Effect of the alpha-1 adrenoceptor blocker on tissue norepinephrine contents in human benign prostatic hyperplasia

To see the effect of the α-adrenergic blocking agent on tissue norepinephrine contents of the prostate, norepinephrine (NE) levels were investigated in patients with symptomatic benign prostatic hyperplasia (BPH). Morphometrical analyses were also performed to detect the differences in tissue composition. Nineteen patients were subdivided into two groups. Patients in Group 1 were given tamsulosin hydrochloride (0.2 mg/day) for at least 4 weeks before transurethral resection of the prostate (TURP), while patients in the control group (Group 2) underwent no previous treatment for BPH before TURP. Tissue NE contents were investigated by high performance liquid chromatography on a chip of the prostate obtained by TURP. These two groups were closely similar in age distribution prostatic size, results of preoperative symptom scoring and relative proportion of smooth muscle component within the evaluated specimen. In the present series, tissue NE contents in these groups were not statistically different (p=0.64). Chronic and acute administration of the α-1 antagonist did not apparently influence the tissue NE level in patients with BPH.     

Study of patients with symptomatic benign prostatic hyperplasia who underwent transurethral resection of the prostate after ineffective alpha-1 blocker treatment by non-urologists

We evaluated the clinical courses of 60 patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TUR-P) in our hospital after ineffective alpha-1 blocker treatment by non-urologists between January 2001 and September 2004. Overall severity just before TUR-P estimated by the criteria for severity in BPH was mild in 0%, moderate in 37%, and severe in 63%. Urinary retention was noted in 5 patients (8.3%). Nine patients (15.0%), four of whom had received an anti-cholinergic agent, had a residual urine volume over 200 ml. Excellent or good overall efficacy of TUR-P according to the criteria for efficacy of treatment in BPH was 86.7%. According to a questionnaire survey, only 28.9% of non-urologists in the Abashiri district had knowledge of the clinical practice guideline for BPH. We should strengthen the partnership among urologists and non-urologists to appropriately treat patients having BPH by using evidence-based information such as the clinical practice guideline.     

Increased bladder apoptosis with alpha-1 adrenoceptor antagonists in benign prostatic hyperplasia

OBJECTIVE: To determine whether preoperative usage of alpha-1 adrenoceptor antagonists (alpha-1ARA) prevents the alterations in bladder wall components due to obstruction via changing apoptotic and/or proliferative activity and provides an advantage for improvement of irritative symptoms following removal of bladder outlet obstruction. MATERIAL AND METHODS: A total of 39 patients were enrolled to the present study. According to preoperative medical treatment, patients were divided into 2 groups as preoperative untreated (n = 15) and medically treated patients with alpha-1ARA (n = 24). Apoptotic and proliferative indices of bladder wall were determined with TUNEL assay and proliferating cell nuclear antigen immunoreactivity, respectively. RESULTS: While the mean apoptotic indexes (AI) of lamina propria were 0.293 +/- 0.163 vs 0.978 +/- 0.194 in untreated and treated patients, the mean AI of myofibroblast cells were 0.10 +/- 0.06 and 0.90 +/- 0.23 in untreated and treated patients, respectively. There were statistically significant differences between lamina propria (p = 0.0067) and myofibroblast cells (p = 0.0280) AI in the two groups. However, there were no significant differences between postoperative symptom indices in preoperatively treated and untreated groups. CONCLUSIONS: alpha 1-ARA treatment might have an effect on hypertrophy and supersensitivity of bladder wall due to increased outlet obstruction via prevention of the imbalance between cell proliferation and apoptosis, providing normal homeostatic control mechanisms, through the interval between the onset of the lower urinary tract symptoms and time surgical intervention. However, further studies should be organized to demonstrate the impact of long-term alpha 1-ARA medication for post-operative significant improvement on irritative symptom index.     

Ejaculatory disorder by alpha-1 adrenoceptor antagonist in patients with benign prostatic hyperplasia; retrospective comparison between naftopidil and tamsulosin

We cross-sectionally studied the incidence and impact on quality of life of ejaculatory disorders caused by alpha-1 adrenoceptor antagonists (tamsulosin or naftopidil) in patients with benign prostatic hyperplasia (BPH). By questionnaire, we queried 88 clinical BPH patients concerning ejaculatory disorders, who were treated with tamsulosin or naftopidil between February 1999 and August 2003. We investigated the difference in the incidence and types of disorders between the two drugs. Of the 88 patients, 63 (71.6%) had sexual activities during the treatment. The incidence of ejaculatory disorders was significantly higher in the tamsulosin group (30.0%) than in the naftopidil group (3.0%). Eighty percent of patients having the disorders noticed the absence or reduced volume of semen although they experienced orgasms. The median quality of life index concerning the disorder was rated as 4, "mostly dissatisfied." Our results indicated that ejaculatory disorders occurred more frequently in the tamsulosin group. We should inform patients about this adverse effect caused by alpha-1 adrenoceptor antagonists prior to treatment.     

Clinical evaluation of supplemental administration of flavoxate hydrochloride in benign prostatic hyperplasia patients with nocturia resistant to an alpha1-adrenoceptor blocker

We examined the effectiveness of supplemental administration of flavoxate hydrochloride in patients with benign prostatic hyperplasia (BPH) whose nocturia was not adequately relieved by an alpha1-adrenoceptor blocker. Fifty-two patients who had two or more nocturnal micturition after administration of tamsulosin hydrochloride or naftopidil for 4 weeks or more received 400-600 mg of flavoxate hydrochloride in addition to an alpha1-adrenoceptor blocker for another 8-12 weeks. With supplemental administration of flavoxate hydrochloride, significant improvement was observed in the number of nocturnal micturition, total International Prostate Sympton Score, quality of life score and BPH impact index. No significant change was observed in the voided volume, Qmax, voiding time and residual urine volume. Supplemental administration of flavoxate hydrochloride is therefore effective for the improvement of nocturia and QOL in BPH patients resistant to an alpha1-adrenoceptor blocker.     

Evaluation of supplemental administration of Eviprostat in patients with benign prostatic hyperplasia with persistent symptoms following treatment with alpha1-adrenoceptor blocker

We examined the effectiveness of supplemental administration of Eviprostat in patients with benign prostatic hyperplasia (BPH) whose lower urinary tract symptoms (LUTS) caused by BPH were not adequately relieved by an alpha1-adrenoceptor blocker. Twenty-nine patients with insufficient improvement in the International Prostate Symptom Score (IPSS) and quality of life (QOL) score after administration of 50 mg naftopidil for 4 weeks or more received 6 tablets of Eviprostat in addition to naftopidil for another 2 weeks or more. With supplemental administration of Eviprostat, significant improvement was observed in the symptoms of incomplete emptying, daytime frequency, intermittency, weak stream, total IPSS, sum of the IPSS subscores for voiding symptoms (intermittency, weak stream and straining), sum of the IPSS subscores for storage symptoms (daytime frequency, urgency and nocturia), and QOL score. Supplemental administration of Eviprostat is therefore effective for the improvement of LUTS and QOL in BPH patients resistant to an alpha1-adrenoceptor blocker.     

Estrogen formation in human prostatic tissue from patients with and without benign prostatic hyperplasia

Prostatic tissue removed at the time of cystoprostatectomy was separated into periurethral and peripheral zones. Homogenized tissue was incubated with [1,2,6,7(3)H] androstenedione in the presence or absence of an aromatase inhibitor, 4-hydroxyandrostenedione (4-OHAD) and a 5 alpha-reductase inhibitor 4-MA (N,N-diethyl-4-methyl-3-oxo-4-aza-5 alpha-androstane 17 beta-carboxamide). Estrogen formation was determined by reverse isotope dilution of [3H] estrone and [3H] estradiol and crystallization to constant specific activity. Control incubations were carried out in parallel utilizing heated prostatic tissue. Total estrogens produced in the periurethral zone in patients with benign prostatic hyperplasia (BPH) was 223 fmol/mg protein/hr (SE +/- 57) compared to 102 fmol (SE +/- 17) in patients without BPH. Estrogen formation in the peripheral zone was 175 fmol (SE +/- 69) and 105 fmol (SE +/- 26) in patients with and without BPH, respectively. The prostatic aromatase exhibits Michaelis-Menton kinetics with an apparent Km of 90 nM. 4-OHAD inhibited aromatization in the prostatic tissue by 57-93%. Aromatization was also strongly inhibited by 4-MA, indicating that 4-MA is a potent aromatase as well as a 5 alpha-reductase inhibitor in this tissue. These results suggest that aromatization of androgens to estrogens in the human prostate proceeds at a substantial rate and that local estrogen formation could preexist and be a factor in the etiology of BPH and prostatic cancer.     

Natural course of lower urinary tract symptoms following discontinuation of alpha-1-adrenergic blockers in patients with benign prostatic hyperplasia

OBJECTIVE: alpha1-adrenergic blockers (alphab) remain the first-line therapy in men with lower urinary tract symptoms (LUTS). The current published work advocates continued use of alphab for their effect to be maintained. However, some patients decide to discontinue use of the medication after their symptoms are relieved and can keep good conditions. In this study, we investigated the natural course of LUTS after the discontinuation of successful treatment of alphab. METHODS: Among 75 patients with LUTS who stopped alphab medication once their symptoms improved, 60 patients (age, 50-87 years; median, 70) who could be followed for at least 12 months after discontinuation of alphab were analyzed in this study. Evaluations included a clinical determination of the International Prostate Symptom Score (IPSS), peak flow rate (Qmax) and postvoid residual urine volume (PVR). Upon patient request or in cases of PVR more than 100 mL, administration of alphab was resumed. RESULTS: Eighteen out of the 60 patients (30%) asked for re-treatment within 12 months after discontinuation (re-treatment group). The other 42 patents were able to maintain good condition without medication (discontinuation group). The IPSS was 15.9, 8.7, 10.1, 10.2, 9.7, 8.8 and 9.0, on the first visit, just before discontinuation, and 1, 3, 6, 9 and 12 months after stopping treatment among the discontinuation group, respectively. Similarly, Qmax was 10.6, 14.8, 14.2, 14.3, 14.7, 13.2 and 13.6 mL/ s, respectively. Treatment periods, prostatic volume and peak flow rates just before discontinuation of medication differed significantly between the re-treatment and discontinuation group. CONCLUSIONS: In spite of the short follow-up periods, these results suggest that selected patients with relatively small prostatic volume and good flow rates after therapy can discontinue alphab medication after their symptoms improve.     

Role of long-acting selective alpha-1 blockers in the treatment of benign prostatic hyperplasia.

Alpha blockers are effective for the treatment of symptomatic BPH, although the long-term response to and compliance with alpha blockers remain critical issues. The ultimate role of alpha blockade for the management of symptomatic BPH is undefined pending their resolution. The effectiveness of nonselective alpha blockers such as phenoxybenzamine is counterbalanced by the incidence and severity of adverse reactions. Selective alpha blockers such as prazosin and terazosin are far better tolerated while providing similar degrees of subjective and objective relief of bladder outlet obstruction. The preliminary experience with alpha blockers demonstrates statistically and clinically significant improvements in the symptoms of prostatism and urinary flow rates, and the majority of patients receiving alpha blockers have been extremely satisfied. The data on alpha blockers are preliminary, and therefore the role of these drugs at present must be decided upon by the individual urologist. There is sufficient evidence to justify the use of alpha blockers for men with moderate symptoms of prostatism, yet urologists may validly interpret the clinical experience with alpha blockers as preliminary. Nevertheless, urologists should at least present this option to patients before performing a prostatectomy. The patients selected for alpha blockade must be advised that the drugs alleviate the symptoms of prostatism rather than permanently reversing the pathophysiology of BPH.(ABSTRACT TRUNCATED AT 250 WORDS)     

内皮素-1及其受体在良性前列腺增生中的表达研究

目的探讨内皮素-1及其受体(ETAR与ETBR)在良性前列腺增生(BPH)移行区组织中表达的意义。方法采用免疫组化及Western blot技术检测5例正常前列腺组织(NP)与16例BPH组织中内皮素-1及其受体表达情况。结果BPH移行区组织中内皮素-1阳性面积为(77936.16±85291.33)μm2,ETAR积分吸光度为316.6±65.2,明显高于正常前列腺组织(阳性面积75.68±110.85μm2,ETAR积分吸光度为140.2±64.8),而2组ETBR的表达(积分吸光度分别为81.4±31.8,105.0±45.5)差异无统计学意义。结论BPH移行区组织中内皮素-1及其ETAR表达上调,在BPH的病理生理过程中可能产生重要作用。     

Assessment of sexual dysfunction in patients with benign prostatic hyperplasia

Sexual dysfunction is a highly prevalent condition in ageing men that considerably affects their quality of life, although it is a frequently neglected aspect of healthcare. The main predictors of sexual dysfunction are age and cardiovascular comorbidities such as hypertension, heart disease, hypercholesterolaemia and diabetes. Recently, the severity of lower urinary tract symptoms (LUTS) has also been identified as a crucial risk factor for sexual dysfunction, independent of age and comorbidities. Despite the increased prevalence of sexual dysfunction with age, health-related problems and psychological factors, there is evidence that many older men remain sexually active. Currently available self-administered questionnaires assessing male sexual dysfunction focus almost exclusively on erectile function. There is evidence from recent large-scale epidemiological studies that ejaculatory dysfunction (EjD) is almost as prevalent as erectile dysfunction (ED), affecting nearly half of men aged > or = 50 years. Other domains such as orgasm, desire, and satisfaction with sex life are important and should be considered. There is thus a need to develop and validate more comprehensive and multidimensional instruments for assessing sexual dysfunction in ageing men. A new instrument, the Male Sexual Health Questionnaire (MSHQ), was developed and validated to assess these specific aspects of male sexual dysfunction . It consists of a 25-item self-administered questionnaire including three core domains (erection, ejaculation, satisfaction with sex life) and additional items related to sexual activity, desire and bother related to sexual dysfunction. The MSHQ scale has excellent psychometric properties and is well suited for use in clinical and research settings. A short form of the MSHQ scale is currently under development.     

良性前列腺增生患者并发膀胱结石的危险因素分析

目的:探讨良性前列腺增生(BPH)患者并发膀胱结石的危险因素。方法:回顾性分析2016年4月～2017年9月我院就诊的321例BPH患者的资料,分别将其分为并发膀胱结石组(n=27)与无并发膀胱结石组(n=294),采用Logistic回归分析BPH患者并发膀胱结石的危险因素。结果:BPH患者的膀胱结石发生率为6.5%。多因素分析显示,年龄、前列腺尿道角(PUA)、前列腺突入膀胱程度(IPP)、前列腺移行带体积(TZV)是BPH患者并发膀胱结石的独立危险因素(P<0.05)。结论:年龄、PUA、IPP和TZV较大的BPH患者易发生膀胱结石。     

Efficacy of terazosin in patients with benign prostatic hyperplasia.

Terazosin, a selective, long-acting alpha 1-adrenergic blocker, was evaluated in 44 men with benign prostatic hyperplasia. The dose was titrated from 2 to 20 mg nightly depending on improvement in symptoms and flow rate. All men completed at least 3 months of therapy, 26 had 6 months and 19 received 9-12 months of terazosin. There was an average increase of 2 ml/s in the peak urinary flow rate compared to baseline. This was statistically significant at the 3-month level. Residual urine decreased under treatment at each 3-month time interval. Prior to initiation of terazosin the mean was 165 ml, and it was 62, 100, and 41 ml at 3, 6 and 9 months respectively. There was a statistically significant improvement in both the obstructive and irritative symptom scores. Side effects were minimal; only 1 patient discontinued terazosin due to a hypotensive episode. Terazosin was found to be safe and effective in the dose range of 2-20 mg taken at bedtime in men with symptoms related to benign prostatic hyperplasia. The present study did not identify any baseline parameters such as initial prostate volume, peak flow rates, or obstructive or irritative symptom scores that correlated with clinical outcome.     

Symptom-specific quality of life in patients with benign prostatic hyperplasia

BACKGROUND: We investigated which factors are most bothersome to preoperative patients with benign prostatic hyperplasia (BPH). METHODS: A total of 423 newly diagnosed patients and 388 preoperative patients with symptomatic BPH were evaluated. International prostate symptom score (IPSS) and IPSS quality-of-life (QOL) assessment score were used for assessment of symptoms and symptom-specific QOL of the patients with BPH. Uroflow variables were measured in all patients. Other objective variables such as prostate volume, transition zone volume, Schaefer's obstruction grade, and detrusor pressure at maximal urinary flow were evaluated in 209 preoperative patients. We analyzed the relationships between symptom-specific QOL and other variables. Statistical analyses were performed using Spearman's correlation coefficient and a stepwise linear regression model. RESULTS: Symptom-specific QOL scores had moderate to good correlation with IPSS (P < 0.0001; r = 0.525-0.560). Filling symptom subscore had a slightly greater impact on symptom-specific QOL than voiding subscore in both groups of patients. Weak stream, feeling of incomplete emptying, and nocturia significantly decreased symptom-specific QOL in both groups of patients. While newly diagnosed patients suffered from frequency as well, urgency had the strongest impact on symptom-specific QOL of preoperative patients. Objectively measurable variables had no association with symptom-specific QOL. CONCLUSION: Japanese patients with BPH generally suffer from weak stream, feeling of incomplete emptying, and nocturia in all disease phases. Frequency is problematic for newly diagnosed patients and urgency is problematic for preoperative patients as well. Symptom-specific QOL of BPH patients cannot be estimated by physically measurable variables.     

Long-term outcome of patients with a successful trial without catheter,after treatment with an alpha-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia

Objective  

To perform a retrospective review of long-term outcome for patients with a first episode of acute urinary retention (AUR) who could void successfully after the initial trial without catheter (TWOC) after treatment with an alpha-adrenergic receptor blocker (AR blocker).     

Impact of a shared decision-making program on patients with benign prostatic hyperplasia

OBJECTIVES: To determine patient views about the Shared Decision-Making Program (SDP), an interactive videodisk program designed to inform patients with benign prostatic hyperplasia (BPH) about their condition and treatment options and to determine its impact on perceived knowledge and treatment preference. METHODS: Six hundred seventy-eight patients with symptomatic BPH from eight Canadian centers viewed the SDP. Before and after viewing the video, patients answered questionnaires designed to assess treatment preference, knowledge gained, and satisfaction with this educational format. A 1-year follow-up survey was also conducted. RESULTS: Most patients showed a high desire for information and high satisfaction with the SDP; this satisfaction persisted at 1 year. Patients' self-reported knowledge increased significantly (P <0.0001). However, the SDP did not alter initial treatment preferences among those with already formed preferences, although it aided almost half of those initially undecided in forming a preference. Viewing the SDP also appeared to enhance the physician-patient relationship. CONCLUSIONS: Patients saw the SDP as an effective method for teaching patients about BPH and the risks and benefits of various treatments, clarifying particular areas about which many patients appear to have a desire for more information than is often provided. Patients were enthusiastic about the educational value of the program, and their active participation in the decision-making process may actually enhance the physician-patient relationship. Contrary to other studies, we found no significant alterations in treatment preferences. Problems relating to the cost and timely updating of the software need to be addressed for these kinds of programs to realize their full potential.