前列腺增生症微波热疗的疗效观察

对２１４例前列腺增生症患者行经尿道前列腺微波热疗治疗。经随访观察，１８８例治疗后３个月的主、客观症状（ＩＰＳＳ评分、ＰＦＲ）改善率分别为７５．０％和７７．７％，３６个月则为３０．３％和３６．１％；余２６例伴尿猪留患者的近、无期疗效分别为５０．０％和１９．１％。提示前列腺微波热疗近期疗效尚可，但远期疗效欠理想。认为该术式适宜年老体弱、无法耐受手术的前列腺增生症患者。     

前列腺增生症微波热疗远期疗效分析

报告前列腺生症（ＢＰＨ）微波热疗后满２年的１５５例患者回顾性分析。１３４例症状型ＢＰＨ患者目前仍维持主观疗效者仅有２４例（１７．９％，Ｍａｄｓｅｎ积分）。最大尿流率和膀胱剩余尿较治疗前有改善者分别为９例（９．３％）和１１例（９．４％）。２１例慢性尿潴留患者微波热疗后现有仍能自行排尿者（膀胱剩余尿少于５０ｍｌ）为５例（２３．８％）。１２６例治疗失败或复发的患者中，重复热疗者２１例（１６．７％），改服     

体外电场热疗治疗前列腺疾病的疗效观察与护理体会

目的探讨体外电场热疗对Ⅲ型前列腺炎的疗效。方法对45例良性前列腺增生患者和50例慢性前列腺炎患者行体外电场热疗,回顾性分析患者的临床资料。结果 95例患者中显效57例(60%),有效27例(28.4%),无效11例(11.6%)。总有效率为88.4%。结论体外电场热疗有助于改善Ⅲ型前列腺炎症状,提高疗效,值得推广、应用。     

高能聚焦超声热疗治疗前列腺疾病的进展

高能聚焦超声热疗是一种能将超声能量传至远处靶组织产生杀伤作用的方法，用于前列腺疾病的治疗，可使前列腺组织发生坏死性损伤，达超声切除前列组织之目的而又不损伤邻近器官，近年来，在国外有关这方面的研究愈来愈受到人们的重视，本文就高能聚焦超声热疗及其在前列腺疾病方面的体外，体内实验，临床应用进展作一综述和探讨。     

微波治疗前列腺增生症疗效的再探讨

本文通过62例前列腺增生症患者的微波治疗,探讨了影响微波疗效的重要原因:单纯前列腺中叶增生及增生不对称,残余尿>250ml,合并有血管病、糖尿病,治疗时间短于60分钟,治疗温度不准确。     

前列腺神经内分泌细胞与前列腺疾病的关系

前列腺神经内分泌细胞(NECs)是一种非常独特的细胞,它不仅具有神经细胞的特性,同时还具有内分泌细胞和上皮细胞的特性。前列腺组织中存在的少量NECs能分泌神经内分泌肽,参与组成神经内分泌调节系统,通过内分泌、旁分泌、自分泌等多种形式,对前列腺的发育和生长分化及内分泌起着调节作用。在前列腺疾病,如慢性前列腺炎、前列腺增生及前列腺癌的发生、发展及转归中,NECs均起到重要作用。尤其是NECs缺乏雄激素受体,在去势治疗时仍可继续生长,可能通过旁分泌的方式促进肿瘤雄激素非依赖性增值,引起肿瘤复发。本文就近年来对NECs分泌的各种细胞因子及受体进行鉴定、深入研究的进展做一综述。     

前列腺体积与移行带体积变化的年龄差异

目的　探讨不同年龄段前列腺体积、移行带体积及移行带指数变化的临床意义。　方法　北京市某社区 2 13例 5 0～ 79岁男性 ,分为三个年龄段 ,采用经直肠超声测量前列腺体积、移行带体积 ,计算移行带指数 ,并对三组资料进行统计学分析。　结果　 5 0岁～、6 0岁～、70～ 79岁三个年龄段例数分别为 75、81、5 7例 ,前列腺总体积平均值分别为 (2 3.82± 8.83)ml、(2 9.16± 10 .0 1)ml、(33.77± 11.74)ml;移行带体积平均值分别为 (1.5 2± 1.19)ml、(3.6 0± 3.6 6 )ml、(7.2 5± 7.0 2 )ml;移行带指数平均值分别为 0 .10± 0 .12、0 .13± 0 .11、0 .2 0± 0 .11。统计分析显示三组间移行带体积及其指数差别有显著性意义 ,前列腺总体积差别无显著性意义。　结论　前列腺总体积、移行带体积随年龄增长而增加 ,移行带增长速度明显快于前列腺总体积 ,移行带指数反映了前列腺总体积、移行带体积的变化差异。     

外周血中血小板计数与前列腺体积相关性研究

目的:探讨外周血中炎症细胞计数与前列腺体积的关系,以期阐明良性前列腺增生(BPH)的机制。方法:严格遵守入组和排除标准募集了本中心自2015~2019年104例病理明确诊断为BPH的患者。分别采用一元和多元线性回归模型分析外周血中性粒细胞计数,血小板计数,中性淋巴比(NLR),血小板白细胞比值(PWR)及淋巴细胞单核细胞比值(LMR)等炎症指标与前列腺体积的相关性。结果:外周血中血小板计数(r=0.401,P<0.001),PWR(r=0.343,P<0.001)均与前列腺体积明显正相关,并与血清PSA水平正相关但与国际前列腺症状评分(IPSS)不相关;系统性炎症指标如NLR,LMR等与前列腺体积没有明确的相关性。结论:BPH人群里外周血中血小板计数是前列腺体积的重要预测因素,血小板可能在BPH的发生发展中扮演重要作用。     

Transurethral microwave thermotherapy for benign prostatic hyperplasia: Relation between clinical response and prostate histology

The effectiveness of transurethral microwave thermotherapy (TUMT) for BPH has been confirmed. To identify the characteristics of the ideal candidate, retrospective analysis and morphometric study of prostatic tissue were performed. Forty-two patients with symptomatic BPH were included in the study; these comprised 10 patients treated for more than 3 months with anti-androgen pre-TUMT (group A) and 32 fresh cases (group B). Subjective and objective responses were evaluated at 2 months post TUMT. In 12 fresh cases who underwent pre-TUMT biopsy of the prostate, the stromal-to-epithelial ratio was determined via quantitative image analysis on a computer-assisted morphometry system. No significant differences in baseline patient characteristics were found between the two groups: age, prostate volume, peak flow rate (PFR), or International Prostate Symptom Score (I-PSS). However, significant differences in treatment outcome were found between the two groups (group A vs. group B, respectively): total energy delivered to the prostate: 96 kJ vs. 125 kJ; I-PSS decrease from baseline: 5.9 vs. 11.6; PFR increase from baseline: 1.1 vs. 4.7 ml/sec. There was a positive correlation between the I-PSS change from baseline and the stromal-to-epithelial ratio of the prostatic tissue (r = 0.4857). The results suggest that microwave interacts poorly with the prostate due to the artificially created “lack” of glandular tissue. The morphometric study also supports the contention that the histological composition of the prostatic tissue plays an important role in terms of microwave thermal interactions and treatment outcome. © 1996 Wiley-Liss, Inc.     

Transurethral resection vs microwave thermotherapy of the prostate: a cost-consequences analysis

OBJECTIVE: To compare the costs and outcome of high-energy transurethral microwave thermotherapy of the prostate (HE-TUMT) with transurethral resection of the prostate (TURP), as the former is considered to be the best minimally invasive method for managing lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Between January 1996 and March 1997, 144 patients were randomized to treatment with HE-TUMT (78) using the Prostatron device and Prostasoft 2.5 software (EDAP Technomed, Lyon, France), or TURP (66). At baseline and during the annual follow-up, patients were evaluated by the International Prostate Symptom Score and uroflowmetry (maximum flow rate and postvoid residual volume). Kaplan-Meier survival analyses were used to calculate the cumulative risk of re-treatment. A cost-consequences analysis was performed based on the prospective measurement of healthcare use, with costs expressed as Netherland guilders (NLG). RESULTS: During a 3-year follow-up period, the mean (95% confidence interval) risk of re-treatment was 22.9 (12.5-33.2)% and 13.2 (4.5-21.9)% for HE-TUMT and TURP, respectively (P = 0.215). The mean direct cost of treatment was 3450 (3444-3456) and 6560 (5992-7128) NLG for HE-TUMT and TURP, respectively. The mean total (including re-treatments), discounted (4%) 3-year cost for the HE-TUMT and TURP group was 5300 (4692-5908) and 7800 (7118-8482) NLG, respectively. CONCLUSIONS: In this prospective randomized trial, HE-TUMT and TURP had a comparable 3-year risk of re-treatment. Healthcare expenditure on HE-TUMT, mainly because it is an outpatient treatment, was significantly lower than for TURP.     

Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: prediction of future prostate volume in individual men

BACKGROUND: We aim to establish the normal pattern of prostate volume change with age to provide a baseline from which accelerated prostate growth might be identified in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). METHODS: In a community-based study, prostate volume was determined at baseline and after 2.1 and 4.2 years in men without prostate cancer. A bivariate multilevel growth curve model was used to estimate the pattern of change of prostate volume with age. RESULTS: The average percentage increase of total prostate volume and transition zone volume per year of follow-up was 2.2% and 3.5%, respectively. The final model showed that prostate volume was related to age only. The future prostate volume of an individual can be predicted based on his age and known history of prostate volume. The model was also used to calculate time needed for the prostate volume to increase with a certain percentage, for men with different baseline prostate volume values at different ages. CONCLUSIONS: This method establishes normal prostate volume values by age using prostate volume history in men without prostate cancer. The model provides baseline data from which disease progression might be detected.     

前列腺结石与良性前列腺增生患者前列腺体积的相关性研究

目的探讨前列腺结石与前列腺增生症患者前列腺体积的相关性。方法回顾性分析本院2012年1月至2013年12月出院诊断为良性前列腺增生的患者392例,根据经直肠前列腺彩超结果将患者分为前列腺结石阴性组与阳性组,比较两组的年龄、前列腺特异性抗原(PSA)、前列腺总体积、内腺体积以及各经线之间有无差别。结果结石阴性组与结石阳性组前列腺总体积(TPV)、总体积宽径(TPV-b)、内腺体积宽径(TZV-b)差别有统计学意义(P0.05);结石阴性组与结石阳性组的年龄、内腺体积(TZV)、血清总PSA(TPSA)密度以及其他各经线差别无统计学意义(P0.05)。结论前列腺结石与前列腺增生程度存在一定的内在关系,结石有可能促进前列腺组织的增生。     

Temperature mapping in the canine prostate during transurethrally-applied local microwave hyperthermia.

Although the therapeutic effects of heat on tumors have been known for more than a century, only recently has hyperthermia been applied in the treatment of various solid tumors in a scientific fashion. In preliminary clinical trials, heat applied by transurethrally or transrectally placed microwave antennas has been used in the treatment of benign prostatic hyperplasia (BPH) with some success. However, basic information about prostatic temperature distribution and the cellular effects of hyperthermia is lacking. In an attempt to establish the safety of local hyperthermia of the prostate and the precise temperature distribution within the gland, we performed temperature mapping studies in canine prostates. Eight mongrel dogs were anesthetized, and a 16 Fr catheter with three helical coil microwave antennas was placed in the bladder through a perineal urethrostomy. Laparotomy was performed and the bladder opened. The antennas were placed under direct control in the prostatic urethra. Linear array and single point thermometers (Clini-Therm TS1200 thermometry system) were placed (1) within the catheter alongside the antennas, (2) alongside the Foley catheter in the urethra, and (3) longitudinally and radially in the prostate for mapping of tissue temperature. Heating was performed with a 915-MHz ISM frequency Z-80 microprocessor controlled microwave power generator (Prostek 3000, Clini-Therm Corporation, Dallas, TX) using 2-9 watts per channel (6-27 watts total) for 30 min to 1 hr. Baseline body temperatures varied between the individual dogs from 37 degrees to 38 degrees C, but temperature distribution within the prostate was even prior to heating. With relatively low power (6 watts total), temperatures of greater than or equal to 45 degrees C were reached within the catheter. Therapeutic temperatures of approximately 43 degrees C were achieved in the periurethral prostate. Intraurethral temperatures were in general 1-2 degrees C lower than within the catheter. The radial temperature dropoff in the prostate was sharp and about 1 degrees C per 3-mm distance from the catheter. This would limit the area of effectiveness to a periurethral zone of 1 cm in diameter in this model. No unsafe temperature peaks were noted either intraurethrally or between the prostate and the rectum during steady-state conditions. Histologic studies demonstrated an intact rectal wall and varying degrees of prostatic inflammation and/or necrosis despite uniform treatment regimens administered. These studies demonstrate the short-term safety of microwave hyperthermia in the canine prostate. Further studies will be necessary to determine the clinical efficacy and toxicity in men with BPH.     

Relationship of serum sex-steroid hormones and prostate volume in African American men

BACKGROUND: Previous epidemiologic investigations of the associations of sex-steroid hormones and benign prostatic hyperplasia (BPH) have focused on predominately white populations. The objective of this study was to evaluate potential associations of body mass index (BMI), cigarette smoking, use of alcohol, and endogenous sex-steroid hormones with prostate volume in a population-based sample of African American (AA) men, ages 40-79 yr. METHODS: A total of 369 AA men without clinical evidence of prostate cancer were identified in the Flint Men's Health Study by using a population-based sampling procedure. All subjects underwent a complete urologic evaluation that included prostate volume determination by transrectal ultrasonography and serum assays for androgens and estrogens. RESULTS: After age adjustment, BMI (weight (kg)/height (m)2) was positively correlated with increasing levels of androstanediol glucuronide (AG), estradiol (E2), estrone sulfate (E1S), and the ratios of E2:total testosterone (TT) and E2:free testosterone (FT); however, increasing BMI was negatively correlated with androstenedione (AD), FT, TT, and sex hormone-binding globulin (SHBG). Multivariable regression models demonstrated that prostate volume increased with age (P < 0.001) and BMI (P = 0.02) and decreased with increasing levels of SHBG (P = 0.01). Larger prostatic volumes were also marginally associated with increasing levels of TT (P = 0.058). CONCLUSION: Circulating serum levels of SHBG and endogenous sex-steroid hormones are correlated with prostate volume and potentially impact the natural history of BPH. However, longitudinal studies are needed to demonstrate the temporal relationships of hormones and growth factors in the pathogenesis of BPH in AA men.     

Correlation of non-invasive urodynamics with International Prostate Symptom Score (IPSS) and prostate volume

AIM: To study the correlation between non-invasive urodynamic data, the International Prostate Symptom Score (IPSS) and the prostate volume. MATERIALS AND METHODS: Data of 667 healthy volunteers participating in a longitudinal study of changes in urinary bladder contractility secondary to BPE were analyzed. The prostate volume was assessed by transabdominal ultrasonography. Uroflowmetry followed to verify if a minimum free flow rate of 4.5 ml/sec could be achieved. While (re)filling the bladder by drinking, the subjects completed the Dutch version of the IPSS. Next, the bladder pressure was non-invasively measured using the condom catheter method. The urethral resistance (URR) was calculated from the maximum condom pressure and the maximum free flow rate. RESULTS: The IPSS ranged from 0 to 29, (6.1 +/- 4.8) (mean +/- SD), whereas the prostate volumes ranged from 8 to 140 cm3, (34 +/- 18). Twenty eight percent (185/667) of the subjects had a non-invasively quantified high URR and a significantly higher IPSS (7.3 +/- 5.2) than those with a low URR (IPSS (5.7 +/- 4.6)), Mann-Whitney U-test: P < 0.001. The IPSS and the URR were significantly correlated, Spearman's rho (rho) = 0.20, P < 0.001. A significant difference between the prostate volumes, 36 +/- 21 cm3 in the high URR versus 33 +/- 17 cm3 in the low URR group, was not found, P = 0.18. CONCLUSIONS: A weak though statistically significant correlation was found between the non-invasively quantified URR and the IPSS. This suggests that an elevated resistance is a necessary, but not a sufficient condition for lower urinary tract symptoms (LUTS). No correlation was found between the URR and the prostate volume.     

The long-term influence of vasectomy on prostatic volume and morphology in man

During the past two decades several papers have described the changes in prostatic secretory capacity following vasectomy. Based upon results indicating a reduction of secretory function, it was suggested that even prostatic size and the incidence of benign prostatic hyperplasia (BPH) might be altered after the operation. In this study, which included 56 males who had been vasectomized 8 years previously and 56 age-matched control persons, transrectal ultrasonic scanning of the prostate was used for exact measurements of the prostatic volume and for the investigation of intraprostatic echo pattern. The total prostatic volume, the volume of the periurethral gland, and the volume of the peripheral zone were not influenced by the vasectomy; nor was the growth rate of these zones affected. In the vasectomy group, the frequency of adenomatous prostates was 19.6%, whereas 30.3% of prostates in the control group had ultrasonic signs of BPH. However, this is not a statistically significant difference. Subdividing the material according to age did not reveal altered BPH frequency in any age group when vasectomized and controls were compared.