Laser therapy for the treatment of benign prostatic hyperplasia: A review

Laser therapies for the treatment of benign prostatic hyperplasia have progressed significantly over the past decade. The main treatment types are coagulation, vaporization, and cutting techniques. Their appeal compared with the transurethral prostatectomy (TURP) is that many laser treatments have equal efficacy, with decreased side effects such as bleeding and irrigant absorption. Disadvantages are increased cost and the need for further demonstration of benefit compared with TURP. However, each technique has specific advantages and disadvantages. Contact lasers can create an intraoperative TURP-like defect with immediate results and appear to be significant advances. Because noncontact lasers have prolonged irritative effects and the need for catheterization, their use has declined dramatically. Interstitial laser coagulation can be effective, but has a delayed improvement. Advances in laser technology in the next decade likely will increase the popularity of these treatments. However, further comparative trials with TURP and newer noninvasive therapies are necessary to define their true benefit.     

良性前列腺增生药物治疗方法

良性前列腺增生(BPH)是老年男性常见病,随着我国进入老龄化社会,该病发病率有着明显的增加,患者年老体弱,长期夜尿次数多、排尿不畅等不仅造成心理上的烦躁甚至恐惧的情绪,还增加了心血管疾病发生的风险.有的患者还伴有痔疮、脱肛、血便、疝气和下肢静脉曲张等多种并发症.可见,BPH已严重影响了老年男性晚年生活质量.     

良性前列腺增生药物治疗方法

良性前列腺增生(BPH)是老年男性常见病,随着我国进入老龄化社会,该病发病率有着明显的增加,患者年老体弱,长期夜尿次数多、排尿不畅等不仅造成心理上的烦躁甚至恐惧的情绪,还增加了心血管疾病发生的风险.有的患者还伴有痔疮、脱肛、血便、疝气和下肢静脉曲张等多种并发症.可见,BPH已严重影响了老年男性晚年生活质量.     

Hedgehog signaling in prostate growth and benign prostate hyperplasia

Hedgehog (Hh) signaling has long been recognized for its role in axial patterning, mesenchymal-epithelial inductive signaling, and growth regulation during fetal development. In many embryonic tissues, Hh functions as a proliferative stimulus. Sonic hedgehog and Indian hedgehog are both expressed by the urothelium of the fetal prostate anlage, where they regulate cell proliferation and differentiation and play a role in prostate ductal budding. Whereas Hh signaling in mouse prostate diminishes during adolescence and is maintained at a low level in the adult, robust Hh signaling is commonly found in the adult human prostate. The reason(s) for robust Hh signaling in the adult human prostate and the actions of Hh signaling on growth and differentiation in the adult are not well understood. However, increased Hh signaling has been associated with prostate cancer and has been shown to accelerate prostate cancer growth. These observations suggest that inappropriate reawakening of this developmental growth signal may play a pivotal role in prostate neoplasia. This review examines the role of Hh signaling during early prostate growth and in its corollary actions during prostate disease, including benign prostate hyperplasia and prostate cancer. The use of Hh inhibitors as a therapeutic modality for androgen-independent treatment of prostate disease is also discussed.     

Combination medical therapy for symptomatic benign prostatic hyperplasia

PURPOSE: The purpose of this study was to evaluate treatment response to terazosin, finasteride, or a combination of both in men with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with BPH were consecutively enrolled from a clinical urology practice. International Prostate Symptom Score (IPSS), peak urinary flow rate, and prostate volume were assessed at baseline and every 2 months for 12 months. Detrusor pressure at maximum flow was assessed at baseline, 4 and 12 months. Patients were randomized into 1 of 3 treatment groups - terazosin alone, finasteride alone, or combination therapy. RESULTS: At 12 months, symptom scores had decreased significantly in all 3 treatment groups (p<0.05). Combination therapy resulted in significantly greater reductions in IPSS than terazosin or finasteride (6.4, 4.9, 4.1 points, respectively, p<0.05) There were significant increases in peak urinary flow rate within each treatment group, although there were no significant changes between groups. Detrusor pressure also significantly decreased from baseline within each treatment group. Patients treated with combination therapy had a significantly greater mean decrease in detrusor pressure after 12 months when compared with finasteride-treated patients (16.7 versus 10.5 cm H20, p<0.03). There were no significant differences between terazosin and combination therapy or between terazosin and finasteride despite the relatively greater decrease in detrusor pressure seen in the terazosin group when compared with the finasteride group. CONCLUSIONS: Combination medical therapy with finasteride and terazosin provides greater symptom relief than monotherapy in men with BPH.     

经尿道前列腺等离子电切治疗80岁及以上前列腺增生患者临床观察

目的 探讨经尿道前列腺等离子双极电切术(PKRP)治疗80岁及以上前列腺增生 (BPH)患者的有效性及安全性.方法 回顾分析PKRP治疗的180例80岁及以上高危BPH患者的临床资料.结果 180例手术顺利,手术操作时间平均(45.5±23.3)min.平均切除前列腺(60.3±23.3)g,无输血病例,术中无闭孔神经反射电切综合征出现.术后国际前列腺症状评分由(29.5±5.3)分降至(10.2±2.8)分;最大尿流率由(6.2±1.8)ml/s上升至(24.5±3.1)ml/s;生活质量评分由术前的(7.2±1.1)分下降至(1.0±0.5)分;残余尿由(130.5±45.5)ml降至(13.5±7.1)ml(均P＜0.05).结论 PKRP具有安全性高、并发症少、前列腺切尽率高、疗效确切等优点,适宜高龄BPH患者的手术治疗.

Abstract：

Objective To study the efficacy and safety of transurethral plasmakinetic resection of prostate (PKRP) in treatment of benign prostate hyperplasia in elderly patients aged 80 years and over. Methods Retrospective clinical analysis of 180 case of high risk of benign prostate hyperplasia treated by PKRP in patients aged 80 years and over. Results All the 180 patients underwent the operation successfully. The average time for operation was (45.5±23.3) min and the resected prostate was in an average of (60.3±23.3) g. Neither of blood transfusion during the operation nor aductor reflex and transurethral resection syndrome occurred. International prostate symptom score,residual urine and quality of life decreased from (29.5±5.3) to (10.2±2.8),from (130.5±45.5) ml to (13.5±7.1)ml and from (7.2±1.1) to (1.0±0.5) respectively. The maximum flow rate elevated from (6.2±1.8) ml/s to (24.5±3.1) ml/s. The differences in the above indicators were statistically significant between pre- and post- operation (P＜0.05). Conclusions Transurethral plasmakinetic prostatectomy is a reliable and effective surgical method, especially for the aged patients with benign prostate hyperplasia.     

良性前列腺增生与动脉粥样硬化的关系

目的 探讨良性前列腺增生(BPH)与动脉粥样硬化(AS)的内在联系和发病机制.方法 依据前列腺体积(PV)将95例患者分为非BPH组(PV≤20 ml)24例和BPH组(PV＞20 ml)71例.采用高分辨率彩色多普勒超声测定颈动脉内膜中层厚度(IMT),采集相关数据进行分析.结果 BPH组三酰甘油(TG)、超敏C反应蛋白(hs-CRP)、空腹血清胰岛素的对数[(l)n(FINS)]、胰岛素抵抗指数的对数[ln(HOMA-IR)]、IMT均显著高于非BPH组,BPH组的冠心病、脑动脉硬化患病率44％、45％,显著高于非BPH组18％、11％(x2=6.532、10.162,均P＜0.05).相关分析显示PV与ln(FINS)、ln(HOMA-IR)、TG、高密度脂蛋白胆固醇(HDL-C)呈正相关(r=0.204、0.196、0.375、0.383,均P＜0.05).结论 BPH与AS具有相关性,胰岛素抵抗、炎性反应和血管内皮功能失调可能是BPH和AS共同的发病机制.     

良性前列腺增生的腔内治疗进展

前列腺增生是中老年男性常见泌尿系统疾病,部分患者需手术治疗解除尿路梗阻。常见的手术方式有开放性手术和腔内镜手术。腔镜方式是目前治疗前列腺增生的主要手术方式,其中经尿道前列腺电切术（ TURP）是目前治疗前列腺增生的“金标准”,但是,近年来随着科技进步也涌现较多的新型腔内治疗方法。该文就良性前列腺增生的腔内治疗进展作一综述。     

Alpha-blocker therapy for benign prostatic hyperplasia: a comparative review

In the past decade there has been a shift in the primary approach to therapy for BPH, from surgical intervention to pharmacotherapy. Therapies with alpha-blockers, particularly long-acting selective alpha1-adrenoreceptor antagonists, has proven effective, and hence has become a popular treatment option. In randomized controlled trials, 3 alpha-adrenoreceptor antagonists -terazosin, doxazosin, and tamsulosin -have been shown to significantly improve both the mean peak urinary flow and the severity of BPH-related symptoms. There are no currently published trials comparing the clinical efficacy of these drugs. Reports from non-comparative trials suggest that the effects on symptoms and flow rates are similar. However, side effects, such as postural hypotension, asthenia, and dizziness may be less with tamsulosin. Use of tamsulosin is associated with loss of ejaculation in 4.5% of men. Until differences in efficacy are demonstrated, the choice of alpha-blocker will depend on tolerance for side effects and convenience of administration.     

胰岛素抵抗与良性前列腺增生的相关性研究

Objective To investigate the correlation of insulin resistance (IR) and benign prostate hyperplasia (BPH). Methods The 200 health examination men were divided into three groups according to the prostate volume (PV). There were 100 healthy subjects as control group (PV≤20 ml), 50 cases in BPH1 group (20 ml＜PV＜50 ml) and 50 cases in BPH2 group (PV≥50 ml).The fasting blood glucose (FBG) and fasting serum insulin (FSI) were determined using hexokinase method and radioimmunoassy, respectively. The IR index (IRI) and body mass index (BMI) were calculated according to the formula in HOMA model. Results There were no statistical differences between BPHl group and healthy control group in IRI (1.10±0. 18 vs. 1.18±0.21) and BMI (22. 0±3.0vs. 21.8±2.7) (t=0.74, 0.18, both P＞0. 05), but the IRI (1.31±0.19) and BMI (24. 8±3.29) increased in BPH2 group (P=0. 01, 0.03). The percentage of hyperglycosemia was higher in BPH patients than in normal controls (25% vs. 5%, P = 0. 00). Of them, the percentage of hyperglycosemia was the highest in BPH2 group (36%, P = 0. 01 ), their IRI ( 1.47 ± 0.21 ) was higher than in euglycemia patients (t=3.92, P=0.00), but the BM1 was unchanged compared with the control group ( 25.8 ± 4.3 vs. 24.3 ± 2.71, P = 0. 95 ). Conclusions There is a positive correlation of IR and hyperglycosemia with severe BPH, and the IR in severe BPH is independent of BMI.     

胰岛素抵抗与良性前列腺增生的相关性研究

目的 探讨胰岛素抵抗与良性前列腺增生间(BPH)的关系. 方法 选取在我院行健康体检老年男性200例,根据前列腺体积(PV)分为对照组(PV≤20 ml)100例,BPHl组(PV 21～49ml)50例,BPH2组(PV≥50 ml)50例.采用己糖激酶法测定空腹血糖(FPG),放免法测定空腹胰岛素(FSI)水平,运用HOMA模型计算胰岛素抵抗指数(IRI);测量身高和体质量,并计算体质指数.结果 BPH1组IRI(1.10±0.18)和体质指数(22.0±3.0)与对照组(1.18±0.21和21.8±2.7)比较,差异无统计学意义(均P＞0.05);BPH2组IRI(1.31±0.19)和体质指数(24.8±3.29)较对照组明显增高(P=0.01,0.03).高血糖所占比例BPH组(25%)高于对照组(5%)(P=0.00),其中BPH2组高血糖所占比例更高(36%)(P=0.01);BPH2组高血糖组IRI(1.47±0.21)较对照组(1.34±0.18)明显增高(t=3.92,P=0.00),但体质指数(25.8±4.3)kg/m2与对照组(24.3±2.7)kg/m2比较,差异无统计学意义(t=0.06,P=0.95). 结论 高血糖和胰岛素抵抗与重度前列腺增生存在相关性,且胰岛素抵抗的存在不依赖于体质指数的改变.     

老年人腹股沟疝修补术与尿道前列腺电切术同期进行的疗效观察

目的 探讨治疗老年腹股沟疝并存前列腺增生症（BPH）患者一次性完成手术的可能性及疗效观察。方法 回顾性分析50例（65～78岁），老年腹股沟疝并存良性前列腺增生患者，采用腹股沟无张力疝修补术的同时行经尿道前列腺电切术（TURP）的临床资料。结果 手术顺利，手术时间60～90min，伤口疼痛较轻，手术切口均为甲级愈合。术后无并存疾病加重，均于术后5～9d出院。50例患者均获得随访，随访6个月至4年，未见疝复发和补片移位，排尿通畅，无尿失禁及尿道狭窄等并发症。结论 老年腹股沟疝并存前列腺增生症患者可在行腹股沟无张力疝修补术同时行TURP，可减少手术的费用，手术安全，术后并发症少。     

良性前列腺增生患者长期联合药物治疗的临床观察

目的 观察非那雄胺联合特拉唑嗪治疗老年良性前列腺增生(BPH)的疗效.方法 对2002年6月到2010年12月我院53例老年BPH患者,连续服用非那雄胺(5 mg/d)和特拉唑嗪(2 mg/d)治疗进行临床观察,记录治疗前、治疗后2年、5年患者IPSS评分、夜尿次数、前列腺体积、膀胱残余尿量的变化.结果 治疗后患者IPSS评分、夜尿次数、前列腺体积、膀胱残余尿量疗效明显优于治疗前(P＜0.05),治疗5年后患者IPSS评分、夜尿次数、前列腺体积优于治疗2年后(P＜0.05),而治疗5年后患者膀胱残余尿量与患者治疗2年后无差别.结论 长期服用非那雄胺和特拉唑嗪治疗老年BPH患者疗效确切,且未出现明显不良反应.     

Combination therapy for benign prostatic hyperplasia: Does size matter?

Lower urinary tract symptoms (LUTS) in men are often associated with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). The current standard of care for men with LUTS is treatment with α-adrenergic receptor antagonists to reduce outlet tone or 5-α-reductase inhibitors to reduce prostatic volume. Up to 60% of men with BOO secondary to BPH have storage symptoms attributable to detrusor overactivity (DO), which makes treatment with anticholinergics, either alone or in combination, an attractive proposition. We present a review of the literature concerning the use of anticholinergic drugs in men with LUTS and focus on the studies that relate to enlarged prostate volumes. There have been a number of uncontrolled studies and one large, randomized controlled trial (RCT) evaluating anticholinergic drugs in men with LUTS, overactive bladder, and BPH. The results of these studies were not stratified by prostate size. A recent post-hoc analysis of the RCT, however, now provides data stratified by prostate size.     

经尿道前列腺汽化电切术治疗前列腺增生症的体会

目的 探讨经尿道前列腺汽化电切术治疗前列腺增生症的临床效果. 方法 采用经尿道前列腺汽化电切术治疗前列腺增生症患者106例. 结果 平均手术时间80 min,手术顺利,出血量少,无经尿道电切综合征发生,疗效满意. 结论 经尿道前列腺汽化电切术是治疗前列腺增生症的理想方法 ,其安全性高,疗效显著,并发症少,值得推广.     

Correlation between benign prostate hyperplasia and the related indicators of atherosclerosis

<正>Objective To investigate the correlation between benign prostate hyperplasia (BPH) and atherosclerotic related indicators. Methods Totally 125 patients were divided into two groups based on prostate volume(PV):50 cases without BPH(PV≤30 ml) and 75 cases with BPH (PV30ml)     

代谢综合征对老年人良性前列腺增生病程的影响

目的 探讨代谢综合征(MS)在老年人良性前列腺增生(BPH)病程中的作用.方法 101例BPH患者分为单纯BPH组45例与合并MS的BPH组56例,分析体质量指数(BMI)、腰围、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBS)、胰岛素抵抗指数(HOMA-IR)等代谢性因素对BPH患者前列腺体积(PV)、血清前列腺特异性抗原(PSA)、国际前列腺症状评分(IPSS)、下尿路症状(LUTS)出现时间的影响.结果 合并MS的BPH患者PV明显大于单纯BPH患者(t=3.22,P=0.003),LUTS出现时间长于后者(t=2.02,P=0.046).超重和肥胖的BPH患者PV明显大于正常体质量组[分别为(49.44±26.83)ml与(38.10±10.64)ml,P=0.021;(51.7±22.2)ml与(38.10±10.64)ml,P=0.043];腹型肥胖的BPH组患者PV明显大于非腹型肥胖的BPH患者组[(50.26±26.51)ml与(38.99±11.25)ml,P=0.005].低HDL-C水平组PV明显大于正常HDL-C水平组[(54.23±28.92)ml与(40.40±14.87) ml,P=0.009].FBS水平异常的BPH患者PV、PSA水平超过正常FBS水平者(t=3.17,2.41; P=0.035,0.013).合并胰岛素抵抗的BPH患者的PV明显大于胰岛素敏感者(t=3.43,P=0.001),LUTS出现时间在胰岛素抵抗组明显延长(t=3.58,P=0.001).PV与BMI (r=0.46,P=0.000)、FINS (r=0.42,P=0.001)、HOMA-IR (r=0.49,P=0.003)呈正相关;而与HDL-C(r=-0.38,P=0.000)呈负相关.多元逐步回归分析显示PV与HOMA-IR关系最密切.结论 MS对BPH的病程和发展具有明显的影响.     

前列腺体积在良性前列腺增生治疗中的意义

药物治疗在良性前列腺增生(BPH)的治疗中占有非常重要的地位,近90%的患者接受药物治疗.不同药物具有不同的治疗靶点,但其应用都应遵循BPH的临床治疗原则.中国BPH诊治指南推荐的BPH患者药物治疗的短期目标为缓解患者的下尿路症状(LUTS),长期目标为延缓疾病的临床进展及预防合并症的发生,在减少药物治疗不良翻印的同时保持患者较高的生活治疗是BPH药物治疗的总体目标。     

血PSA与前列腺增生症患者年龄及前列腺体积的关系

目的探讨血前列腺特异性抗原（PSA）与前列腺增生症患者年龄、前列腺体积之间的关系。方法选取前列腺增生症患者120例,采用放射免疫法测定其血PSA,采用B超检查及直肠指诊估算前列腺体积。结果血PSA与前列腺增生患者年龄关系不大,而与前列腺体积明显相关。结论测定前列腺增生症患者血PSA时,将其前列腺体积作为血PSA的影响因素考虑进去,有助于前列腺增生症与前列腺癌的鉴别。