良性前列腺增生与血管损害高危因素相关性分析

目的:探讨血管损害高危因素与良性前列腺增生(BPH)病变程度相关性。方法:877例BPH确诊患者,进行经直肠B超估算前列腺重量、国际前列腺症状评分(IPSS)及尿流动力学检查评估梗阻程度。血管损害高危因素包括年龄、高血压、高血脂、2型糖尿病、吸烟。采用单因素和多因素分析对资料进行分析对比。结果:单因素资料分析,在病变程度不同的各组间比较,随高危因素程度或病例百分率增加,BPH病变程度随之增加。而多因素资料采用分级变量Logistic分析,显示2型糖尿病在前列腺大小、IPSS评分及梗阻程度中均为最显著的相关独立因素(OR分别为3.179、3.862、2.847,P均<0.01),血清甘油三脂在前列腺大小、IPSS评分及梗阻程度中均非显著的相关独立因素(P均>0.05),年龄、高血压、高血脂和吸烟均是上述BPH病变程度显著相关独立因素。结论:血管损害高危因素在BPH病变程度中发挥作用,其中糖尿病是BPH病变程度最显著的独立相关危险因素,其他血管损害高危因素在BPH病程中也起到不可忽视的作用。进一步证实局部血管损害与BPH之间存在密切关系。     

Validity of three calliper-based transrectal ultrasound methods and digital rectal examination in the estimation of prostate volume and its changes with age: the Krimpen study

BACKGROUND: Prostate volume and its changes are important parameters in studies of the natural history of benign prostatic hyperplasia (BPH), for prediction of treatment effect and the risk of adverse outcomes. The validity of three calliper-based transrectal ultrasound (TRUS) methods and digital rectal examination (DRE) is compared to transrectal planimetric prostate ultrasonometry. METHODS: Data were collected from 1,688 population-based men aged 50-78 years. Measurements included DRE, TRUS using the planimetric method, and three different calliper-based TRUS methods for the estimation of prostate volume. After 2.1 and 4.2 years these measurements were repeated. The agreement between these methods and the ability to discriminate between prostates with volumes above or below a certain cut-off was analyzed. The performance of the different methods to measure changes in prostate volume with age was also studied. RESULTS: All three ultrasound-based methods showed good discrimination compared to the planimetric method. However, the agreement between planimetric volumetry and the other ultrasound methods and DRE is poor. In this study, 22.6% of the men had a real increase in prostate volume after 4.2 years, using the planimetric technique of transrectal ultrasonometry. Only a small percentage of the men (<1.5%) has a real decrease in prostate volume. The alternative measurement methods had a low predictive value for changes in prostate volume with age as measured with the planimetric method. CONCLUSIONS: Calliper-based ultrasonometry and DRE show poor agreement with planimetric volume measurement of the prostate. Changes in prostate volume as determined by the planimetric method are poorly detected by the alternative methods. (c) 2004 Wiley-Liss, Inc.     

Resistance index in benign prostatic hyperplasia using power doppler imaging and clinical outcomes after transurethral vaporization of the prostate

BACKGROUND: Using power Doppler ultrasonography (PDUS), we investigate the change of resistance index (RI) before and after transurethral vaporization of the prostate (TUVP) in benign prostatic hyperplasia (BPH) patients. METHODS: In all, 49 patients underwent transrectal PDUS before receiving TUVP, three were excluded because of cancer and three could not be followed up. The remaining 43 were enrolled in the present study. Patients were assessed before and 1, 3 and 6 months after surgery, giving a mean duration of follow-up of 9.1 months. International prostate symptom scores (IPSS), quality of life (QOL) scores, postvoiding residual urine volumes (PVR) and maximum urinary flow rates (Qmax) were evaluated and total prostatic volume (TPV) and RI were measured using PDUS. RESULTS: Resistance index ranged from 0.64 to 0.91. The postoperative parameters except for RI, such as TPV, PVR, IPSS and QOL scores improved significantly at the follow-up assessment after surgery. The elevated RI decreased significantly 1, 3 and 6 months after the treatment. Resistance index significantly decreased after TUVP and IPSS and other urodymamics parameters improved. CONCLUSIONS: The present study suggested that RI could evaluate the severity of BPH and the degree of intraprostatic pressure or bladder outlet obstruction.     

Functional and anatomical effects of hormonally induced experimental prostate growth: a urodynamic model of benign prostatic hyperplasia (BPH) in the beagle

BACKGROUND: Benign prostatic hypertrophy (BPH) produces a variety of changes in the urodynamic pattern of micturition and is usually associated with high detrusor voiding pressure and poor urine flow-rate. In most previous experimental models, designed to simulate this condition, some degree of obstruction is immediately imposed by the technique employed to produce urethral occlusion. Consequently these models cannot reproduce the gradual onset of obstruction. In the present study a canine prostatic enlargement model, using 5alpha-dihydrotestosterone (DHT) + 17beta-estradiol (E) was adapted in order to produce a more gradual onset of partial obstruction and impaired voiding. MATERIALS AND METHODS: Hormonally induced prostatic enlargement was produced using seven beagles, given DHT 75 mg/day together with E 0.75 mg/day for 28 days via an implantable pump. The functional effects of DHT + E treatment on micturition pressure/flow were measured in the conscious animal. Identical measurements were also made using a separate older group of five beagles with symptoms of BPH. In addition seven beagles similarly instrumented were used as controls. RESULTS: Pressure/flow studies show that DHT + E produced obstructive micturition, characterized by a significantly increased micturition detrusor pressure, from 33.3 +/- 10.5 to 50.8 +/- 10.7 cmH(2)O and significantly decreased low urine flow-rate from 8.6 +/- 2.1 to 6.9 +/- 0.9 ml/sec. Associated with the obstructive micturition, this treatment increased wet prostate weight from 11.9 +/- 2.5 to 31.6 +/- 10.0 g. Prostate volume of the BPH beagles was 29.3 +/- 8.9 g. Morphologic studies show that DHT + E produced epithelial hyperplasia extending focally into the lumen. CONCLUSIONS: Hormonally induced prostate growth produced bladder obstruction, in terms of pressure/flow characteristics, that are analogous to BPH. It is suggested that this type of hormonal treatment can be used to create a model for the study of the effects of controlled increased in prostate growth and the development of BPH on micturition.     

前列腺中叶增生与膀胱出口梗阻程度的相关性分析(附131例报告)

目的:分析良性前列腺增生(BPH)患者中叶增生大小与膀胱出口梗阻(BOO)程度之间的相关性。方法:对2008年5月~2010年6月因排尿困难就诊的BPH患者131例,通过经腹超声测定前列腺三径和前列腺突入膀胱的距离(IPP),尿动力学检查测定最大尿流率(Qm ax)、最大尿流率时的逼尿肌压力(Pdet@Qm ax),利用L in-PURR图判断梗阻级别和逼尿肌收缩力,并计算出AG值(AG=Pdet@Qm ax-2Qm ax)。不同IPP梗阻程度的比较采用方差分析,并对前列腺体积(PV)、IPP与AG值进行相关性分析。结果:当IPP>10 mm时,IPP与BOO高度正相关(相关系数r=0.821,P<0.01)。PV与BOO相关度较低(r=0.475,P<0.01)。IPP与Pdet@Qm ax高度正相关(r=0.865,P<0.01)。结论:前列腺中叶增生与BOO存在高度相关性,超声测定中叶突入膀胱的距离是判断BOO程度较为可靠的方法。     

维汉族BPH患者前列腺形态与尿流动力学的相关性

目的 探讨维汉民族前列腺增生患前列腺的体积、症状积分和膀胱排尿症状的相关性。方法 对71例住院手术的维汉不同民族前列腺增生症(BPH)患进行国际前列腺症状评分(BPSS)，生活质量评分(L)，前列腺体积(V)，重量(M)，患年龄(age)，尿流动力学指标的直线相关分析。结果 40例汉族及31例维族BPH患的前列腺体积与膀胱颈压，膀胱颈压与膀胱顺应性，最大尿流率与膀胱顺应性均呈正相关。结论 最大尿流率、前列腺体积、膀胱顺应性、膀胱颈压四个参数不但能了解膀胱排尿功能和形态改变，也可做为临床上手术切除增生前列腺组织，解除梗阻，缓解症状，评价治疗效果的指标。     

Should high-grade prostatic intraepithelial neoplasia change our approach to infravesical obstruction?

OBJECTIVES: To investigate whether coexistence of high-grade prostatic intraepithelial neoplasia (HPIN) should change our therapeutic approach to infravesical obstruction. MATERIAL AND METHODS: Of 505 patients who underwent sextant transrectal ultrasonography (TRUS)-guided prostate biopsy, 65 (12.8%) had HPIN and 29 of them underwent prostatectomy (23 transurethral resection of prostate (TURP), 6 open) due to obstructive urinary symptoms. Patients without carcinoma were followed up with semiannual prostate-specific antigen (PSA) and digital rectal examination. After a follow-up of 24.8 +/- 11.0 months, 19 of 29 patients who accepted our call had another sextant biopsy. RESULTS: Mean age and initial mean PSA values of 29 patients were 67.6 +/- 6.7 years and 9.26 +/- 5.91 ng/ml, respectively. The final pathological evaluation of the surgical specimens revealed 2 prostatic adenocarcinomas both in the TURP group. The remaining 27 (93.2%) patients were found to have benign prostatic hyperplasia (BPH) and their serum PSA levels declined from 9.26 +/- 5.91 to 4.59 +/- 2.0 ng/ml 3 months after prostatectomy. Of the 19 patients who had another biopsy with a mean PSA value of 4.06 +/- 4.61 ng/ml, 15 and 4 of them had BPH and HPIN respectively. CONCLUSIONS: Our preliminary data indicate that the presence of HPIN on TRUS-guided biopsies is not a factor to delay an indicated surgical intervention for infravesical obstruction.     

The relationship of detrusor instability and symptoms with objective parameters used for diagnosing bladder outlet obstruction: a prospective study

PURPOSE: Detrusor instability is a common urodynamic finding in patients with prostatic obstruction. In prospective fashion we evaluated detrusor instability in patients with lower urinary tract symptoms attributable to benign prostatic hyperplasia and determined its possible association with the degree of obstruction. MATERIALS AND METHODS: A total of 459 men with a mean age plus or minus standard deviation of 60.4 +/- 9.4 years who were investigated for lower urinary tract symptoms at our facility answered an Arabic standardized version of International Prostate Symptom Score and underwent simple uroflowmetry, outpatient cystoscopy and transrectal ultrasound. Invasive urodynamics, including filling and voiding cystometry, was done with pressure flow analysis according to the Sch?fer nomogram. Statistical significance was tested by the Mann-Whitney U and Wilcoxon rank sum tests. RESULTS: Of the 459 patients 108 (23.5%) had detrusor instability. Instability significantly affected patient symptom score and conception of quality of life. Moreover, instability significantly affected the degree of obstruction, as measured by the maximum flow rate, post-void residual urine, prostate volume and Sch?fer grade of obstruction. CONCLUSIONS: Detrusor instability affects patient symptoms and quality of life. It also signifies a more severe degree of obstruction in male patients with lower urinary tract symptoms and bladder outlet obstruction due to benign prostatic hyperplasia.     

Transrectal Microwave Hyperthermia for Patients with Benign Prostatic Hyperplasia

Background:
A randomized study evaluated the efficacy of treatment with transrectal microwave hyperthermia (TMH) treatment in patients with benign prostatic hyperplasia (BPH).
Methods:
Eighty BPH patients received TMH therapy and 20 patients were given a sham treatment. TMH was achieved using a prostathermer which includes a microwave transrectal heat generator, a cooling system and a transurethral sensor probe. Patients that received TMH had 5 to 6 sessions of 1 hour each where the prostate was heated to 42°C to 43.5°C. The sham treatment consisted of a single session where the temperature was maintained at 37°. All patients were evaluated at 3 and 12 months after treatment.
Results:
There was an improvement of subjective obstructive symptoms in 54 patients (75%) after TMH. An evaluation of urodynamic parameters revealed an increase in the maximum flow rate and a decrease of the detrusor opening pressure as well as the detrusor pressure at maximum flow in patients treated with TMH. A significant improvement in the amount of residual urine was seen in all TMH-treated patients ( P <0.0001).
Conclusion:
Although TMH cannot be considered a superior alternative to open surgical or transurethral excision of the prostate, it is a valid option for patients who have indwelling urethral catheters and for those at high surgical risk.     

A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years

OBJECTIVE: To compare holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP) for treatment of men with bladder outflow obstruction (BOO) secondary to benign prostatic hyperplasia with a minimum of 24-month follow-up. PATIENTS AND METHODS: Sixty-one patients were randomised to either HoLEP or TURP. All patients had BOO proven on urodynamic studies pre-operatively (prostate size 40-200 g). One patient died before treatment, which left 30 patients in each group. Perioperative data, as well as symptom scores, Quality of Life (QoL) scores, and maximum urinary flow rates (Qmax) were obtained at one, three, six,12, and 24 months. Post-void residual volumes, transrectal ultrasound (TRUS) volumes, and pressure flow studies were obtained six months post-operatively. Continence and potency data were also recorded. RESULTS: There were no significant differences between the two surgical groups pre-operatively. Mean pre-operative TRUS volume was 77.8+/-5.6 g (42-152) in the HoLEP group and 70.0+/-5.0 g (46-156) in the TURP group. Patients in the HoLEP group had shorter catheter times and hospital stays. More prostate tissue was retrieved in the HoLEP group. At six months, HoLEP was urodynamically superior to TURP in relieving BOO. At 24 months, there was no significant difference between the two surgical groups with respect to American Urology Association scores, QoL scores, or Qmax values; however, two patients in the TURP group required re-operation. CONCLUSIONS: HoLEP has less perioperative morbidity and produces superior urodynamic outcomes than TURP, when treating prostates >40 g. At 24 months of follow-up, HoLEP is equivalent to TURP.     

THE EFFECT OF HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA ON SERUM TOTAL AND PERCENTAGE OF FREE PROSTATE SPECIFIC ANTIGEN LEVELS

PURPOSE: It is established that the percentage of free prostate specific antigen (PSA) in serum is low in patients with prostate cancer. An unanswered question is whether a low percentage of free PSA can be explained by high grade prostatic intraepithelial neoplasia alone. We compared the percentage of free PSA in men with high grade prostatic intraepithelial neoplasia alone, prostate cancer, benign prostatic hyperplasia (BPH) and a normal prostate (that is normal digital rectal examination and PSA less than or equal to 2.5 ng./ml.). MATERIALS AND METHODS: From October 1994 through December 1997, 48 men were diagnosed with high grade prostatic intraepithelial neoplasia without concomitant prostate cancer. Of these men 43 with a mean age plus or minus standard deviation of 67.4 +/- 7.8 years comprised our study group. To date none has been diagnosed with cancer during followup. Serum free and total PSA levels were measured, and the percentage of free PSA was calculated. The percentage of free PSA in the 43 men was compared to that in 50 with prostate cancer (mean age 65.4 +/- 7.8 years), 50 with biopsy proved BPH (67 +/- 7) and 43 with a normal prostate (61 +/- 8). RESULTS: There was no significant difference in mean total serum PSA in patients with high grade prostatic intraepithelial neoplasia, prostate cancer or BPH. The percentage of free PSA was significantly lower in patients with prostate cancer (14.9 +/- 6.5%) than those with high grade prostatic intraepithelial neoplasia (20.8 +/- 7.1%), BPH (20.1 +/- 7.3%) or a normal prostate (27.7 +/- 12.2%). There was also no significant difference in the percentage of free PSA between men with high grade prostatic intraepithelial neoplasia (20.8 +/- 7.1%) and those with BPH (20.1 +/- 7.3%). Additionally, men with a normal prostate had a higher percentage of free PSA (27.7%) than those with BPH (20.1%), high grade prostatic intraepithelial neoplasia (20.8%) or prostate cancer (14.9%). CONCLUSIONS: The percentages of free PSA in men with high grade prostatic intraepithelial neoplasia and BPH are similar, and significantly higher than those found in men with prostate cancer.     

A PROSPECTIVE STUDY OF THE SAFETY AND EFFICACY OF SUPRAPUBIC TRANSVESICAL PROSTATECTOMY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

PURPOSE: We investigate the safety and efficacy of suprapubic transvesical prostatectomy, and the change in bladder wall thickness after surgery. MATERIALS AND METHODS: We conducted a prospective 1 center study of 32 consecutive patients who underwent transvesical prostatectomy from December 1996 to March 1997 for benign prostatic hyperplasia with large prostate volume, who were followed for 1 year. Pressure flow study and transrectal sonography were performed at baseline and repeated at 6 months. Bladder wall thickness was measured at baseline and regular intervals postoperatively. A morbidity questionnaire was completed during the first 6 weeks after surgery. RESULTS: An average of 63 gm. prostate adenoma were enucleated at surgery. An indwelling catheter was required for an average plus or minus standard deviation of 5.4 +/- 2.6 days after treatment. The International Prostate Symptom Score decreased from 19.9 +/- 4.4 to 1.5 +/- 2.7 and the quality of life score decreased from 4.9 +/- 1.0 to 0.2 +/- 0.4 at year 1, respectively. Maximum flow rate improved from 9.1 +/- 5.3 to 29.0 +/- 8.9 ml. per second. Residual urine decreased from 128 +/- 113 to 8 +/- 18 ml. Before surgery 30 patients had obstruction and 2 were in the equivocal zone of the International Continence Society nomogram. At 6 months after prostatectomy 30 patients did not have obstruction, and 2 who were subsequently operated on for bladder neck sclerosis were equivocal and had obstruction, respectively. No patient had significant postoperative bleeding and no heterologous blood transfusions were required. There were 4 men who had urinary tract infection and 1 who had wound infection. A slight decrease in erectile function was observed 6 weeks postoperatively, and no change in patient libido and quality of sex life was reported. The total complication rate was 31.3%. The bladder was unstable in 7 men before and 3 after surgery. A significant decrease in bladder wall thickness was observed from 5.2 +/- 0.7 at baseline to 2.9 +/- 0.9 mm. at year 1 postoperatively. CONCLUSIONS: Our study confirms the excellent clinical outcome of transvesical prostatectomy, and rapid improvement of most subjective and objective parameters during the 4 weeks after surgery. Bladder hypertrophy appears to be significantly reduced after prostate surgery. The urodynamic results in patients who underwent open surgery probably represent the maximum obtainable relief of obstruction and should be considered the reference standard to which all other treatments, including transurethral resection, should aspire.     

Rising PSA in patients with minor LUTS without evidence of prostatic carcinoma: a missing link?

Objectives To determine the role of pressure flowmetry in patients without bothersome lower urinary tract symptoms (LUTS), rising prostate-specific antigen (PSA) levels and diagnosed as having clinical benign prostatic hyperplasia (BPH) after negative (multiple) extended multi-site biopsy. Methods The study enrolled patients with minor LUTS who were referred to our urological practice by their general practitioner because of a rising PSA level (≥4 ng/ml). After exclusion of clinical prostatic carcinoma by digital rectal examination and transrectal ultrasound, all patients underwent at least one set of extended multi-site biopsies to exclude T1c prostate cancer. Patients with negative biopsies (clinical BPH) were subjected to pressure flowmetry whereafter those with bladder outlet obstruction underwent TURP. Results The study included 82 patients, with a mean age of 64.8 years (50.2–78.2 years), satisfying the inclusion criteria. Urodynamic analysis showed that all patients had bladder outlet obstruction. After TURP, eight patients (9.8%) were diagnosed as having histologically proven prostate cancer; 74 patients (90.2%) were diagnosed as having BPH. Patients of the BPH group had a mean preoperative PSA level of 8.8 ng/ml (4.3–25.8 ng/ml) and a mean international prostate symptom score of 8.8 (2–18). The mean detrusor pressure at maximum flow in BPH patients was 89.5 cmH₂O (20–200 cmH₂O). Conclusions An increased PSA in patients with minor or no LUTS, clinical BPH and negative extended multi-site prostate biopsy is strongly correlated to bladder outlet obstruction. Therefore, patients with these characteristics should be treated with TURP.     

Sonographic measurements of transition zone of prostate in men with and without benign prostatic hyperplasia.

Modern transrectal ultrasonography is a reliable means of visualizing the transition zone within the prostate gland. We measured the transverse, longitudinal, and anterior diameters and calculated the volume of the prostate and the transition zone in 400 patients. Ninety-seven patients with neither clinical nor sonographic evidence of benign prostatic hyperplasia (BPH) were compared with 108 patients with sonographically apparent BPH. The mean size of the transition zone was 6.14 +/- 3.2 g in the normal group and 24.81 +/- 14.4 g in the BPH group. The size of the transition zone increased significantly in relation to increased age of the patient. Ultrasonography allows accurate measurement of the transition zone and would be useful for documenting changes in the extent of BPH in response to therapy.     

A new parameter in decision making for transurethral electroresection of benign prostate hyperplasia

OBJECTIVE: In this study, the clinical usefulness of transition zone (TZ) volume (TZV) measured by transrectal ultrasonography (TRUS) was investigated as a new parameter for the preoperative prediction of the treatment efficacy of transurethral resection of the prostate (TURP). METHODS: Fifty-six men with symptomatic benign prostatic hyperplasia (BPH; age 68.6 +/- 9.7 years) underwent TURP and were evaluated based on ordinary BPH parameters such as the international prostatic symptom score (I-PSS), quality of life (QOL) score, peak urine flow and entire prostate volume (PV), as well as the new TZV parameters and calculation of the TZ index. Relative risks were adjusted simultaneously for potentially confounding variables by multiple logistic regression analysis after adjustment for age, QOL, I-PSS, Qmax and residual urine. RESULTS: The adjusted relative risk for TURP at a TZ index of 0.1 increased to 4.5 (95% confidence interval 2.3-8.78). In general, poor responses were observed in patients with less symptomatic scores or lower values prior to operation, but there was a weak correlation between treatment outcome and preoperative scores or values of ordinary parameters. The volume parameters of BPH and PV did not predict treatment efficacy preoperatively, but TZV and the TZ index correlated with the treatment efficacy of TURP. CONCLUSION: TZV and the TZ index seem to be useful new parameters in preoperative decision-making with regard to TURP.     

Videourodynamics identifies the causes of young men with lower urinary tract symptoms and low uroflow

OBJECTIVES: Using videourodynamics (VUDS) we prospectively investigated the etiologies of lower urinary tract symptoms (LUTS) and low uroflow in young men and correlated the results with clinical symptoms and noninvasive exams. METHODS: From 1999 to 2001, 90 men 18-50 years old with LUTS and low uroflow were enrolled. Patients with active urinary tract infection, congenital urogenital diseases, neurological diseases, diabetes mellitus or urinary tract malignancy were excluded. Evaluation included International Prostate Symptom Score (I-PSS), renosonography, transrectal ultrasonography of prostate and VUDS. The clinical parameters were compared in the different diagnostic groups of patients classified by VUDS. RESULTS: Mean patient age was 37.5+/-7.8 years and mean symptom duration was 28.3+/-21.3 months. Mean total I-PSS was 19.8, voiding 11.1 and storage 8.7. VUDS showed dysfunctional voiding in 39 (43%), primary bladder neck obstruction in 37 (41%), impaired detrusor contractility in 9 (10%) and benign prostatic obstruction in 5 (6%). Patients with impaired detrusor contractility had higher symptoms scores and poorer quality of life than those in the other diagnostic groups. Mean age and size of prostate in patients with benign prostatic obstruction were greater than those in the remaining groups. The remaining clinical symptoms or noninvasive tests could not predict a specific urodynamic diagnosis. CONCLUSIONS: VUDS is recommended to make an accurate diagnosis in young men with LUTS and low uroflow because few clinical symptoms or noninvasive tests were helpful in this regard.     

Rotoresection versus transurethral resection of the prostate: short-term evaluation of a prospective randomized study

PURPOSE: We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate. MATERIALS AND METHODS: A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean+/-SD patient age was 60.76+/-5.85 years in the rotoresection and 64.24+/-6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer's grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis. RESULTS: At 6 months International Prostate Symptom Score decreased from 26.2+/-4.06 to 5.32+/-1.52 in the rotoresection group and from 22.84+/-4.56 to 7+/-1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87+/-2.24 to 25.29+/-10.39 ml per second in the rotoresection group and from 9.44+/-2.29 to 25.2+/-5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2+/-16.58 to 17.24+/-7.61 ml in the rotoresection group and from 40.6+/-16.93 to 18.28+/-8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84+/-26.8 cm H2O and 4.24+/-0.97 to 38.8+/-18.8 cm H2O and 1.24+/-0.93 in the rotoresection group, and from 63.04+/-21.08 cm H2O and 3.48+/-0.65 to 34.16+/-12.7 cm H2O and 1+/-0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p=0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group. CONCLUSIONS: Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.     

Clinical and pressure-flow changes after long-term treatment with alfuzosin SR

OBJECTIVES: The aim of our study was to evaluate the symptomatic and urodynamic changes after 1-5 years of treatment with alfuzosin in patients with benign prostatic hyperplasia. METHODS: Out of 255 patients with lower urinary tract symptoms observed from 1992 to 1997, who completed the International Prostatic Symptom Score (I-PSS) and underwent full urodynamic investigation, 161 were found to be obstructed (Sch?fer classes 2-6). One hundred and two subsequently consented to a second clinical and urodynamic evaluation. Out of these, 46 underwent surgical treatment, 20 were elected for watchful waiting (WW) and 36 received a medical treatment. Twenty out of these, with a mean age of 65 years, a mean prostatic volume of 44 ml (20-70) a median Sch?fer's obstruction class of 3 (range 2-5) were treated with slow release alfuzosin 5 mg twice a day. We re-evaluated these 20 patients with a second I-PSS and pressure-flow study after 1-5 years (mean: 2 years) of treatment. The patients in the WW group with comparable baseline characteristics were considered as controls. The Wilcoxon matched-pairs signed rank test and the Kruskal-Wallis test were used for statistical analysis. RESULTS: In the group treated with alfuzosin, no differences were noted for I-PSS (14.9 +/- 6,8; 13.3 +/- 5); maximum flow (124 +/- 6; 14 +/- 6) and projected isometric pressure (105 +/- 36; 105 +/- 26). Statistically significant differences were noted for residual urine (103 +/- 100; 33 +/- 38, p = 0.02); detrusor pressure at maximum flow (64.4 +/- 23; 53 +/- 12, p = 0.04), minimum urethral opening pressure (36.5 +/- 9; 31 +/- 9, p = 0.02), Sch?fer class (2.7 +/- 0.7; 2 +/- 0.8, p = 0.04); urethral resistance algorithm (34.7 +/- 11; 27 +/- 7, p = 0.02). Statistically significant differences between baseline and follow-up were noted for none of the clinical and urodynamic parameters in the WW group. CONCLUSIONS: Patients with bladder outlet obstruction seem to remain clinically stable and to improve urodynamically when treated with alfuzosin for a long period of time.     

Prediction of prostate volume based on total and free serum prostate-specific antigen: is it reliable?

OBJECTIVE: To analyze the utility of total/free prostate-specific antigen (PSA) and age as predictors of the prostate volume in men with symptomatic benign prostatic hyperplasia (BPH) and no evidence of prostate cancer. PATIENTS AND METHODS: Total and free serum PSA were determined in 681 patients with normal digital rectal examination and symptomatic BPH using the Hybritech method. Prostate volume was measured by transrectal ultrasound (TRUS). TRUS-guided biopsy was performed in 459 (67.4%) of the patients with a serum PSA >4.0 ng/ml. RESULTS: The relationship with prostate volume was best described in a log linear fashion by free PSA (R(2) = 0.367), total PSA (R(2) = 0.264) and age (R(2) = 0.017). Multiple linear regression demonstrates no significant influence of age. Free PSA was able to predict the individual TRUS prostate volume +/-10% in 67% of the patients and +/-20% in 91.2% and total PSA in 63 and 90. 9%, respectively. CONCLUSION: Prostate volume is strongly related with free and total PSA. Both determinations would be able to predict the TRUS prostate volume +/-20% in more than 90% of the patients.     

Role of Doppler ultrasound and resistive index in benign prostatic hypertrophy

BACKGROUND: The aim of the present study was to assess the resistive index in patients with benign prostatic hypertrophy (BPH) and the role of power Doppler ultrasonography. METHODS: From April 1996 to December 1997, a total of 214 men aged 48-86 years with symptoms of BPH were prospectively enrolled to participate in our study. All patients presented to our clinic with lower urinary tract symptoms. Transrectal ultrasonography was used to calculate the total prostate volume (TPV), transition zone (TZ) volume, transition zone index (TZI = TZ volume/TPV) and presumed circle area ratio (PCAR). Power Doppler imaging was used to identify the capsular and urethral arteries of the prostate and measure its resistive index (RI) value. RESULTS: The RI of capsular arteries significantly correlated with theTPV, TZ volume, TZI (r = 0.470; P < 0.0001) and PCAR (r = 0.334; P < 0.0001). Correlations were found between the RI of capsular arteries and the International Prostatic Symptom Score (IPSS) (r = 0.389; P < 0.0001), peak flow rate of uroflowmetry (r = -0.393; P < 0.0001). CONCLUSION: We demonstrated that an increase of the RI of capsular arteries correlated with increases in the TZI and PCAR in BPH. The lower IPSS and peak flow rate correlated with the high RI of capsular arteries; however, no correlation between the RI of urethral arteries and prostatic parameters was found. The findings suggested that the RI of capsular arteries may become the index for measuring lower urinary obstruction in the future.