A rare diagnosis： testicular dysgenesis with carcinoma in situ detected in a patient with ultrasonic microlithiasis

A rare case is presented where a dysgenetic testis with microinvasive carcinoma in situ （CIS, also known as intratubular germ cell neoplasm of unclassified type [IGCNU] and testicular intraepithelial neoplasia [TIN]） with microinvasion to rete testis and the interstitial tissue was found in a 32-year-old man presenting with mild scrotal pain and ultrasonic testicular microlithiasis. Knowledge of the association of ultrasound and CIS is important to diagnose patients at the stage prior to development of an overt germ cell tumor. The patient had three of four disorders considered symptoms of the testicular dysgenesis syndrome （TDS）： a dysgenetic left testicle with CIS, a mild left-sided cryptorchidism （high positioned scrotal hypotrophic testis） and a slightly reduced semen quality. Therefore, it should be kept in mind that a patient with one TDS symptom may harbour the other, even CIS or testicular cancer. Accordingly, patients with one TDS symptom ought to be examined for the presence of the others, and if more that one is present, extra concern is warranted.     

Arterial embolization for iatrogenic life-threatening bleeding from subcutaneous hypervascular tumor in prone position

Performing angiography in the prone position is a difficult technique; however it is useful in some emergency situation. We experienced a 60 years old male who was performed lipema excision on his back in his family doctor＇s clinic. Since massive arterial bleeding could not be controlled with manual astriction, he transferred to our hospital in prone position with hemodynamic instability. Operating field was not kept because of massive bleeding; therefore surgical treatment was impossible. We planed emergency arterial embolization （AE） in prone position. Hence we chose the left radial artery for vascular access. The left subclavicle arteriography showed many major and minor feeding arteries from left subclavicular and axillary arteries and a massive extravasation of the contrast medium. Three major feeding arteries were performed AE with gelatin sponge and steel coils, After AE, massive bleeding was controlled. He could discharge from our hospital on the 5th hospital day without any complication. Arterial embolization for lifethreatening bleeding from subcutaneous hypervascular tumor in the prone position is first report to our knowledge, and it is extremely rare. However we thought that this technique is useful for patients who could not turn in the supine position, e.g. massive bleeding during renal biopsy and penetrating trauma from back.     

Evaluation of stress hormones in traumatic brain injury patients with gastrointestinal bleeding

Objective： To evaluate the local risk factors of traumatic brain injury （TBI） patients developing gastrointestinal （GI） bleeding during the early hospitalization in neurosurgery intensive care unit （NICU）. Method： From September 2005 to February 2006, 41 patients admitted to NICU and 13 healthy volunteers were involved in our study. Blood samples at 24 hours, 2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m. to measure the concentrations of serum adrenocorticotropic hormone （ACTH）, total cortisol and gastrin. The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems. Data were analyzed by SPSS 11.5. Results： Within 24 hours following TBI, the concentrations of total cortisol, ACTH and gastrin increased proportionally to the severity of injury, especially significant in the experimental group （P〈0.05）. The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group, （F=1.413, P=0.253） for ACTH and （F=9.371, P=0.006） for gastrin. GI bleeding had a positive correlation with gastrin concentration （r=0. 312, P〈0.05） and a negative correlation with serum hemoglobin （Hb） （r=-0.420, P〈0.01）. The clinical incidence of GI bleeding was 24.39% （10/41） in the experimental group. Within 24 hours, GI bleeding had a strong correlation with gastrin concentration （OR=26.643, P〈0.05） and hematocrit （Hct） （OR=5.385, P〈0.05）. High ACTH concentration （〉100 pg/ml） increased the frequency of GI bleeding. For patients with severe TBI and treated with routine antacids, the incidence of GI bleeding was 40.91% （9/22） and the mortality rate was 20%（2/10）. Conclusions： Low Glasgow coma scale scores, low Hb, high concentrations of gastrin and ACTH （〉 100 pg/ml） are risk factors and can be predictive values for post-traumatic GI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality.     

Penile fracture and its treatment： Is retrograde urethrograghy necessary for management of penile fracture？

[Abstract] Objective： Penile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography. Methods： From February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable （3-0 nylon） sutures and the ties were placed on the internal surface （continuous method）. All patients were followed up for 12 months. Results： Patients＇ mean age was （32.78±10.61） years and ranged （16-62） years. The mechanism of trauma was sexual intercourse in 103 patients （89%） and masturbation in 13 patients （11%）. The most common site of injury found after exploration was right （55%） and lateral （74%） of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm （mean 1.88±0.72）. Three of the patients had Marphan＇s syndrome. Urethral injury was detected by retrograde urethrography in 4 patients （3%） who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen. Conclusion： There is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.     

Long-term testosterone supplementation is useful for ED Nith testosterone deficiency

Dear Editor,
We present an interesting case of a patient with erectile dysfunction （ED） and testosterone deficiency （TD） who was treated with testoster- one supplementation therapy （TST） in combination with sildenafil for 45 months. The patient continued to respond well even after the discontinuation of sildenafil for 8 months. Major side effects and complications were not reported at the long-term follow-up.     

Retrospective descriptive analysis of the physiological kinetics of prostate-specific antigen in men older than 75 years

Several studies have compared prostate-specific antigen （PSA） kinetics in men with and without cancer, but there has been no adequate analysis of the longitudinal variation in PSA. The aim of this study was to assess the fluctuations in PSA in a cohort of elderly men in an attempt to define a physiological pattern of PSA kinetics. We searched a specific cohort of patients aged 〉 75 years and with PSA value 〈 2.0 ng mL^-1. A history of all PSA values over the past 10 years was compiled for each patient to create a database of patients fitting the following criteria： （1） minimum of five PSA measurements, （2） over at least 5 years. Exclusion criteria were： （1） PSA 〈 0.2 ng mL^-1 at each measurement and （2） having had more than one PSA test per year. In all, 1 327 patients （mean age： 78.52 years） fit the inclusion criteria. The mean variation from the first to the last PSA test was 0.05 ± 0.43, with a mean follow-up of 6.79 ± 1.71 years. Over the same period, the mean fluctuation from the lowest to the highest PSA value was 0.04 ± 0.55 （P = 0.925）. The mean annual PSA velocity （PSAV） was calculated by dividing the mean variation from the first to the last PSA test by the number of years of observation for each patient and was set at 0.0104 ± 0.1050. Concluding, in a large-scale cohort of elderly individuals considered healthy and evaluated for a considerable follow-up, the average annual PSAV as well as the average fluctuation from the lowest to the highest PSA value are insignificant.     

Prevention of erectile dysfunction after radiotherapy for prostate cancer

With increasing scrutiny of prostate cancer （PCa） diagnosis and treatment, much attention has been given to the morbidity caused by radical prostatectomy （RP） and/or radiotherapy （RT）. One of the most common side-effects of either treatment is erectile dysfunction （ED）.1 Approximately, 40% of patients will experience ED after RT for PCa. The post-RT ED causes significant patient dissatisfaction with cancer treatment as well as decrease in patient and partner psychosocial function,z To address this issue in patients undergoing RT, Pisansky et al.3 conducted a prospective, randomized, double-blinded, placebo-controlled trial to assess the efficacy of a phosphodiesterase enzyme-5 inhibitor （PDE5i）, tadalafil, as a preventive measure for patients undergoing RT for PCa and found no difference in erectile function between the control and treatment groups.     

The Minimum Local Analgesic Concentration of Epidural Lidocaine for Herpetic Neuralgia

Objectives： To determine the Minimum local analgesic concentration （MLAC） of epidural lidocaine for herpetic neuralgia. Methods： Thirty-one cases of thoracic herpetic neuralgia patients received thoracic epidural catheterization under the guidance of the digital subtraction angiography （DSA）, securing the end of catheter to the side gap of lesions of the central segmentation of epidural affected by herpes zoster. An injection of iohexol mixed with lidocaine under the guidance of DSA to make sure that drug solution covered all injured nerve roots. The first patient was administered 0.37% lidocaine weight by volume; subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.02% increments. Efficacy was assessed using a visual analogue pain scale（VAS）, and accepted if this was ≤10 mm on a 100 mm scale within 30 minutes. The median effective concentration （EC50） was estimated with probit regression analysis. Results： A total of 30 patients were successfully completed, except one patient withdraw from the trial due to vascular puncture. The EC50 of epidural lidocaine for herpetic neuralgia was 0.1 99% （95%CI 0.1 68% -0.216%）. Conclusions： The MLAC of epidural lidocaine for herpetic neuralgia was 0.199% （95% CI 0.168%-0.216%）.     

Relaxation mechanisms of neferine on the rabbit corpus cavernosum tissue in vitro

Aim： To investigate the relaxation mechanisms of neferine （Nef） on the rabbit corpus cavemosum tissue in vitro. Methods： Strips of rabbit corpus cavemosum were mounted in organ chambers. The effects of Nef were examined on isolated muscle strips precontracted with phenylephrine （PE） alone, in the presence of NW-nitro-L-arginine （LNNA, a nitric oxide synthase inhibitor）, 1-H-[ 1,2,4]oxadiazolo[4,3-tx]quinoxalin- 1-one （ODQ, a guanylyl cyclase inhibitor）, indomethacin （cyclooxygenase inhibitor）, tetraethylammonium （Ca^2＋ -activated K^＋ channel blocker）, 4-aminopiridine （4-AP ,voltage dependent K^＋ channel blocker） and glibenclamide （ATP sensitive K^＋channel blocker）. The effects of Nef on KCl-induced contraction of isolated muscle strips were also investigated. The procedure of calcium absencecalcium addition was designed to observe the effect of Nef on two components of the contractile responses to PE based on the source of Ca^2＋ （extracellular vs. intracellular）. Results： Corpus cavemosum strips relaxed in response to Nef （10-9-10-4 mol/L） in a concentration-dependent manner with an IC50 of 4.60 × 10^-6 mol/L. However, they were not affected by LNNA, ODQ, indomethacin or K^＋-channel blockers. Nef （10^-6 mol/L, 10^-5 mol/L） concentration dependently reduced the maximal contraction response of isolated strips induced by KC1 to 79.3% ± 5.5% and 61.5% ±3.2%, respectively （P 〈 0.01）. In the calcium absence-calcium addition procedure, Nef 10.5 mol/L inhibited both intracellular calcium-dependent and extracellular calcium-dependent contraction induced by PE （2 × 10^5 mol/L） （P 〈 0.05）. The inhibition ratios were 26.2% ± 5.4% and 48.3% ±7.6%, respectively. Conclusion： The results of the present study suggest that Nef possesses a relaxant effect on rabbit corpus cavemosum tissues, which is attributable to the inhibition of extracellular Ca^2＋ influx and the inhibition of release of intracellular stored Ca^2＋, but not mediated by the     

Respiratory distress due to malignant ascites palliated by hyperthermic intraperitoneal chemotherapy

Malignant ascites is a common symptom in patients with peritoneal cancer. Current assumption is that anincreased vascular permeability and obstruction of lymphatic channels lead to the accumulation of fluid in the abdominal cavity. This case report describes a severely symptomatic patient with malignant ascites. The previously healthy 73-year-old male was presented with abdominal distention causing respiratory distress. Computed tomography revealed large amounts of ascites, a recto-sigmoidal mass with locoregional lymphadenopathy and an omental cake. Biopsy taken during colonoscopy revealed an adenocarcinoma of the colon with signet cell differentiation. A widespread peritoneal carcinomatosis was found during a diagnostic laparoscopy. The extent of peritoneal disease rendered the patient not suitable for cytoreductive surgery with curative intent. The ascites proved to be refractory to ultrasound-guided paracentesis; thus, a decision was made to perform palliative hyperthermic intraperitoneal chemotherapy without cytoreductive surgery. Consequently, ascites production stopped, and the respiratory distress was relieved thereafter. The postoperative recovery was uneventful. Ascites recurred eight months later, and a second hyperthermic intraperitoneal chemotherapy procedure was performed. The patient was still alive at the time of writing, 16 mo after the initial diagnosis.     

Pharmacotherapy of benign prostatic hyperplasia: Inhibitor of 5 alpha-reductase

We studied the effects of 5 alpha-reductase inhibitor (finasteride) in the treatment of benign prostatic hyperplasia (BPH). This study is a randomized controlled trial. Sixty-two patients were treated with 5 alpha-reductase (finasteride 5 mg/day) and 61 patients (control group) with placebo for one year. Prostatic volume, maximal urine flow rate, AUA symptom scoring, residual urine volume and prostate-specific antigen (PSA) levels were evaluated at 3, 6, 9 and 12 months. In the first 6 months prostatic volume decreased rapidly (20.5%), in the second 6 months it decreased slowly and reached the maximal rate (23.3%). Maximal urine flow rate increased in the second 6 months. AUA symptom scores decreased first at 3 months and were 4.6 points lower at the end of the 12th month. There were no significant changes in residual volume. The 5 alpha-reductase inhibitor caused a 50% decrease in PSA levels, like in other studies. Becuase of the prolonged use of the drug, treatment with 5 alpha-reductase inhibitor is not tolerated by many patients and being expensive its future in the pharmacotherapy of BPH is unclear.     

非那雄胺对抗栓治疗的良性前列腺增生患者继发肉眼血尿治疗的研究

目的:探讨非那雄胺对抗栓治疗的BPH患者继发肉眼血尿的治疗。方法:2006年9月～2007年2月明确诊断为BPH继发肉眼血尿的患者105例,分为抗栓组(81例)和对照组(24例)。抗栓组采用抗栓治疗联合非那雄胺,对照组仅采用非那雄胺治疗,随访6个月比较血尿的治疗结果。结果:抗栓组肉眼血尿完全消失52例(64.2%),血尿消失平均时间3.9周(1～6周);血尿较治疗前减轻者12例(14.8%)。对照组肉眼血尿完全消失16例(66.7%),平均时间3.2周(1～5周);血尿较治疗前减轻者4例(16.7%)。抗栓组肉眼血尿消失的平均时间长于对照组(P<0.05),两组之间在血尿治愈率(血尿消失)和有效率(血尿消失+血尿减轻)方面无显著差异,服用不同种类抗栓药物的患者间血尿治愈率无显著差异。结论:对于使用抗栓药物治疗的BPH患者继发肉眼血尿,口服非那雄胺是一种有效的治疗方法,治愈率和有效率与未抗栓治疗组接近,但治愈血尿所用的时间略长。     

Decreased suburethral prostatic microvessel density in finasteride treated prostates: a possible mechanism for reduced bleeding in benign prostatic hyperplasia

PURPOSE: We evaluated the influence of finasteride on prostatic microvessel density to elucidate a mechanism of decreased bleeding in finasteride treated patients with hematuria secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 22 patients with clinical BPH and gross hematuria who underwent prostate reductive surgery between 1998 and 2000 were prospectively evaluated. The prostate from 10 finasteride treated and 12 untreated patients was immunohistochemically stained for CD-34. Microvessel density analysis was performed by quantifying positive stained blood vessels located within the stroma of hyperplastic nodules as well as in the suburethral portion of the prostate. RESULTS: Mean microvessel density plus or minus standard deviation in finasteride treated patients was significantly lower in the suburethral portion of the prostate versus untreated controls (14.0 +/- 2.8 versus 20.2 +/- 5.3 vessels per high power field, p <0.05). In the nodular hyperplasia there was no statistically significant difference in the treatment and control groups (mean 17.5 +/- 2.8 and 16.7 +/- 4.6 vessels per high power field, respectively). CONCLUSIONS: Finasteride significantly decreases suburethral prostatic microvessel density in patients with BPH, which may explain its efficacy for decreasing BPH associated bleeding.     

良性前列腺增生症规范化治疗方案的多中心临床研究

目的 比较不同种类药物治疗良性前列腺增生（BPH）的疗效与差异,确定不同药物对不同患者的最佳适应证。方法 采用随机平行对照、多中心临床研究方法,对2002年9月至2003年12月906例BPH患者,随机进入选择性α-受体阻滞剂特拉唑嗪、多沙唑嗪、坦索罗辛与萘哌地尔;50α-还原酶抑制剂非那雄胺与爱普列特以及植物制剂舍尼通等7种治疗药物组。每3个月随访一次,国际前列腺症状评分（IPSS）与生活质量评分（QOL）,最大尿流率（Qmax）与平均尿流率（Qave）,前列腺总体积（TPV）与前列腺移行带体积以及残余尿量为观察指标进行疗效评价。根据不同指标基线水平将患者进行分层,比较各治疗组患者主观指标IPSS和客观指标Qmax的改善情况。结果 基线指标分析显示,全组主观指标IPSS评分和客观指标Qmax水平与TPV以及移行带体积呈明显相关性（P〈0．01）。至随访6个月时各类药物均使BPH患者的主观指标IPSS与QOL评分及客观指标Qmax与残余尿量有明显改善。各种药物对主客观指标的影响程度的组间比较显示,对IPSS的改善无显著差异;5α-还原酶抑制剂类药物爱普列特与非那雄胺可以使TPV和移行带体积均明显缩小（P〈0．05）。将患者以前列腺体积〈35．5cm^3和≥35．5cm^3分为两层,在非那雄胺治疗的患者中Qmax平均增加5．7ml／s和2．2ml／s（P〈0．01）,在舍尼通、萘哌地尔及多沙唑嗪治疗组,≥35．5cm^3者症状改善更为明显（P〈0．05）。以IPSS〈20分和≥20分进行分层,各种药物的疗效均在≥20分时更为明显（P〈0．01）。结论 各种药物均可明显改善BPH患者的主、客观症状,各种药物的疗效均对基线IPSS评分较高的患者疗效更为明显。5α-还原酶抑制剂能明显减小前列腺体积,对于前列腺体积≥35．5cm^2者有更为明显的主客观疗效。     

Inhibition of androgen metabolism in stroma and epithelium of the human benign prostatic hyperplasia by progesterone, estrone, and estradiol

It has been shown that progesterone, estrone, and estradiol are present in significant amounts in the human benign prostatic hyperplasia (BPH). Therefore it was of interest to determine the inhibitory effect of these steroids on the 5 alpha-reductase and 3 alpha (beta)-hydroxysteroiddehydrogenase (HSDH) activities, the enzymes responsible for the conversion of testosterone to 5 alpha-dihydrotestosterone (DHT), and DHT to 3 alpha (beta)-androstanediols, respectively. The enzyme inhibition was analyzed in vitro by measuring the 5 alpha-reductase in the presence of either progesterone, estrone, or estradiol, using testosterone as substrate. The DHT was used as substrate for HSDH. The metabolites were quantified by t.l.c. The main results were as follows: (1) Concerning 5 alpha-reductase in BPH, the mean inhibitor constants (KI; microM) of progesterone, estrone, and estradiol were 0.11, 15.5, and 5.1, respectively. (2) Analyzing epithelium and stroma of BPH separately, the inhibition of 5 alpha-reductase resulted in nearly identical KI's. (3) Concerning HSDH in BPH, the mean KI's of progesterone, estrone, and estradiol were 169, 63, and 192, respectively. (4) Analyzing epithelium and stroma of BPH separately, the inhibition of HSDH led to nearly identical KI's. (5) The kinetic parameters (KM, Vmax) of the 5 alpha-reduction of progesterone and testosterone were nearly identical. These results led to the suggestion that the endogenous concentrations of progesterone, estrone, and estradiol have no significant inhibitory effect on the 5 alpha-reductase and HSDH in vivo. Furthermore, the nearly identical inhibitor constants found for both enzymes in epithelium and stroma of BPH indicate that in both compartments the 5 alpha-reductase and HSDH are qualitatively identical.     

Clinical predictors in the use of finasteride for control of gross hematuria due to benign prostatic hyperplasia

PURPOSE: We identify predictors of clinical response as well as response time in patients treated with finasteride for gross hematuria due to benign prostatic hyperplasia. MATERIALS AND METHODS: A retrospective chart review was preformed of 53 patients who had been given 5 mg. finasteride daily for the treatment of active bleeding or a recent history of recurrent bleeding. Urological evaluations were negative for tumor in all patients. A history of prostatectomy, anticoagulant status and prostate size was determined. The degree of hematuria was then graded before and after finasteride treatment according to our previously described system. Of the 53 patients who were actively bleeding at initial evaluation 16 were followed to determine time required for complete resolution of hematuria. RESULTS: Hematuria grade improved after finasteride in 50 (94%) patients. Overall 77% of patients (41 of 53) experienced no further bleeding while taking finasteride. Mean followup was 38 months (range 3 to 86). Of the patients 86% (12 of 14) taking coumadin, 77% (10 of 13) taking aspirin and 73% (19 of 26) on no anticoagulants had no further bleeding once on finasteride. Of the patients who had undergone prior transurethral prostatectomy 84% (26 of 31) experienced no further bleeding versus 68% (15 of 22) of those who had not undergone previous surgery. In the 16 patients who began finasteride while actively bleeding the average time to clear urine was 12 days (range 2 to 45). Prostatic volume correlated with the average time needed for resolution of hematuria, which was 2.7 days or longer for small (less than 40 gm.), 10.3 days or longer for large (40 to 100), 19 days or longer for extra large (100 to 150) and 45 days or longer for extra extra large (greater than 150) glands. Hematuria resolved an average of 5.5 days versus 18.6 days in those who had or had not undergone previous prostatectomy, respectively. CONCLUSIONS: Our long-term followup demonstrates finasteride as a useful treatment for benign prostatic hyperplasia related gross hematuria, which is effective in patients who are on anticoagulants. In patients with larger prostatic volumes a longer time to response and higher incidence of recurrent but lower grade bleeding should be anticipated compared to those who have undergone prior prostatectomy or have a smaller prostate.     

Selectivity of finasteride as an in vivo inhibitor of 5alpha-reductase isozyme enzymatic activity in the human prostate

The type II 5alpha-reductase inhibitor finasteride is used in the treatment of benign prostatic hyperplasia (BPH), reducing local production of the growth promoting androgen dihydrotestosterone (DHT). The effect of prolonged treatment with this time-dependent irreversible inhibitor on the recently described prostatic type I 5alpha-reductase, however, is not clear. Therefore, we assessed the effects of 5 mg. finasteride per day for 6 months on prostatic 5alpha-reductase isozymes, and prostatic tissue composition and androgen content of patients suffering from BPH. In prostatic tissue from these patients, the type II enzymatic activity is inhibited 100-fold compared with tissues obtained from placebo treated patients. The type II immunoreactivity is up regulated 2-fold. The type I isozyme is inhibited 3-fold and potentially still contributes to DHT production. In conclusion, finasteride is a selective type II inhibitor in vivo. Further research is warranted to assess the possibly distinct roles of the 5alpha-reductase isozymes in the normal prostate, in BPH, and during finasteride treatment.     

Pretreatment with finasteride decreases perioperative bleeding associated with transurethral resection of the prostate

OBJECTIVES: The efficacy of finasteride in the treatment of gross hematuria associated with benign prostatic hyperplasia is well established. We evaluated a regimen of pretreatment with finasteride in decreasing perioperative bleeding associated with transurethral resection of the prostate (TURP). METHODS: A prospective analysis compared 25 patients pretreated with finasteride for 2 to 4 months before TURP with 50 patients without pretreatment. Patients in each group were further separated by the amount of prostate tissue resected. Patients were then followed up for perioperative bleeding, defined as a perioperative blood transfusion requirement or a return visit to the emergency room with gross hematuria or clot retention. RESULTS: None of the patients with less than 30 g of prostate tissue resected experienced perioperative bleeding. In patients with 30 g or more resected, several episodes of bleeding occurred. In the patients pretreated with finasteride, 1 (8.3%) of 12 experienced perioperative bleeding; in the control group, 7 (36.8%) of 19 had an episode of bleeding. CONCLUSIONS: In patients with large prostate glands undergoing TURP, pretreatment with finasteride appears useful in reducing perioperative bleeding.     

Clinical profiles of gross hematuria in autosomal dominant polycystic kidney disease.

There is little information on the characteristics, management, or sequelae of gross hematuria in autosomal dominant polycystic kidney disease (ADPKD). Therefore, we obtained detailed information regarding gross hematuria in 191 adult ADPKD subjects. Forty-two percent (N = 81) experienced at least one episode of gross hematuria. The mean age of the initial episode was 30 +/- 1 years; only 10% of subjects reported the first episode before age 16. Twenty-three percent of those with gross hematuria had experienced more than six occurrences. Sixty-two percent of patients with bleeding indicated a presumptive precipitating event, most commonly urinary tract infection (42% overall, 61% of females v 17% of males, P less than 0.01), or sports or strenuous activity (20% of males v 11% of females, NS). In 56% of subjects, the episode persisted for 2 to 7 days. Hypertensive ADPKD subjects were more likely to have gross hematuria than normotensive subjects (48% v 30%, P less than 0.02) and those with gross hematuria had larger renal size (820 +/- 87 v 588 +/- 52 cm3, P less than 0.03). Moreover, those subjects with more episodes of gross hematuria had a higher serum creatinine concentration than those with fewer episodes (serum creatinine: 0 episodes, 120 +/- 10 v greater than 5 episodes, 190 +/- 30 mumol/L, P less than 0.04 [1.4 +/- 0.1 v 2.1 +/- 0.3 mg/dL]). This association suggests that, although self-limited, cumulative episodes of gross hematuria may have an unfavorable impact on long-term renal function.     

Phospholipase A2 degradation products modulate epithelial and stromal 5alpha-reductase activity of human benign prostatic hyperplasia in vitro.

BACKGROUND: Recent studies have demonstrated the inhibition of 5alpha-reductase activity in human prostate by phospholipases. Among those phospholipases, phospholipase A2 cleaves one of the acyl chains from phospholipids, thereby producing fatty acids and lysophospholipids such as LPC, LPS, and LPE. Therefore, we were interested in the effect of those lysophospholipids on 5alpha-reductase activity in human benign prostatic hyperplasia (BPH). METHODS: In a first set of experiments, cell homogenates were incubated with phospholipase A2 either in the presence or absence of albumin, which is known to bind fatty acids and lysophospholipids. Thereafter, the effect of lysophospholipids of known structure on 5alpha-reductase activity was investigated. RESULTS: In epithelium and stroma of human BPH, 5alpha-reductase activity was inhibited in a dose-dependent manner by phospholipase A2. In the presence of albumin, this inhibition was enhanced. In epithelium, LPC at low concentration yielded a dose-dependent stimulation of 5alpha-reductase activity up to 167%. At higher concentrations, epithelial as well as stromal 5alpha-reductase activity was inhibited significantly. As indicated by results of enzyme kinetic analyses, the LPC-mediated activation in the epithelium results from an increase of the active population of 5alpha-reductase. In contrast, LPC reduces the affinity of epithelial 5alpha-reductase to testosterone. LPE had no effect on epithelial 5alpha-reductase, whereas stromal 5alpha-reductase was inhibited in a dose-dependent manner up to 46%. Finally, LPS stimulated epithelial and stromal 5alpha-reductase activity; this stimulation was significantly stronger in epithelium (296%) than in stroma (163%). The LPC-mediated effects could be neutralized by the addition of albumin. CONCLUSIONS: The present data on BPH tissue suggest that lysophospholipids may play a specific and structure-related role in the posttranslational regulation of human prostatic 5alpha-reductase.