Correlation between the International Prostate Symptom Score, Ultrasound Features and Maximum Flow Rate in Cameroonian Patients with Benign Prostatic Hypertrophy

Background: Benign prostatic hypertrophy is the non-malignant stromal and epithelial proliferation of the prostate gland, with or without associated anatomical enlargement of the gland and clinical symptoms. Symptomatic Benign prostatic hypertrophy may cause obstructive symptoms, irritative symptoms or both obstructive symptoms include a sensation of incomplete bladder emptying, straining to void, urinary hesitancy and weak stream while irritative symptoms include dysuria, nocturia, urinary frequency and urinary urgency. A quantitative measure of the severity of lower urinary tract symptoms due to benign prostatic hypertrophy can be obtained using the International Prostate Symptoms Score. Ultrasonography is useful for helping to determine bladder and prostate size in patients with urinary lower urinary tract symptoms. Uroflowmetry is a non-invasive test that assesses voiding function. It provides valuable data on the voided volume, time is taken to reach maximum flow rate and average flow rate. The goal of this study was to improve the follow up of patients with benign prostatic hypertrophy by providing simple, available, affordable and non-invasive that best predict bladder outlet obstruction and the quality of life in these patients. Method: This was a cross-sectional analytic study carried out over a period of five months from May 2020 to September 2020 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital, which is a tertiary hospital in Cameroon. Were included in the study, adult males who presented with lower urinary tract symptoms and prostatic enlargement suggestive of benign prostatic hypertrophy taking into account clinical, uroflowmetry and ultrasound findings. Results: A study population of 103 participants was recruited. The mean age of patients was 63.17 ± 10.26 years. Concerning the International Prostate Symptoms Score, the mean total, voiding (obstructive) and storage (irritative) scores were 14.6 ± 6.2, 8.5 ± 4.1 and 6.05 ± 2.7 respectively. The mean maximum flow rate was 13.44 ± 3.88 mL/s. The mean prostate volume was 53.71 ± 16.46 ml. A majority of patients have an enlarged prostate 1.5 to 2 times (46 to 60 mL) the upper limit for normal value. The intravesical prostatic protrusion was present in eighty-three (80.58%) and absent in 20 (19.42%). Above a prostate volume of 60 mL, 91% to 100% of our patients had intravesical prostatic protrusion. There was strong evidence (p < 0.001) that a change from no intravesical prostatic protrusion to intravesical prostatic protrusion grade 1 increased the chances of having a low maximum flow rate with a crude odds ratio of 7.98. The adjusted odds ratio after multivariate analysis was 5.26 and this remained statistically significant (p = 0.03). Conclusion: the measure of intravesical prostatic protrusion is superior to the prostate volume in the assessment of maximum flow rate and thus the follow up of patients with benign prostatic hypertrophy. This measure which is non-invasive, easy to measure, easily accessible, and cost effective may be a useful tool in predicting voiding dysfunction and acute urinary retention.

Associations among benign prostate hypertrophy, atypical adenomatous hyperplasia and latent carcinoma of the prostate

Aim： To investigate the frequency of atypical adenomatous hyperplasia （AAH） and its associations with benign prostate hypertrophy （BPH） and latent histological carcinoma of the prostate （LPC） in autopsy material. Methods： Two hundred and twelve prostate specimens obtained from autopsy material were subjected to whole mount analysis in an attempt to investigate the associations among BPH, AAH and LPC. Results： Most histological carcinomas and AAH lesions were found in enlarged prostates with intense hypertrophy. No statistically significant relation was found between BPH and the main characteristics of LPC, such as tumor volume, histological differentiation and biological behavior. Our data regarding multi-focal tumors showed a tendency for multi-focal carcinomas to develop in larger prostates, and a tendency of AAH lesions to develop in larger prostates. No statistically significant relation was found between AAH and LPC. Conclusion： There seems not any causative aetiopathogenetical or topographical relation between AAH lesions and prostate adenocarcinoma. AAH lesion seems to be a well-defined mimicker of prostatic adenocarcinoma, and the reported association of AAH with prostatic carcinoma could probably be an epiphenomenon.

The Effect of Switching Patients with Symptomatic Benign Prostatic Hyperplasia from Tamsulosin 0.2 mg to 0.4 mg

Objectives: In 2010, tamsulosin 0.2 mg (OD) was withdrawn from Thailand and replaced with tamsulosin 0.4 mg (OD). Therefore, we assessed the impact of this change on the patients, at a men’s health clinic, with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Material and Methods: Subjects were 100 men with BPH who had been taking tamsulosin 0.2 mg as needed for at least 3 months. The outcome measures were IPSS, AMS and IEFF5 scores and uroflowmetry. Tolerability was evaluated on by adverse events. Changes from baseline were assessed using the paired t-test. SPSS version 12.0 was used for statistical analysis, with p 0.05 considered significant. Results: The mean follow up of tamsulosin 0.2 and 0.4 mg were 20.23 and 10.56 months respectively. On switching from tamsulosin 0.2 to 0.4 mg, mean IPSS score improved from 15.54 ± SD 1.25 to 14.13 ± SD 1.09 (p = 0.034), Q max 15.91 cm3/sec ± SD 1.36 to 16.69 cm3/sec ± SD 1.52 (p = 0.128), and nocturia 3.15 ± SD 0.32 to 2.68 ± SD 0.39 (p = 0.015), respectively. However IEFF-5 score and AMS score increased from14.78 ± SD 1.38 to 15.79 ± SD 1.03 (p = 0.0055) and 34.76 ± SD 2.76 to 33.21 ± SD 2.62 (p = 0.0853), respectively. Treatment-related adverse events of Tamsulosin 0.2 mg included dizziness (4%), postural hypotension (3%) and retrograde ejaculation (3%). Interestingly, no withdrawals resulted from adverse events during Tamsulosin 0.4 mg assessment. Conclusions: Switching to tamsulosin 0.4 mg improves LUTS. The change was well tolerated by the majority of patients. Increased symptoms scores of erectile dysfunction and aging male during the study may be due to increased age.

Clinical value of intravesical prostatic protrusion in the evaluation and management of prostatic and other lower urinary tract diseases

Intravesical prostatic protrusion(IPP)has emerged as a new prostatic morphometric parameter of significance to aid the clinicians in various aspects of managing the patients with some diseases of the lower urinary tract and the prostate.These include but may not be limited to its role in such conditions as:bladder outlet obstruction,trial without catheter,medical treatment effect,progression of lower urinary tract symptoms related to benign prostatic hypertrophy(LUTS/BPH),risk factor for bladder stone in BPH,overactive bladder,prostate carcinoma,and early urinary continence recovery after laparoscopic radical prostatectomy.In this review,I will try to summarize the different researchers’efforts on the potential practical application of this clinical tool.Technology is ever evolving to help us in the diagnosis and management of our patients.However,we as clinicians should contemplate their cost and possible suffering for the patient by wise and judicious utilization based on our clinical experience and tools.IPP seems to be one such promising clinical tool.

Prostatic Adenomectomy by High Approach versus Millin: Our Results on a Series of 15 Cases

Background: In 2023, conventional surgery for benign prostatic hyperplasia (BPH) is still used despite the introduction of minimally invasive techniques in the therapeutic arsenal. Objective: To present our results of Millin prostatic adenomectomy in a preliminary series of 15 cases. Patients and Methods: Cross-sectional study conducted at the Urology Department of the Bouaké University Hospital from January 2022 to January 2023. It involved 15 patients with benign prostatic hyperplasia (BPH) who had undergone high adenomectomy using the Millin technique. Results: During the study period, 15 cases of benign prostatic hyperplasia were treated surgically by high adenomectomy using the Millin technique. The mean age of the patients was 63.6 years, ranging from 53 to 78 years. Nine (9) patients were consulted for progressive complications of benign prostatic hyperplasia (BPH), i.e. 60% (n = 9). The mean IPSS score was 28 (20 to 35), and seven (7) patients had a comorbidity (46.44%). The digital rectal examination (DRE) was in favour of benign prostatic hypertrophy in all patients, and the mean weight of the prostate at DRE was 75 g, ranging from 55 g to 100 g. From a paraclinical point of view, prostatic ultrasound revealed a mean BPH weight of 82.7 g with extremes of 55 to 100 g. Post-micturition residue was greater than 150 ml in 60% (n = 9). The mean prostate-specific antigen (PSA) level was 3.8 ng/ml, ranging from 1.4 to 15 ng/ml. There was one case of severe anaemia with a haemoglobin level of 6 g/dl on haemogram, treated by blood transfusion. The cytobacteriological examination of the urine (ECBU) revealed five cases of E. coli infection, i.e. 33.33% (n = 5). Millin prostatic adenomectomy was performed under antibiotic prophylaxis at induction. All patients underwent locoregional anaesthesia. The mean weight of the adenoma was 80 g with extremes of 55 to 155 g. Blood loss was minimal at less than 100 ml, i.e. 86.6% (n = 13). The average operating time was 56.9 minutes, ranging from 45 to 75 minutes. The Retzius space was drained in an average of 2.75 days, with extremes of 2 to 4 days. The average duration of postoperative bladder catheterisation was 8.7 days, with extremes of 7 to 10 days. The average duration of bladder irrigation-washing was 3.6 days. The average hospital stay was 8.55 days, with extremes of 8 to 10 days. Morbidity was represented by Orchi-epididymitis (66%, n = 1) and mortality was 6.66% (n = 1). 6 months later, the 14 patients had good micturition comfort with an RPM of less than 10 ml. Anatomo-pathological examination of the adenomectomy specimen was in favour of an adenomyofibroma of the prostate with no stigma of malignancy. Conclusion: Prostatic adenomectomy using the Millin technique is rarely performed, but a look at the results shows that it is still the least morbid and fatal technique.

Trace Element Levels in Prostate Gland as Carcinoma’s Markers

Objectives: The aim of this study was to evaluate the changes in the prostatic levels of trace elements in the malignant human prostate. Methods: Contents of 43 trace elements in normal (N, n = 37), benign hypertrophic (BPH, n = 32) and cancerous (PCa, n = 60) prostate were investigated. Measurements were performed using instrumental neutron activation analysis and inductively coupled plasma mass spectrometry. Results: The mass fractions of all trace elements with the exception of La, Nb, and Yb show significant variations in cancerous prostate when compared with normal and BPH prostate. The contents of Co, Hg, Rb, Sc, Se, and Zn were significantly lower and those of Ag, Al, Au, B, Be, Bi, Br, Ce, Cr, Cs, Dy, Er, Gd, Ho, Li, Mn, Mo, Nd, Ni, Pb, Pr, Sb, Sm, Sn, Tb, Th, Ti, Tl, Tm, U, Y, Yb, and Zr were significantly higher in PCa than in BPH tissues. When trace elements of cancerous prostate were compared with those in normal prostatic parenchyma, contents of Cd, Rb, Sc, Se, and Zn were significantly lower and Ag, Al, Au, B, Be, Bi, Br, Ce, Cr, Dy, Er, Fe, Gd, Hg, Ho, Li, Mn, Nd, Ni, Pr, Sb, Sm, Sn, Tb, Th, Tl, Y, and Zr were significantly higher. Conclusion: The Ag, Al, B, Br, Li, Mn, Ni, and Zn mass fraction in a needle-biopsy core can be used as the informative indicators for distinguishing malignant from benign prostate. Sensitivity, specificity, and accuracy of these tests were in range 72% - 100%, 66% - 100%, and 74% - 98%, respectively.

非那雄胺对经尿道前列腺切除术中出血和冲洗液吸收影响的定量性研究

目的 :探讨术前口服非那雄胺对经尿道前列腺切除术 ( TURP)患者术中出血量和冲洗液吸收量的影响。方法 :将 80例前列腺增生患者随机分为两组 ,对照组 4 0例术前不用非那雄胺 ,试验组 4 0例术前口服非那雄胺 ;应用比色法和庆大霉素标记法定量测定两组患者术中出血量和冲洗液吸收量。结果 :两组术中出血总量、冲洗液血红蛋白浓度、每克切除前列腺组织出血量、每分钟出血量、冲洗液吸收总量、每克切除前列腺组织冲洗液吸收量、每分钟冲洗液吸收量比较 ,实验组明显比对照组减少 ( P<0 .0 5 )。实验组低血压发生率、输血量、手术结束时血钠下降值、低钠血症发生率均较对照组明显减少 ( P<0 .0 5 )。结论 :术前短期服用非那雄胺可以减少 TURP术中出血和冲洗液吸收 ,降低手术并发症。

90岁以上高龄前列腺增生患者经尿道前列腺电切术的围手术期处理(附25例报道)

目的总结90岁以上前列腺增生(BPH)经尿道前列腺电切术(TURP)的临床经验,提出该手术围手术期处理的特别措施,减少手术并发症,降低死亡率。方法1995年1月至2004年12月对25例90岁以上高龄BPH患者行TURP,年龄90～93岁,平均为90.23岁。其中23例患者认知能力正常,2例合并有老年痴呆。5例合并严重的血尿,7例合并膀胱结石,11例慢性尿潴留拒绝留置导尿管或膀胱造瘘管。20例于连续低位硬膜外麻醉下行TURP,5例于全麻下行手术。结果手术时间5～45min,平均为19.4min;电切前列腺组织称重15～71g,平均为28.9g;出血量30～220ml,平均为105ml。25例中4例术中在无严重出血的情况下出现生命体征紊乱,21例顺利度过手术期。术后未发生严重的并发症,48～72h拔导尿管,22例排尿通畅;3例尿潴留,留置导尿。结论严密的围手术期保护、电切时间短是手术成功的关键。对90岁以上高龄BPH患者而言,TURP是安全的手术方法。

前列腺增生症患者术后排尿异常的尿动力学诊断及治疗

目的 :探讨前列腺增生症术后症状未改善患者的尿动力学改变及再次治疗的方法。方法 :对前列腺增生症术后排尿症状未改善 1 5例患者进行尿动力学检查 ,并根据结果选择治疗方法。结果 :4例患者存在不稳定性膀胱 (4/ 1 5) ;逼尿肌收缩乏力 3例 ;膀胱出口梗阻 5例 ;外括约肌痉挛 2例 ;真性尿失禁 1例。采用不同方法治疗后有效 1 3例 ,无变化 1例。结论

膀胱逼尿肌功能改变对前列腺增生手术效果的影响

为探讨膀胱逼尿肌功能改变对前列腺增生 (BPH)手术效果的影响 ,对 336例 BPH患者于术前行尿流动力学检查 ,对 82例术后疗效不满意患者行尿流动力学加膀胱镜检查。结果术前膀胱逼尿肌功能异常者 32 6例(97% ) ,其中痉挛 10 9例 (32 .4 % )、低顺应性 73例 (2 1.7% )、逼尿肌括约肌功能失调 (DSD) 4 3例 (12 .8% )、功能亢进 5 1例 (15 .2 % )、收缩乏力 5 0例 (14 .9% )。术后共 82例疗效不满意 (2 4 .4 % ) ,其中膀胱逼尿肌功能紊乱为主要因素者 39例 (47.6 % ) ;2 5例术后 6个月症状改善 ,合并神经损害及高龄、膀胱逼尿肌收缩乏力者疗效较差。认为膀胱逼尿肌功能可预测 BPH手术效果 ,并指导术前。

经尿道电切术治疗重度前列腺增生症

目的 :探讨重度前列腺增生症经尿道电切治疗效果。方法 :采用经尿道前列腺电切术 (TURP)治疗重度 BPH 70例 ,随访 3～ 18个月。结果 :切除前列腺重量平均 74.6 g,平均手术时间 70 min。术后平均留置导尿管 3 d,术后平均住院时间 5 d。最大尿流率 (Qmax)由术前的 (6 .3± 1.5 ) ml/ s上升至术后 3个月的 (15 .1± 4.7)m l/ s,前列腺症状评分 (IPSS)术前为 (2 9.7± 1.2 )分 ,术后 3个月降至 (5 .1± 1.0 )分 (P<0 .0 1)。结论 :TURP安全、并发症少、疗效好。重度 BPH不是 TU RP的禁忌证。

通关胶囊治疗前列腺增生症临床观察及机理探讨

目的 :为了评估中药通关胶囊对良性前列腺增生症 (BPH)的疗效和安全性。 方法 :对 90例BPH进行了临床观察 ,治疗组 6 0例给予通关胶囊 ,对照组 30例给予前列康 ,治疗观察 3个月。 结果 :治疗组总有效率为 88 3% ,明显优于对照组 ,经统计学处理P <0 0 5。不良反应的发生率为 3%。 结论 :认为通关胶囊治疗BPH疗效肯定 。

前列腺增生症疗效不佳者尿流动力学原因分析

为分析良性前列腺增生症（BPH）疗效不佳的原因，对58例曾接受经膀胱及Madigan前列腺摘除术、经尿道前列腺切除术、经尿道激光治疗、微波及射频热疗等不同方法治疗并诉疗效不满意的BPH患者进行尿流动力学测定，项目为充盈期膀眈测压、压力－流率测定、EMG测定、静态及加压尿道压力测定。测定结果为膀胱出口梗阻（BOO）占48．3％、逼尿肌收缩无力（DDC）占17．2％、逼尿肌不稳定（DIS）占20．7％、压力性尿失禁（SIC）占5．6％及神经原件膀胱尿道功能障碍（NBUD）为8．6％。对各原因在不同方法中的发生率进行比较，并对各方法易出现的失败原因进行分析．表明微波及射频治疗后残留BOO发生率较高，开放手术致BOO与手术并发症及适应证的选择有关；DDC及DIS为BOO继发性改变，梗阻解除后可以恢复；顽固性DDC及DIS应与NBUD相鉴别；BPH患者易并发糖尿病及脑血管病变，应注意对BPH并发NBUD的诊断。全面的尿流动力学分析有助于科学客观地总结经验，制定进一步治疗方案，同时对于治疗方法的评价、适应证的选择及进一步提高疗效等均具有重要意义。

血管内皮生长因子受体激酶插入嵌合受体在前列腺癌及良性前列腺增生组织中的表达

目的:探讨血管内皮生长因子受体KDR在PCa组织中的表达及其与PCa病理学分级之间的关系。方法:用KDR多克隆抗体对48例PCa组织和20例BPH组织石蜡包埋切片进行免疫组化染色。分析KDR在PCa、BPH组织中的表达情况以及表达强度与PCa组织病理学分级之间的关系。结果:KDR在73%PCa组织、30%BPH组织中呈不同程度的阳性表达。在PCa组织中呈明显高表达(P<0.05),表达强度与前列腺癌的Gleason评分无相关性(r=0.09,P>0.05)。结论:KDR在PCa组织中的表达明显增高,有望成为治疗PCa的一个新靶点。

雌激素受体α基因多态性与良性前列腺增生相关研究

目的:探讨雌激素受体α基因PvuII和XbaI位点的单核苷酸多态性与良性前列腺增生(BPH)发病风险的关系。方法:收集112例BPH患者和111例健康对照人群的外周血标本,应用PCR-RFLP技术分析雌激素受体α基因PvuII和XbaI的单核苷酸变异,采用非条件logistic回归分析和计算其基因型和等位基因频率。结果:PvuII和XbaI位点基因型符合Hardy-Weinberg平衡检验;PvuII位点以杂合子基因型Pp占多数(占44.84%),基因型PP最少(占14.35%);XbaI位点以纯合子基因型xx为主,为64.13%;XX最少,为4.48%;比较PvuII和XbaI位点的基因型和等位基因在BPH患者和健康对照中的分布频率,差异均无显著性(P>0.05);雌激素受体α基因PvuII与XbaI位点间具有较强的连锁不平衡效应(D’=0.958,r2=0.398)。单体型分析显示pX在BPH患者中的分布显著高于健康对照人群(P=0.032108,OR=6.394,95%CI:0.919～44.517),提示单体型pX是BPH发生的易感因素。结论:雌激素受体α基因的单核苷酸多态性与前列腺增生发病存在一定的相关性。

经尿道三种电切术治疗前列腺增生的疗效比较

目的:比较经尿道电切(TURP)、经尿道汽化电切(TUVP)、经尿道等离子电切(PKRP)3种手术方法治疗良性前列腺增生的疗效及并发症。方法:分别采用TURP、TUVP、PKRP3种方式治疗BPH患者615例。TURP组270例,TUVP组280例,PKRP组65例,3组病例术前前列腺症状评分(IPSS)、剩余尿量(RUV)、最大尿流率(Qmax)、生活质量评分(QOL)比较差异均无统计学意义(P>0.05)。比较3组手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率及疗效。结果:TURP组成功267例(99%);TUVP组成功274例(98%);PKRP组65例均获成功。TURP、TUVP、PKRP组手术时间组间比较差异无统计学意义(P>0.05);3组术中出血量组间比较差异有统计学意义(P<0.01);3组术后平均留置尿管时间分别为4.1、4.2、3.5d(P>0.05);3组平均住院时间分别为6.2、6.7、5.1d(P<0.01)。TURP组并发症发生率2.6%。TUVP组并发症发生率6.8%。PKRP组术后并发症发生率3.1%。术后3、6个月随访,3组IPSS、RUV、QOL均较术前明显下降,Qmax均较术前明显增加,但组间比较差异均无统计学意义(P>0.05)。结论:3种方法均有明确的临床效果,临床上可根据患者情况和适应证选择不同方法,以获得更好的临床疗效。

大豆异黄酮、姜黄素预防良性前列腺增生的实验研究

目的探讨大豆异黄酮和姜黄素对良性前列腺增生的预防作用。方法体外试验用药物直接与组织培养前列腺平滑肌细胞作用,噻唑蓝比色法检测药物的抑制率;体内试验以口服给药观察大豆异黄酮、姜黄素对丙酸睾酮诱导的小鼠前列腺增生的对抗作用;RT-PCR法探讨端粒酶逆转录酶(TERT)的mRNA表达。结果大豆异黄酮和姜黄素可抑制大鼠前列腺平滑肌细胞生长,对抗高雄激素诱导的小鼠前列腺指数增高,降低TERT的mRNA表达。结论大豆异黄酮和姜黄素对前列腺增生有预防作用,其作用机制可能与下调TERT有关。

常规磁共振成像与三维磁共振波谱对前列腺特异性抗原灰区患者鉴别诊断价值研究

目的：探讨常规磁共振成像（magnetic resonance imaging,MRI）联合三维磁共振波谱（magnetic resonance spectroscopy,MRS）成像对PSA灰区患者在前列腺癌与BPH的鉴别价值.方法：回顾性分析25例经病理证实的前列腺癌、20例前列腺增生PSA灰区患者进行MRI及MRS检查.MRS成像计算（cho＋ cre） /Cit的比值,比值大于0.99为前列腺癌的可疑波谱,将病灶的多体素取平均值,并与病理及其他磁共振方法进行对照.结果：MRI确诊率77.8％,MRS确诊率86.7％,MRI联合MRS确诊率95.6％.结论：MRI联合MRS用于临床诊断PSA范围在4～10ng/mL的患者,可以提高前列腺疾病的诊断率,但还需要前列腺活检以确定诊断.

经尿道前列腺等离子双极气化电切术治疗高危前列腺增生的疗效分析

目的比较经尿道前列腺等离子双极气化电切术(TUP-KVP)治疗高危前列腺增生(BPH)的疗效。方法将224例老年高危BPH患者随机分为TUP-KVP组和TURP组,每组各112例,分别采用经尿道前列腺等离子双极气化电切术和经尿道前列腺电切术进行治疗。结果 TUP-KVP组的手术时间、术中出血量较TURP组明显减少,而术后IPPS评分、尿流动力学检查结果均明显优于TURP组,差异有统计学意义(P<0.05);TUP-KVP组并发症发生率显著低于TURP组,差异有统计学意义(P<0.05)。结论 TUP-KVP具有切除腺体彻底,手术时间短,术中出血少及并发症少等优势,是治疗高危BPH理想的手术方式。

杭州地区军队离休老干部前列腺症状调查

目的 了解杭州地区军队离休老干部前列腺增生 (BPH)的症状情况。方法 采用国际前列腺症状评分 (IPSS)及生活质量评估 (QOL)的方法对 389名 6 5岁以上的军队离休老干部进行问卷调查。结果 BPH的患病率为 5 4 .3% ,按年龄分组的患病率 6 5 ,70 ,75 ,≥ 80岁者分别为 32 .0 % ,4 8.4 % ,5 2 .7%和 6 7.0 %。IPSS及QOL的平均分分别为 12 .5 9和 2 .39。BPH症状轻、中、重度的比例分别是 4 5 .8% ,36 .8%和 17.5 %。结论 前列腺增生症患病率较高 ,是离休老干部的常见病之一。随年龄增大 。