Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia
    

• Debruyne FMJ, Jardin A, Colloi D, et al [Univ Hosp. Nijmegen, The Netherlands; Hopital Bicetre, Kremlin- Bicetre, France; Ospedale Maggiore, Lodi, Italy; et al]
  Sustained- Release Alfuzosin, Finasteride & the Combination of Both in the Treatment of Benign Prostatic Hyperplasia
  Eur Urol 34: 169-175, 1998
      
  Conclusions – Six months of therapy with sustained release alfuzosin either alone or in combination with finasteride, significantly improved LUTS in all patients, and significantly increased Qmax in those with low Qmax. Finasteride alone was not effective in treating LUTs and in addition to the a1 blocker provided no additional benefit.
        

• Welch G, Kawachi I, Barry MJ, et al [ Joshlin Diabetes Ctr, Boston Harvard School of public Health, Boston : et al ]
  Distinction Between Symptoms of Voiding and Filling in Benign Prostatic Hyperplasia : Findings from Health Professional Follow-up Study.
  Urology 51 : 422-427, 1998
      
  Filling and voiding are two distinct subgroups of LUTS that are strongly related to symptom severity in BPH.
       
  The AUA SI [ American Urological Association Symptom Index ] was found to  reliably characterize filling and voiding symptoms in these men.
       
  The clinical utility of distinguishing symptoms as either voiding or filing is unknown. More research is needed to determine if a particular symptoms.
       

• Reynard JM,  Yang Q, Donovan JL, et al [ Royal London ] Hosp ; Bristol Urological Inst, England, Univ of Bristol, England; et al ]
  The ICS-“BHP’ Study : Uroflowmetry, Lower Urinary Tract Symptoms and Bladder Outlet Obstruction.
  Br J Urol 82; 619-623,1998      
  
  Background : Are variables measured by uroflowmetry related to lower urinary tract symptoms [LUTS] ? Does uroflowmetry accurately diagnose bladder outlet obstruction ? Are data obtained from low-volume voids useful in diagnosis ?
       
  Conclusions : Although the results of uroflowmetry do not correlate with LUTS, Qmax and PVR are significantly related to BOO (Bladder Outlet Obstruction)
       
  Low void volumes do provide important diagnostic information because 77% of patients voiding less than 150 ml had B.O.O
        

• Terris MK, Afzal N. Kabalin JN [ Palo Alto Veterans Affairs Health Care System, Califl Stanford Univ. Calif ]
  Correlation of Transrectal Ultrasound Measurement of Prostate and Transition Zone size With Symptom Score, Bother Score, Urinary Flow Rate and Post-void Residual Volume 
  Urology 52 : 462-466m 1998
       
  Conclusion – Compared with total prostatic dimension and calculated prostatic or transitional zone volume, transrectal US of transition zone dimensions are better correlated with the severity benign prostatic hyperplasia. Transverse transition zone dimension had the best correlation, although this is probably not adequate for clinical use.
        

• Y. Cai [ Department of Urology, the Second Clinical College, China Medical University, Shenyang, China]
  Benign Prostatic Hyperplasia is a Reawakened Process of Persistent Mullerian Duct Mesenchyme
  BJU International, volume 87, Number 1, January 2001, Pg.Nos. 177-182
        
  The aetiology of BPH should be interpreted monophylotically as a reactivation of the persistant Mullerian Duct Mesenchyme [ MDM] in the transitional zone.
        
  This theory is also supported by Bierhoff, who reported that the development of stromal nodules in BPH repeated the fetal sequence. This results from the MDM cells that have been in the embryonic state.
       
  Some investigators believe that BPH may be a stem cell disease. These stem cells are exactly those MDM cells that have been in the embryonic state.
       
  The occurrence of the first diffuse state is because in the transitional zone the MDM that has been stunted in the embryonic state recovers its development.
       
  The inhibition of aromatase activity may decrease further because free testosterone declines with age, which leads to the accumulation at estrogens and a progressive imbalance of sex hormones in the transitional zone.
       
  The persistent estrogenic stimulation results in the development of stromal nodules, the mechanism of which may be similar to female leiomyoma.
       
  The transitional zone epithelium originates from the urogenital sinus, and the stroma from Mullerian Duct Mesenchyme, according to the author.
       
  At birth because of persistent inhibition by MIS and a rapid reduction of serum estrogens the development of the MDM is stunted in the embryonic state until adulthood.
       

• S.S. Nielsen, A.M.Thulstrup, L.Lund, H.Vilstrup and H.T.Sorensen [ Departments of Medicine [Hepatology and Gastroenterology] and Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aarhus and Department of Surgery, Viborg Hospital, Viborg, Denmark]
  Postoperative Mortality in Patients with Liver Cirrhosis Undergoing Transurethral Resection of the Prostate: A Danish Nationwide Cohort Study
  BJU International, volume 87, Number 1, January 2001, Pg.Nos. 183-186
       
  Results : In a cohort of 23133 patients with liver cirrhosis, 30 underwent TURP; 150 controls with no liver cirrhosis also underwent the same procedure.
       
  Of the patients with liver cirrhosis, 6.7% died within 30 days of TURP; the estimated adjusted odds ratio was 3.0 [95% confidence interval 0.4-22.9] for the 30 day postoperative mortality in patients with liver cirrhosis compared with patients without [mortality 2%]. Advanced age, co-morbidity and acute admission seemed to be associated with an increased postoperative mortality.
       
  Conclusion : TURP in patients with liver cirrhosis was associated with increased mortality.
        

• S. Mustonen, I.O. Ala-Houhala and T.L.J. Tammela [ Division of Urology and Department of Medicine, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland]
  Characteristics of Protein Excretion in Patients With Acute Urinary Retention.
  BJU International, volume 87, Number 1, January 2001, Pg.Nos. 187-191
        
  Acute Urinary Retention causes disturbances in both the glomerular filtration and tubular reabsorption of proteins. Albuminuria and increased excretion of IgG, IgG4, and a1-microglobulin occurred in most patients during AUR. After relieving the retention, the albuminuria and elevated a1 -microglobulin level persisted indicating slight glomerular dysfunction and a permanent defect in the proximal tubule to reabsorb proteins. This could be caused partly by previous chronic obstruction.
       
  AUR should be revealed immediately and the basic cause treated effectively to prevent further deterioration of renal function.
       
  In this study; during AUR and after 1 and 6 months, albuminuria was detected in 100%, 92% and 54% of patients, and increased excretion of a-1 microglobulin in 52%, 36% and 58%, of IgG in 79%, 58% and 40% and of IgG4 in 67%, 42% and 20% respectively.
       
  The mean GFR was normal during retention and during follow-up.
       

• R.S. Kirby, M. Andersen, P. Gratzke, C. Dahlstrand and K. Hoye [ St. George’s Hospital, London University, London, UK, Lillehammer County Hospital, Lillehammer, Norway, Rosenheim, Germany, Sahlgrenska University Hospital, Gotenburg, Sweden and General Practice, Elverum, Norway]
  A Combined Analysis of Double-Blind Trials of the Efficacy and Tolerability of Doxazosin-Gastrointestinal Therapeutic System, Doxazosin Standard and Placebo in Patients with Benign Prostatic Hyperplasia
  BJU International, volume 87, Number 1, January 2001, Pg.Nos. 192-200
        
  Conclusion – Doxazosin GITS is significantly more effective than placebo in reducing the clinical symptoms of BPH and improving Qmax, and as effective as doxazosin-s. Both doxazosin formulations improved sexual function in patients with BPH and sexual dysfunction at baseline. 
       
  Doxazosin GITS produced a therapeutic effect equivalent to that of doxazocin-s but with fewer titration steps and a slightly lower overall incidence of adverse effects.
        
  The GITS system has been developed to enhance the pharmacokinetic profile and drug delivery rate reducing the plasma doxazocin peak to trough ratio and minimizing the need for titration. The GITS formulation uses push-pull pump technology, allowing a more gradual controlled absorption of drug over a 24 hr period at steady state with once daily dosing. The alternations in the pharmocokinetic profile allow doxazosin GITS therapy to be initiated at a low dose.
        

• E.P. Arnold [ Department of Urology, Christchurch Hospital, Christchurch, New Zealand]
  Tamsulosin in Men with Confirmed Bladder Outlet Obstruction: A Clinical and Urodynamic Analysis From a Single Centre in New Zealand
  BJU International, volume 87, Number 1, January 2001, Pg.Nos. 24-31
      
  Results – 42 patients were enrolled in a 2 week placebo run-in period after which 30 received active treatment with tamsulosin 0.4 mg once daily. All 12 patients [29%] who discontinued during the placebo run-in period failed to fulfill the pressure flow entry criteria of conformed obstruction. The 30 patients who received tamsulosin had a significant reduction in mean PdetQmax [-10.6 cm H20 or -13%]. The mean AG number decreased accordingly.
      
  The pressure flow mean Qmax was increased by 2.5mL/s [36%] from 7.0 mL/s at baseline. Urodynamic improvements were accompanied by a reduction of IPSS score by 6.7 points from a baseline value at 18.1 
       
  Patients with LUTS who are unobstructed and have a low initial detrusor pressure appear to have no improvement in detrusor pressure, but have similar clinical responses to those in obstructed patients.
        

• M.C. Michel, H.G. Neumann, L. Mehlburger H. Schumacher and M. Goepel [ Departments of Medicine and Urology, University of Essen, Essen, and Boehringer Ingelheim, Ingelheim, Germany]
  Does the Time of Administration [Morning or Evening] Affect the Tolerability or Efficacy of Tamsulosin?
  BJU International, volume 87, Number 1, January 2001, Pg.Nos. 31-34
       
  Results : While no specific recommendation about the dosing time was given in the trial; the retrospective analysis showed that 4420 and 2087 patients received tamsulosin in the morning and evening, respectively. Both groups had similar values for all variables before treatment. There were small advantages for morning dosing, which were statistically significant because there were many patients. 
      
  Conclusion : In contrast to other a-blockers, night-time dosing is not necessary to improve the tolerability or efficacy of tamsulosin.
       

• B. A. O’Reilly, A. H. Kosaka, T. K. Chang, A. P.D. W. Ford, R. Popert and S . B. McMahon (Guy’s and St Thomas’ Hospital, London, Neurobiology Unit, Roche Bioscience, Palo Alto, CA, USA, and Centre for Neuroscience Research, Kings College London, UK)
  A Quantitative Analysis of Purinoceptor Expression in the Bladders of Patients with Symptomatic Outlet Obstruction
  BJU Intl. May 2001 Vol. 87 (7) Pg. 617-622
          
  P2X₁ is the predominant purinoceptor subtype in the human male bladder, consistent with pharmacological evidence. The amount of P2X₁ receptor per smooth muscle cell is greater in the obstructed than in control bladder, suggesting an increase in purinergic function in the unstable bladder arising from bladder outlet obstruction.