Clinical Implications of Residual Urine in Korean Benign Prostatic Hyperplasia (BPH) Patients: A Prognostic Factor for BPH-Related Clinical Events

Efficacy and Safety of the Sandwich Method in Patients with Benign Prostate Hyperplasia: Bipolar Transurethral Resection with GreenLight Vaporization

Benign prostate hyperplasia (BPH) refers to the nonmalignant enlargement of the transition zone of the prostate gland. While holmium laser enucleation of the prostate and open simple prostatectomy are effective in the management of patients with large prostates, they have some limitations. Thus, this study aimed to analyze the efficacy and safety of the sandwich method of bipolar transurethral resection of the prostate (B-TURP) and GreenLight photoselective vaporization of the prostate (GLPVP) in patients with large prostates. Patients diagnosed with BPH who underwent the sandwich method with B-TURP and GLPVP from 2015 to 2020 were included. Efficacy analyses included the change in the uroflowmetry results in both group A (prostate volume < 80 g) and group B (prostate volume ≥ 80 g), and complication analyses included perioperative complications, early postoperative complications at three months and late postoperative complications at 12 months. The cohort comprised 188 and 44 patients in groups A and B, respectively. The prostate volume of groups A and B were 50.83 ± 14.14 g and 102.03 ± 19.36 g (p < 0.001), respectively. The peak (Qmax) and average (Qavg) flow rates were comparable between the two groups. The only significant difference noted was in the postoperative post-void residual (PVR) urine. Improvement was seen in all the variables including the Qmax, Qavg and PVR urine in each group. No patient experienced perioperative complications. Analysis of the overall one-year complication rate showed no significant difference between the two groups. The sandwich method of B-TURP and GLPVP may be feasible for the management of patients with large prostate.

Moxibustion as an adjunct for lower urinary tract symptoms associated with benign prostate enlargement: A randomized controlled pilot trial

BACKGROUND

Benign prostatic enlargement (BPE) causes discomfort in daily life, including lower urinary tract symptoms (LUTSs) caused by the enlarged prostate, and requires long-term management as a chronic, irreversible disease. To improve LUTS, certain complementary therapies have been used with or without doctors' directions. Conventional treatments and complementary therapies tend to be combined unsystematically, depending on patient preference; thus, research for safe and efficient combination therapy is warranted.

METHODS

Twenty-nine participants were randomly assigned to an integrative group (IG, n = 15) or a conventional group (CG, n = 14). The IG received moxibustion (twice weekly for 4 weeks, at the acupuncture points SP6, LR3, and CV4) and conventional medication for 4 weeks, followed by conventional medication alone for 8 weeks. The CG received conventional medication alone for 12 weeks. The outcome measures were International Prostate Symptom Score (IPSS), patient's global impression of changes (PGIC), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and frequency-volume chart.

RESULTS

Total IPSS (IG, -2.4 ± 4.2; CG, 0.9 ± 4.0; P = .039), PGIC-A (IG, 3.5 ± 1.0; CG, 2.2 ± 1.0; P = .001), and PGIC-B (IG, 3.5 ± 0.1; CG, 4.7 ± 0.6; P = .004) were significantly improved in the IG compared with the CG, 4 weeks after baseline. Among the IPSS items, incomplete emptying (IG, -0.6 ± 0.7; CG, 0.4 ± 1.2; P = .019), straining (IG, -0.6 ± 0.8; CG, 0.2 ± 1.2; P = .046), and nocturia (IG, -0.8 ± 1.4; CG, 0.1 ± 1.0; P = .045) showed significant differences. The Qmax and PVR volume did not differ significantly at 12 weeks after the baseline.

CONCLUSION

Moxibustion can be considered an adjunct therapy to improve LUTS in BPE patients. A full-sized randomized controlled trial would be feasible with comparator modifications and an extended study period. The study design should include a placebo group and narrow the eligibility to subjects who do not respond well to conventional treatments.

Heritability and genome-wide association study of benign prostatic hyperplasia (BPH) in the eMERGE network

Benign prostatic hyperplasia (BPH) results in a significant public health burden due to the morbidity caused by the disease and many of the available remedies. As much as 70% of men over 70 will develop BPH. Few studies have been conducted to discover the genetic determinants of BPH risk. Understanding the biological basis for this condition may provide necessary insight for development of novel pharmaceutical therapies or risk prediction. We have evaluated SNP-based heritability of BPH in two cohorts and conducted a genome-wide association study (GWAS) of BPH risk using 2,656 cases and 7,763 controls identified from the Electronic Medical Records and Genomics (eMERGE) network. SNP-based heritability estimates suggest that roughly 60% of the phenotypic variation in BPH is accounted for by genetic factors. We used logistic regression to model BPH risk as a function of principal components of ancestry, age, and imputed genotype data, with meta-analysis performed using METAL. The top result was on chromosome 22 in SYN3 at rs2710383 (p-value = 4.6 × 10-7; Odds Ratio = 0.69, 95% confidence interval = 0.55-0.83). Other suggestive signals were near genes GLGC, UNCA13, SORCS1 and between BTBD3 and SPTLC3. We also evaluated genetically-predicted gene expression in prostate tissue. The most significant result was with increasing predicted expression of ETV4 (chr17; p-value = 0.0015). Overexpression of this gene has been associated with poor prognosis in prostate cancer. In conclusion, although there were no genome-wide significant variants identified for BPH susceptibility, we present evidence supporting the heritability of this phenotype, have identified suggestive signals, and evaluated the association between BPH and genetically-predicted gene expression in prostate.

Oxidative stress in the bladder of men with LUTS undergoing open prostatectomy: a pilot study

Purpose:

This study aims to evaluate the link between preoperative parameters and oxidative stress (OS) markers in the bladder wall of men undergoing open prostatectomy.

Materials and Methods:

From July 2014 to August 2016, men aged ≥ 50 years and presenting with LUTS were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB - V8), lower urinary tract ultrasound and urodynamics. Bladder biopsies were taken during open prostatectomy for determination of OS markers. Increased OS was defined by increased concentration of malondialdehyde (MDA) and / or decreased concentration of antioxidant enzymes (superoxide dismutase and / or catalase). P<0.05 was regarded as statistically significant.

Results:

Thirty - eight consecutive patients were included. Mean age was 66.36 ± 6.44 years, mean prostate volume was 77.7 ± 20.63 cm3, and mean IPSS was 11.05 ± 8.72 points. MDA concentration was increased in men with severe bladder outlet obstruction (BOO grade V - VI according to the Schaefer's nomogram) in comparison with BOO grade III - IV (p = 0.022). Patients with severe LUTS also had higher MDA concentration when compared to those with mild LUTS (p = 0.031). There was a statistically significant association between increased post - void residual urine (cut off ≥ 50 mL) and not only higher levels of MDA, but also reduced activity of SOD and catalase (p < 0.05).

Conclusions:

This pilot study showed that severity of LUTS and BOO were associated with increased MDA concentration in the bladder wall of men undergoing open prostatectomy. Further studies are still needed to assess the role of non - invasive biomarkers of OS in predicting bladder dysfunction in men with LUTS.

Associations of SRD5A2/CYP17/CYP19/VDR gene polymorphisms with the development and clinical progression of benign prostatic hyperplasia: a case-control study in northern Chinese population

This study aims to explore the effect of gene polymorphisms of 5a-reduction enzyme (SRD5A2), steroidogenic cytochrome P-450 17alpha-hydroxylase (CYP17), aromatase cytochrome P450 family 19 (CYP19) and vita-min D receptor (VDR) on benign prostatic hyperplasia (BPH) susceptibility and clinical progress. A total of 452 BHP patients and 501 healthy individuals were selected in Harbin Medical University Daqing School from October 2014 and December 2015 as the case and control groups. All BPH patients received drug treatment and were subsequently divided into the progression and non-progression groups based on their therapeutic efficacy. PCR-RFLP was applied to detect the genotype distributions of SRD5A2/CYP17/CYP19/VDR, which were further tested with Hardy-Weinberg (H-W) equilibrium. Logistic regression analysis was applied to determine the risk factors for BPH progression. Compared with subjects carrying VV genotype and V allele at SRD5A2 V89L, those with LL genotype and L allele at SRD5A2 V89L may have reduced risk of BPH susceptibility or progression (all P < 0.05). Compared with subjects carrying TT genotype and T allele at CYP17 -34T>C, those with CC genotype and C allele at CYP17 -34T>C may have increased risk of BPH susceptibility or progression (all P < 0.05). Compared with individuals carrying FF genotype and F allele at VDRVDR Fok I, those with ff genotype and f allele at VDRVDR Fok I may have increased susceptibility to BPH (all P < 0.05). Logistic regression analysis showed that SRD5A2 V89L and CYP17 -34T>C polymorphisms and CYP17 -34T>C (TC + CC)/SRD5A2 V89L (VV) combined genotypes were significantly related with the clinical progression of BHP. These results revealed that SRD5A2 V89L and CYP17 -34T>C polymorphisms were associated with the risk of BPH and its clinical progression.

The value of respective urodynamic parameters for evaluating the occurrence of complications linked to benign prostatic enlargement

PURPOSE

To assess the correlation between urodynamic parameters and urinary tract complications linked to benign prostatic enlargement (BPE), as well to assess the possible value of these parameters for predicting complications.

METHODS

We retrospectively analyzed the relationship between the complications and correlative urodynamic data of 486 BPH patients. Multivariate stepwise logistic regression was used to identify major independent predictors and establish regression models. Receiver operating characteristic (ROC) curves were constructed to evaluate the models' predictive values.

RESULTS

All of the individual parameters examined significantly correlated with most of the complications linked to BPE, except bladder calculus. According to ROC analysis, all of the areas under ROC curves (AUC), comparison of the individual parameters and the combined effects from the logistical regression models reached statistical significance (p < 0.05), and combining the parameters revealed a higher AUC compared to the individual parameters; however, all of the AUCs were below 0.9.

CONCLUSIONS

Urodynamic parameters are significantly correlated with most of the complications linked to BPE, and these parameters have predictive value for the occurrence of these complications with limited values.