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Mdivnishvili M, Khuskivadze N, Khuskivadze A. Giant Benign Prostatic Hyperplasia: A Case Report. Cureus 2024; 16:e61295. [PMID: 38947583 PMCID: PMC11212843 DOI: 10.7759/cureus.61295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
We present the case of a 69-year-old man experiencing lower urinary tract symptoms (LUTS), notably difficulties with urination. His total prostate-specific antigen level was measured at 3.52 ng/ml, accompanied by an International Prostate Symptom Score of 32. Transrectal ultrasound revealed a prostate volume of 268 cm3. Benign prostatic hyperplasia (BPH) is a common condition among aging men, often manifesting as LUTS. However, in rare instances, BPH can progress pathologically to giant prostatic hyperplasia, characterized by a prostate gland exceeding 500 g in weight. This report documents the successful enucleation of the giant BPH without significant complications, utilizing a transvesical prostatectomy technique. Our case underscores the importance of early diagnosis and appropriate management strategies.
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Quaresima L, Tramanzoli P, Fasanella D, Galosi AB, Giannubilo W. Conservative approach for a giant prostatic hyperplasia of 1280 ml: a case report and literature review. J Surg Case Rep 2023; 2023:rjad422. [PMID: 37621957 PMCID: PMC10447075 DOI: 10.1093/jscr/rjad422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
Benign Prostatic Hypertrophy (BPH) affects at least one-third of men over 60 years. A giant prostatic hyperplasia (GPH) is a prostate enlargement that exceeds 500 g. We present a case of a 72-year-old man with a GPH volume of 1280 ml, referred to our hospital for a worsening of the lower urinary tract symptoms (LUTS), bilateral loin pain and kidney failure. Although the patient had a negligible post-void residual urine, he had bilateral hydronephrosis. The patient was managed conservatory because of a high anesthesiologic risk but a bilateral percutaneous nephrostomy was placed soon due to kidney function worsening. The presence of serious comorbidities and the resolution of the loin pain and the renal failure, achieved first with the nephrostomy and then with periodic replacement of ureteral stents, along with an improvement of the LUTS obtained with medical therapy, have oriented us towards a conservative management of the patient.
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Affiliation(s)
- Luigi Quaresima
- Division of Urology , Civitanova Marche Hospital, Civitanova Marche, Italy
| | - Pietro Tramanzoli
- Department of Clinical and Specialist Sciences, Division of Urology, Polytechnic University of the Marche Region Medical School, Ancona, Italy
| | - Daniela Fasanella
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Benedetto Galosi
- Department of Clinical and Specialist Sciences, Division of Urology, Polytechnic University of the Marche Region Medical School, Ancona, Italy
| | - Willy Giannubilo
- Division of Urology , Civitanova Marche Hospital, Civitanova Marche, Italy
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Abo Kasem R, Kassab F, Haidar M, Hmaidy O. A case report of giant prostatic hyperplasia in a resource-challenged center. Urol Case Rep 2022; 43:102094. [PMID: 35520028 PMCID: PMC9062451 DOI: 10.1016/j.eucr.2022.102094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022] Open
Abstract
A benign enlargement of the prostate with weight measured above 500 gr is a rare entity that is not characterized with specific clinical findings, and requires simple open prostatectomy as the chosen management for such cases especially, in low resource context. Hereby we present a rare case of 570 gr weighted prostate hyperplasia, managed within resource-challenged hospital.
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Affiliation(s)
- Rahim Abo Kasem
- Faculty of Medicine, Damascus University, Damascus, Syria
- Corresponding author.
| | - Faiz Kassab
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mariam Haidar
- Department of Pathology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Osama Hmaidy
- Department of Urologic Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
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de Assis AM, Moreira AM, Carnevale FC, Lanz-Luces JR. Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience. Radiol Bras 2021; 54:219-224. [PMID: 34393287 PMCID: PMC8354184 DOI: 10.1590/0100-3984.2020.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 08/30/2023] Open
Abstract
Objective To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.
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Affiliation(s)
- André Moreira de Assis
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Airton Mota Moreira
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - José Ramón Lanz-Luces
- Interventional Radiology Department, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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Alshayyah RWA, Yu Y, Lv H, Liu W, Yang B. Bipolar transurethral enucleation of the prostate combined with open cystolithotomy in the treatment of large and giant prostate with bladder stones: Case series. Urologia 2021; 89:195-202. [PMID: 33784912 DOI: 10.1177/03915603211001686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The surgical management of large or giant prostate still has challenges to urologists, especially if combined with bladder stones, and the traditional techniques by open prostatectomy and cystolithotomy have significant morbidity rates. The endoscopic procedure might not be feasible to treat both conditions in a single procedure, despite advances in surgical techniques and instrumentation, we present a one-session procedure by a combined endoscopic and open approach for treating benign prostatic hyperplasia (BPH) larger than 100 g combined with bladder stones in the elderly patient with other comorbidities. Between May 2017 and January 2020, bipolar transurethral plasma kinetic enucleation of the prostate (TUEP) followed by open cystolithotomy was performed to six patients at our institution, three of them combined with a big bladder stone(s). All the patients have other chronic chest and heart diseases; we retrospectively collected the data. All the patients diagnosed as BPH of big size or giant prostate over 100 g, with bladder stone, and all the patients treated with the same procedure. We founded that the combination methods showed a significant effect in terms of surgery time, patient outcomes and recovery, hospital discharge. The mean age of patients was 78.16 ± 4.2 (73-84) years, and the mean prostate-specific antigen (PSA) value was 16.27 ± 10.01 (8.32-32.17) ng/mL. The mean size of the prostate measured by MRI/US was 266.16 ± 89.1 (169-405) mL. The mean total operation time was 70.5 ± 10.9 (60-90) min, while the mean enucleation time was 28.38 ± 6.61 (23-40) min. The mean intraoperative blood loss was 193.33 ± 19.66 (170-220) mL. The mean resected prostate weight was 217.166 ± 94.67 (117-365) g. The mean post-operative hospital stay was 2.6 ± 0.81 (2-4) days. One patient was readmitted 2 months later due to urinary tract infection, and one patient complains of urine incontinence who spontaneously subsided in 4 months after surgery, other that no severe postoperative complications observed, a significant reduction of serum PSA and IPSS recorded at 3 months, postoperatively. Although simple open prostatectomy remains the reference standard for the treatment. Of excessively large or giant prostatic hyperplasia, the combination procedure not only facilitates the management of selected cases of hyperplasia but further imparts significant benefits to patients and surgeons alike. This treatment plan is safe, time-consuming, and could revolutionize future treatment approaches to giant prostate.
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Affiliation(s)
- Rami Walid Abdullah Alshayyah
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yang Yu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Hang Lv
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Wengtong Liu
- Department of Urology, the Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bo Yang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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Idowu N, Ajamu O, Oguntola AS, Adeleye-Idowu S, Elijah A, Adekunle A. Giant Benign prostatic hyperplasia in a 46-year-old man. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_175_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Somwaru AS, Metting S, Flisnik LM, Nellamattathil MG, Sharma A, Katabathina VS. Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia. BMC Urol 2020; 20:153. [PMID: 33032577 PMCID: PMC7545894 DOI: 10.1186/s12894-020-00726-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patients with severe lower urinary tract symptoms (LUTS) from giant prostatic hyperplasia (GPH): prostate volume greater than 200 mL that do not respond to medical therapy may not be eligible for surgical treatments due to morbidities, technical challenges, and patient preference. This retrospective investigation examined the long-term efficacy and safety of prostatic arterial embolization (PAE) as a treatment option for severe LUTS due to GPH in a large patient cohort. Methods Of 529 patients who underwent PAE between January 2016 and January 2020, 72 patients had severe LUTS from GPH and were retrospectively evaluated. PAE was performed with two embolic agents in sequence: 100–250 μm particles followed by 2 mm and 3 mm coils. Clinical assessment was performed with international prostate symptoms score (IPSS), quality of life (QoL), peak flow rate (Qmax), post-void residual volume (PVR), and prostate specific antigen (PSA) measurements before and 12 months and 24 months after PAE. Prostate volume (PV) was measured by multiparametric magnetic resonance (MR) imaging before and 12 months and 24 months after PAE. Results Patients with severe LUTS from GPH experienced significant clinical improvements in IPSS, QoL, Qmax, PVR, PSA, and PV at 12 months and 24 months after PAE. Mean IPSS decreased from 26.5 to 18.0 (P < 0.01) to 10.5 (P < 0.01). Mean QoL decreased from 6.0 to 4.0 (P < 0.01) to 2.0 (P < 0.01). Mean Qmax increased from 8.0 to 14 mL/s (P < 0.01) to 18 mL/s (P < 0.01). Mean PVR decreased from 198.0 to 152.0 mL (P < 0.01) to 90 mL (P < 0.01). Mean PV decreased from 303.0 mL to 258.0 mL (P < 0.01) to 209.0 mL (P < 0.01). Mean PSA decreased from 11.2 ng/mL to 9.5 ng/mL (P < 0.05) to 7.9 ng/mL (P < 0.05). No major complications occurred. Conclusions PAE is a safe treatment with long term efficacy for severe LUTS from GPH. PAE may be a viable therapeutic option for patients with severe LUTS from GPH whom fail medical therapy and are not candidates for surgical treatments.
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Affiliation(s)
- Alexander S Somwaru
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine At Mount Sinai, 1000 10th Avenue, New York, NY, 10019, USA.
| | | | - Laura M Flisnik
- Department of Radiology, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | | | - Arjun Sharma
- Department of Interventional Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Venkat S Katabathina
- Department of Radiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Anglickis M, Platkevičius G, Stulpinas R, Miklyčiūtė L, Anglickienė G, Keina V, Štarolis E, Gradauskas A. Giant prostatic hyperplasia and its causes. Acta Med Litu 2019; 26:237-243. [PMID: 32355462 DOI: 10.6001/actamedica.v26i4.4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present a case of a 59-year-old male who was admitted to the emergency department with urinary retention, with a history of lower urinary tract symptoms, with the value of serum prostate specific antigen level of 100 ng/mL and an estimated prostate size of 800 mL, according to magnetic resonance imaging. A prostate biopsy showed benign prostatic hyperplasia. Transvesical prostatectomy was performed, following additional procedure of transurethral resection of the prostate. To the best of our knowledge, this is the fourth highest prostate volume reported in medical literature. In this paper, we examine the factors that may have influenced the development of giant prostate hyperplasia.
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Affiliation(s)
- Marius Anglickis
- Vilnius City Clinical Hospital, Department of Urology, Vilnius, Lithuania
| | - Gediminas Platkevičius
- Clinic of Gastroenterology, Nephro-urology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rokas Stulpinas
- National Centre of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Giedrė Anglickienė
- National Cancer Institute, Department of Chemotherapy, Vilnius, Lithuania
| | - Vytautas Keina
- Vilnius City Clinical Hospital, Department of Urology, Vilnius, Lithuania
| | - Edmundas Štarolis
- Vilnius City Clinical Hospital, Department of Urology, Vilnius, Lithuania
| | - Audrius Gradauskas
- Clinic of Gastroenterology, Nephro-urology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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