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PURPOSE: To investigate whether MRI-guided transrectal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH. MATERIALS AND METHODS: This single-center retrospective cohort study evaluated men who underwent MRI-guided transrectal laser ablation for BPH between February 2017 and July 2021. Age, prostate-specific antigen, prostate volume, prior surgical BPH treatments if any, International Prostate Symptom Score (IPSS) and Sexual Health Inventory of Men (SHIM) were collected. The primary outcome measures assessed were change in IPSS and SHIM 6, 12 and 24 months after laser ablation and adverse events. RESULTS: Fifty-two patients were included, having completed at least one follow-up survey. The mean patient age was 62.9 ± 5.7 years, and mean prostate volume was 80.2 ± 39.2 cc. Eighteen patients (34.6%) had received a prior BPH treatment. The IPSS scores dropped an average of 16.7 ± 7.0 (p < 0.001), 16.9 ± 7.5 (p < 0.001) and 17.1 ± 7.2 (p < 0.001) points from baseline at 6, 12 and 24 months, respectively. There was no statistically significant difference in IPSS score drop between patients who had received a prior BPH procedure and those who had not (p = 0.628). The SHIM scores showed a statistically insignificant increase at all time points. Nineteen patients (36.5%) reported a complication. There were 12 grade II complications (23%) and seven grade I complications (13.5%). There were no grade III or higher complications. CONCLUSION: Transrectal MRI-guided focal laser ablation is safe and effective for the treatment of lower urinary tract symptoms caused by BPH, with a significant improvement in symptom severity after 2 years.
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PURPOSE: In France, transurethral resection of the prostate (TURP) is still the most commonly used surgical treatment for medium sized benign prostatic hyperplasia (BPH), but the Holmium Laser Enucleation of the Prostate (HoLEP) and laser vaporization procedures are becoming more common. For these three surgical procedures, we evaluate the initial complications, the short term (3 months) and the 4-12-month postoperative complications necessitating re-hospitalization. METHODS: From the French national hospital data base (PMSI-MCO), all hospitalizations for BPH treatment in 2018 were extracted. We document the complications during the initial hospitalization and any subsequent rehospitalizations during the one-year postoperative period. RESULTS: In 2018, 67,220 patients were treated for BPH: 46,242 TURP, 13,509 HoLEP and 7469 laser vaporization. Age and anticoagulation medications were similar for men treated by the three procedures, but TURP patients were more often hypertensive. Infections and hemorrhagic complications were the most common complications at the initial hospitalization: 17%, 10%, 13% for infections and 15%, 8.1%, 11% for hemorrhagic complications respectively, and TURP performed worse than the other two procedures at the initial hospitalization. During the first three months and then the subsequent nine months, there were fewer complications than initially, with little difference between the three procedures, all differences being less than 1%. CONCLUSION: Laser vaporization techniques led to fewer complications. However, the PMSI-MCO only registers complications during hospitalizations. This study should be extended to non-hospitalized, more minor complications.
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Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Masculino , Humanos , Hiperplasia Prostática/cirurgia , Hiperplasia Prostática/complicações , Próstata/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/métodos , Readmissão do Paciente , Resultado do Tratamento , Terapia a Laser/métodos , Hospitais , Lasers de Estado Sólido/uso terapêuticoRESUMO
Benign prostatic hypertrophy (BPH) is a condition where the prostate becomes enlarged. It affects all men and is part of the ageing process. Globally, the incidence rates of BPH have risen by 70% between 2000-2019. When left untreated, it can lead to acute urinary retention, impaired bladder emptying, urinary tract infections, bladder stones, kidney failure or gross haematuria. In this article, Linda Nazarko describes the causes and consequences of BPH along with treatment options that are available for it.
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Hiperplasia Prostática , Retenção Urinária , Masculino , Humanos , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia , Retenção Urinária/diagnóstico , Retenção Urinária/terapiaRESUMO
OBJECTIVE: To investigate the potential application of α-1 blocker (urapidil) in the treatment of lower urinary tract symptoms (LUTS) in male patients with benign prostatic hypertrophy (BPH), we conducted a comprehensive meta-analysis. METHODS: Our study involved identifying and collecting randomized controlled trials (RCT) and clinical observational studies from databases including PubMedãMEDLINEãWeb of scienceãCNKI and Wanfang database. We performed meta-analysis using RevMan 5.2.0 software for both fixed effects model and random effects model. RESULTS: Our analysis included 3 short-term (within 1 month) observational studies and 1 RCT involving 142 patients. We found that urapidil significantly improved the International Prostate Symptom Score (IPSS, MD=ï¼5.57, 95%CI: ï¼7.98ï½ï¼3.16ï¼P<0.00001), nocturiaï¼MD=ï¼0.7, 95%CI: ï¼1.16ï½ï¼0.24ï¼P=0.003ï¼, residual urine rateï¼MD=ï¼6.97ï¼95%CI: ï¼12.57ï½ï¼1.37ï¼P=0.01ï¼, average flow rateï¼MD=2.04ï¼95%CI: 0.52ï½3.56ï¼P=0.008ï¼, and maximum flow rate ï¼MD=4.29ï¼95%CI: 0.58ï½8.01ï¼P=0.02ï¼of patients. However, there was no significant difference in the residual urine volumeï¼MD=ï¼35.93ï¼95%CI: ï¼78.62ï½6.76ï¼P=0.10ï¼between pre-treatment and post-treatment groups. CONCLUSION: Urapidil is an effective medication for relieving LUTS in BPH patients. However, due to the limited quantity and quality of current RCT studies, high-quality and large-scale RCT studies are still needed to further confirm this conclusion.
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Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Masculino , Humanos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Sintomas do Trato Urinário Inferior/etiologia , Piperazinas , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Observacionais como AssuntoRESUMO
AIM: This study aimed to evaluate concurrent laparoscopic totally extraperitoneal (TEP) inguinal hernia repair and transurethral resection of the prostate (TURP) with determination of outcomes. MATERIALS AND METHODS: This retrospective study was conducted at our hospital, from June 2011 to June 2020. Over 9 years, 17 patients with co-existing uncomplicated unilateral or bilateral inguinal hernia (primary/recurrent) and significant benign prostatic hypertrophy were operated in the same sitting. The following outcomes were compared: duration of the surgery, conversion to open hernia surgery, intraoperative and post-operative complications, duration of hospital stay, recurrence, time taken to resume normal activity and cost of the treatment. RESULTS: This study included 17 patients with a mean age of 65 years (range of 50-87 years). The average time taken for the surgery was 115 min with no conversion to open hernia repair. The mean post-operative stay was 3.7 days. There were four patients (23.5%) with seromas identified at day 10, only two remained at 6 weeks and none at 12 weeks. None had significant bleeding intraoperatively or postoperatively. There was no superficial or deep wound infection (including mesh infection). There was no recurrence of inguinal hernia. Two patients (11.7%) developed post-TURP urethral stricture and underwent cystoscopic stricturoplasty, 3 and 2.5 months after the initial procedure. The time taken to resume normal activity was 7 (±1) days. The hospital cost is reduced by 25% as compared to the sum of costs when both the operations are done separately. CONCLUSION: Concurrent TEP inguinal hernia repair and TURP is a practical, safe and cost-effective procedure.
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Background: Benign prostatic hypertrophy (BPH) is a common urological condition in men older than 50 years. It is important in the aetiologies of life-threatening obstructive uropathies. Ultrasound measurement of prostate volume is non-invasive, easily available, and a cost-effective method, useful in assessing bladder outlet obstruction (BOO). The International Prostate Symptoms Score (IPSS) on the other hand objectively assesses symptoms severity in BOO patients. Aim: This study was aimed at determining the correlation between ultrasound-measured prostate volume and IPSS in men with BPH. Patients and Methods: Following ethical approval from the Nnamdi Azikiwe University Teaching Hospital Ethical Committee, 100 patients who met the inclusion criteria and were diagnosed with clinical BPH were enrolled into the study. They had no other identifiable cause of BOO except BPH after clinical evaluation. The IPSS, Quality of life score (QOL), and prostate volumes were measured. Correlation between prostate volume, IPSS, and QOL were done using SPSS version 20. P value <0.05 was considered significant. Results: The mean age of patients was 69.3 ± 10.6 years with a range of 48-100 years. The mean prostate volume, IPSS, and QOL were 96.0 ± 70.5 cm3, 15.63 ± 8.6, and 4.8 ± 1.3, respectively. The highest recorded IPSS was 35 and the lowest was 4, whereas the smallest and largest recorded prostate volumes were 19 cm3 and 350 cm3, respectively. Nocturia was the major IPSS subscore. There was a weak positive correlation between prostate volume and IPSS in men with BPH (r = +0.109; P = 0.28) and between prostate volume and QOL (r = +0.072; P = 0.45). There was also a weak positive correlation between patients with only severe symptoms and corresponding prostate volumes (r = +0.122; P = 0.125). The correlation between patients with severe symptoms and their corresponding QOL was strong (r = +0.537; P = 0.135, respectively). These findings were, however, not statistically significant. Conclusion: There is a weak positive correlation between prostate volume measured by ultrasound and symptoms severity scores in patients with BPH, although not statistically significant. This may be as a result of the small sample size. A larger sample size may be able to achieve statistical significance.
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Hiperplasia Prostática , Obstrução do Colo da Bexiga Urinária , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Próstata/diagnóstico por imagem , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico por imagem , Qualidade de Vida , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
PURPOSE: To perform a global survey to identify contemporary practice patterns of transurethral therapies for benign prostatic hypertrophy. METHODS: A REDCap survey was distributed to the ~ 3500 members of the Endourological Society. Surgeons completed demographic information and then selected the BPH therapies they perform 10 cases/year. There were four categories of BPH therapies: ablation, enucleation, resection/vaporization, and MIST (minimally invasive surgical technique). Within each category, there were subcategories to account for different energy modalities. All statistical analyses were performed using SAS 9.4. RESULTS: A total of 175 surgeons responded to our survey. Prostate resection/vaporization remained the most commonly utilized technique (51.9%, n = 147/283) followed by enucleation (22.6%, n = 64/283). Bipolar TURP (bTURP) was the most common modality for prostate resection (69.4%, n = 102/147). Holmium laser enucleation (HoLEP) was the most common modality for enucleation (46.9%, n = 30/64). Urolift® was performed more often than Rezum™ (55.9% vs. 44.1%, n = 19/34 vs. 15/34, respectively). Among surgeons performing ablation, country of practice was a significantly associated with length of stay (LOS), p < 0.0001. For surgeons performing enucleation, academic institution and completion of a fellowship were associated with postoperative day (POD) 1 catheter removal (p = 0.0240 and p = 0.020, respectively). CONCLUSIONS: In this contemporary, global survey of the Endourology Society, resection/vaporization techniques were the most commonly performed. Rates of MISTs remained relatively low at 12.1%. Academic institution and fellowship status were associated with shorter catheterization times and LOS for certain surgical categories.
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Padrões de Prática Médica , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Adulto , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Internacionalidade , Masculino , Pessoa de Meia-IdadeRESUMO
Benign prostatic hypertrophy (BPH) is an intractable chronic inflammatory disease. We studied the efficacy of two ellagitannins, namely camptothin B (1) and cornusiin A (2) that were isolated from Cornus alba (CA) for the treatment of BPH, which is a common health issue in older men. The ellagitannins (1 and 2) were evaluated on its inhibitory activities of the enzyme 5α-reductase and tumor necrosis factor (TNF)-α, its interleukin (IL)-1ß, IL-6, and IL-8 production, and its anti-proliferation and apoptosis induction in prostate cells that show hypertrophy (RWPE-1 cell). In inhibition of 5α-reductase, the ellagitannins (1 and 2) showed potential effects, compared to the positive control, finasteride. In the case of IL-1ß, IL-6, IL-8, and TNF-α, 1 and 2 showed good inhibitory effects as compared to the control group treated with LPS. The ellagitannins (1 and 2) were also shown to inhibit proliferation of, and induce apoptosis in, the RWPE-1 cell. These results suggest that the ellagitannins (1 and 2) may be good candidates for the treatment of BPH.
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Colestenona 5 alfa-Redutase/metabolismo , Cornus/química , Taninos Hidrolisáveis/farmacologia , Interleucinas/metabolismo , Hiperplasia Prostática/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Animais , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Taninos Hidrolisáveis/química , Taninos Hidrolisáveis/isolamento & purificação , Masculino , Estrutura Molecular , Hiperplasia Prostática/tratamento farmacológico , Ratos , Células Th1RESUMO
OBJECTIVE: In this study, we aimed to examine the clinical efficacy of simultaneous transurethral resection of bladder cancer and the prostate (TURBT + TURP) in non-muscle invasive bladder cancer (NMIBC) and benign prostatic hyperplasia (BPH) patients. METHOD: We conducted systematic research in PubMed, EMBASE, and Cochrane Library databases to identify retrospective studies and prospective randomized controlled trials (RCTs) comparing patient outcomes between TURBT + TURP and TURBT-only patients. The meta-analysis was conducted using Review Manager 5.3. RESULTS: We identified eight relevant studies involving a total of 1032 patients. We found that patients that underwent TURBT + TURP exhibited significantly lower recurrence rates [odds ratio (OR), 0.70; 95% confidence interval (CI), 0.53-0.93; p = .01] and increased maximal urinary flow rate (Qmax) (WMD, 5.92; 95% CI, 4.67-7.16; p < .001) compared with patients that underwent TURBT-only. However, rates of recurrence at the prostatic urethra/bladder neck and bladder tumor progression, as well as the time to recurrence did not differ significantly between these two groups. CONCLUSIONS: Simultaneous TURBT + TURP can be safely performed in patients with NMIBC and BPH and improves patient quality of life, without any risk of increasing tumor recurrence or metastasis rates. Comprehensive RCTs are needed to confirm the results of this study.
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Hiperplasia Prostática , Ressecção Transuretral da Próstata , Neoplasias da Bexiga Urinária , Cistectomia , Humanos , Masculino , Próstata , Hiperplasia Prostática/cirurgia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
BPH associated with LUTS and sexual dysfunction is common. We performed UroLift on 11 patients, average age 71 years (range 56-90). IPSS improved by an average of 9 points post-procedure. Pre-operatively their post-void residuals were 306.3 ml (range 120-499 ml SD [120.6]) and their QMAX was 7 ml/s (range 4-14 SD [2.8] ml/s). Post-procedure the post-void residual decreased by 35.4% at 4 months (mean difference - 106.3 ml). QMAX improved by an average of 1.7 ml/s, which was not statistically significant. No patients suffered any sexual dysfunction side effects and all patients were satisfied with their result. Hospital stay and theatre time were significantly reduced. Average length of stay was just 10.6 (6-18) hours and average theatre time just 18.7 (12-30) min. This is significantly faster than other surgery for LUTS. We therefore feel that there are significant benefits for both the patients, who are able to go home much faster, and also the hospital, who are able to perform far more surgeries for their patients. Patients also do not require an inpatient bed so patients should not be cancelled on the day of theatre.
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Disfunção Erétil/prevenção & controle , Hiperplasia Prostática/cirurgia , Próteses e Implantes , Idoso , Idoso de 80 Anos ou mais , Humanos , Tempo de Internação , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Próstata/fisiopatologia , Hiperplasia Prostática/complicações , Qualidade de Vida , Estudos Retrospectivos , Ressecção Transuretral da PróstataRESUMO
The etiology of men's lower urinary tract storage and voiding symptoms involves a contribution from both detrusor and outlet. As such, treatment of benign prostatic enlargement (BPE) ± benign prostatic obstruction (BPO) with standard alpha-adrenergic blockade and 5-alpha reductase inhibitor therapy may leave a population of men with persistent and bothersome urinary storage symptoms. An abundance of adequately powered, randomized, placebo-controlled trials indicate that the use of antimuscarinics and beta-3 adrenergic agonists, either alone or in combination with standard BPE/BPO therapy, leads to improvement in storage symptoms. At the same time, metrics associated with urinary emptying, such as maximum flow rate, post-void residual urinary volume, and incidence of treatment-associated urinary retention, appear to be stable and not significantly impacted by the addition of antimuscarinics.
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Hiperplasia Prostática/terapia , Bexiga Urinária Hiperativa/terapia , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Hiperplasia Prostática/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Bexiga Urinária Hiperativa/etiologia , Retenção UrináriaRESUMO
PURPOSE OF REVIEW: Holmium laser enucleation of the prostate (HoLEP) is a proven technique to alleviate bladder outlet obstruction (BOO) from benign prostatic hyperplasia (BPH). Herein, we review factors relevant to selecting patients who will benefit from this procedure and expected outcomes. RECENT FINDINGS: New randomized trials have validated the excellent outcomes achieved by HoLEP in the management of BOO from BPH. Its success has been reproduced in a diverse array of patients including those on anticoagulation, with detrusor underactivity/acontractility, prostate cancer, and in the retreatment setting. HoLEP can be applied to the majority of patients with BOO from BPH regardless of prostate size, previous operations, or the condition of the detrusor. HoLEP can also be carefully considered in patients requiring anticoagulation or who are undergoing active surveillance for low-risk prostate cancer. Immediate complication rate is low and incontinence is rare. Retrograde ejaculation occurs in approximately 75% patients. Furthermore, the retreatment rate for HoLEP is lower than reported for other endoscopic BPH procedures demonstrating its durability.
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Terapia a Laser/métodos , Lasers de Estado Sólido , Próstata/cirurgia , Hiperplasia Prostática/cirurgia , Obstrução do Colo da Bexiga Urinária/cirurgia , Comorbidade , Humanos , Terapia a Laser/instrumentação , Masculino , Seleção de Pacientes , Próstata/patologia , Hiperplasia Prostática/complicações , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/etiologiaRESUMO
It is well known that there is an association of lower urinary tract symptoms/benign prostatic hypertrophy with cardiovascular disease, suggesting that lower urinary tract symptoms/benign prostatic hypertrophy is a risk factor for cardiovascular events. Vascular function, including endothelial function and vascular smooth muscle function, is involved in the pathogenesis, maintenance and development of atherosclerosis, leading to cardiovascular events. Vascular dysfunction per se should also contribute to lower urinary tract symptoms/benign prostatic hypertrophy. Both lower urinary tract symptoms/benign prostatic hypertrophy and vascular dysfunction have cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes mellitus, aging, obesity and smoking. Inactivation of the phosphodiesterase type 5-cyclic guanosine 3',5'-monophosphate-nitric oxide pathway causes lower urinary tract symptoms/benign prostatic hypertrophy through an enhancement of sympathetic nervous activity, endothelial dysfunction, increase in Rho-associated kinase activity and vasoconstriction, and decrease in blood flow of pelvic viscera. Both endogenous nitric oxide and exogenous nitric oxide act as vasodilators on vascular smooth muscle cells through an increase in the content of cyclic guanosine 3',5'-monophosphate, which is inactivated by phosphodiesterase type 5. In a clinical setting, phosphodiesterase type 5 inhibitors are widely used in patients with lower urinary tract symptoms/benign prostatic hypertrophy. Phosphodiesterase type 5 inhibitors might have beneficial effects on vascular function through not only inhibition of cyclic guanosine 3',5'-monophosphate degradation, but also increases in testosterone levels and nitric oxide bioavailability, increase in the number and improvement of the function of endothelial progenitor cells, and decrease in insulin resistance. In the present review, the relationships between lower urinary tract symptoms/benign prostatic hypertrophy, the phosphodiesterase type 5-nitric oxide-cyclic guanosine 3',5'-monophosphate pathway, vascular function and cardiovascular outcomes are examined.
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Doenças Cardiovasculares/fisiopatologia , Nucleotídeo Cíclico Fosfodiesterase do Tipo 5/fisiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Óxido Nítrico/fisiologia , Hiperplasia Prostática/fisiopatologia , 3',5'-GMP Cíclico Fosfodiesterases/fisiologia , Animais , Aterosclerose/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Masculino , Músculo Liso Vascular/fisiopatologia , Ratos , Fatores de Risco , Transdução de Sinais , Doenças Vasculares/fisiopatologia , Quinases Associadas a rho/fisiologia , Proteína rhoA de Ligação ao GTP/fisiologiaRESUMO
OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) has been shown to be effective in treating large prostates compared to prostate transurethral resection (TURP). There are no published data evaluating specifically the impact of the learning curve on the direct costs of HoLEP. The objective of this study was to evaluate the direct costs generated by the use of HoLEP laser during the learning curve period. METHOD: The costs of all medical devices (DM) and drugs used, pre- and post-operative parameters during surgery have been prospectively collected between March and October 2016. RESULTS: A total of 32 patients were included in the study with a mean age of 70.8 years and a mean prostate volume of 68.6 cm3. The mean cost of anesthesia was 39.0 and that of drugs and DM used for surgery was 257.95 but could reach 470.76 in case of conversion to bipolar resection. The mean duration of enucleation and morcellation was 150minutes with a mean weight of enucleated specimens of 40.4g. The total mean duration of patient care was 197minutes at an estimated hourly cost of 636. CONCLUSIONS: Despite some limitations, this study makes it possible to analyze the direct costs of the management of benign prostatic hypertrophy using HoLEP, an innovative surgical technique, and to specify that these costs are more related to bipolar conversion and voluminous adenomas especially during the learning curve. LEVEL OF EVIDENCE: 5.
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Terapia a Laser/economia , Curva de Aprendizado , Doenças Prostáticas/economia , Doenças Prostáticas/cirurgia , Ressecção Transuretral da Próstata/economia , Ressecção Transuretral da Próstata/educação , Idoso , França , Humanos , Lasers de Estado Sólido , Masculino , Duração da Cirurgia , Estudos Prospectivos , Resultado do TratamentoRESUMO
Adina rubella Hance (AR), a plant native to Korea, has been used as traditional medicine for dysentery, eczema, intoxication, and external hemorrhages. Previous phytochemical studies of AR have reported several components, including terpenoids, phenolics, and alkaloids. The current study evaluated the anti-oxidative and anti-inflammatory activities and 5α-reductase inhibition of isolated compounds of AR leaves to find a potential therapeutic agent for benign prostatic hypertrophy (BPH). Repeated chromatographic isolation of an 80% acetone extract of AR leaves yielded seven phenolic compounds: caffeic acid (1), chlorogenic acid (2), methyl chlorogenate (3), quercetin-3-rutinoside (4), kaempferol-3-O-α-l-rhamnopyranosyl-(1â6)-ß-d-glucopyranoside (5), hyperoside (6), and grandifloroside (7). Compound 7 is a novel compound in AR. Caffeoyl derivatives 1-3 and 7 showed good anti-oxidative activities. In particular, caffeic acid (1) and grandifloroside (7) showed potent anti-inflammatory activities, and 7 also exhibited potent inhibitory activity against TNF-α and 5α-reductase. Our results show that the extract and grandifloroside (7) from leaves of AR might be developed as a source of potent anti-oxidative and anti-inflammatory agents and therapeutic agent for BPH.
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Inibidores de 5-alfa Redutase/química , Inibidores de 5-alfa Redutase/farmacologia , Fenóis/química , Fenóis/farmacologia , Folhas de Planta/química , Rubiaceae/química , Inibidores de 5-alfa Redutase/isolamento & purificação , Animais , Anti-Inflamatórios/química , Anti-Inflamatórios/farmacologia , Antioxidantes/química , Antioxidantes/farmacologia , Linhagem Celular , Citocinas/biossíntese , Ativação Enzimática/efeitos dos fármacos , Humanos , Concentração Inibidora 50 , Masculino , Camundongos , Estrutura Molecular , Fenóis/isolamento & purificação , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/metabolismo , Hiperplasia Prostática/patologiaRESUMO
INTRODUCTION: Conflicting reports exist regarding the role of statins in male gonadal and sexual function. Some studies report a beneficial effect, particularly for erectile dysfunction (ED), through statins' anti-inflammatory and cardiovascular protective properties. Others suggest that statins might be associated with sexual dysfunction through negative effects on hormone levels. AIM: This study aims to compare the risk of gonadal or sexual dysfunction in statin users vs. nonusers in a single-payer healthcare system. METHODS: This was a retrospective cohort study of all male patients (30-85 years) enrolled in the Tricare San Antonio market. Using 79 baseline characteristics, we created a propensity score-matched cohort of statin users and nonusers. The study duration was divided into a baseline period (October 1, 2003 to September 30, 2005) to describe patient baseline characteristics, and a follow-up period (October 1, 2005 to March 1, 2012) to determine patient outcomes. Statin users were defined as those prescribed a statin for ≥3 months between October 1, 2004 and September 30, 2005. MAIN OUTCOME MEASURES: Outcomes were identified as the occurrence of benign prostatic hypertrophy (BPH), ED, infertility, testicular dysfunction, or psychosexual dysfunction during the follow-up period as identified by inpatient or outpatient Internationalâ Classification ofâ Diseases, 9thâ Revision, Clinicalâ Modification codes. Logistic regression was used to determine the association of statin use with patient outcomes. RESULTS: Of 20,731 patients who met study criteria, we propensity score-matched 3,302 statin users with 3,302 nonusers. Statin use in men was not significantly associated with an increased or decreased risk of BPH (odds ratio [OR] 1.08; 95% confidence interval [CI] 0.97-1.19), ED (OR 1.01; 95% CI 0.90-1.13), infertility (OR 1.22; 95% CI 0.66-2.29), testicular dysfunction (OR 0.91; 95% CI 0.73-1.14), or psychosexual dysfunction (OR 1.03; 95% CI 0.94-1.14). CONCLUSIONS: Statin use was not associated with increased risk of being diagnosed with gonadal or sexual dysfunction in men. Further studies using a larger sample may be needed.
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Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hiperlipidemias/tratamento farmacológico , Disfunções Sexuais Fisiológicas/epidemiologia , Adulto , Idoso , Estudos de Coortes , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hiperlipidemias/epidemiologia , Modelos Logísticos , Masculino , Saúde do Homem , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Disfunções Sexuais Fisiológicas/induzido quimicamente , Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: In a population-based case-control study (PROtEuS), we examined the association between prostate cancer (PCa) and (1) benign prostatic hypertrophy (BPH) history at any time prior to PCa diagnosis, (2) BPH-history reported at least 1 year prior to interview/diagnosis (index date) and (3) exposure to BPH-medications. METHODS: Cases were 1933 men with incident prostate cancer diagnosed across Montreal French hospitals between 2005 and 2009. Population controls were 1994 men from the same age distribution and residential area. In-person interviews collected socio-demographic characteristics and medical history, e.g., BPH diagnosis, duration and treatment, as well as on PCa screening. Logistic regression analyses tested overall and grade-specific associations, including subgroup analyses with frequent PSA testing. RESULTS: A BPH-history was associated with an increased risk of PCa (OR 1.37 [95 % CI 1.16-2.61]), more pronounced for low-grade PCa (Gleason ≤6: OR 1.54 [1.26-1.87]; Gleason ≥7: OR 1.05 [0.86-1.27]). The association was not significant when BPH-history diagnosis was more than 1 year prior to index date, except for low-grade PCa (OR 1.29 [1.05-1.60]). Exposure to 5α reductase inhibitors (5α-RI) resulted in a decreased risk of overall PCa (OR 0.62 [0.42-0.92]), particularly for intermediate- to high-grade PCa (Gleason ≤6: OR 0.70 [0.43-1.14]; Gleason ≥7: OR 0.43 [0.26-0.72]). Adjusting for PSA testing frequency or restricting analyses to frequently screened subjects did not affect these results. CONCLUSION: BPH-history was associated with an increased PCa risk, which disappeared, when BPH-history did not include BPH diagnosis within the previous year. Our results also suggest that 5α-RI exposure exerts a protective effect on intermediate and high-grade PCa.
Assuntos
Hiperplasia Prostática/epidemiologia , Neoplasias da Próstata/complicações , Inibidores de 5-alfa Redutase/uso terapêutico , Idoso , Canadá , Estudos de Casos e Controles , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/tratamento farmacológico , Neoplasias da Próstata/sangue , Fatores de Risco , Fatores Socioeconômicos , Fatores de TempoRESUMO
There is a well-known link between treatment for lower urinary tract symptoms (LUTS) and erectile dysfunction. Surgical and medical management of LUTS all have side effect profiles which may affect erectile dysfunction, ejaculatory dysfunction, or libido. These should be taken into consideration during patient counseling. This article reviews the common side effects of the medical and surgical treatments of LUTS.