Benign Prostatic Hyperplasia

Abstract: Benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) are highly prevalent in older men. Medical therapy is the first-line treatment for LUTS due to BPH. Alpha-adrenergic receptor blockers remain one of the mainstays in the treatment of male LUTS and clinical BPH. They exhibit early onset of efficacy with regard to both symptoms and flow rate improvement, and this is clearly demonstrated in placebo-controlled trials with extensions out to five years. These agents have been shown to prevent symptomatic progression of the disease. The aim of this article is to offer a critical review of the current literature on silodosin, formerly known as KMD-3213, a novel alpha-blocker with unprecedented selectivity for α 1A -adrenergic receptors, as compared with both α 1B - and α 1D -adrenoceptors, exceeding the selectivity of all currently used α 1 -blockers, and with clinically promising effects.

Figure 2 demonstrates the growth in the citation counts of the top 5 most cited articles since the year 1980. This mirrors the growth in citations overall. Of these five, only one article was published before 1992, titled, “The Development of Human Benign Prostatic Hyperplasia with Age” by Berry SJ et al. The total citations per article ranged from 732 to 2,042. The AUA Symptom Index experienced a sharp peak in citations from 2013 to 2015 which coincided with the peak of total overall citations on the subject of BPH in these 100 articles.

Background: Benign prostatic hyperplasia (BPH) is a noncancerous increase of the size of the prostate gland. The two main medication classes for BPH management are alpha blockers and 5α - reductase inhibitors .Urinary bladder stones account for 5% of all urinary stone disease. Lithotripsy with the holmium: YAG laser started with making small perforations on the stone surface. the laser fiber should be moved over the surface of the stone vaporizing the stone rather than fragmenting it till fragments become small enough to pass spontaneously or can be safely retrieved.

Abstract: Benign prostatic hyperplasia (BPH) is a complex and progressive disease common in aging men. While associated with bothersome lower urinary tract symptoms, it may also result in additional serious complications such as refractory hematuria, acute urinary retention, and BPH-related surgery. Medical therapy has been offered as an approach to halt this progression and perhaps reverse the pathophysiology of BPH. While alpha-blockers provide rapid relief in the form of improved flow rate, their effects may not reduce the overall risk of BPH-related complications. 5α-reductase inhibitors were therefore introduced to affect the underlying disease process by inhibiting the enzyme which converts testosterone to dihydrotesterone, the primary androgen involved in normal and abnormal prostate growth. Through this inhibition, prostate size is decreased, thereby reducing the risk of acute urinary retention and BPH-related surgery while providing symptom control. These effects are most pronounced in men with enlarged prostates (25 mL) who are at the greatest risk of disease progression. This article reviews the literature for finasteride used in the treatment of BPH and provides evidence for its efficacy, safety and tolerability, applicability for combination therapy, and considerations of its effects on prostate cancer risk.

Short-term effects of cross- over treatment with silodosin and tamsulosin hydrochloride for lower urinary tract symptoms associated with benign prostatic hyperplasia. Kobayashi K, Masum[r]

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are regarded as a common problem managed by urologists. The severity of LUTS and a fear of prostate cancer result in referrals to urologists, but it is the degree of bother, interference with activities, decreased quality of life and, in some cases, complications of BPH, that drive men to seek treatment. Initial investigations are designed to determine the severity of LUTS and the degree of bother,

39. Nickel JC, Barkin J, Koch C, et al. PROACT Investigators. Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperpla- sia following cessation of alpha blockers. Can Urol Ass J 2008;2:16-21. 40. Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane

49 McConnell, J. D., Bruskewitz, R., Walsh, P., Andriole, G., Lieber, M., Holtgrewe, H. L., . . . Finasteride Long-Term Eff Saf Study, G. (1998). The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. New England Journal of Medicine, 338(9), 557-563. doi:10.1056/nejm199802263380901

Within the past decade, a number of significant advance- ments have occurred in our knowledge of benign prostatic hyperplasia (BPH) resulting in new approaches to both the diagnosis and treatment of this common and potentially progressive condition of aging men. The current document attempts to summarize the state-of-the-art knowledge regard- ing BPH and to highlight the essential diagnostic and thera- peutic information in a Canadian context. The information included in this document was obtained from a MEDLINE search of the English language literature. Although references of historical importance are included, management recom- mendations are based on literature published between 2000 and 2009.

The answers are assigned points ranging from 0 to 5, indicating the increased severity of a particular symptom. The score ranges from 0 to 35 (asymptomatic to symptomatic) [30]. The Symptom index is categorized as mild (≤7), moderate (8-19) and severe (≥20). For symptomatic score classification, IPSS divides the symptoms into obstructive and irritative symptoms as assessed by questionnaire. [31]. Among these irritative symptoms are Frequency, Urgency, Nocturia and obstructive symptoms are Incomplete emptying, Intermittency, Weak stream and Straining. LUTS has been used to depict a group of storage, voiding and postmicturition symptoms [26]. Benign Prostatic Hyperplasia has been used to explain a group of obstructive and irritative voiding symptoms [1].

Benign Prostatic Hyperplasia (BPH) is a major geriatric problem which is described in Ayurveda classics as Vatastheela, a one type of Mutraghata (obstructive uropathy). The term “Mutraghata” consists of two words “Mutra” and “Aghata”. The verbal meaning of these two words it “Mutra” (urine) and “Aghata” (Trauma) explains the etymological meaning as trauma on the urine forming apparatus. The term Mutraghata stands for low urine output due to obstruction in the passage of urine. It can be considered as a syndrome, because it covers most of the pathological entity of the urinary system into twelve type of Mutraghata are described as obstructive uropathy related to either upper or lower urinary tract. The Vatastheela, Mutraghata reflects the symptoms of urinary retention, incomplete voiding, distension etc. These are feature of Lower Urinary Tract Symptoms and can be co- related with Benign Prostatic Hyperplasia.

In Unani medicine, any such growth which may be directly or indirectly referred to as Benign Prostatic Hyperplasia (BPH) has not been mentioned as such however, many Unani resource books describe vividly various causes, conditions and pathophysiologies which collectively and indirectly may be correlated to the BPH. Ibn-e-zohar in his book Kitab-al-Taiseer described that the cause of retention of urine is ―Inflammation at the neck of urinary bladder‖. [17]

testosterone on prostate growth documented and has been used to assess the effects of many treatments. [14] Prostate specific antigen is a protein produced by prostate cells. Serum PSA levels increase abnormally in patients with benign prostatic hyperplasia and prostatitis. Therefore reduaction of the serum PSA level can show protective effectson benign prostatic hyperplasia. In this study the serum PSA levels in treated with pistacia atlantica extract groups decreased compared to treated with testosterone group. Subcutaneous injection of testosterone led to increasing of serum testosterone levels in the treated with testosterone group. While the serum testosterone levels in the treated with pistacia atlantica extract groups showed significant decrease compared to treated with positive group. The blood urea levels is a biochemical parameter that increases in renal disorders. Benign prostatic hyperplasia clinically includes lower urinary tract symptom and prostate enlargement.BPH symptoms range from minimal bother to urinary retention and renal failure. [15] The results of this study show that the blood urea levels in the treated with pistacia atlantica extract decrease compared to treated with testosterone group.

Abstract: Naftopidil, approved only in Japan, is an α1-adrenergic receptor antagonist (α1-blocker) used to treat lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Different from tamsulosin hydrochloride and silodosin, in that it has higher and extremely higher affinity respectively, for the α1A-adrenergic receptor subtype than for the α1D type, naftopidil has distinct characteristics because it has a three times greater affinity for the α1D-adrenergic receptor subtype than for the α1A subtype. Although well-designed large-scale randomized controlled studies are lacking and the optimal dosage of naftopidil is not always completely determined, previous reports from Japan have shown that naftopidil has superior efficacy to a placebo and comparable efficacy to other α1-blockers such as tamsulosin. On the other hand, the incidences of ejaculatory disorders and intraoperative floppy iris syndrome induced by naftopidil may be lower than for tamsulosin and silodosin having high affinity for the α1A-adrenergic receptor subtype. However, it remains unknown if the efficacy and safety of naftopidil in Japanese is applicable to white, black and Hispanic men having LUTS/BPH in western countries.

Citation Platz, E. A., E. B. Rimm, I. Kawachi, G. A. Colditz, M. J. Stampfer, W. C. Willett, and E. Giovannucci. 1999. “Alcohol Consumption, Cigarette Smoking, and Risk of Benign Prostatic Hyperplasia.” American Journal of Epidemiology 149 (2): 106–15. https:// doi.org/10.1093/oxfordjournals.aje.a009775.

Benign Prostatic Hyperplasia (BPH) is the commonest benign tumor in the ageing male and is universal after the age of 80 yrs. It is symptomatic in 25% of the total male population and in 50% of those aged 80 years and more, however the incidence is rising [1]. The cellular features of BPH are:- Cell clusters flat and cohesive, honeycombing prominent, myoepithelial cells present, detached single epithelial cells with normal nuclei, Nuclei- round, oval and equal in size, Mitosis-absent. Other cells include inflammatory cells, corpora amylacea, squamous cells and epithelial contaminants from the rectal mucosa and cells of the seminal epithelium. Prostatic secretion includes: Water and Electrolytes (Calcium, Potassium, Sodium chloride, Phosphate, Bicarbonates), Zinc- mean content in prostate (692mg/100gm) of dry weight, Polyols i.e. sorbitol and inositol, nitrogenous bases i.e. choline and its derivatives and spermine and spermidine that distinguish human semen from other body fluids, lipids, Prostaglandins, citric acid –maintains an osmotic equilibrium of semen, proteins, fibrinolysin and fibrinogenase–maintains the semen in liquid statduring ejaculation, proteolytic enzymes, phosphatase, glucoronidase, prostate specific antigen (PSA). Prostate gland remains relatively small throughout childhood and begins to grow at puberty under the influence of testosterone. The gland is almost stationary by the age of 20yrs and remains at this size upto the age of approximately 50yrs.

This is to certify that this dissertation “A PROSPECTIVE STUDY OF SEXUAL DYSFUNCTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA” submitted by Dr. J. SARAVANAN appearing for M.Ch UROLOGY degree examination in August 2015 is an original bonafide record of work done by him during the academic period of August 2012 to July 2015 under my guidance and supervision in partial fulfilment of requirement of the Tamil Nadu Dr. M.G.R. Medical University, Chennai. I forward this to the Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India.

8. Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic- controlled analysis. Cardiovasc Intervent Radiol. 2016;39(1):44 – 52. 9. Wang MQ, Wang Y, Yan JY, Yuan K, Zhang GD, Duan F, Li K. Prostatic artery

Trichrome Mallory stain showed statistically significant change between stromal cancer cells (CAFs) and stromal cells in benign prostatic hyperplasia (Chi-square=31.71 df=1 p<0.001). Vimentin antibody had significantly (Chi- square=45,55 df=1 p<0,001) greater expression in CAFs compared to stromal cells in benign prostatic hyperplasia. There are significant (Chi-square=117,89 df=1 p<0,001) differences in the staining index for the antibody desmin in benign prostatic hyperplasia and prostatic carcinoma and in all cases stromal cells of benign prostatic hyperplasia showed a staining index of 3. The difference of actin expression in stromal cells of benign prostatic hyperplasia and prostatic carcinoma was not significant (Chi-square=0,2 df=1 p=0,65 ). The values of Spearman coefficient and p values show that the intensity of trichrome Mallory staining has positive correlation with vimentin expression (R=0,68 p<0,001), Gleason score (R=0,27 p=0,023) and extraprostatic extension of the disease (R=0,24 p=0,049), while there is inverse correlation with desmin expression (R= - 0,28 p=0,023). The intensity of the blue staining using trichrome Mallory in the cancer stroma grows with the intensity of vimentin expression and with the increase of Gleason score and tumor stage (extraprostatic spread of the disease) (Table 3).

PROSTATIC INFLAMMATION ON THE OUTCOME OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA TREATED BY TRANSURETHRAL RESECTION OF THE PROSTATE” is a bona fide work done by Dr. RAMYA NAGARAJAN in partial fulfillment of the rules and regulations of M.Ch. Branch IV (Genitourinary Surgery) examination of the Tamil Nadu Dr. M. G. R Medical University Chennai to be held in August 2012.