Evaluation and results of treatments for prostatism

Men with symptoms of prostatism form a heterogenous group. The best treatment of proven obstruction or retention in fit men remains transurethral prostatectomy (TURP). Men presenting with symptoms of prostatism may have bladder outflow obstruction, detrusor instability or weak bladder contraction leading to low pressure/low flow voiding so it is perhaps not surprising that only 75% of men selected for TURP purely on the basis of symptoms have a good outcome. Pressure flow studies are the only precise method of diagnosing outflow obstruction. The problem of accurately diagnosing obstruction before treatment is started applies particularly to trials of new treatments such as lasers, high energy focused ultrasound and drugs. Laser treatment is producing short term results that are slightly inferior to TURP but may have less morbidity. The role of conservative treatment is important in selected men. Men who have severe intercurrent illness may be treated by means of intra-prostatic stents. In order to accurately assess a new treatment it is necessary to determine the short-term mortality, the morbidity, complication rate and outcome as well as the cost-effectiveness, long-term outcome and patient preference. These conditions have not yet been met for any of the new treatments for prostatism.     

Perfiles de severidad en pacientes diagnosticados de hiperplasia benigna prostática en España

ObjectivesTo analyse the severity profiles and progression criteria in patients diagnosed of benign prostatic hyperplasia (BPH) in urology clinics in Spain.Material and methodsA multicentre observational epidemiological study conducted in Spain between May-November 2008. A representative sample of 392 urologist gathered socio-demographic, clinical and patient-centered data from three consecutive patients with new diagnostic of BPH in urology clinics.ResultsA total of 1.115 patients were evaluated. Mean age was 65.7 years old. Mean time from the onset of symptoms to diagnostic was18,8 months. Mean IPSS score was 17.2. 63 patients (5,7%) had mild symptoms; 670 (60,1%) had moderate symptoms with a mean IPSS score of 14.6 and 382 (34.3%) had severe symptoms with a mean IPSS score of 23.7. Mean PSA was 2.6 ng/ml and ultrasound measured prostatic volume was 49.2 cc. A total of 713 (63,9%) patients met progression criteria (PSA >1.5 ng/ml and volume > 30 cc). Symptoms severity was directly correlated with age, prostatic volume, PSA, presence of progression criteria and time from the onset of symptoms and inversely correlated with urine flow rate (P < .001). Progression criteria was directly correlated with age, symptoms severity and inversely with urine flow rate (P < .01).ConclusionsMore than 90% of patients diagnosed of BPH in urology clinics in Spain had moderate to severe symptoms. Two thirds met progression criteria that correlate with age and severity of symptoms.     

压力－流率测定在诊断膀胱出口梗阻中的意义

对４２例前列腺病症候群患者进行压力－流率测定，３５例被诊断为膀胱出口梗阻，７例排尿异常症状为逼尿肌功能异常所致。与单纯尿流率测定结果比较，压力－流率测定可以降低假阳性及假阴性率，为诊断膀胱出口梗阻的最佳方法，具有重要的临床意义。     

顺铂在膀胱癌合并前列腺增生同期手术中的应用

目的：探讨顺铂在膀胱癌合并前列腺增生同期手术中对肿瘤复发种植的预防作用。方法：回顾分析膀胱癌合并前列腺增生15例临床资料。结果：15例术后随访2～5a，14例无肿瘤复发，1例术后2a复发，无前列腺窝种植。结论：术中用顺铂能有效预防术后肿瘤复发和种植。     

Age-specific reference ranges for prostate specific antigen-total and free in patients with prostatitis symptoms and patients at risk

Background Prostate-specific antigen (PSA) is a tumor marker helpful in the diagnosis and follow-up of prostate cancer. However, PSA level may rise due to other causes than prostate cancer such as benign prostatic hyperplasia (BPH), acute prostatitis, chronic bacteria and a bacterial prostatitis. Total serum PSA (TPSA) and free prostate-specific antigen (FPSA) levels of patients with prostatitis symptoms as well as these levels in male population at risk but without clinical prostatic diseases (>40-years-old) with regard to age should be documented in order to increase the sensitivity and specificity of PSA in prostate carcinoma. Methods A comprehensive urological examination was performed on 1150 male patients over the age of 40 with prostatism symptoms from the random-sample community based in with no diagnostic prostate cancer. Men with PSA level 4.1 ng/ml or greater were referred for biopsy and those with positive biopsies or with medical record, cancer registry, or self-reported evidence of prostate cancer were excluded. Data were studied as a function of age to determine the usefulness of measuring TPSA and FPSA as screening tests for risk patient’s cancer. Results Because of the greater variability at older ages, the 95th percentile increased faster than the median, the following age-specific reference ranges of TPSA and FPSA for patients with prostatism symptoms were as follows: 3.1 and 0.7 ng/ml for the age group 40–49 years, 4.4 and 0.89 ng/ml for the age group 50–59 years, 5.6 and 1.3 ng/ml for the age group 60–69 years, and 6.3 and 1.8 ng/ml for age group 70–79 years. There was a continuous increase in TPSA and FPSA means and medians with significant correlation (P < 0.001, P < 0.005) and advancing age group. The aim of this study was to find out age-specific values and ranges of TPSA and FPSA in patients with prostatism symptoms to ensure low false-positive biopsy rates.     

Transrectal ultrasound of the prostatic urethra related to urodynamically assessed urethral resistance

In this pilot study on 17 men who underwent urodynamic investigation for various dysuric complaints, real-time transrectal ultrasonography (TRUS) was performed. From the images anatomical parameters were identified that correlated with obstructive urodynamic findings and urethral resistance parameters based on pressure-flow analysis. This study gives support for further clinical investigations to determine the value of TRUS for male patients with dysuric disorders. It also illustrates the anatomical basis of prostatic obstruction as quantified by objective urodynamic parameters.