Therapie des benignen Prostatasyndroms (BPS)

[S2e guideline of the German urologists: Conservative and pharmacologic treatment of benign prostatic hyperplasia]

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

[S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia]

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

Fixed-dose combination PRO 160/120 of sabal and urtica extracts improves nocturia in men with LUTS suggestive of BPH: re-evaluation of four controlled clinical studies

PURPOSE

To determine the effects of the herbal fixed-dose combination PRO 160/120 (extracts from saw palmetto fruits and stinging nettle roots) on nocturnal voiding frequency, as measured by question 7 of the IPSS questionnaire, in patients with moderate-to-severe LUTS/BPH after 24 weeks of treatment compared to placebo, to the α-blocker tamsulosin, or to the 5α-reductase inhibitor finasteride.

METHODS

The study is about post hoc evaluation of four published randomized, double-blind clinical trials on PRO 160/120, two compared with placebo, one with finasteride and one with tamsulosin. In addition, a pooled data analysis of the two placebo-controlled trials was conducted.

RESULTS

We analyzed data from a total of 922 patients with a mean age of 66 years and a mean baseline nocturnal voiding frequency of 2.1. In the pooled analysis of placebo-controlled trials, nocturnal voids improved by 0.8 (29 %) with PRO 160/120 compared to 0.6 (18 %) with placebo (p = 0.015, Wilcoxon test, one-tailed). The 69 % responder rate to PRO 160/120 was significantly superior to the placebo response (52 %; p = 0.003, χ (2)-test, two-tailed). The majority of responders improved by 1 void/night. Absolute improvements and response rates were consistently higher with PRO 160/120 than with placebo over a range of baseline nocturnal voiding frequencies. There were no differences between PRO 160/120 and finasteride or tamsulosin regarding absolute improvement of nocturnal voids or responds rates.

CONCLUSION

PRO 160/120 significantly improved nocturnal voiding frequency compared to placebo and similar to tamsulosin or finasteride.

[UroLift®: an operative non-ablative procedure for treatment of benign prostatic syndrome]

The implantation of a tissue retractor (UroLift®, Neotract, Pleasanton, CA) allows for the first time as a non-ablative operative technique, moderate deobstruction without removal or destruction of prostate tissue. The achievable treatment results are at least comparable to drug therapy with respect to alleviation of suffering and symptoms (primary treatment aim) and superior with respect deobstruction. The advantage of this method compared to all other conservative and operative therapy procedures is preservation of sexual function. An evaluation of this method is currently being carried out and compared to TURP in prospective, randomized studies (BPH6 study) and the results are expected in 2015.

[Urinary incontinence in the elderly: what can and should be done?]

The demographic development of society shows a clear increase in the elderly population in the coming decades, which will result in an increasing prevalence of urinary incontinence. Diagnosis and treatment of many patients is not carried out for a myriad of reasons and thus incontinence care is often inadequate. A detailed medical history is the basis of identification of the problem and underpins the effective diagnostic and therapeutic management of the problem. In this context, the algorithms based on the national and international guidelines and age-specific characteristics should be considered. The initial focus should be on conservative management. In a few cases of elderly patients, invasive diagnostics using urodynamics or cystoscopy might be indicated. The increased use of medication in the elderly both from an etiological and therapeutic point of view, especially in terms of drug/drug interactions requires special consideration. In particular cognitive impairment using pharmacological approaches should be avoided. Although incontinence surgery of the patient applies less often with increasing age it still plays a role in the appropriate selection of treatment.

[Medical therapy of lower urinary tract symptoms [corrected]]

Male lower urinary tract symptoms (LUTS) include storage and voiding disorders and should be carefully evaluated before the start of any treatment. Medical therapy is directed at improving symptoms and reducing the risk of progression in order to improve quality of life and prevent complications, such as acute urinary retention, or the need for surgical intervention. Careful assessment of the individual complaints helps to identify the best drug which should be adapted to each individual patient's risk profile. At present, α(1)-adrenoreceptor inhibitors and 5-alpha reductase inhibitors and their combination form the gold standard for pharmacological treatment. In addition, anticholinergic agents are increasingly being used as monotherapy or in combination with α1-adrenocepetor inhibitors for patients with predominant storage disorders while phosphodiesterase 5 (PDE5) inhibitors may be suitable for patients suffering from LUTS and concomitant erectile dysfunction.

[Surgical treatment of male lower urinary tract symptoms (LUTS)]

Surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) comprises a variety of treatment modalities. Transurethral resection of the prostate (TURP) is considered the gold standard. In the last decade various new techniques have emerged with encouraging functional results. However, long-term data are missing in order to evaluate the efficacy and safety. This review aims to describe new widely available techniques and to assess the underlying evidence.