Lymphoma of the prostate presenting as benign prostatic hypertrophy.

A case of lymphocytic lymphoma involving the prostate is reported. Lymphomatous infiltration of the prostate had been mentioned infrequently in the literature, so that the incidence, prognosis, and treatment are not well known. Lymphomatous or leukemic infiltrate should be considered as a causative agent of prostatism, particularly in patients with hematologic abnormalities where chemotherapy may relieve the symptoms.     

Intracellular localisation of 5alpha-dihydrotestosterone in human benign prostatic hypertrophy.

When slices of benign hypertrophied human prostate and abdominal muscle were incubated with either [3H]testosterone or 5alpha-dihydro[3H]testosterone, the uptake of radioactivity by prostatic tissue was significantly higher than that of the muscle (P less than 0.01). The uptake of labelled androgen by prostatic tissue could be significantly reduced by adding the unlabelled steroid to the incubation medium. After the incubation of prostatic tissue with 5alpha-dihydro[3H]testosterone, the amount of the radioactivity taken up by the whole homogenate and the nuclear preparation of the prostatic tissue were measured. DNA content of the nuclei and the whole homogenate was also estimated. The mean+/-S.E.M. of 5alpha-dihydrotestosterone associated with the nuclei was 65+/-4.4%, ranging from (52.2-79.8%). The activity of acid phosphatase was measured in 30 samples of prostatic tissue. The mean +/- S.E.M. was 20.7+/-1.5 U/g tissue (9.8+/-0.9 U/mg DNA). The correlation between the activity of this enzyme and the uptake of androgen by prostatic tissue is evaluated.     

Alpha-1 adrenoceptors and calcium in isolated canine coronary arteries

Experiments were designed to define the postjunctional alpha adrenoceptor subtype(s) in large canine coronary arteries and to determine the dependency of contractions due to their activation upon the entry of extracellular calcium. Rings of left circumflex coronary artery were mounted at their optimal length for isometric tension recording in organ chambers filled with physiological salt solution. Phenylephrine and cirazoline were full agonists relative to norepinephrine. Methoxamine was a partial agonist relative to norepinephrine whereas clonidine, xylazine, B-HT 920 and B-HT 933 produced minimal contractions. Prazosin competitively inhibited the contractile response to phenylephrine (pA2 = 8.6), whereas rauwolscine caused a noncompetitive inhibition and was more than 100 times less potent than prazosin at inhibiting the response to phenylephrine. Similar results were obtained using norepinephrine (in the presence of propranolol) as the agonist. The calcium-entry blockers nimodipine, verapamil and diltiazem inhibited contractions caused by norepinephrine, phenylephrine and cirazoline. Removal of extracellular calcium abolished the response to cirazoline. These results suggest that in large canine coronary arteries: 1) only alpha-1 adrenoceptors are present postjunctionally and 2) responses due to alpha-1 adrenoceptor activation are dependent upon extracellular calcium.     

Tamsulosin for the treatment of benign prostatic hypertrophy

OBJECTIVE: To review the information necessary to assess the efficacy and safety of tamsulosin compared with other adrenergic antagonists for treatment of symptomatic benign prostatic hyperplasia. DATA SOURCES: A search was conducted of Cumulated Index Medicus, January 1993-August 1999, which was restricted to human trials and English-language journals. STUDY SELECTION AND DATA EXTRACTION: Efficacy studies were included if the design was randomized and included a control group. Drug safety was assessed using data from any patient series or controlled study. DATA SYNTHESIS: Tamsulosin, a uroselective alpha1A-adrenergic receptor antagonist, relaxes smooth muscle in the prostate and bladder neck, thereby enhancing bladder emptying. In randomized, controlled clinical trials using standardized instruments, tamsulosin improves obstructive voiding symptoms by at least 25% in 65-80% of patients with symptomatic benign prostatic hyperplasia. Tamsulosin also improves peak urinary flow rate by 1.4-3.6 mL/sec in various studies and reduces post-void residual urine volume. The usual dosage of tamsulosin was 0.4 or 0.8 mg orally once a day in the studies performed in the US and Europe; daily doses of 0.1-0.4 mg were used in studies performed in Japan. The beneficial effects of tamsulosin on voiding symptoms, peak urinary flow rate, and bladder emptying appear to be dose-related, up to a ceiling dose of 0.4 mg. The most common adverse effects are headache, asthenia, dizziness, and rhinitis-like complaints. Retrograde or delayed ejaculation occurs in 4.5-14.0% of patients and has required discontinuation of treatment in a minority of these patients. At the usual dose of 0.4-0.8 mg/d, tamsulosin does not appear to significantly reduce blood pressure, increase heart rate, or cause first-dose syncope; therefore, dosage titration is not necessary when initiating treatment. Use of nifedipine, enalapril, atenolol, furosemide, or digoxin does not require dosage modification when tamsulosin is initiated concomitantly; hypotension has not been reported with combined use of tamsulosin and these commonly used agents. CONCLUSIONS: Tamsulosin is an improvement over other alpha-adrenergic antagonists for the management of symptoms of benign prostatic hyperplasia. It is a more convenient alternative that does not require initial dosage titration, has a fast onset of action, and has a low potential to cause hypotension when used alone or in combination with commonly used antihypertensive agents. It is more costly than some of the other second-generation alpha-adrenergic antagonists.     

Incontinence related to management of benign prostatic hypertrophy

Background: The prevalence of incontinence ranges from 11% to 34% among community-dwelling men aged ≥65 years.Objective: The objective of this analysis was to determine the nature of incontinence diagnosed in men with benign prostatic hypertrophy (BPH), focusing on its incidence, prevalence, diagnostic workup, and management.Methods: A cohort of patients with BPH was identified in the Integrated Healthcare Information Services National Managed Care Benchmark Database (1997-2003). Age and duration in the database after the first diagnosis of BPH were used as matching strata. Therapeutic subgroups consisted of watchful waiting, g-blockers, 5-α-reductase inhibitors (5ARIs), and BPH-related surgery.Results: A total of 411,658 males with BPH were identified from 12,298,027 males (3.3%). Of the BPH cohort, 2.7% (n = 11,172) were identified as having incontinence; of these, 57.8% of patients were ≥65 years of age. Alter applying inclusion/exclusion criteria, the final matched case-control sample included 6346 men as case subjects and 229,154 men as control subjects. The overall incidence of incontinence in this BPH sample was 1835/100,000/year, and the prevalence was 2713/100,000 men. In 48.5% of the incontinent men, the type of incontinence was not specified. Diagnostic testing was performed in 2.9% of men with incontinence. Conditional logistic regression analyses found that BPH-related surgery and g-blocker use increased the adjusted odds ratio for the risk of incontinence 3.1-fold, and 1.1- to 1.7-fold, respectively. The odds ratio of the risk of incontinence was not significantly increased with long-term 5ARI use.Condusions: Use of g-blockers, 5ARIs for the short term (<1 year), and BPH-related surgery were independently, significantly associated with BPH-related incontinence; 5ARI use for >1 year and watchful waiting were not. BPH-related incontinence may be related to progression of BPH or as a postsurgical complication. Patients with BPH should be asked specifically about incontinence, especially after BPH-related surgery, and undergo a full diagnostic workup for the diagnosis of urinary incontinence.     

超声估测前列腺质量在经尿道前列腺电切术中的应用

目的应用超声测量前列腺体积,估测前列腺质量,以提高前列腺增生组织的切除率。方法前列腺增生患者经尿道前列腺电切术(TURP)前,经腹超声测量前列腺体积,估测前列腺腺体的质量,对比术后腺体切除质量。结果TURP切除率与前列腺估测质量呈正相关。结论术前超声测量前列腺体积对提高前列腺增生TURP的切除率具有重要的临床价值。     

糖调节受损合并良性前列腺增生症患者血清瘦素和胰岛素抵抗与前列腺体积的相关性研究

目的研究糖调节受损(IGR)合并良性前列腺增生症(BPH)患者血清瘦素(Lep)和胰岛素抵抗(IR)与前列腺体积(PV)的相关性。方法选取IGR且无BPH者100例,其中空腹血糖受损(IFG)组50例(IFG+non-BPH组),糖耐量异常(IGT)组50例(IGT+non-BPH组);IGR合并BPH者100例,其中IFG+BPH组50例,IGT+BPH组50例;健康对照组50例(NC组)。测量各组人群的身高、体重、腰围、臀围,测量空腹血糖、胰岛素、Lep、血脂、血清前列腺特异抗原(PSA),超声检测前列腺大小并计算体积,采用稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)。探讨IGR合并BPH时Lep、IR及相关参数即体重指数(BMI)、腰臀比(WHR)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)与PV的相关性。结果 IGR组BMI、WHR、TG、LDL-C、FPG、Lep、HOMA-IR显著高于NC组(P<0.05)。IGT+BPH组Lep、HOMA-IR、TG、LDL-C水平高于IFG+BPH组(P<0.05)和IGT+non-BPH组(P<0.05)。多元线性回归分析显示PV与Lep、HOMA-IR、TG呈正相关,与HDL-C呈负相关。结论高血清Lep和IR共同参与了IGR合并BPH患者前列腺增生的发生和发展,糖脂代谢紊乱是PV增大的危险因素。     

TUVP联合TURP治疗良性前列腺增生病人的护理

目的：探讨经尿道前列腺汽化切割术联合经尿道前列腺电切术治疗良性前列腺增生的护理对策。方法：回顾性分析2006年1月～2008年5月我院经尿道前列腺汽化切割术联合经尿道前列腺电切术81例病人的临床护理资料，总结围术期护理对策。结果：平均手术时间（52．9±13．6）min，术中出血量（52．1±29．8）ml，术后离床活动时间（23．8±2．27）h，平均住院天数（7．3±1．1）d。术后病理报告均为良性前列腺增生。术后发生电切综合征2例、暂时性尿失禁4例、膀胱颈痉挛6例、术后出血2例、尿道狭窄并尿路感染1例，术后无1例输血。均及时采取有效的治疗和护理措施，全部痊愈出院。结论：经尿道前列腺汽化切割术联合经尿道前列腺电切术是治疗前列腺增生安全有效的外科治疗方法，同时良好的围术期护理是手术成功的保障。     

正常前列腺与良性前列腺增生经直肠超声实时弹性成像

目的 观察正常前列腺与良性前列腺增生(BPH)经直肠超声实时弹性成像(TRTE)的特征.方法 对77例BPH患者及17名男性正常志愿者行TRTE检查,获得弹性图像后,采用弹性评分5分法进行分析,同时测量前列腺两侧移行区应变率比值、两侧周围区应变率比值及移行区与周围区的应变率比值,比较各个区域的硬度比.结果 BPH组和正常前列腺组的前列腺弹性评分均为1～2分,两组评分差异无统计学意义(P=0.2252).前列腺移行区应变率比值差异(P=0.9793)、周围区应变率比值差异(P=0.8986)、移行区与周围区的应变率比值差异(P=0.5233)均无统计学意义.结论 TRTE能够提供正常前列腺和增生前列腺组织的硬度信息.     

Urogastrone-epidermal growth factor concentrations in prostatic fluid of normal individuals and patients with benign prostatic hypertrophy

High concentrations (272 +/- 33 ng/ml) of urogastrone-epidermal growth factor were measured in prostatic fluid from normal males by a specific radioimmunoassay. Significantly lower concentrations (155 +/- 24 ng/ml) were observed in the prostatic fluid of patients with benign prostatic hypertrophy than in the age-matched normal controls (2P less than 0.01). The growth factor content of seminal fluid was accounted for by the contribution of prostatic fluid. Immunochemical studies failed to show evidence of synthesis within the gland nor could high affinity receptors for the protein be demonstrated in membrane preparations of the gland.     

Men's lived experiences following transurethral prostatectomy for benign prostatic hypertrophy

The aim of this study was to illuminate the lived experience of prostatectomy recovery by means of semi-structured interviews. Despite the commonality of prostatic enlargement and the corrective transurethral procedure, surprisingly little is known of the impact upon the men's social and psychological well-being. The interviews have produced very rich data, which illustrate the extent to which the men are initially very reluctant to identify 'problems' either with their hospital experience or their subsequent recovery period. However, once respondents appeared to feel more comfortable, we began to learn of their very substantial difficulties both before and after the operation.