sonographic signs of BPH and haemospermia did not fit with normal and increased CPSE concentrations, a breed-specific higher incidence of BPH in the RR breed could be clearly verified.


Assuntos
Doenças do Cão/epidemiologia , Hiperplasia Prostática/veterinária , Animais , Hidrolases de Éster Carboxílico/sangue , Di-Hidrotestosterona/sangue , Di-Hidrotestosterona/metabolismo , Doenças do Cão/sangue , Doenças do Cão/diagnóstico , Cães , Estradiol/sangue , Estradiol/metabolismo , Hemospermia/veterinária , Masculino , Próstata/diagnóstico por imagem , Hiperplasia Prostática/sangue , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/epidemiologia , Análise do Sêmen , Especificidade da Espécie , Testosterona/sangue , Testosterona/metabolismo , Ultrassonografia/veterinária
20.
Int Braz J Urol ; 45(6): 1113-1121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808398

RESUMO

PURPOSE: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. MATERIALS AND METHODS: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. RESULTS: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). CONCLUSION: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.


Assuntos
Ácido Cítrico/análise , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Sêmen/química , Idoso , Biomarcadores Tumorais/análise , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/sangue , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas
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