Comparative analysis of the safety and efficacy of 1470-nm diode laser enucleation of the prostate and plasmakinetic resection of prostate in the treatment of large volume benign prostatic hyperplasia (>80 ml)

OBJECTIVE

To compare the efficacy and safety of 1470-nm diode laser enucleation of the prostate (DiLEP) with that of plasmakinetic resection of the prostate (PKRP) in treating patients with large benign prostatic hyperplasia (BPH > 80ml).

METHODS

The clinical data from 211 cases of BPH (>80 ml) were collected for analysis. The patients were divided into two groups: the PKRP group (n = 118) and the DiLEP group (n = 93), based on the surgical method used.

RESULT

The DiLEP group demonstrated significantly lower surgical time (p < 0.001), intraoperative bleeding (p < 0.001), bladder flushing time (p = 0.003), indwelling catheter time (p < 0.005), and length of hospital stay (p = 0.018) compared to the PKRP group. However, the quality of the prostatectomy was significantly higher in the DiLEP group (p = 0.005). The Qmax for the DiLEP group was significantly higher than that of the PKRP group (p < 0.05). Compared to the PKRP group, the incidence of urinary incontinence in the DiLEP group increased significantly 4 weeks post-surgery (p = 0.026), although the need for blood transfusion during surgery was significantly reduced (p = 0.037).

CONCLUSION

Both DiLEP and PKRP are safe and effective methods for treating large-volume BPH. However, DiLEP offers advantages such as more thorough glandular resection, shorter surgical time, reduced bleeding, quicker recovery, and fewer complications.

Primary prostate Burkitt's lymphoma resected with holmium laser enucleation of the prostate: A rare case report

BACKGROUND

Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis. Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia. Given the rarity of primary prostate Burkitt's lymphoma, its diagnosis and treatment remain unclear.

CASE SUMMARY

This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma, initially misdiagnosed as prostatic hyperplasia. This case's operative process, intraoperative findings and postoperative management are discussed in detail.

CONCLUSION

Primary prostate lymphoma is difficult to distinguish from other prostate diseases. Holmium laser enucleation of the prostate (HoLEP), a minimally invasive procedure, is crucial in diagnosing and treating this rare disease. Clinicians should remain vigilant and thoroughly combine physical examination, imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms. HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.

Age, weight and circulating concentrations of total testosterone are associated with the relative prostatic size in adult intact male dogs

Prostatic hyperplasia (PH) is an androgen-dependent condition associated with increased prostatic size that is common in intact dogs, and similar to the condition in men. In dogs, the increase in prostatic size is most prominent the first years, and after approximately four years (in beagles), a plateau is reached, and further growth is slower. Why the prostate continues to grow more in some individuals is not clear. Most testosterone in the circulation is bound to albumin or sex hormone binding globulin (SHBG) and only a minor part is unbound and biologically active. The binding to SHBG has higher affinity than that to albumin. In addition, SHBG has own biological functions, modifying testosterone action. The aim of the present study was to investigate if there is an association between relative prostatic size and the variables total testosterone concentration, SHBG concentration, an estimation of bioavailable testosterone: the ratio between testosterone and SHBG (free androgen index, FAI), estradiol concentration, the estradiol/testosterone ratio, dog age and dog weight. Hormone concentrations were measured in serum from 79 intact male dogs aged ≥ four years, weighing ≥ five kg. The size of the prostate was estimated using ultrasonography, and relative prostate size, S_rel, was calculated as the estimated size related to the normal size for a 4-year-old dog of the same weight. There as a negative correlation between testosterone concentration and age (ρ = -0.27, P = 0.018) and a positive correlation between age and S_rel (ρ = 0.27, P = 0.016) and between SHBG and weight (ρ = 0.38, P = 0.001). The FAI was negatively correlated with dog weight (ρ = -0.32, P = 0.004). There were no significant correlations between S_rel and SHBG or FAI or between estradiol or estradiol/testosterone and S_rel, age or weight. A multiple regression analysis showed significant associations between log S_rel and log testosterone concentration, log age and log weight of the dog, with an adjusted R² of 9.5%. Although the variables total testosterone concentration, age and weight of the dog were all significantly associated with S_rel, the coefficient of determination was low, indicating that they only explained a minor part of the prostatic size. The results support the analysis of total testosterone in studies of prostatic growth in the dog.

En Bloc enucleation with early apical release technique using MOSES (En Bloc MoLEP) vs. classic En Bloc HoLEP: a single arm study comparing intra- and postoperative outcomes

BACKGROUND AND PURPOSE

We aimed to describe the technique and outcomes of En-Bloc MOSES laser enucleation of the prostate (En-Bloc MoLEP) with early apical release comparing it to En-Bloc HoLEP (non-MOSES).

PATIENTS AND METHODS

This is a single-arm prospective study, using a historical control. n = 80 patients were enrolled to the En Bloc MoLEP group and compared to a retrospective group of n = 137 patients treated by En Bloc HoLEP (non-MOSES), in total n = 217 patients.

RESULTS

En-Bloc MoLEP, showed to significantly improve the surgical time by 32% compared to non-MOSES HoLEP (32.16 ± 14.46 min, 47.58 ± 21.32, respectively; P = 0.003). Enucleation time, ablation rate and hemostasis time were also significantly improved (P < 0.001, for all three parameters). Enucleation time was 22.10 ± 9.27 min and 31.46 ± 14.85 min (P < 0.001), ablation rate 4.11 ± 2.41 and 2.54 ± 1.31 gr/min (P < 0.001), Hemostasis time 3.01 ± 2.50 and 8.35 ± 5.38 min (P < 0.001), for En Bloc MoLEP and En Bloc HoLEP, respectively. Q-max, PVR, PSA and IPSS showed significant improvement, however, at 12 months no significant differences were observed comparing both groups.

CONCLUSIONS

En-Bloc MoLEP was significantly better than En-Bloc HoLEP in terms of surgical time, enucleation time, ablation rate and hemostasis time. However, large comparative RCT with long-term follow-up are needed.

Rat age-related benign prostate hyperplasia is concomitant with an increase in the secretion of low ramified α-glycosydic polysaccharides

This work analysed the expression of prostate polysaccharides in rats with age-related benign prostatic hyperplasia (BPH) for a better understanding of the possible relationship between prostate polysaccharides secretion and BPH onset. For this, prostatic glands from 1 month-old, 3 months-old, 6 months-old and 12 months-old Sprague-Dawley rats were processed in order to identify their overall polysaccharide content. Additionally, serum testosterone was also determined. One-month old rats showed significantly (P < 0.05) lower testosterone levels (0.77 ng/mL±0.12 ng/mL) compared with the other groups, which showed no significant difference among them. PAS staining showed positive polysaccharides markings in both the prostatic lumen and inside of luminal prostatic cells in all groups. Semiquantitative analysis of intraluminal PAS showed that one month-old rats had significantly (P < 0.005) lower PAS intensity when compared with all other groups (100.0 ± 0.5, arbitrary units vs. 107.3 ± 0.6, arbitrary units in 3 months-old ones), whereas 12 months-old ones showed significantly (P < 0.005) higher values when compared with all other groups (133.6 ± 3.5, arbitrary units in 12 months-old rats vs. 108.6 ± 1.4, arbitrary units in 6 months-old ones). The PAS + content practically disappeared when tissues were pre-incubated with either α-amylase or amyloglucosidase, regardless of a previous incubation with proteinase K. Incubation of prostate extracts from 12 months-old rats for 2 h with α-amylase yielded a significantly higher amount of free glucose (1.47 nmol/mg protein±0.23 nmol/mg protein vs. 0.32 nmol/mg protein±0.01 nmol/mg protein in untreated extracts). Similar results were obtained when extracts were pre-incubated with amyloglucosidase. Contrarily, pre-incubation with N-glycosidase induced a significantly (P < 0.05), much lower increase of free glucose. Pre-treatment with proteinase K did not significantly modify these results, which indicate that BPH is related to an increase in the secretion of low ramified ductal α-glycosydic polysaccharides that were not protected against lysis by any type of protein protective core. These changes seem to not be related with concomitant variations in serum testosterone levels.

High-fat diet during sexual maturation induces hyperplastic differentiation of rat prostate and higher expression of AR45 isoform and ERα

We examined the consequences of high-fat diet (HFD) on prostate histophysiology in two periods along sexual maturation of rats and the impact on the gland in adulthood. After weaning, male Wistar rats were fed a balanced diet (4 % fat-C3, C6, C9) or a HFD (20 % fat- HF3, HF6, HF9) for 3, 6 or 9 weeks. Fat deposit weights, blood glucose and levels of serum testosterone and estrogen were measured. Prostate was evaluated for histology, proliferative and apoptotic cell index, and for the expression of androgen (AR), estrogen receptors type α (ERα) and aromatase. HFD did not affect estrogen levels and elevated serum testosterone only in HF9. HFD reduced prostate weight in HF6 and increased it in adulthood (HF9) but relative prostate weight was unchanged among groups. Cell proliferation, height and density were higher in epithelium of all HFD-groups, compared to controls, featuring the epithelial hyperplasia. Epithelial apoptosis was lower in HF9. HF3 and HF9 exhibited higher expressions of ERα, indicating that HFD triggers a new activation of ERα expression in the acinar epithelium. The content of prostatic aromatase was also elevated in HF9. Increased numbers of AR-positive cells were observed in all HFD groups, and western blotting analysis showed an increase in the truncated form of 45 kDa (AR45) and a reduction in the expression of 110 kDa-AR for HF3 and HF9. In conclusion, excessive dietary fats during sexual maturation of rats led to developmental programming of the prostate, inducing a hyperplastic status with perturbations in AR isoforms expression and reactivation of ERα in adulthood, whose implications for posterior prostatic health could be detrimental.

Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis

Background

Thulium laser (Tm:YAG) prostate surgery is a safe and effective procedure with low morbidity and comparable clinical outcomes to those of transurethral resection of the prostate (TURP). However, the sexual function outcomes (erectile and ejaculatory function) have been scarcely studied.

Aim

We aimed to assess the impact of Tm:YAG prostate surgery on sexual outcomes (erectile and ejaculatory function) and compare them with those patients undergoing TURP.

Material and Methods

We searched digital databases like PUBMED, SCOPUS, CENTRAL and EMBASE using relevant keywords to identify comparative studies on TURP and non-comparative studies on Tm:YAG prostate surgery that assessed sexual outcomes. We performed qualitative and quantitative analyses with the extracted data. We carried out a meta-analysis to compare postoperative International Index of Erectile Function (IIEF-5) scores and incidences of retrograde ejaculation (RE) in patients undergoing either Tm:YAG or TURP. The pre-operative and post-operative IIEF-5 scores were pooled to estimate overall scores.

Results

We included 5 comparative and 8 non-comparative studies in this review. We found the postoperative IIEF-5 score improvements to be significantly higher in the Tm:YAG prostate surgery group than in the TURP group with a significant mean difference (MD) of 0.45 (95% CI, 0.18 to 0.72; P = .001). We found no significant associations between the procedures. The pooled OR for the association of RE was estimated at 0.90 (95% CI, 0.50 to 1.60; P = .71; I² = 0%).

Conclusion

Tm:YAG prostate surgery improves erectile function more than TURP, according to our findings. Tm:YAG prostate aided surgery also outperforms TURP in terms of preserving sexual function following surgery.However, We found similar or no difference in incidence of RE between Tm:YAG prostate surgery and TURP.

Bibo L, Hao L, Pang K, et al. Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis. Sex Med 2022;10:100483.

Photothermal therapeutic potency of plasmonic silver nanoparticles for apoptosis and anti-angiogenesis in testosterone induced benign prostate hyperplasia in rats

AIMS

In this study, we used a near-infrared laser (NIR) to increase the potency of silver nanoparticles (AgNPs) to develop a novel, less invasive, and simple photothermal therapy technique for benign prostate hyperplasia (BPH).

MATERIALS AND METHODS

The shape, particle size, and zeta-potential of polyvinylpyrrolidone coated-AgNPs (PVP-AgNPs) were determined using transmission electron microscopy (TEM), Zeta-potential, and Particle size analyzer (ELSZ). To induce BPH, thirty-six male Sprague-Dawley (SD) rats were given intramuscular (i.m) injections of testosterone propionate (TP) at 5 mg/kg body weight (b.w)/day suspended in 0.1 ml of olive oil for 14 days. Photothermal therapy with AgNPs-NIR for 14 days was carried out. Prostate size, prostate index (PI), dihydrotestosterone (DHT), prostate-specific antigen (PSA), gross, hepatic, and renal toxicity, as well as antioxidant activity, apoptosis, and angiogenesis markers in prostatic tissues were measured. Histological examinations of prostates and biocompatibility of NIR-AgNPs on vital organs were also performed.

KEY FINDINGS

The aggregated spherical AgNPs with a mean size of 50-90 nm and a Zeta potential of -53.22 mV displayed high effectiveness in the NIR (532 nm-1 W) region by decreasing prostate size, PI, DHT, and PSA in BPH rats with no signs of gross, hepatic, or renal damage. As compared to alternative therapies, hyperthermia therapy increased antioxidant activities, induced apoptosis, inhibited angiogenesis, reduced histological alterations in the prostates of BPH rats, and improved biocompatibility of the vital organs.

SIGNIFICANCE

The current study demonstrated the effectiveness of plasmonic AgNPs photothermal therapy in the treatment of BPH.

Using prostate contrast retention (PCR) as the procedural endpoint in prostatic artery embolization for benign prostatic hyperplasia

OBJECTIVES

The failure rate following prostate artery embolization (PAE) is around 20%, which may in part result from inadequate embolization. Prostate contrast retention (PCR) adequacy on immediate post-embolization cone-beam CT may provide better assessment of embolization completeness than arterial contrast stasis seen on fluoroscopy alone. The aim of this study was to evaluate outcomes of PAE using PCR adequacy as the procedural endpoint.

METHODS

A retrospective cohort study of all PAE cases using this technique at a single large volume center was conducted. Following initial embolization of the main prostatic arteries, if PCR was inadequate, additional embolization was performed. Technical success (adequate PCR) was defined as > 75% global prostate gland contrast staining. Clinical success was determined in accordance to CIRSE standards of practice.

RESULTS

One hundred sixty-five patients (mean age 68 ± 8.4 years) underwent PAE from June 2017 to March 2019. Technical and clinical success rates were 98.8% and 96.4% respectively. Clinical success rate was significantly higher in patients with adequate PCR. International Prostate Symptom Scores (IPSS) and Quality of Life (QoL) scores significantly improved at 1-, 3-, 6-, and 12-month follow-up when compared to baseline. Prostate volume (PV) and post-voiding residual bladder volume were significantly reduced at 3, 6, and 12 months in comparison to baseline. Mild (Clavien-Dindo grade I/II) and moderate (grade III) complication rates were 12.1% and 3.6% respectively.

CONCLUSIONS

By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.

KEY POINTS

• By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.

Concentrations of canine prostate specific esterase, CPSE, at baseline are associated with the relative size of the prostate at three-year follow-up

Background

Enlargement of the prostate is associated with prostatic diseases in dogs, and an estimation of prostatic size is a central part in the diagnostic workup. Ultrasonography is often the method of choice, but biomarkers constitute an alternative. Canine prostate specific esterase (CPSE) shares many characteristics with human prostate specific antigen (PSA) and is related to prostate size. In men with clinical symptoms of prostatic disease, PSA concentrations are related to prostate growth. The aims of the present follow-up study were to evaluate if the concentration of CPSE is associated with future growth of the prostate, and if analysis of a panel of 16 steroids gives further information on prostatic growth. Owners of dogs included in a previous study were 3 years later contacted for a follow-up study that included an interview and a clinical examination. The prostate was examined by ultrasonography. Serum concentrations of CPSE were measured, as was a panel of steroids.

Results

Of the 79 dogs included at baseline, owners of 77 dogs (97%) were reached for an interview, and 22 were available for a follow-up examination. Six of the 79 dogs had clinical signs of prostatic disease at baseline, and eight of the remaining 73 dogs (11%) developed clinical signs between baseline and follow-up, information was lacking for two dogs. Development of clinical signs was significantly more common in dogs with a relative prostate size of ≥2.5 at baseline (n = 20) than in dogs with smaller prostates (n = 51). Serum concentrations of CPSE at baseline were not associated with the change in prostatic size between baseline and follow-up. Serum concentrations of CPSE at baseline and at follow-up were positively associated with the relative prostatic size (S_rel) at follow-up. Concentrations of corticosterone (P = 0.024), and the class corticosteroids (P = 0.0035) were positively associated with the difference in S_rel between baseline and follow-up.

Conclusions

The results support the use of CPSE for estimating present and future prostatic size in dogs ≥4 years, and the clinical usefulness of prostatic size for predicting development of clinical signs of prostatic disease in the dog. The association between corticosteroids and prostate growth warrants further investigation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-02874-1.

Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

The effects of Pueraria mirifica extract, diadzein and genistein in testosterone-induced prostate hyperplasia in male Sprague Dawley rats

Pueraria mirifica (PM) is a medicinal plant native to Thailand contained high amount of phytoestrogen and possesses anticancer activity. This study reports the effect of P. mirifica extract, phytoestrogen of diadzein and genistein for its benign prostate hyperplasia properties in testosterone-induced prostate hyperplasia in male Sprague Dawley rats. The P. mirifica extract was evaluated for its total phenols, flavonoid and antioxidant activity using DPPH, FRAP and metal chelating assay. The assessment of P. mirifica, diadzein and genistein against benign prostate hyperplasia was determined in testosterone-induced prostate hyperplasia in male Sprague Dawley rats. The total phenol was higher than flavonoid but showed low antioxidant activity of DPPH, FRAP and metal chelating. The aqueous PM extract at 1000 mg/kg significantly increased testosterone levels in testosterone-induced rats by 13% while diadzein and genistein increased it by 11% and 17% respectively. However, levels of FSH, LH, triglyceride and HDL are not affected by the oral administration of PM, diadzein and genistein to the rats. Similarly, total protein, albumin, globulin, total bilirubin, conjugated bilirubin, alkaline phosphatase, alanine aminotransferase, AST, and G-glutamyltransferase showed no significant difference as compared with negative control rats. The body weight of the rats, testis, kidney and liver showed no toxic effect. The zinc content increased significantly and the zinc transporter gen of ZnT4 and ZIP4 highly expressed suggesting that the PM, diadzein and genistein plays essential role in modulating prostate zinc homeostasis. Similarly, the expression of IL-6, AR and ER was significantly reduced indicating functioning in regulation of prostate growth and acts as anti-inflammatory role in preventing BPH. In conclusion, the results indicated that PM reduced BPH and contributed to the regulation in the zinc transport expression of the prostate cells in the benign prostate hyperplasia (BPH).

Myeloperoxidase and Prostate volume: A preliminary study

OBJECTIVES

Oxidative stress is associated with the development of BPH and might be modulated by several factors. Myeloperoxidase (MPO) has recently been observed in prostate tissue. Our goal was to investigate the correlation between MPO and the prostate volume.

MATERIAL AND METHODS

Hundred and twenty-one patients (48-70 years) with a filled IPSS were prospectively included. Blood sampling (PSA, testosterone, Angiotensin II (AngII), MPO, Mox-LDL) and transrectal ultrasound of the prostate were performed with total volume (TV) and transitional zone volume (TZ) measurements. For correlation, univariate analyses were depicted by Pearson's coefficient. Multilinear regression analysis used a stepwise backward selection of the explicative variables.

RESULTS

In multivariate analysis, the TV was positively correlated to the combination of age and Ang II but negatively to MPO specific activity (Std Coef=-0.272, P=0.004). Significant correlations were confirmed between TZ, age and MPO specific activity but not with Ang II. A negative correlation between TZ and MPO specific activity was also observed (Std Coef=-0.21, P=0.016). No correlation was found with Mox-LDL.

CONCLUSIONS

Negative correlation between MPO and prostate volume was observed but careful interpretations may be endorsed and longitudinal study is necessary. It seems relevant to focus on the potential contribution of MPO in the development of prostatic diseases as this enzyme can also promote DNA oxidation.

LEVEL OF EVIDENCE

4.

Patients with small prostates and low-grade intravesical prostatic protrusion - A urodynamic evaluation

OBJECTIVE

Despite high-grade intravesical prostatic protrusion (IPP) being closely related to bladder outlet obstruction (BOO), up to 21% of patients with low IPP remain obstructed. This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP.

METHODS

One hundred and fourteen men aged >50 years old with lower urinary tract symptoms (LUTS) were assessed with symptoms, uroflowmetry, serum prostate-specific antigen (PSA), transabdominal ultrasound measurement of prostate volume (PV), IPP and post-void residual urine (PVRU). All patients underwent pressure flow studies. Patients with PV < 30 mL and IPP ≤ 10 mm were examined for parameters correlating with BOO or impaired detrusor contractility.

RESULTS

Thirty-six patients had PV < 30 mL and IPP <10 mm. Nine patients (25.0%) had urodynamic BOO, all with normal bladder contractility. Fourteen patients (38.9%) had poor detrusor contractility and all had no BOO. PV, PVRU and IPP were significantly associated with BOO, with IPP showing greatest positive correlation. Both Qmax and IPP were significantly associated with detrusor contractility. At 5-year follow-up, most patients responded to medical therapy. Only three out of nine patients (33.3%) with BOO eventually underwent surgery, and all had a high bladder neck seen on the resectoscope. Only one patient (7.1%) with poor detrusor contractility eventually required surgery after repeat pressure flow study revealed BOO.

CONCLUSION

In men with small prostates and low IPP, the presence of BOO is associated with higher PV, PVRU and IPP, and most respond well to medical management. BOO can possibly be explained by elevation of the bladder neck by a small subcervical adenoma.

Prostatic Lymphoma Masquerading as Urinary Retention and Hematuria With Review of Literature

Lymphomas of prostate are very rare tumors. They are not commonly considered in the clinical and histological differential diagnosis of prostatic enlargement. We report a case of a 49-year-old man who presented to emergency department with several weeks of difficulty in urination, for which he was being treated for benign prostate hyperplasia with no improvement. Computerized tomography scan showed lobulated mass originating from the superior aspect of the prostate with right inguinal lymph node involvement and no distant organ metastatic disease. Prostatic biopsy revealed diffuse large B-cell lymphoma. The patient achieved complete remission after six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy regimen. Lymphomas of the prostate should be considered in differential diagnosis of the patient presenting with obstructive lower urinary tract symptoms especially in patients with normal prostatic-specific antigen level and previous history of lymphoma in other sites.

Effect of Motherwort total alkaloids on the prostate hyperplasia mice model of pathological changes of related tissue morphology induced by the fetal urogenital sinus implants

Aim

The research was to study the effect of Motherwort total alkaloids on the prostate hyperplasia mice model of pathological changes of related tissue morphology.

Results

Compared with the model group(MG), Motherwort total alkaloid high, medium dose group(HD, MD) could significantly reduced the pathological changes of the prostate (P < 0.01); Finasteride(FG) and Motherwort total alkaloid low dose group(LD) could significantly reduce the pathological changes of the prostate (P < 0.05); Longbishu capsules(LG), Finasteride, Motherwort total alkaloid medium dose group could significantly reduce the pathological changes of the kidney (P < 0.01); Motherwort total alkaloid low dose group could significantly reduce the pathological changes of the kidney (P < 0.05); Motherwort total alkaloids could improve the pathological changes of the thymus and spleen.

Conclusion

Motherwort total alkaloid can improve the pathological changes of prostatic hyperplasia in mice.

Cyclooxygenase 2 (rs2745557) Polymorphism and the Susceptibility to Benign Prostate Hyperplasia and Prostate Cancer in Egyptians

Cyclooxygenase-2 (COX-2), an inducible isoform of cyclooxygenase, has been reported to be correlated with tumorigenesis, tumor progression, and metastasis. We aimed to evaluate the association between COX-2 (rs2745557) polymorphism and prostate cancer (PCa), benign prostate hyperplasia (BPH) risk. We also assessed the influence of other risk factors such as obesity, smoking, diabetes in modulating the risk of PCa in Egyptian men. COX-2 (rs2745557) was genotyped in 112 PC patients, 111 BPH and 120 subjects as a control group. COX-2 and PSA levels were measured by ELISA. We found that GG genotype was associated with a 17-fold increased risk for PCa and 20-fold increased the risk for BPH more than AA genotype. Also, G allele carriers of COX-2 were associated with metastatic cancer (OR = 1.3, P < 0.05) and disease aggressiveness (OR = 3.5, P < 0.001). The coexistence of obesity, smoking, or diabetes with GG genotype may lead to increasing the risk of developing BPH (OR = 3.3, 4, and 2.7, respectively) and of developing PCa (OR = 2.9, 4.9, and 3.2, respectively). Our results showed evidence suggesting the involvement of the COX-2 (rs2745557) polymorphism and its protein in PCa or BPH initiation and progression. Also, the coexistence of COX-2 (rs2745557) and obesity, smoking, or diabetes may lead to the development of PCa or BPH.

Can intravesical prostatic protrusion predict bladder outlet obstruction even in men with good flow?

Objective

Men with benign prostate hyperplasia (BPH) with good urinary flow may still have bladder outlet obstruction (BOO). Intravesical prostatic protrusion (IPP) has been shown to be able to predict BOO. We aim to investigate the use of IPP to predict BOO in men with good urinary flow.

Methods

One hundred and fourteen consecutive men (>50 years old) presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002. They were evaluated with serum prostate specific antigen (PSA), uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume (PV). Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index > 40. Men with Q_max ≥ 12.0 mL/s were considered to have good flow.

Results

Among the 114 men, 61 patients had good urinary flow. Their median age, PV and Q_max were 66 years, 32.9 mm³ and 14.5 mL/s respectively. 14/61 (23.0%) patients had BOO and their distribution of IPP were as follows: Grade 1 – 0/20 (0%) obstructed, Grade 2 – 6/22 (27.3%) and Grade 3 – 8/19 (42.1%). Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%. The area-under-curve (AUC) for IPP was greater than that for PV (0.757 vs. 0.696).

Conclusion

Even in men with good flow, high grades of IPP were more likely to have BOO and hence, may be a useful adjunct to predict BOO.

Holmium laser enucleation of the prostate is effective in the treatment of symptomatic benign prostatic hyperplasia of any size including a small prostate

Purpose

Although transurethral resection of the prostate (TURP) is considered the standard surgical treatment for benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) is replacing TURP. We compared TURP with HoLEP with matching for prostate size.

Materials and Methods

We retrospectively reviewed the medical charts of patients who underwent TURP and HoLEP performed by one surgeon at our institute. All patients were categorized into 3 groups on the basis of prostate size (group 1, <40 g; group 2, 40-79 g; and group 3, >80 g), and 45 patients were selected for each method.

Results

No major intraoperative complications were encountered. The mean resected tissue weight was 6.3, 18.3, and 28.0 g for groups 1, 2, and 3, respectively, for TURP and 8.7, 25.0, and 39.8 g, respectively, for HoLEP. The mean operation time was 51.8, 89.3, and 101.9 minutes for TURP and 83.6, 122.8, and 131.2 minutes for HoLEP in groups 1, 2, and 3, respectively. HoLEP had better resection efficacy than TURP for any size prostate, but there was no statistical difference between the methods. Both methods resulted in an immediate and significant improvement of International Prostate Symptom Score, peak urinary flow rates, and postvoid residual urine volume.

Conclusions

HoLEP is effective for BPH treatment, regardless of prostate size, even in a small prostate. The perioperative morbidity of HoLEP is also comparable to that of TURP.

[Thulium vapoenucleation of prostates larger than 80 ml using a 1.9-µm and a 2-µm thulium laser. Early perioperative results from two centres]

BACKGROUND

Numerous studies have shown that thulium vapoenucleation of the prostate (ThuVEP) is a size-independent minimally invasive procedure for the treatment of benign prostatic enlargement. All ThuVEP series have been performed with a 2-µm thulium laser device so far. The aim of this study was to evaluate the complications and early postoperative results of two thulium-devices with different wavelengths for ThuVEP in prostates larger than 80 ml.

MATERIALS AND METHODS

A retrospective bi-centric matched-paired analysis with 296 patients was performed. Based on prostate size, 148 were matched at each centre and laser device, respectively. A 2-µm (RevoLix, LISA Laser products, Katlenburg, Germany n=148) and a 1.9-µm (vela XL, starmedtec, Starnberg, Germany, n=148) thulium laser with a power output of 90 and 80 W was used. Patients' data were assessed and compared.

RESULTS

The median prostate volume (interquartile) was 100 ml (range 86.25-120 ml). At discharge, Qmax (preoperative 7.9 and 9 ml/s vs. postoperative 19.35 and 16.2 ml/s) and postvoiding-residual urine (preoperative 130 and 45 ml vs. postoperative 20 and 25 ml) were significantly improved after 2-µm and 1.9-µm ThuVEP (p<0.001). The median catheterization time and hospitalization times were 2 and 4 days in both groups. Perioperative complications occurred in 89 patients (30.1%): Clavien 1 (12.2%), Clavien 2 (9.1%), Clavien 3a (0.7%), Clavien 3b (7.1%), and Clavien 4a (1%). Regarding the occurrence of complications, there were no differences between the two thulium devices.

CONCLUSION

ThuVEP represents a safe and effective treatment for prostates larger than 80 ml. Both thulium laser devices give satisfactory immediate micturition improvement with low perioperative morbidity.

Holmium laser enucleation of the prostate: modified morcellation technique and results

PURPOSE

We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency.

MATERIALS AND METHODS

From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique.

RESULTS

There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups.

CONCLUSIONS

In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.