Nonsurgical treatment of benign prostatic hypertrophy

Drug therapy has never been widely used in benign prostatic hypertrophy (BPH), partly because the introduction of safe and radical surgical techniques provides rapid improvement of symptoms of outflow obstruction. However, some patients hesitate to undergo surgical intervention, and others are in poor condition, making them less than ideal candidates for surgery. A conservative means by which outflow problems could be relieved should be of benefit for a significant number of patients. Drugs from primitive cultures, usually herbal, have been reported to be of benefit; however, in double-blind controlled studies none seems to be superior to placebo. ₁-Blockers do not influence prostate size but may still be of value in patients with dysuria, bladder neck sclerosis, and mild prostatic enlargement. Endocrine therapy appears to be effective in reducing prostate size and hence improving urinary outflow. The most promising agents thus far used include progestational antiandrogens and LHRH agonists as an alternative to pure castration. The drugs must be provided for the patient's lifetime, since the prostate rapidly regains its enlarged size following termination of the treatment. A combination of progestational antiandrogens and antiprolactin seems to be an efficient remedy for symptoms of prostatism when surgery is not applicable or wanted. Recent research has introduced new drugs with endocrine effects such as aromatizing inhibitors and 5-reductase inhibitors; their efficacy has not as yet been confirmed in randomized clinical trials.     

Candicidin in treatment of benign prostatic hypertrophy

In a prospective, double-blind, placebo-controlled multicenter study, candicidin (a polyene macrolide) was investigated in the treatment of benign prostatic hypertrophy. Seventy-six patients were included in the study--34 in the candicidin group and 42 in the placebo group. Patients treated with 270 mg. of candicidin daily for 6 months had a significant decrease in residual urine, voided volume and bladder volume. No significant increases were found in flow rates. Symptoms improved significantly in both the candicidin and the placebo group, but no differences in improvement were found between the groups. The results of candicidin treatment are less satisfactory than those following surgery.     

Megestrol acetate in treatment of benign prostatic hypertrophy.

In this study we found no significant effect on benign prostatic hypertrophy due to megestrol using standard clinical criteria. However, there is evidence using urinary drop spectrometer data which makes one suspect that megestrol does have a positive effect. If there is an effect, it is apparently so small as to be undetectable using the clinical protocol of this investigation. Since the urodynamic evidence does indicate a possibility of a positive effect, it appears reasonable to investigate further using a different protocol - perhaps a higher dosage and/or a more controlled test population.     

Hyperthermic treatment in patients with benign prostatic hypertrophy]

Hyperthermic treatment was performed in 31 patients with benign prostatic hypertrophy (BPH). Eight patients of them had a urethral catheter because of urinary retention. The prostate was heated trans-rectally to 43-45 degrees C. The treatment consisted of 10 sessions of 60 min. each. To evaluate this treatment, the following parameters were determined before, during and one week after the last hyperthermia session: subjective symptoms score, and residual urine volume, uroflowmetry and transrectal ultrasound of the prostate as objective data. Symptoms score improve in all patients. Of 8 patients with a catheter, the catheter could be removed from 4 patients. There was no significant change in prostate volume, but significant decreases of residual urine volume, and increases of maximum flow rate and mean flow rate were observed. No adverse reactions were seen. Judging from the above results, this treatment is considered to be useful for patients with BPH.     

Clinical evaluation of surgical treatment for benign prostatic hypertrophy

Prostatectomy was performed on 300 patients at our Hospital for the period of 5 years from January 1978 to December 1982. Among those cases, clinical evaluation was made on 290 patients whose medical records were available. Ages of the subjects ranged from 53 to 92 years with an average age at 71.6. Retropubic prostatectomy (RPP) was performed on 81 cases, and suprapubic prostatectomy (SPP) and transurethral resection of prostate (TUR) on 39 and 170 cases, respectively. Surgery was made on 206 cases under epidural anesthesia, 82 cases under spinal anesthesia, and 2 cases under general anesthesia. Preoperative laboratory tests showed abnormalities in 62% of the total. The most frequent preoperative complications were circulatory abnormality and urinary tract infection. Average surgical time was 78.6 min. for RPP, 69.8 min. for SPP, and 76.9 min. for TUR. Average blood volume transfused during operation was 446.3 ml for RPP, 430.8 ml for SPP, and 80.7 ml for TUR. Average period of catheter retention after surgery was 9.2 days for RPP, 10.1 days for SPP, and 4.9 days for TUR. Average postoperative admission period was 18.6 days for RPP, 20.6 days for SPP, and 14.1 days for TUR. Average weight of the isolated adenoma was 41.8 g for RPP, 30.2 g for SPP, 11.5 g for TUR. Postoperative complications such as epididymitis, traumatic infection, and hepatic dysfunction were often found. Latent prostatic carcinoma found in the isolated adenoma was found in 11 cases (3.8%). The presence of anomalies in preoperative laboratory findings did not influence the frequency of postoperative complications.     

Lipids in human benign prostatic hypertrophy

Summary Lipids in human prostate have been the subject of limited research and the most complete studies were published forty years ago. In this study we report on the total lipid, total cholesterol, free cholesterol and triglyceride content in human benign prostatic hypertrophy. By means of thin-layer chromatography, we separated the cholesterolesters in five fractions. The effect of treatment with anti-androgens before prostatectomy was examined.     

Medical aspects of the treatment of benign prostatic hypertrophy

The importance of a careful and complete physical examination of the patient suffering from benign hypertrophy of the prostate is emphasized. Generalized vascular disease may play no small part in the renal insufficiency so often encountered in these patients.Many of the medical problems of hypertrophy of the prostate have to do with the anatomical and physiological changes which occur with advancing age. Among them the alteration in the cardiovascular system are most significant.The preoperative and postoperative treatment of this condition is discussed from a medical standpoint.The author desired to express his appreciation to Dr. Hugh H. Young for permission to follow these cases on his service, and to acknowledge with thanks the assistance of the staff of the Brady Urological Institute.     

Prolactin secretion in benign prostatic hypertrophy

Prolactin secretion was evaluated in 22 patients with benign prostatic hypertrophy, before and after thyrotropin-releasing hormone stimulation. Increased prolactin reserve was found. In 11 patients, in whom the test was performed twice, the prolactin response after surgery was higher than in the pre-surgical test. The possible role of prolactin in the genesis of benign prostatic hypertrophy is discussed.     

Urodynamics studies in benign prostatic hypertrophy

A study of patients with benign prostatic hypertrophy indicates that flow rates may well be useful in evaluating the degree of obstruction and the results of therapy. Electromyography and cytometry studies, while demonstrating certain tendencies in benign prostatic hypertrophy, do not give statistically significant data for evaluation and prognostication either by themselves or when correlated with radiographic changes and flow rates.     

Urodynamics in benign prostatic hypertrophy.

Synchronous urinary flow and pressure studies were carried out on 51 male subjects of whom 12 were normal subjects and 39 had benign prostatic hypertrophy with varying degrees of bladder outlet obstruction. A urodynamic scoring system was evolved for accurate and objective diagnosis of bladder outlet obstruction. The minimum urethral resistance was found to be the most valuable single urodynamic parameter for the diagnosis of bladder outlet obstruction. Hitherto this urodynamic parameter was determined through tedious calculations. In the course of the present study a new instrument, the Urethroresistance, was devised for the direct recording of urethral resistance during micturition.     

Long-term results of treatment of benign prostatic hypertrophy by trans-rectal prostatic hyperthermia]

From November 1987, 250 patients with symptomatic benign prostatic hyperplasia underwent transrectal prostatic hyperthermia. Forty-six patients had an indwelling catheter while 204 patients were obstructed but could still void spontaneously. Hyperthermia was administered in 5 or 10 sixty-minute sessions, with a calculated intraprostatic temperature of 42.5 or 43 degrees C. At the two-year follow-up, residual urine volume was significantly decreased while peak flow rate, maximum flow nomogram and subjective symptoms were only slightly improved, i.e. patients were still obstructed postoperatively. Transrectal prostatic hyperthermia cannot be considered as a first choice therapy for symptomatic benign hyperplasia but it can be offered only to carefully selected patients who cannot undergo any alternative therapeutic procedure.     

Hormonal treatment of patients with benign prostatic hyperplasia: pros and cons

The recognition that dihydrotestosterone is a “major player” in the development of benign prostatic hyperplasia (BPH) provided an impetus for the development of a 5a-reductase inhibitor, finasteride. During the past 5 years, a number of publications have noted that alpha blockers appear more efficacious than finasteride. This article reviews the role of hormones (particularly finasteride) in the treatment of lower urinary tract symptoms caused by BPH. These observations indicate that finasteride has a role in the management of larger prostates. Long-term use reduces the development of urinary retention and need for invasive procedures such as transurethral prostatectomy. The major adverse impact of finasteride is its effect on the patient’s libido and sexual function. This is a less morbid problem for the elderly than the potential syncope associated with the use of alpha blockers. A greater understanding of the interaction of hormones on prostate receptors will provide newer tools for the treatment of BPH.