Benign Prostatic Enlargement, the International Prostate Symptoms Score and a Review of Other Symptom Scores

Benign prostatic hyperplasia (BPH) is the most common benign prostate disease in elderly men, and its incidence increases with age and is associated with lower urinary tract symptoms (LUTS). The international prostate symptoms score (IPSS) is the most common symptom score used to assess LUTS even though other symptom scores exist. This study aims to evaluate the LUTS of patients secondary to BPH presenting to the urology clinic of UPTH using the IPSS and to review other scoring systems. Materials and Methods: This was a prospective hospital based descriptive cross-sectional study carried out in University of Port Harcourt Teaching Hospital (UPTH). All adult male patients with LUTS secondary to BPE were given an IPSS questionnaire to fill. Another IPSS questionnaire was filled by the patient assisted by the researcher. The data were collated using Microsoft Excel 2016 version and they were analyzed using SPSS version 20. Results were presented in tables. Results: Sixty-nine (69%) patients had at least secondary level of education. Sixty-four (64%) could complete their questionnaire without any aid. The mean IPSS was 22.13 ± 6.34 as most patients presented with severe symptoms. The mean Quality of Life score was 4.60 ± 1.38. There was a significant positive correlation between Quality of Life and IPSS. Conclusion: A level of literacy is needed to complete the questionnaire. Most patients in our study presented late with severe symptoms and significant level of bother. Nocturia was the worst symptom.

Tumor necrosis factor-alpha, transforming growth factor-beta, degree of lower urinary tract symptoms as predictors of erectile dysfunction in benign prostatic hyperplasia patients

Objective: Erectile dysfunction (ED) is a condition of insufficient penile erection, consistently or recurrently, for sexual activity. Tumor necrosis factor-alpha (TNF-α) induces transforming growth factor-beta (TGF-β), which causes the transition of epithelial cells into mesenchymal cells that affect ED. This study aimed to evaluate the roles of TNF-α, TGF-β, degree of lower urinary tract symptoms, and prostatic volume for the presence of ED in benign prostatic hyperplasia (BPH) patients.Methods: Our study performed an analytic observational retrospective cohort study using secondary data from four hospitals in Bali, Indonesia, including medical records and other administrative data. The sample was BPH patients with several history qualifications.Results: Our sample was 83 respondents, ranging from 50 years to 80 years, 61 respondents with ED and 22 with non-ED. The International Prostate Symptom Score showed a significant result, which indicates that ED is more common in patients with higher International Prostate Symptom Score (p=0.002). Moreover, the TNF-α of ≥43.9 pg/mg and TGF-β of ≥175.8 pg/mL were significantly associated with the presence of ED in BPH patients (p<0.0001). Despite these results, prostate volume is not significant with ED (p=0.947).Conclusion: TNF-α, TGF-β, and lower urinary tract symptoms severity can predict the occurrence of ED in BPH, while prostatic volume was not significant.

Methylated CpG dinucleotides in the 5 -a reductase 2 gene may explain finasteride resistance in benign prostatic enlargement patients

The inhibition of 5-a reductase type 2(SRD5A2)by finasteride is commonly used for the management of urinary obstruction resulting from benign prostatic enlargement(BPE).Certain BPE patients showing no SRD5A2 protein expression are resistant to finasteride therapy.Our previous work showed that methylated cytosine-phosphate-guanine(CpG)islands in the SRD5A2 gene might account for the absence or reduction of SRD5A2 protein expression.Here,we found that the expression of the SRD5A2 protein was variable and that weak expression of the SRD5A2 protein(scored 0-100)occurred in 10.0%(4/40)of benign adult prostates.We showed that the expression of SRD5A2 was negatively correlated with DNA methyltransferase 1(DNMT1)expression.In vitro SRD5A2-negative BPH-1 cells were resistant to finasteride treatment,and SRD5A2 was re-expressed in BPH-1 cells when SRD5A2 was demethylated by 5-Aza-2T-deoxycytidine(5-Aza-CdR)or N-phthalyl-L-tryptophan(RG108).Furthermore,we determined the exact methylation ratios of CpG dinucleotides in a CpG island of SRD5A2 through MassArray quantitative methylation analysis.Ten methylated CpG dinucleotides,including four CpG dinucleotides in the promoter and six CpG dinucleotides in the first exon,were found in a CpG island located from-400 bp to+600 bp in SRD5A2,which might lead to the silencing of SRD5A2 and the absence or reduction of SRD5A2 protein expression.Finasteride cannot exert a therapeutic effect on patients lacking SRD5A2,which may partially account for the resistance to finasteride observed in certain BPE patients.

Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?

Objective:We sought to determine if urodynamic study(UDS)predicted voiding outcomes in men with detrusor underactivity(DU)and benign prostatic enlargement(BPE)who underwent photovaporization of the prostate(PVP).Methods:Between September 2010 and July 2015,106 male patients with BPE and DU were identified.All patients underwent PVP.Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter.Data collection included comorbidities,quality of life(QoL)scores,prostate volume,prostate-specific antigen(PSA),UDS and perioperative outcomes.UDS parameters included volume at first desire to void,volume at first urge to void,volume of severe urge,volume at capacity,compliance,detrusor contractions,maximum urinary flow rate(Qmax),and postvoid residual(PVR).Results:A total of 106 men were included in this analysis,who had urinary retention with a Foley catheter or clean intermittent catheterization(CIC)at the time of surgery.At baseline we found patients who voided had a detrusor pressure at Qmax(Pdet@Qmax)of 10.05±6.45 cmH2O compared to 16.78±12.17 cmH2O in those who did not void(p=0.071).Postoperatively,96(90.6%,mean age 76.9±26.2 years)of patients voided successfully while 10(9.4%,mean age 80.52±9.61 years)of patients remained in urinary retention.Mean baseline Qmax was 4.895±5.452 mL/s and 2.900±3.356 mL/s(p=0.087)in those who voided and did not respectively.PVR was 319.23±330.62 mL in those who voided and 276.88
263.27 mL(p=0.344)in those who did not void.No UDS parameter predicted who would void postoperatively or improvements in QoL.Conclusions:The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings.All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.

Non-invasive evaluation of lower urinary tract symptoms(LUTS)in men

Lower urinary tract symptoms(LUTS)are common in males over the age of 40 years old and are likely to increase with an aging population.Currently urodynamic studies are the gold standard to determine the aetiology of voiding dysfunction and LUTS.However,due to its invasive nature,a great number of non-invasive ultrasound based investigations have been developed to assess patients with symptomatic LUTS.The clinical application of noninvasive tests could potentially stratify patients who would require more invasive investigations and allow more precise patient directed treatment.A PubMed literature review was performed and we will discuss the non-invasive investigations that have been developed thus far,focusing on bladder wall and detrusor wall thickness(BWT&DWT),ultrasound estimated bladder weight(UEBW)and intravesical prostatic protrusion(IPP).

Surgical Haematuria: An Analysis of Causes in a Southern Nigerian State

Background: Surgical haematuria is not very common but ominous when it occurs. Knowledge of the causes will help in the adequate management of the disease. Aim: To evaluate the causes of surgical haematuria in Port Harcourt, Nigeria. Materials and Method: This is 10 years retrospective study of patients who presented at the University of Port Harcourt Teaching Hospital and 4 other private urology centres in Port Harcourt with haematuria of surgical aetiology between January 2012 and December 2021. Their history, examination findings and investigations were evaluated. Patients with medical haematuria and incomplete records were excluded from the study. Results: Three hundred and forty-six patients were evaluated. The mean age was 58.12 ± 5.1. Two hundred and sixty-four (76.3%) were men and eighty-two (23.7%) were females. The three commonest causes of haematuria were Benign prostatic enlargement, prostate cancer and urolithiasis with a frequency of 126 (36.41%), 66 (19.08%) and 40 (11.56%) respectively. The cause of haematuria was benign in 232 (67.06%) subjects and malignant in 114 (32.94%). Conclusion: The commonest causes of haematuria are of prostatic origin, mainly benign although malignancy is a significant cause.

Clinical correlates of enlarged prostate size in subjects with sexual dysfunction

Digito-rectal examination （DRE） of the prostate provides useful information on the state of prostate growth and on the presence of suspected peripheral nodules. The aim of this study is to describe the clinical and biochemical correlates of finding an enlarged prostate size at DRE in subjects with sexual dysfunction （SD）. A consecutive series of 2379 patients was retrospectively studied. The analysis was focused on a subset of subjects （n = 1823; mean age 54.7± 11.4） selected for being free from overt prostatic diseases. Several parameters were investigated. After adjusting for confounders, the presence of an enlarged prostate size at DRE was associated with a higher risk of metabolic syndrome （HR = 1.346 （1,129-1.759）; P = 0.030）, type 2 diabetes mellitus （HR = 1.489 （1.120-1.980）; P = 0.006）, increased LDL cholesterol （〉100mgdl^-1; HR = 1.354 （1.018-1.801）; P = 0.037） and increased mean blood pressure （BP） values （HR = 1.017 （1.007-1.027） for each mmHg increment; P = 0.001）. Accordingly, enlarged prostate size was also associated with a higher risk of arteriogenic erectile dysfunction （ED）, as well as with other andrological conditions, such as varicocele and premature ejaculation （PE）. PSA levels were significantly higher in subjects with enlarged prostate size when compared to the rest of the sample （HR = 3.318 （2.304; 4.799） for each log unit increment in PSA levels; P 〈 0.0001）. Arteriogenic ED, according to different criteria, was also associated with increased PSA levels. In conclusion, our data support the need to examine prostate size either by clinical （DRE） or biochemical （PSA） inspection in subjects with SD, in order to have insights into the nature of the SD and the metabolic and cardiovascular （CV） background of the patient.

A 30-year retrospective study of rare ectopic seminal tract opening cases

Ectopic seminal tract openi ng is a rare con genital malformation.Until rece ntly,there has been a lack of comprehensive reporting on the condition.The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years.We conducted auxiliary examinations on such patients including routine tests,imaging examinations,and endoscopy.Among these 28 cases,there were ectopic opening of vas deferens into enlarged prostatic utricles(6 cases);ejaculatory ducts into enlarged prostatic utricles,Mullerian ducts cysts,and urethras(18 cases,2 cases,and 1 case,respectively);and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle(1 case).The size of the enlarged prostatic utricle,the type of ectopic seminal tract opening,and the opening's location effectively assisted in the selection of clinical treatment methods,including transurethral fenestration of the utricle,transurethral cold-knife incision,open operation,laparoscopic operation,and conservative treatment.Satisfactory effect was achieved during follow-up.In conclusion,a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.