Combined use of 5 alpha-reductase inhibitors and alpha-l adrenergic receptor blockers in patients with benign prostatic hyperplasia

Historically, the ethics of a professional were the ethics of a gentleman. The social changes in the 1960s, where citizens asked for a greater voice in all affairs that affected them gave rise to formal approaches to ethics in the health fields. Principle-based and case-based reasoning have been dominant. Neither codes nor approaches based on virtue (the character of the professional) are perfect solutions in all cases, but professions are strengthened through the development and discussion of statements about ethical conduct.     

Managing patients with benign prostatic hyperplasia

Benign prostatic hyperplasia is the usual cause of prostatism--irritative and obstructive urinary symptoms. Steps in making the diagnosis include a focused neurologic examination, urinalysis, serum creatinine determination and, possibly, catheterization to detect urinary retention. It is difficult to predict the likelihood of future complications, such as complete urinary obstruction, even for patients with severe symptoms. The natural course of prostatism is a waxing and waning of symptoms. Treatment options are watchful waiting, medication, transurethral prostatectomy, and newer surgical treatments such as microwave thermopathy and laser ablation. The family physician can counsel patients about the potential side effects of these treatments as well as the problems incurred by simply adjusting to the disabilities associated with benign prostatic hyperplasia.     

The treatment of benign prostatic hyperplasia using the Mumie-Vitas preparation

Overall thirty-eight patients presenting with stage I-II benign prostate hyperplasia received treatment with a new local drug preparation Mumiyo-Vitas, 0.2 g on a once- or twice-daily basis over six months. Effects were studied of the drug on the urologic symptomatology and quality of life of patients presenting with ongoing micturitional disturbances, functional state of detrusor vesicae, prostate volume and urethral resistance. Efficiency of the treatment given was assessed by the International system, uroflowmetry, ultrasonic investigation. Mumiyo-Vitas appeared to be of therapeutic benefit in those patients with subjective and objective symptoms of the urinary bladder obstruction who had innocent prostate hyperplasia.     

Errors in the diagnosis of benign prostatic hyperplasia

Monitor blood glucose level before, during and for up to 24 hours after exercise. Ensure refined carbohydrate snack is taken prior to exercise. Reduce insulin dosage if possible. Inject insulin away from any exercising muscle. Remember that glycogen stores are replenished in two phases: immediately after the exercise and two to three hours later. These are the key risk times for hypoglycaemia. If blood glucose control is poor (14 mmol/litre or higher) prior to exercise, the 'stress' effect of the exercise may cause further increases in the blood sugar level unless control is achieved.     

Transurethral enzyme injection--future management of benign prostatic hyperplasia

Although benign prostatic hyperplasia, a common condition among elderly men, has been effectively treated with transurethral resection of the prostate, this surgical procedure is associated with many well-recognized risks and complications. Because of this potential morbidity and mortality, various alternative treatment strategies for benign prostatic hyperplasia have been proposed. The use of enzyme solubilization and ablation of prostatic tissue to alleviate urinary outlet obstruction has proved effective in dogs and warrants investigation in human trials. Transurethral enzyme injection of the prostate has the potential for being a treatment modality with minimal invasiveness, limited requirements for anesthesia, and minimal associated toxicity for the management of benign prostatic hyperplasia.     

前列腺增生危险因素的病例对照研究

目的 研究前列腺增生(BPH)的各种危险因素及其危害程度.方法 以132例病理确诊的前列腺增生患者为病例组,以年龄匹配的132例无前列腺增生患者为对照组进行1:1配对病例对照研究.采集人口学因素、高血压史、糖尿病史、实验检测等临床资料.资料分析采用单因素和多因素条件Logistic回归分析.结果 (1)单因素分析显示:在吸烟、饮酒、糖尿病史、高血压史、慢性支气管炎史、肾囊肿史和慢性前列腺炎史差异统计学意义(P<0.05).(2)多因素分析显示:吸烟(OR=0.530)、糖尿病史(OR=2.227)、高血压史(OR=1.862)、慢性前列腺炎(OR=2.414)是BPH的独立危险因素(P<0.05).结论 前列腺炎史、高血压史、糖尿病史是BPH发病的危险因素,吸烟为保护性因素.良好的血压和血糖控制是预防BPH的重要方法.     

Bladder compliance in patients with benign prostatic hyperplasia

Factors influencing bladder compliance were examined in 116 patients with benign prostatic hyperplasia (BPH), by evaluating patients' histories, response of isolated bladder strips to acetylcholine, and the effect of prostatic urethral anesthesia. Patients' age, frequency of micturition, and duration of voiding difficulty were not correlated with bladder compliance. Bladder compliance was significantly low in patients within 30 days after urinary retention, as compared with bladder compliance in patients without an episode of retention. More than 30 days after retention, however, there was a tendency toward increased bladder compliance. Restricted to patients without an episode of retention, bladder compliance in the overactive detrusor group was found to be significantly lower than in the normal group. The responses to acetylcholine of bladder strips were compared between patients with low and normal-compliance bladders. The dose-response curve of patients with low-compliance bladders did not differ from that of those with normal compliance bladders, even when patients with an episode of retention were excluded. After prostatic urethral anesthesia, a significant increase of bladder compliance was observed in patients with an overactive detrusor, while the increase was not significant in patients with a normal detrusor. Our results strongly suggest that easy irritability of the anatomically altered prostatic urethra, as well as bladder over-distension caused by urinary retention, are important factors affecting bladder compliance in BPH patients.     

Association of benign prostatic hyperplasia with male pattern baldness

OBJECTIVE: To determine whether crude extracts of ginseng saponin (GCS), containing the active ingredients from Panax ginseng and used as an aphrodisiac in oriental countries, relax corpus cavernosal smooth muscle in the rabbit. MATERIALS AND METHODS: Corpus cavernosal strips were prepared from rabbit penises. Isometric tension changes, recorded with a pressure transducer, in response to various drugs and electrical stimulation were assessed in an organ chamber, after active muscle tone had been induced by 10 micromol/L phenylephrine. RESULTS: GCS (0.2-8.0 mg) relaxed the smooth muscle of rabbit corpus cavernosum (SMRCC) pre-contracted with phenylephrine in a dose-dependent manner. GCS at 0.75 mg significantly enhanced the relaxation of SMRCC induced by electrical field stimulation. The relaxation induced by 0.2-8.0 mg GCS was significantly attenuated by atropine (1 micromol/L), methylene blue (100 micromol/L) and N-omega-nitro-L-arginine methyl ester (L-NAME, 10 micromol/L). However, there was no significant difference in the attenuation of GCS-induced relaxation of SMRCC by adding vasoactive intestinal peptide antagonists or indomethacin. In addition, the decreasing rate of GCS-induced relaxation of SMRCC by methylene blue and L-NAME was greater than that by atropine. L-arginine (10 mmol/L) reversed the inhibitory effect induced by L-NAME (1 mmol/L) on the attenuation of GCS-induced relaxation. CONCLUSIONS: These data suggest that GCS, as a nitric oxide donor, induces the relaxation of SMRCC through the L-arginine/nitric oxide pathway. For the clinical application of ginseng saponin, further studies are required to clarify the active subfraction(s) of GCS.     

Transurethral thermotherapy in the management of benign prostatic hyperplasia

To elucidate the intradialytic urea concentration gradients, we examined 26 hemodialysis patients wearing a double-lumen central venous catheter during their first or second fistula-punctured dialysis session. In 17 patients (group A), after 60 and 240 minutes of treatment with a mean blood flow of 196.4 +/- 9.9 mL/min, blood urea nitrogen (BUN) was measured in blood samples taken simultaneously from the central venous catheter, a vein in the arm opposite the access site, and the arterial and venous lines of the dialyzer. In 16 patients (group B), after 60 minutes of treatment with a mean blood flow rate of 197.5 +/- 12.3 mL/min, BUN was measured in blood samples taken from the dialyzer arterial line and then, after decreasing the blood flow to 50 to 60 mL/min for 1 minute, in samples taken from a vein in the arm opposite the access site, the central venous catheter, and the dialyzer arterial line. In group A, the mean BUN values in the dialyzer arterial line at 60 and 240 minutes were found to be 3.7% +/- 3.7% and 3.5% +/- 3.4% higher than the corresponding values in the central veins, respectively (P = NS between 60 and 240 minutes). In group B, after 1 minute of low blood flow, this difference was 1.5% +/- 2.4% (P = 0.06 compared with group A). The peripheral veins in group A patients at 60 and 240 minutes had 9.7% +/- 5.2% and 10.9% +/- 5.3% higher BUN values, respectively, compared with the central veins. This difference in group B patients after 1 minute of low blood flow was 6.8% +/- 4.2%. Urea access recirculation rate in group A, calculated by the classical three-samples method, was found to be 7.6% +/- 5.0% at 60 minutes and 9.9% +/- 5.8% at 240 minutes (P = NS). In group B, BUN values in the dialyzer arterial line after 1 minute of low blood flow increased significantly by 3.4% +/- 4.5% (P < 0.01). Our study shows that during conventional hemodialysis with a blood flow rate of 200 mL/min, urea concentration in the central veins is lower than in the dialyzer arterial line. This gradient after 1 minute of low-flow dialysis had a tendency to decrease. At the same time, however, the urea concentration gradient between the peripheral and central veins remained high, indicating that during conventional hemodialysis, intercompartmental disequilibrium plays a significant role in the arteriovenous gradient.     

Medical management of benign prostatic hyperplasia: a review

Benign prostatic hyperplasia (BPH) is a common disease affecting elderly men with 70% of men over 70 years showing microscopic evidence of hyperplasia. Transurethral resection of the prostate is the gold standard treatment. Medical management of BPH has involved the use of plant extracts, amino acids, kampo and animal organ preparations in various countries with unsatisfactory results. The use of alpha adrenergic antagonists dates back twenty years representing a major breakthrough in the treatment by relaxation of the dynamic contraction of smooth muscle component of prostatic obstruction. The evolution of alpha antagonist therapy resulted in clinical trials with selective antagonists such as prazosin, alfuzosin, indoramin, terazosin and doxazosin all of which achieve similar effective relief of obstructive symptoms as phenoxybenzamine, but with fewer side effects related to postural hypotension. 5-alpha reductase inhibitors, finasteride and episteride, recently synthesised act on the static component of obstruction caused by the enlarging prostate. They inhibit conversion of testosterone to the potent intracellular androgen dihydrotestosterone (DHT) resulting in the reduction of prostate volume and improvement of obstructive symptoms. Clinical trials with finasteride for three years indicate that 63% of patients had a reduction of greater than 20% in prostatic volume and 42% had a decrease of greater than 30% with a mean increase peak flow rate of 2.4 mls/s equivalent, to 20 years reversal of disease progression.     

Ultrasonically determined patterns of enlargement in benign prostatic hyperplasia

A series of 430 men aged 40 to 79 years underwent transrectal ultrasonography (TRUS) as part of a community survey of benign prostatic hyperplasia (BPH). We describe a reproducible method of prostate volume estimation and discuss the implications of prostate dimension changes in BPH. The mean prostate and adenoma volumes for the group were 32 ml (SD 14) and 15 ml (SD 11) respectively. The antero-posterior dimension of the prostate (APD) had the strongest correlation with gland volume compared with the transverse dimension (TD) and length (L). The mean ratio of adenoma volume to prostate volume was 0.45 (SD 0.13) and this increased with increasing gland volume. There was a modest correlation between the ratio and prostate volume. BPH is characterised by a proportionally greater increase in the APD compared with L and TD and by an increasing adenoma/prostate ratio. TRUS is useful in assessing the type and extent of adenoma and prostate enlargement in BPH.     

Modern approach to conservative treatment of benign prostatic hyperplasia

It has been estimated that more than 30 million of people suffer from the symptoms in the lower urinary tract caused by benign hyperplasia of the prostate. According to data from literature the term benign hyperplasia of the prostate should be reserved only for histological diagnosis. The paper presents contemporary approaches to diagnostics and non-surgical, i.e. conservative modalities of the therapy. These modalities include: follow up of the patients, medicamentous therapy and non-surgical invasive therapies. Medicamentous therapy implies phytotherapy, inhibitors of 5-Alpha reductase and antagonists of Alpha-adrenergic receptors. Non-surgical invasive therapies include: balloon dilatation, ureteral stents and thermotherapy. The paper indicates the place of certain options related to the conservative treatment of benign hyperplasia of the prostate. A fact that only 10% of these patients are treated surgically means that majority of them need other, i.e. conservative therapy. New achievements in the treatment of benign hyperplasia of the prostate have aroused new hope for men suffering from this disease.     

The CAG repeat within the androgen receptor gene and benign prostatic hyperplasia

Thalidomide, a glutamic acid derivative, has recently been shown to inhibit in vitro angiogenesis, the process of formation of new blood vessels. This Phase II study examined the pharmacokinetics of thalidomide in patients with clinically progressive hormone-refractory prostate cancer. Patients (aged 55 to 80 years) were randomized to two different arms, low dose versus high dose. Patients in the low-dose group were given 200 mg of thalidomide and patients in the high-dose group received 200 mg of thalidomide, with subsequent dose escalations to 1200 mg. Serial serum or blood samples were obtained for pharmacokinetic assessment after administration of a single oral dose or multiple daily dosing of thalidomide and were assayed by reversed-phase HPLC. Pharmacokinetic parameters for both the single and multiple dosing were calculated with ADAPT II. A one-compartment model best fit the data. After single dosing, the oral clearance and apparent volume of distribution for the low-dose regimen (n = 13) were 7.41 +/- 2.05 L/h and 66.93 +/- 34.27 L, respectively, whereas for the high-dose regimen (n = 11), these values were 7.21 +/- 2.89 L/h and 165.81 +/- 84.18 L, respectively. The elimination half-lives for the low and high dose were 6.52 +/- 3.81 and 18.25 +/- 14.08 h, respectively. After the multiple dosing of thalidomide, the oral clearance and apparent volume of distribution for the low-dose group (n = 10) were 6.35 +/- 1.64 L/h and 64.63 +/- 23.20 L, respectively, whereas for the high-dose group (n = 11), these values were 7.73 +/- 2.27 L/h and 167.85 +/- 82.08 L, respectively. The elimination half-lives for the low and high dose were 7.08 +/- 1.87 and 16.19 +/- 9.57 h, respectively. For both the single and multiple dosing of thalidomide, the apparent volume of distribution and half-life were significantly higher for the high-dose group than those for the low-dose group. The higher apparent volume of distribution may be attributable to several factors, such as change in absorption, protein binding, etc. A dose-proportional increase in thalidomide steady-state concentrations was seen after multiple daily dosing of thalidomide.     

Sexual readaptation after the surgical treatment of benign prostatic hyperplasia

Lesions of the tongue are often encountered in the process of a dental examination. These can include alterations of the tongue surface texture or colour, ulcers or exophytic lesions (lumps). The latter can represent variations of normal, benign or malignant pathological processes. This article will not provide a detailed list of all possible exophytic tongue lesions but will present a few of the more common conditions to be considered when such lesions are encountered.     

Treatment of benign prostatic hyperplasia with alpha 1-adrenoreceptor antagonists

The International Consensus Committee recommends alpha-adrenoceptor antagonists for medical therapy benign prostatic hyperplasia (BPH). This review evaluates 52 randomized, placebo-controlled, double-blind studies, including 10399 patients and, moreover, 40 clinical studies including 33600 patients undergoing treatment with alpha-adrenoceptor antagonists because of BPH. The therapeutic efficacy of all alpha-adrenoceptor antagonists is more or less the same. There is an average improvement of symptom scores of about 35% and a mean increase in maximum flow rate of between 1.8 and 2.5 ml/s. Studies investigating long-term efficacy and quality of life tend to show a long-term benefit. The introduction of selective alpha 1-adrenoceptor antagonists led to a significant reduction of side effects. These side effects are primarily caused by the vasodilatatory qualities of alpha-blockers. The development of so-called uroselective alpha 1A-adrenoceptor antagonists in the treatment of BPH possibly leads to further reduction of side effects related to vasodilatation. Medical therapy by alpha 1-adrenoceptor antagonists seems to be superior to phytotherapy or treatment with 5 alpha-reductase inhibitors, as shown in a few studies. So far, it is not clear whether there is any advantage of combination therapy. The application of alpha 1-adrenoceptor antagonists is indicated in all cases of symptomatic BPH, excluding patients who need TUR-P (e.g., middle lobe) or prostatectomy. If patients are either willing or eligible to have surgical treatment, therapy by alpha 1-adrenoceptor antagonists is a rational choice. Comparative clinical trials have to be conducted to provide additional information and to clarify which alpha-blocker may be recommended as the first choice. Until then, those alpha 1-adrenoceptor antagonists should be used for which safety and efficacy are well documented and which can be prescribed at reasonable costs.     

Disorders of kidney function in patients with benign prostatic hyperplasia

The examination of 648 males aged 50 to 86 to conduct an early outpatient detection of renal dysfunction in the elderly men employed an original technique of renal function assessment based on the kinetics of urinary 5-NOK elimination. Renal dysfunctions were revealed in 165 patients, in 159 of them the underlying cause was benign prostatic hyperplasia. The results were compared with those obtained at radionuclide tracing and Reberg-Tareev test. The correlation found indicated the authors' technique informative value and its compatibility with the above methods. Identification of renal dysfunction at early stages of benign prostatic hyperplasia allowed their timely hospitalization and operative treatment which enables the physicians to prevent progression of chronic renal failure in these patients.     

Economic public health aspects of benign prostatic hyperplasia in Austria

Benign prostatic hyperplasia (BPH) is one of the most frequent diseases in advanced aged men. The introduction of a new coding system (ICD-VESKA) in 1989 made it possible to analyze the number of hospitalized cases and to calculate the costs of inpatient care. In 1990 10,710 BPH cases were treated within Austrian hospitals. Controlling for multiple entries 9,742 individual patients (269.4 per 100,000) were treated 138,761 days. Case fatality was 0.5% (46 deaths). The number of inpatients comprises only the top 1,3% of morbidity, the total number is estimated with 770,000 patients. Based on the official nursing fees total costs in public affiliated hospitals were AS 250 millions. Including private hospitals total costs increase to AS 306 millions. The inpatient care of BPH represents only a small proportion of the total health and economic burden, which obviously mainly occurs in the outpatient system. Therefore BPH is one of the diseases of which social and economic importance is usually underestimated due to a lack of information.     

The treatment of patients with benign prostatic hyperplasia using the selective alpha-blocker alfuzosin

40 patients with benign prostatic hyperplasia (BPH) were treated with the alpha-blocker alfuzosin which was administered per os twice a day in a dose 5 mg. The treatment brought about a decrease of the mean symptom score from 19.6 to 12.2, of quality of life from 5.2 to 2.1, of residual urine from 152 to 82 ml. Mean and maximal urinary flow rates rose by 35 and 45%, respectively. The level of prostate-specific antigen over the treatment course did not change. The findings of the trial evidence for high efficacy of alfuzosin in the treatment of urination disorders in BPH patients.