Hiperplasia prostática benigna y síntomas del tracto urinario inferior / Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms

Introducción: La hiperplasia prostática benigna constituye un problema de primer nivel de atención de salud por su alta prevalencia en los hombres. Objetivo: Identificar la presencia de síntomas del tracto urinario inferior relacionados a la hiperplasia prostática benigna y su repercusión en la calidad de vida de hombres de 50 o más años de edad, sin diagnóstico previo de hiperplasia prostática benigna, que asistieron al centro de salud de la parroquia Javier Loyola. Métodos: Estudio descriptivo transversal entre noviembre del 2018 y enero 2019, que incluyó al total pacientes (106), que asistieron al centro de salud de la parroquia Javier Loyola y que aceptaron completar la Escala internacional de síntomas prostáticos. Los datos fueron analizados por medio de la estadística descriptiva y el test de χ2. Resultados: El 35,3 por ciento de investigados pertenecieron al grupo etario de 40 a 50 años, la presencia de síntomas del tracto urinario inferior leves (38,8 por ciento), moderados (39,7 por ciento) y severos (21,5 por ciento). Prevalecieron en porcentaje de participantes los desocupados (22,4 por ciento), los albañiles (23,3 por ciento), los hipertensos (26,7 por ciento), diabéticos (17,2 por ciento) y obesos (14,7 por ciento). La severidad de los síntomas del tracto urinario inferior no se asoció significativamente al tipo de ocupación. El 61,2 por ciento de pacientes presentaban síntomas del tracto urinario inferior moderados o severos y un 56,8 por ciento percibieron que su calidad de vida se veía afectada de alguna manera por los síntomas del tracto urinario inferior. Conclusiones: Preocupa el alto porcentaje de participantes con síntomas del tracto urinario inferior moderados/severos sin un diagnóstico previo de hiperplasia prostática benigna y con percepción de que su calidad de vida se ve afectada. La severidad de los síntomas del tracto urinario inferior incrementó con la edad y no a otros factores, excepto la ocupación(AU)

Introduction: Benign prostatic hyperplasia constitutes a first-level healthcare concern, due to its high prevalence among men. Objective: To identify the presence of lower urinary tract symptoms related to benign prostatic hyperplasia and its impact on the quality of life of men aged 50 years or older, without a previous diagnosis of benign prostatic hyperplasia, who attended the health center of Javier Loyola Parish. Methods: Cross-sectional descriptive study carried out between November 2018 and January 2019, which included all the patients (106) who attended the health center of Javier Loyola Parish and agreed to complete the International Prostate Symptom Scale. The data were analyzed using descriptive statistics and the chi-square test. Results: 35.3 percent of the participants belonged to the age group from 40 to 50 years. The presence was observed of mild (38.8 percent), moderate (39.7 percent) and severe (21.5 percent) lower urinary tract symptoms. There was a prevalence of unemployed (22.4 percent), bricklayers (23.3 percent), hypertensive (26.7 percent), diabetic (17.2 percent) and obese (14.7 percent) participants. The severity of the lower urinary tract symptoms was not significantly associated with the type of occupation. 61.2 percent of patients had mild or severe lower urinary tract symptoms and 56.8 percent perceived that their quality of life was affected, in some way, by lower urinary tract symptoms. Conclusions: There is concern about the high percentage of participants with mild or severe lower urinary tract symptoms, without a previous diagnosis of benign prostatic hyperplasia, and with some perception that their quality of life is affected is. The severity of lower urinary tract symptoms increased with age but not with other factors, except occupation(AU)

Depressive males have higher odds of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a retrospective cohort study based on propensity score matching / 亚洲男科学杂志(英文版)

Lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and depression are both increasing in Chinese aging males. However, the relationship still remains unknown. To explore their relationship, a retrospective cohort study based on propensity score matching (PSM) was conducted by analyzing the China Health and Retirement Longitudinal Study dataset. After data cleaning, a total of 5125 participants were enrolled and subjected to PSM; 1351 pairs were matched and followed for 2 years. Further logistic regression and restricted cubic spline (RCS) were performed to evaluate, model and visualize the relationship between depression and LUTS/BPH. Moreover, subgroup analyses and sensitivity analyses were adopted to verify the robustness of the conclusions. Before PSM, depressive patients showed higher odds of LUTS/BPH in all three models adjusting for different covariates (P < 0.001). After PSM, univariate logistic regression revealed that depressive patients had higher risks for LUTS/BPH than participants in the control group (odds ratio [OR] = 2.10, P < 0.001). The RCS results indicated a nonlinear (P < 0.05) and inverted U-shaped relationship between depression and LUTS/BPH. In the subgroup analyses, no increased risks were found among participants who were not married or cohabitating, received an education, had an abnormal body mass index (<18.5 kg m

Hiperplasia prostática gigante. Adenocarcinoma. Reporte de un caso / Giant prostatic hyperplasia. Adenocarcinoma. Case report

RESUMEN Se presenta el caso de una hiperplasia prostática gigante, combinada con un adenocarcinoma que se presentó como una tumoración abdominal. El paciente presentaba una tumoración palpable en hipogastrio y un síndrome obstructivo urinario bajo. Se intervino quirúrgicamente y se realizó adenomectomía combinada, transvesical y retropúbica. La biopsia informó pequeño adenocarcinoma prostático acinar Gleason 3-4 puntos, en el contexto de una hiperplasia prostática. El paciente evolucionó satisfactoriamente y se sigue en consulta. La tumoración extraída tenía 736 g y constituye la de mayor peso reportada en Cuba y la quinta a nivel mundial (AU).

ABSTRACT We describe the case of a giant prostatic hyperplasia, combined with an adenocarcinoma presented as an abdominal tumor. The patient had a palpable tumor in the hypogastrium and a low urinary obstructive syndrome. He was operated and a combined, transvesicular and retropubic adenomectomy was performed. The biopsy informed a little 3-4 points-Gleason, acinar, prostatic adenocarcinoma, in the context of a prostatic hyperplasia. The patient evolved satisfactorily and was followed up in consultation. The removed tumor was 736 g, and is the heaviest one reported in Cuba and the fifth worldwide (AU).

Comportamiento sindrómico de pacientes con hiperplasia benigna de la próstata según la Medicina Tradicional China / Syndrome behavior of patients with prostate benign hyperplasia according to the Traditional Chinese Medicine

Introducción: la hiperplasia benigna de la próstata se define como una entidad histopatológica caracterizada por un crecimiento fibromioadenoso de la glándula prostática. Según la Medicina Tradicional China se clasifica bajo categorías diferentes, dependiendo de cada paciente y de sus síntomas clínicos principales. Objetivo: establecer el comportamiento de esta enfermedad según la Medicina Tradicional China. Materiales y Métodos: se realizó un estudio observacional, descriptivo, en pacientes con diagnóstico de hiperplasia benigna de próstata atendidos en el Servicio de Referencia Provincial de Medicina Natural y Tradicional "Dr. Mario E. Dihigo" de Matanzas, en el período correspondiente a febrero 2013 agosto de 2014. El universo lo conformaron los pacientes diagnosticados con la patología y que asistieron a consulta de Medicina Natural y Tradicional. La muestra fueron los 100 pacientes dispuestos a participar en la investigación que firmaron voluntariamente el consentimiento informado y se les realizó historia clínica. Resultados: la deficiencia de Yin en riñón e hígado y la humedad-calor en Jiao inferior fueron los diagnósticos que prevalecieron en la investigación. Conclusiones: la realización del diagnóstico tradicional chino posibilita indicar un tratamiento individualizado a los pacientes al tratar la causa que lo origina (AU).

Introduction: the prostate benign hyperplasia is defined as a histopathologic entity characterized by the prostate gland fibromioadenomatous growth. According to the Traditional Chinese Medicine it is classified in different categories, depending on each patient and his/her main clinical symptoms. Objective: to establish this disease behavior according to the Traditional Chinese Medicine. Materials and methods: an observational, descriptive study was carried out in patients diagnosed with prostate benign hyperplasia attended at the Provincial Reference Service of Natural and Traditional Medicine "Dr. Mario E. Dihigo" of Matanzas, in the period from February 2013 to August 2014. The universe was formed by the patients diagnosed with that pathology who assisted to the consultation of Natural and Traditional Medicine. The 100 patients who were ready to participate and voluntarily gave their informed consent were the sample; medical records were written. Results: Yin deficiency in kidney and liver, and humidity-warm in lower Jiao were the diagnoses that prevailed in the research. Conclusions: to make the traditional Chinese diagnosis allos to indicate an individualized treatment to the patients while treating the originating cause (AU).

Community-based research on the benign prostatic hyperplasia prevalence rate in Korean rural area

PURPOSE: We investigated the prevalence rate of benign prostatic hyperplasia (BPH) among Korean males in a rural area through a cross-sectional, community-based epidemiologic survey and analyzed the correlation with epidemiologic factors. MATERIALS AND METHODS: A total of 779 males who lived in Yangpyeong County participated in a prostate examination campaign. Targeting these men, we collected the International Prostate Symptom Score (IPSS), medical history, demographic information, serum prostate-specific antigen, and prostate volume as measured by transrectal ultrasonography. The data for 599 participants were analyzed, excluding 180 men who had a possibility of prostate cancer. BPH was defined as an IPSS of 8 points or higher and a prostate volume of 25 mL or more. RESULTS: The prevalence rate of BPH was 20.0%. The prevalence rate increased with age. There were 2 subjects (4.4%) in the age group of 40-49 years, 18 subjects (10.9%) in the age group of 50-59 years, 44 subjects (22%) in the age group of 60-69 years, and 56 subjects (26.6%) in the age group of over 70 years; this increase with age was statistically significant (p<0.001). In the BPH group, the average IPSS was 14.67+/-5.95, the average prostate volume was 37.04+/-11.71 g, and the average prostate-specific antigen value was 1.56+/-0.88 ng/mL. In the analysis of correlations between the epidemiologic factors and the risk of BPH, smoking was the only statistically significant factor. CONCLUSIONS: The total prevalence rate of BPH in this study was 20.0%, which was a little lower than the rate reported in other cities or rural areas.

The Influence of Depression, Anxiety and Somatization on the Clinical Symptoms and Treatment Response in Patients with Symptoms of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

This is the first study to investigate the influence of depression, anxiety and somatization on the treatment response for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the Korean versions of the International Prostate Symptom Score (IPSS), the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the PHQ-15. The primary endpoint was a responder rate defined by the total score of IPSS (< or = 7) at the end of treatment. The LUTS/BPH severity was significantly higher in patients with depression (whole symptoms P = 0.024; storage sub-symptom P = 0.021) or somatization (P = 0.024) than in those without, while the quality of life (QOL) was significantly higher in patients with anxiety (P = 0.038) than in those without. Anxious patients showed significantly higher proportion of non-response (odds ratio [OR], 3.294, P = 0.022) than those without, while somatic patients had a trend toward having more non-responders (OR, 2.552, P = 0.067). Our exploratory results suggest that depression, anxiety and somatization may have some influences on the clinical manifestation of LUTS/BPH. Further, anxious patients had a lower response to treatment in patients with LUTS/BPH. Despite of limitations, the present study demonstrates that clinicians may need careful evaluation of psychiatric symptoms for proper management of patients with LUTS/BPH.

The Influence of Depression, Anxiety and Somatization on the Clinical Symptoms and Treatment Response in Patients with Symptoms of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

This is the first study to investigate the influence of depression, anxiety and somatization on the treatment response for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the Korean versions of the International Prostate Symptom Score (IPSS), the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the PHQ-15. The primary endpoint was a responder rate defined by the total score of IPSS (< or = 7) at the end of treatment. The LUTS/BPH severity was significantly higher in patients with depression (whole symptoms P = 0.024; storage sub-symptom P = 0.021) or somatization (P = 0.024) than in those without, while the quality of life (QOL) was significantly higher in patients with anxiety (P = 0.038) than in those without. Anxious patients showed significantly higher proportion of non-response (odds ratio [OR], 3.294, P = 0.022) than those without, while somatic patients had a trend toward having more non-responders (OR, 2.552, P = 0.067). Our exploratory results suggest that depression, anxiety and somatization may have some influences on the clinical manifestation of LUTS/BPH. Further, anxious patients had a lower response to treatment in patients with LUTS/BPH. Despite of limitations, the present study demonstrates that clinicians may need careful evaluation of psychiatric symptoms for proper management of patients with LUTS/BPH.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

Prostate biopsy findings in Indian men: A hospital-based study.

Aims: To review prostatic biopsy findings in Indian patients with elevated serum prostate-specific antigen (PSA) attending the Urology department at a tertiary care hospital. Settings and Design: A retrospective study of 119 patients, who underwent TRUS-guided prostatic biopsy, was conducted. Materials and Methods: A total of 119 patients undergoing TRUS-guided prostatic biopsy were evaluated. Age, presentation, PSA, digital rectal examination, number of cores, and final histology were analyzed. Minimum 10 cores biopsies were performed in 109/119 (92%) and 12 cores in 92/119 (77%). Patients were stratified into three groups based on their PSA: 4-10 ng/ml (group I), 10-20 ng/ml (group II), and >20 ng/ml (group III). Statistical Analysis: Unpaired t-test, Chi-square test, and logistic regression were calculated using an Excel (Ver 2007) and online calculators (P < 0.05 significant). Results: Mean age was 67.6 years. Inflammatory pathology (30/119) was common at all PSA levels. In men with negative DRE and PSA > 10 ng/ml, inflammatory pathology was more likely (Chi 4.2798, P = 0.039). Cancer was found in 29/119 biopsies (group I 2/28, group II 3/45, and group III 24/46). Patients with PSA > 20 ng/ml were more likely to show cancer. Precursor lesions were noted in 10/119 (8.4%). On univariate analysis age, PSA, and DRE all showed significant association with histologic cancer but on multiple logistic regression analysis, only PSA (OR 1.03, P = 0.0021) and DRE (OR 8.07, P = 0.0007) were predictive of cancer. Conclusions: Cancer is less common and inflammatory lesions more common at all levels of PSA in our patients. The effect of antibiotics on PSA and biopsy in our patients needs to be explored.

Diagnóstico e tratamento da hiperplasia benigna da próstata / Diagnosis and treatment of benign prostatic hyperplasia

A hiperplasia benigna da próstata (HBP) é uma condição muito prevalente em homens a partir dos 40 anos, atingindo mais da metade da população masculina na sétima década e a quase totalidade na oitava década. Os sintomas a ela relacionados podem causar grande prejuízo à qualidade de vida desses pacientes. O objetivo da presente revisão é resumir a literatura atual sobre a patologia, focando na sua epidemiologia, diagnóstico e manejo. A avaliação inicial do paciente com HBP deve compreender a anamnese com aplicação do escore de sintomas prostáticos (IPSS), exame físico com toque retal, avaliação laboratorial (PSA sérico, exame de urina e função renal), além de métodos de imagem e urodinâmica para casos selecionados. O tratamento inicial para casos leves e moderados é medicamentoso, com o uso de alfa-bloqueadores ou inibidores da 5-alfaredutase, ou ainda a combinação desses. Pacientes que não respondem ao tratamento medicamentoso, com sintomas graves, ou que desenvolvem complicações da HBP devem ser considerados para tratamento cirúrgico. Este consiste em cirurgia aberta para próstatas de grande volume, ressecção transuretral para próstatas menores, além de outros tratamentos invasivos pouco disponíveis ou indisponíveis no nosso meio. O tratamento expectante para casos leves deve ser lembrado. Em conclusão, a HBP é doença com alta prevalência, cujo tratamento deve ser individualizado e instituído antes do surgimento de complicações maiores

Benign prostatic hyperplasia (BPH) is a very prevalent condition in men after 40 years of age, affecting more than half the male population in the seventh decade, and almost all in the eighth decade of life. The related symptoms can cause great damage to the quality of life of these patients. The purpose of this review is to summarize the current literature on the disease, focusing on epidemiology, diagnosis, and management. The initial evaluation of patients with BPH must include anamnesis with scoring of prostatic symptoms (IPSS), physical examination with digital rectal examination, laboratory evaluation (serum PSA, urinalysis and renal function), and imaging and urodynamics for selected cases. The initial treatment for mild to moderate cases is drug-based, using alpha blockers or 5-alpha-reductase inhibitors, or a combination of these. Patients who do respond to drug treatment, with severe symptoms, or who develop complications of BPH should be considered for surgical treatment. This consists in open surgery for large-volume prostates, transurethral resection for smaller prostates, and other invasive treatments little or unavailable in our community. The expectant treatment for mild cases should be considered. In conclusion, BPH is a highly prevalent disease whose treatment should be individualized and started before the onset of major complications

Perfil epidemiológico del paciente con antígeno prostático específico sobre 4 ng/mL: Región del Bío Bío, Chile / Epidemiological profile of the patient with prostate specific antigen over 4 ng/mL: Bio Bio Region, Chile

Objetivo: Describir el perfil epidemiológico de una muestra de pacientes beneficiarios del Servicio de Salud Bío Bío con examen de antígeno prostático sobre 4 ng/mL. Método: Se realizó un estudio transversal descriptivo donde se revisaron 436 fichas clínicas de pacientes con niveles APE > 4,0 ng/ml determinado en el Laboratorio Clínico del Hospital Dr. Víctor Ríos Ruiz, entre enero y junio del año 2006. También se obtuvo información a partir de los certificados de defunción y de anatomía patológica. Resultados: El 42,4 por ciento pertenecía a la comuna de Los Ángeles y el 57,6 por ciento restante se distribuye homogéneamente dentro de la región de Bío Bío. El promedio de edad de los pacientes fue de 72 años (31 a 98 años). El 75,6 por ciento pertenece a los grupos A y B del Fondo Nacional de Atención de Salud (FONASA), habiendo 10 por ciento sin afiliación conocida. El 63,4 por ciento presentaba hipertensión arterial. El 24,8 por ciento tuvo como diagnóstico cáncer de próstata (CaP) y el 58,2 por ciento hiperplasia benigna prostática. El 58,26 por ciento de los pacientes tuvo un valor de APE entre 4,00 a 10,00 ng/ml, el 34,59 por ciento entre 10,01 a 50,00 ng/ml y el 7,57por ciento un valor de APE >50,00 ng/ml. Conclusiones: El mayor porcentaje de los pacientes se concentra en la ciudad de Los Ángeles, siendo la mayoría del segmento A y B del fondo nacional de salud. La edad promedio fue de 72 años. La hipertensión arterial, la diabetes mellitus y el cáncer de próstata fueron las patologías más prevalentes en estos pacientes.

Objective: To describe the epidemiologic profile of a sample of patient beneficiaries of the Bio Bio Health Service with prostate specific antigen (PSA) up 4 ng/mL. Method: A descriptive cross-sectional study was made between January and June of 2006, where436 clinical histories of patients with levels APE up 4.0 ng/ml were reviewed. Also information from certificates of death and pathological anatomy was obtained. Results: The 42.4 percent belonged of Los Angeles province and the rest were distributed homogenous within Bio Bio region. The average of age of the patients was of 72 years old (31 to 98 years). The 75.6 percent belong to the groups A and B of the National Found of Health Attention (FONASA), being a 10.0 percent without well-known affiliation. The 63.4 percent presented arterial hypertension. The 24.8 percent present prostate cancer diagnostic (CaP) and the 58.2 percent had benign prostatic hyperplasia. 58.26 percent of the patients had a value of PSA between 4.0 to.10.0 ng/ml, the 34.59 percent between 10.01 to 50.00 ng/ml and the 7.57 percent a value of APE>50.00 ng/ml. Conclusions: The larger percentages of the patients live in the urban area of Los Angeles city, belonging most of the segment A and B of the National Found of Health Attention (FONASA). The average age was of 72 years. The hypertension arterial, the diabetes mellitus and the prostate cancer were the most prevalent pathologies in these patients.

Incidência de mutação no códon 12 do protoncogene K-ras em carcinoma de próstata humana em uma amostra da população brasileira / The incidence of mutation in codon 12 of the k-ras proto-oncogene in human prostate carcinoma with a Brazilian population sample

Com o intuito de estudar a participação do gene ras ativado na tumorigênese humana, pesquisamos a freqüência de mutação pontual no códon 12 do gene K-ras em espécimes cirúrgicos de pacientes portadores de câncer de próstata. Foi utilizado um grupo controle de pacientes com hiperplasia prostática benigna (HPB). Os cortes destinados ao estudo foram submetidos a extração do DNA pelo método da proteinase K. A amplificação do fragmento isolado foi obtida pela reação em cadeia de polimerase seguida por clivagem, utilizando-se a enzima de restrição Mval. A eletroforese em gel de agarose permitiu a verificação da presença de mutações. Constatamos a presença de mutação no códon 12 do gene K-ras em dois dos 15 carcinomas de próstata estudados (13,3 por cento), sendo que nenhuma em pacientes com HPB. A ocorrência de mutação de 13,3 por cento na amostra da população brasileira analisada caracteriza uma incidência intermediária entre as populações japonesa e americana. É pouco provável que a mutação isolada do K-ras seja um evento significativo na carcinogênese prostática nesta população.

Salient and co-morbid features in benign prostatic hyperplasia: a histopathological study of the prostate.

OBJECTIVES: To study the salient histological features of prostatic tissues in relation to age and to analyse the co-morbid histopathological changes in benign prostatic hyperplasia. (BPH). DESIGN: Prospective study. SETTING: Histopathology unit of a busy clinical pathological laboratory in Kathmandu Metropolitan City. SUBJECTS: 106 prostatic biopsy specimens from patients diagnosed as BPH received for histopathological examination during 2001-2. MAIN OUTCOME MEASURES: Prominent histological features observed in prostatic biopsy specimens obtained from patients of various age groups and frequency of co-morbid histopathological changes in benign prostatic hyperplasia. RESULTS: Prominent histological features. All (106) specimens included in the series had BPH showing glandulostromal proliferation of which 4 cases (3.77%) (all aged below 70 years) showed predominantly stromal pattern. Corpora amylacea present in 25% (in 5th decade) increased in frequency to 100% (8th decade onwards) in the later years. Cystically dilated glands also showed age correlated increase (through 5th to 8th decade) from 50% to 100%. Other prominent features observed with an overall decreasing frequency in all age groups (taken together) were glands showing papillary infoldings (44.33%), lymphocytic collection/infiltration (31.13%), proteinaceous material (7.54%), calcification (6.60%), homogenous eosinophilic material (2.83%), and glands showing necrotic cells (1.88%).Of all these, corpora amylacea, proteinaceous material, cystically dilated glands and glands showing papillary infoldings were present in all cases beyond 7th decade. Co-morbid histopathological changes of BPH. Twenty six specimens (24.52%) showed co-morbid features in association with BPH which included inflammatory (16.98%) and neoplastic (7.54%). Acute prostatitis was observed in 2 cases (1.88%), chronic prostatitis in 16 cases (15.09%) and none showed features of both. Neoplastic changes( 8 cases) ranged from intraepithelial neoplasm (PIN) (2 cases), atypical glands (2 cases, both in 7th decade) to adenocarcinomatous changes (2 cases, one each in 6th and 7th decade) were also observed co-existent with BPH. Both PIN cases (1.88%) were grade PIN-2 and occurred one each in the 6th and 7th decade. CONCLUSION: Histological profiles of prostatic biopsy specimens were observed to correlate well with the senile changes of advancing age. A predominantly stromal proliferation was found in a relatively lower age group, while corpora amylacea and cystically dilated glands along with glandular proliferation heralded changes of senescence. Co-morbid histopathological features were associated with BPH in a quarter (24.52%) of cases. Prostatitis was twice as common as neoplastic changes. Adenocarcinomatous changes were observed (2 cases) incidentally. PIN was recorded in 1.88% of specimens examined. Peak frequency of prostatitis was noted in the 6th decade while 7 of 8 neoplastic changes occurred in those of 60-80 years.

Manejo quirúrgico transvesical de la hiperplasia prostática benigna: Servicio de Urología Hospital Barros Luco Trudeau / Suprapubic prostatectomy of the benign prostatic hyperplasia: urology service at the Hospital Barros Luco Trudeau

La hiperplasia prostática benigna (HPB) es una patología de alta prevalencia en la consulta urológica. Una herramienta efectiva de tratamiento es la cirugía abierta transvesical, que en nuestro Servicio se indica principalmente a pacientes con volúmenes prostáticos superiores a 50 gramos. El objetivo de este estudio es conocer el manejo de los pacientes con HPB con indicación de cirugía abierta. Para esto, se efectúo un análisis retrospectivo de 328 fichas clínicas de pacientes intervenidos quirúrgicamente entre agosto de 1999 a julio de 2002. Dentro del estudio, el promedio de edad fue 68 años. El antígeno prostático específico (APE) promedio fue de 7,22 ng/ml, con antígeno menor a 4 ng/ml en el 41 por ciento y mayor a 10 ng/ml en el 19 por ciento. Dentro del estudio diagnóstico se practicó biopsia prostática transrectal ecodirigida al 32 por ciento. El volumen prostático promedio fue de 79,2 gramos, con un rango de 33 a 190 gramos. El principal motivo de consulta fue la sintomatología obstructiva baja (86 por ciento). Al momento de la cirugía, un 52 por ciento portaba sonda Foley uretrovesical. El 66 por ciento de las cirugías fueron realizadas por médicos residentes, asesorados por urólogo del servicio. Las complicaciones intra operatorias fueron 2,7 por ciento, siendo la principal el desgarro capsular. La sonda se retiró a los 6,3 días, con un promedio de estadía hospitalaria postoperatoria de 7,4 días. En el seguimiento, se destaca infección de herida operatoria (7,9 por ciento), hematuria (2,7 por ciento), infección del tracto urinario (ITU) (2,7 por ciento). El 1,2 por ciento fue reintervenido, principalmente por hemovejiga. Se encontró en forma incidental, cáncer prostático en 1,2 por ciento de los casos. No se registró mortalidad en esta revisión. El abordaje quirúrgico transvesical constituye la vía de elección en pacientes con volúmenes prostáticos superiores a 50 gramos. Es una técnica segura y presenta pocas complicaciones intra operatorias. Como complicación tardía más frecuente se presentó la infección de herida operatoria, no siendo significativo el uso de sonda Foley a permanencia en el preoperatorio. Las demás complicaciones están bajo los estándares mundiales esperados. En comparación con la literatura internacional, llama la atención el bajo porcentaje de adenocarcinoma prostático diagnosticado en forma incidental, a pesar de un APE promedio elevado.

Benign prostatic hyperplasia in elderly Thai men in an urban community: the prevalence, natural history and health related behavior.

PROBLEM: Although benign prostatic hyperplasia (BPH) is a common disease in elderly Thai men the prevalence in the community and its natural history is unknown. OBJECTIVES: To determine the prevalence of symptomatic BPH and its natural history. To determine the health related behaviors which have an impact on the voiding symptoms. MATERIAL AND METHOD: 879 elderly men aged > or = 60 years from communities around Siriraj Hospital were studied. The International Prostate Symptom Scores (IPSS) and Quality of Life (QOL) scores were evaluated in the participants at the beginning of the study and 1 year later. The overall assessment, complications and health related behaviors were also evaluated. RESULT: The prevalence of symptomatic BPH in the community was 41.3 per cent. In terms of overall assessment at 1 year follow-up, symptomatic BPH patients (IPSS 8-35), the rate of "improved", "same" and "worse" was 10.6, 70.2 and 19.2 per cent respectively. The complication rate was about 10 per cent. Three quarters of the elderly men had health related behavior at risk. CONCLUSION: The prevalence of symptomatic BPH was high. Its natural history was unpredictable and some BPH symptoms may be influenced by their behaviors.

Aspectos epidemiológicos de la patología prostática en Chile / Epidemiology of prostatic diseases in Chile

Se presentan los resultados del análisis de datos epidemiológicos relativos a la frecuencia en Chile del cáncer y la hiperplasia benigna de próstata. En las últimas 5 décadas los egresos hospitalarios han aumentado 9,5 veces y las tasas se han cuadruplicado. Chile tiene una frecuencia de mortalidad por cáncer de próstata de nivel intermedio en la comparación internacional. En el conjunto de la mortalidad global por cáncer en Chile, el cáncer de próstata aparece con el mayor aumento del número absoluto de muertes y un ascenso anual de las tasas de 7,8 por ciento cifra que supera 8 veces el aumento global de la mortalidad por cáncer. El ajuste de las tasas por edades revela que 29,8 por ciento del aumento es atribuible al envejecimiento poblacional. La probabilidad de morir por cáncer de próstata era de 2.41 por ciento (1 de cada 40 varones) en 1970 y ha subido en la actualidad a 5,82 por ciento (1 de cada 17 hombres). Se registra un exceso de riesgo en el Valle Central y la Patagonia, y bajos valores en el Norte Grande del país. La hiperplasia prostática benigna constituye la 6a. causa de hospitalización de varones en Chile y la primera entre los 65-74 años. Entre 1970 y 1996 la tasa de hospitalización subió de 62 a 146 por 100.000 mientras la mortalidad declinó de 4,1 a 0,9. La edad media de los hospitalizados es de 69 años mientras las muertes promedian 75 años. Se comentan los factores de riesgo asociados a estas patologías, los problemas de tamizaje y las necesidades de cirugía urológica que generan estos problemas

Evaluación clínica de la correlación entre el volumen prostático, el flujo urinario, la edad y el residuo posciccional en 250 pacientes con trastornos miccionales / Clinical evaluation of the correlation between prostatic volume (PV), peak flow rate (PFR), age, and post void residual urine (PVR) in 250 patients with lower urinary tract symptoms (LUTS)

Objetivo: Interpretar clínicamente los resultados de la correlación existente entre los parámetros objetivos que utilizamos en la evaluación de pacientes portadores de síntomas urinarios, en relación con la presencia de HPB. Material y métodos: se evaluó la variación de las relaciones entre el tscto rectal, la flujometría, el volumen prostático, la edad y el residuo, en 250 pacientes con síntomas urinarios. Resultados: El tamaño de la próstata aumentó con la edad, con un brusco incremento en la década de los 50 años (p<0,01), el Qmax fue menor (p<0,01) y el residuo fue más frecuente (p<0,01) cuanto más grande ( o más pesada) fue la próstata; del mismo modo se relacionó el menor flujo con la mayor prevalencia de residuo (p<0,01). mientras que la edad no demostró una influencia significativa (p>0.05) para condicionar estos resultados. Conclusión En los pacientes que consultan por trastornos miccionales en asociación con HPB clínicamente demostrable se observa una correlación estadísticamente significativa entre el mayor tamaño de la misma, un flujo bajo, menor de 10ml/s y la presencia de residuo posmicional clínicamente significativo, independientemente de la edad

Tratamiento farmacológico de la hiperplasia prostática benigna

La hiperplasia benigna de la próstata, uno de los padecimientos más frecuentes en hombres de edad madura, es motivo de consulta no solo para el especialista sino para el médico general, quien debe estar preparado para reconocer los sintomas, tomar las medidas adecuadas -incluyendo el tratamiento farmacológico inicial- que eviten complicaciones, entre ellas la obstrucción urinaria aguda, y si llega el caso remitir oportunamente el enfermo al urólogo para tratamiento más especializado