前列腺移行区体积和移行区指数在诊断良性前列腺增生中的作用

目的 :评价前列腺移行区体积 (TZV)和移行区指数 (TZI)在诊断良性前列腺增生 (BPH)中的作用。方法 :采用经直肠超声测量 2 62例患者的前列腺体积 (TPV)和TZV ,其中A组 2 2 0例为有症状 ,未出现过尿潴留的BPH患者 ,B组 19例为反复出现尿潴留的BPH患者 ,对照组 2 3例为非BPH患者 ,并推算TZI(TZI =TZV/TPV)。以上患者同时接受了国际前列腺症状评分 (IPSS)、生活质量评分 (QOL)、最大尿流率 (Qmax)检查。所得数据进行统计学处理。结果 :A组、B组和对照组之间的TPV、TZV、TZI、IPSS、QOL、Qmax比较差异均有显著性意义 ,年龄与TPV和TZV有非常显著相关性 (分别r =0 .2 4,P <0 .0 1;r =0 .2 5 ,P <0 .0 1) ,与Qmax有非常显著负相关性 (r =- 0 .2 7,P <0 .0 1) ,与IPSS有显著相关性 (r =0 .15 ,P <0 .0 5 ) ,与QOL无相关性 (r =0 .11,P >0 .0 5 )。TPV与IPSS、QOL、Qmax有显著相关性 (r =0 .2 6,r =0 .2 0 ,r =- 0 .2 9,P均 <0 .0 5 ) ,而TZV和TZI与IPSS ,QOL ,Qmax均有非常显著相关性 (分别r =0 .40 ,r =0 .3 2 ,r =- 0 .43 ,P均 <0 .0 1;r =0 .5 1,r =0 .41,r =- 0 .5 2 ,均P <0 .0 1)。结论 :BPH患者随着年龄的增加 ,TPV、TZV、IPSS、QOL增加 ,Qmax减小。发生尿潴留的BPH患者 ,其TPV、TZV和TZI大于没有出现过     

前列腺动脉栓塞术治疗良性前列腺增生远期疗效

目的探讨前列腺动脉栓塞术(PAE)治疗良性前列腺增生(BPH)的远期临床疗效。方法对38例BPH患者行PAE治疗后进行36个月以上随访,比较手术前后国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Q_(max))、剩余尿(RU)、前列腺特异抗原(PSA)及国际勃起功能指数(IIEF)变化,并采用经直肠CDFI检测前列腺动脉收缩期峰值速度(V_(max))、舒张期速度(V_(min))及阻力指数(RI),以MRI观测前列腺体积(PV)。结果 PAE技术成功率100%(38/38),临床成功率84.21%(32/38)。PAE前后IPSS、QOL评分、Q_(max)、RU、PSA、PV、V_(max)、V_(min)及RI总体差异均有统计学意义(P均0.05),术前与术后各时间点两两比较差异均有统计学意义(P均0.05),术后各时间点两两比较差异均无统计学意义(P均0.05)。随访第48个月3例PV较术前增大约3.44%;4例尿路梗阻症状加重,RU增多,夜尿次数增多,内部血流信号丰富,予以第2次PAE治疗。结论 PAE治疗BPH远期疗效稳定、可靠。     

New conservative therapeutic approaches in benign prostatic hyperplasia]

The efficacy of treatment for benign prostatic hyperplasia (BPH) is presently under critical consideration. In addition, various new therapeutic modalities are currently being evaluated. When medicamentous treatment is planned, in particular, the natural history of the disease must be carefully considered. Summarized data from several studies indicate that spontaneous improvement of symptoms may occur within 3-6 months, while in most cases deterioration takes a longer period of time. As intraprostatic urethral pressure depends on prostatic volume as well as on tone of the prostate smooth muscle, different medical treatment modalities seem reasonable. The dynamic component of the smooth muscle cells may be influenced by alpha-blockers. Administration of selective alpha 1-blockers will be advantageous as these have fewer side effects. Prostate volume represents the static component, which can be influenced by hormone treatment. Androgen deprivation via surgical castration must now be regarded as of historical interest only. Antiandrogens or LH-RH analogues have undesirable side effects and are expensive, making such treatment unacceptable for routine use. 5 alpha-Reductase inhibitors may emerge as a new treatment form allowing androgen suppression with a low rate of side effects. As it has been proposed that estrogens play an important role in the regulation of prostatic growth, aromatase inhibitors, which inhibit metabolization from androgens to estrogens, may receive special attention in the near future. Based on the theory that androgens may be of special importance for the epithelium, while estrogen action may be concentrated on the stroma, a combined treatment with inhibitors of 5 alpha-reductase plus aromatase may be even more effective.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variations of transition zone volume and transition zone index after transurethral needle ablation for symptomatic benign prostatic hyperplasia

BACKGROUND: Transurethral needle ablation (TUNA) is less invasive than other therapies for benign prostatic hyperplasia (BPH) and produces coagulative necrosis within selected adenoma lesions. The action mechanism of TUNA is still obscure, even though many early studies have demonstrated good clinical results of TUNA. It is of interest and importance to know how TUNA influences the volume of the intraprostatic region responsible for bladder outlet obstruction in order to elucidate the anatomical action mechanism of TUNA. METHODS: We retrospectively investigated postoperative variations in volumetric parameters of whole prostate volume (PV), transition zone volume (TZV) and transition zone index (TZI = TZV/PV) in 41 patients with symptomatic BPH who were treated with TUNA. The data were analyzed statistically in relation to the preoperative overall severity and postoperative therapeutic efficacy. RESULTS: Both PV and TZV showed a significant decrease at 3 months after TUNA (P < 0.01) as did the symptom score, quality of life (QOL) score and functional variables, and a decreased level of PV and TZV was sustained until 12 months of follow-up when compared to the baseline (P < 0.01 at 6 months, not significant at 12 months). TZI also showed a similar pattern with a significantly decreased level until the postoperative 6th month (P < 0.05 at 6 months, not significant at 12 months). In 'moderate' cases, TZI achieved the minimum value (0.44 +/- 0.13, P < 0.05 compared to the baseline) at 3 months of follow-up, but the level immediately increased, while in 'severe' cases, TZI gradually decreased and achieved the minimum value (0.44 +/- 0.08, P < 0.05 compared to the baseline) at 12 months of follow-up. In the evaluation by postoperative therapeutic efficacy, there were no significant differences in PV, TZV and TZI between 'excellent and good' cases (E/G group) and 'fair and poor/worse' cases (F/P group) at the baseline or 3 months of follow-up. Both of the efficacy groups showed a significant decrease in PV, TZV and TZI at 3 months when compared to the baseline (P < 0.05). The mean decrease in TZI was significantly larger in the E/G group than in the F/P group (0.064 +/- 0.13 vs 0.027 +/- 0.12, P < 0.05). CONCLUSION: Therapeutic efficacy of TUNA did not depend on the baseline value of PV, TZV and TZI, but on variation of a decrease in TZI during follow-up. Moreover, a slow and lasting decrease in TZI seemed to influence durability of the therapeutic efficacy of TUNA, which was clearly observed in 'severe' cases with a larger prostatic volume than in 'moderate' cases.     

前列腺突入膀胱程度对前列腺电切术后效果评估的价值

目的 探讨前列腺突入膀胱程度（IPP）对预测前列腺等离子电切术（TUPKP）术后临床效果的价值.方法 收集2007年1月至2012年1月在两家医院接受TUPKP的265例患者的术前临床资料及电切术后6个月的临床资料.我们依据IPP值把患者分为两组：IPP显著组（IPP≥5mm）105例和IPP非显著组（IPP＜5 mm）160例.研究两组手术前后各指标的变化,包括国际前列腺症状评分（IPSS）、生活质量指数评分表（QOL）、前列腺体积（TPV）,最大尿流率（Qmax）和残余尿量（PVR）,为术后临床效果评估提供参考.结果 术前两组各指标无统计学差异.IPP显著组的IPSS术前后变化值和QOL评分术前后变化值与IPP非显著组的相比有明显的升高,且有统计学差异（分别为P=0.038和P=0.000）.但是两组患者在Qmax和PVR的术前后改变值上无统计学差异.结论 IPP可以作为预测TUPKP术后患者IPSS和QOL评分的一个指标.     

The clinical efficacy and tolerability of doxazosin standard and gastrointestinal therapeutic system for benign prostatic hyperplasia

The therapeutic goal of treating benign prostatic hyperplasia (BPH) through early detection and effective therapy is to relieve the symptoms, improve patients' quality of life, decrease postvoid residual urine volume, and prevent the associated morbidity when the condition remains untreated. Alpha1-adrenoreceptor antagonists, e.g. doxazosin, terazosin, tamsulosin and alfuzosin, relax the bladder outlet to improve urinary flow, by reducing prostatic smooth muscle tone through the blockade of sympathetic adrenergic receptors. Doxazosin gastrointestinal therapeutic system (GITS) is a controlled-release formulation developed to enhance the pharmacokinetic profile of the drug while simultaneously minimizing possible adverse effects and reducing the need for dose titration. While both doxazosin standard and GITS are indicated for hypertension, they are also useful in the pharmacologically or naturally normotensive patient with BPH. In a cross-over trial comparing doxazosin GITS and tamsulosin, doxazosin gave a significantly greater improvement from baseline in symptoms. Results from recent trials (e.g. Medical Therapy of Prostatic Symptoms, MTOPS) showed that doxazosin was significantly more effective than the 5alpha-reductase inhibitor finasteride in relieving lower urinary tract symptoms, irrespective of prostate volume. The MTOPS trial showed clearly that over the long term, the combination of doxazosin and finasteride was more effective than either agent alone in significantly improving symptoms and reducing the clinical progression of BPH. Both doxazosin standard and GITS are well-tolerated, long-term therapies that are equally effective in younger and older men, and not associated with causing sexual dysfunction.     

纤维连接蛋白在良性前列腺增生中的表达及意义

利用免疫组织化学和计算机辅助图像分析的方法对２０例正常前列腺和２０例良性前列腺增生组织中的纤维连接蛋白（ＦＮ）进行形态学和定量研究。结果表明，ＦＮ主要分布于前列腺间质和腺体的基底膜，呈线网状或弥漫状分布。间质中ＦＮ的相对含量与年龄无明显相关。良性前列腺增生组织间质中ＦＮ的相对含量（０．１１０±０．０２２）明显多于正常前列腺组织间质中的ＦＮ相对含量（０．０８６±０．０２７，Ｐ＜０．０１），而且ＦＮ的含量与良性前列腺增生组织中间质的增生程度密切相关。提示ＦＮ在前列腺良性增生的发生中起重要作用。     

爱普列特治疗良性前列腺增生临床疗效观察

目的:研究观察爱普列特治疗BPH的疗效和安全性.方法:60例患者分为两组,试验组30例,服用爱普列特每天两次,每次5 mg,对照组30例,服用保列治每天一次,每次5 mg,疗程6个月.结果:给药3个月后,爱普列特和保列治有效率分别为56.7%和60.0%,6个月后有效率分别为86.7%和90.0%,两组相比均差异无统计学意义(P＞0.05).不良反应发生率爱普列特组为10.0%(3/30),保列治组为13.3%(4/30),两者相比差异无统计学意义(P＞0.05).结论:爱普列特可明显改善BPH患者临床症状,不良反应发生率低,疗效和耐受性与保列治类似,是一种安全有效的治疗BPH的药物.     

经尿道等离子前列腺剜除术治疗高龄高危前列腺增生症

目的 探讨经尿道等离子前列腺剜除术治疗高龄高危良性前列腺增生(BPH)患者的安全性及疗效.方法 将70例高龄高危BPH患者随机分为两组,每组35例,分别行经尿道等离子前列腺剜除术(TUPKEP)和传统的经尿道前列腺电切术(TURP).比较两组患者的手术时间、出血量、前列腺腺体切除重量、术后膀胱冲洗时间、术后住院天数、术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)、最大尿流率(Qmax)等指标.对两组指标进行统计学分析.结果 TUPKEP组在手术的出血量、手术时间、术后膀胱冲洗时间以及术后的住院时间要明显小于TURP组(P＜0.05);TUPKEP组前列腺腺体切除重量大于TURP组(P＜0.05);两组患者术后随访3个月,残余尿、国际前列腺症状评分、生活质量评分差异均无显著性意义(P ＜0.05);TUPKEP组术后最大尿流率大于TURP组,两组比较有显著性差异(P＜0.05).结论 TUPKEP治疗BPH疗效确切,且安全性较好,特别适用于高龄高危的患者.     

良性前列腺增生的流行病学研究现状

良性前列腺增生是老年男性常见疾病,随年龄的增长其患病率不断增加。过去我国男性老年人群良性前列腺增生的患病率较低,现在由于人均寿命的延长、生活水平提高所带来的膳食结构的变化、生活习惯、环境因素以及疾病的状态等因素的影响,良性前列腺增生患病率已经接近发达国家水平。     

前列腺增生症尿流动力学分析

目的：研究前列腺增生症（ＢＰＨ）患者尿流动力学状况。方法：对２０例正常成人和３５例ＢＰＨ患者进行尿流动力学研究。结果：ＢＰＨ患者与正常成人各项检测指标有极显著性差异（Ｐ〈０．０１）。在３０例ＢＰＨ患者中随机抽样１０例进行了尿流动力学各项指标的直线相关分析,其相关系数最大尿流率与膀胱顺应性有显著性意义（Ｐ〈０．０５）,膀胱顺应性与膀胱颈压有显著性意义（Ｐ〈０．０５）,膀胱颈压与前列腺体积有显著性意义     

Inflammation and benign prostatic hyperplasia

Prostatitis, a histologic diagnosis, has evolved over the years to describe a clinical syndrome that was believed to be associated with prostatic inflammation. Similarly, benign prostatic hyperplasia (BPH), another histologic diagnosis, has evolved to describe a clinical syndrome believed to be associated with prostatic enlargement. Recent explorations of the interrelationships between these prostate-associated histologic and clinical conditions have generated much interest and excitement. This article describes these relationships and their impact on the management of, in particular, BPH.     

Transurethral microwave thermotherapy in the armamentarium of therapeutic modalities for benign prostatic hyperplasia

Transurethral microwave thermotherapy (TUMT) has gained a firm place in the spectrum of therapeutic modalities for management of patients with lower urinary tract symptoms suggestive of bladder outflow obstruction. To achieve optimum results following TUMT, intense research focuses on appropriate patient selection, heat-tissue interactions, and modification of technical specifications. Results of TUMT are good to excellent for the majority of patients, but there is a non-negligible number of patients who respond poorly. The selection of favorable candidates for TUMT aims to improve the therapeutic results, and both clinical baseline parameters and intrinsic characteristics of the prostate (histologic composition and vasculature) may influence treatment outcome. TUMT achieves therapeutic response through coagulative necrosis of the hyperplastic tissue, but additional theories have been proposed recently, suggesting that TUMT may cause neural destruction and induce apoptosis. Individualization of the treatment is expected to offer the best results, and because the temperature achieved inside the prostate determines the actual parenchymal necrosis, thermal monitoring during treatment will permit application of microwave energy in a feedback mode. Various microwave devices differ in technical specifications (operating frequency, design of antenna, cooling system), and recently introduced software programs (high-energy protocols, heat-shock strategy, short-duration protocols) aim at better efficacy, providing a more patient-friendly procedure. TUMT has survived the "test of time" that other, initially promising, modalities have failed. What remains to be determined is the maximum benefit that patients and health systems can gain from such a technique.