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1.
Revista Digital de Postgrado ; 10(1): 262, abr. 2021. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1147578

ABSTRACT

El bloqueo del nervio peri prostático con lidocaína, proporciona un buen alivio del dolor en la realización de la biopsia prostática guiada por ultrasonido, pero el dolor post-procedimiento, puede llegar a ser significativo, la adición del supositorio de diclofenac, podría proporcionar alivio adicional. Se asignaron al azar pacientes en 2 grupos el grupo 1 bloqueo con lidocaína del plexo peri prostático + supositorio de diclofenac sódico y el grupo 2 bloqueo con lidocaína del plexo peri prostático + supositorio de placebo, realizando biopsia doble sextante, el dolor a varios intervalos después del procedimiento se registró en una escala visual análoga (EVA) de 0 a 10. Los 2 grupos fueron similares en cuanto a edad, volumen de próstata, antígeno prostático específico, diagnóstico histopatológico. Los pacientes que recibieron diclofenac tuvieron puntajes de dolor significativamente más bajos que los que recibieron placebo (2 frente a 3,35) p 0,02. La administración rectal de diclofenac antes de la realización de la biopsia de próstata es un procedimiento simple que alivia significativamente el dolor experimentado sin aumento en la morbilidad(AU)


The peri-prostatic nerve block with lidocaine, provides good pain relief in performing ultrasoundguided prostate biopsy, but the postprocedure pain can be significant, the addition of diclofenac suppository, could provide additional relief. Patients were randomly assigned in 2 groups to group 1 blockade with lidocaine of the prostatic peri plexus + suppository of diclofenac sodium and group 2 blockade with lidocaine of the prostatic peri plexus + placebo suppository, performing double sextant biopsy, pain at several intervals after the procedure was recorded on a visual analog scale (EVA) from 0 to 10. Thee 2 groups were similar in terms of age, prostate volume, prostate-specific antigen, histopathological diagnosis. Patients who received diclofenac had pain scores significantly lower than those who received placebo (2 vs. 3.35) p 0.02. Rectal administration of diclofenac before performing a prostate biopsy is a simple procedure that relieves significantly pain experienced without increased morbidity(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Prostate/pathology , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diclofenac/therapeutic use , Anesthetics, Local/therapeutic use , Lidocaine/therapeutic use , Nerve Block/methods , Placebos/therapeutic use , Prostate/diagnostic imaging , Administration, Rectal , Prospective Studies , Pain Management/methods , Image-Guided Biopsy , Anesthesia, Local
2.
Protein & Cell ; (12): 29-38, 2021.
Article in English | WPRIM | ID: wpr-880916

ABSTRACT

Prostate cancer is the most commonly diagnosed non-cutaneous cancers in North American men. While androgen deprivation has remained as the cornerstone of prostate cancer treatment, resistance ensues leading to lethal disease. Forkhead box A1 (FOXA1) encodes a pioneer factor that induces open chromatin conformation to allow the binding of other transcription factors. Through direct interactions with the Androgen Receptor (AR), FOXA1 helps to shape AR signaling that drives the growth and survival of normal prostate and prostate cancer cells. FOXA1 also possesses an AR-independent role of regulating epithelial-to-mesenchymal transition (EMT). In prostate cancer, mutations converge onto the coding sequence and cis-regulatory elements (CREs) of FOXA1, leading to functional alterations. In addition, FOXA1 activity in prostate cancer can be modulated post-translationally through various mechanisms such as LSD1-mediated protein demethylation. In this review, we describe the latest discoveries related to the function and regulation of FOXA1 in prostate cancer, pointing to their relevance to guide future clinical interventions.


Subject(s)
Amino Acid Sequence , Epigenesis, Genetic , Epithelial-Mesenchymal Transition , Gene Expression Regulation, Neoplastic , Hepatocyte Nuclear Factor 3-alpha/metabolism , Histone Demethylases/metabolism , Histones/metabolism , Humans , Male , Mutation , Prostate/pathology , Prostatic Neoplasms/pathology , Protein Binding , Protein Processing, Post-Translational , Receptors, Androgen/metabolism , Signal Transduction , Transcription, Genetic
3.
Rev. argent. radiol ; 84(4): 115-122, ago. 2020. tab, graf, il.
Article in Spanish | LILACS | ID: biblio-1149663

ABSTRACT

Resumen Objetivo: El objetivo de este estudio es demostrar la utilidad de una secuencia tardía post-contraste en la resonancia magnética multiparamétrica de próstata (RMMP) para caracterizar lesiones PI-RADS II. Materiales y métodos: Se analizaron en forma retrospectiva las RMMP realizadas entre enero de 2015 y diciembre de 2016. El protocolo de la RMMP fue basado en las recomendaciones del PI-RADS versión 2, y se agregó una adquisición tardía luego del dinámico post-contraste. Los reportes fueron revisados bajo la versión 2.1. Resultados: Se seleccionaron 31 pacientes que presentaron lesiones categorizadas como PI-RADS II en la zona periférica, los cuales se encontraban en seguimiento del antígeno prostático específico y presentaron confirmación histológica de prostatitis crónica. Se evidenció un realce tardío de la lesión en todos los pacientes. Según los resultados histopatológicos, 30 presentaban prostatitis crónica y el restante tejido benigno (tejido fibromuscular). Discusión: La prostatitis crónica no muestra realce temprano, y presenta realce tardío debido al tejido conectivo fibroso que la compone. En la RMMP, la prostatitis puede imitar el cáncer de próstata. Agregar una adquisición tardía solo adiciona 150 segundos al estudio y podría ayudar a resolver aquellos casos inciertos categorizados como PI-RADS III empleando las secuencias convencionales, debido a que el realce tardío de la lesión es altamente sugestivo de un proceso inflamatorio (PI-RADS II). Conclusión: La presencia de realce tardío es una herramienta útil para realizar un adecuado diagnóstico de una lesión PI-RADS II en la zona periférica, pudiendo evitar una biopsia innecesaria.


Abstract Objective: The aim of this study is to demonstrate the utility of a post-contrast late sequence in multiparametric magnetic resonance imaging (RMMP) to characterize PI-RADS II lesions. Materials and methods: The RMMPs performed between January 2015 and December 2016 were retrospectively analyzed. The RMMP protocol was based on the recommendations of the PI-RADS version 2, and a late acquisition was added, after the dynamic post-contrast. The reports were reviewed under the version 2.1. Results: 31 patients with PI-RADS II lesions in the peripheral zone were selected, who were in prostate specific antigen follow-up and had histological confirmation of chronic prostatitis. A late enhancement of the lesion was evidenced in all patients. According to the histopathological results, 30 had chronic prostatitis and the remaining benign tissue (fibromuscular tissue). Discussion: Chronic prostatitis does not show early enhancement, and presents late enhancement due to its fibrous connective tissue. In RMMP, prostatitis may mimic prostate cancer. Adding a late sequence only adds 150 seconds to the study and could help to resolve those uncertain cases categorized as PI-RADS III using traditional sequences because the late enhancement of the lesion is highly suggestive of an inflammatory process (PI-RADS II). Conclusion: The presence of late enhancement is a useful tool to perform an adequate diagnosis of a PI-RADS II lesion in the peripheral zone, helping to avoid an unnecessary biopsy.


Subject(s)
Humans , Male , Middle Aged , Aged , Prostatitis/diagnostic imaging , Multiparametric Magnetic Resonance Imaging/methods , Prostate/pathology , Prostatic Neoplasms/diagnostic imaging , Biopsy , Retrospective Studies
4.
Int. j. morphol ; 38(4): 882-887, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1124870

ABSTRACT

The different pathologies of the prostate, involve the presence of a new microenvironment where inflammatory cells are actively recruited. This research explores the presence of mast cells and eosinophils associated with age and the evaluation of prostate cancer progress (Gleason Index). Forty two biopsies of anonymized patients, with confirmed prostate cancer, were used for histological analysis for eosinophils and mast cells and subsequent determination of Gleason index according to age. The results of the histological analyzes show the presence of eosinophils and mast cells in prostate biopsies with confirmed cancer. In the multiple correlation studies, a high correlation was observed between the presence of lymphocytes and the age of the patient diagnosed with prostate cancer, same correlation was observed between the patient's age and higher Gleason Index (Pearson and Spearman p< 0.05). It is concluded that in prostate biopsies from Chilean patients with confirmed cancer, eosinophilia and tissue mastocytosis were observed. Correlation analyzes show a direct correlation between older patients, higher Gleason index and presence of mast cell. Regarding eosinophilia, only a correlation between age and Gleason index was observed Further studies are suggested to determine that the presence of eosinophils and mast cells can be used as early bioindicators of prostate cancer.


Las diferentes patologías de próstata, involucran la presencia de un nuevo microambiente donde las células inflamatorias son activamente reclutadas. La presente investigación explora la presencia de mastocitos y eosinófilos asociadas a la edad y la evaluación del progreso del cáncer de próstata según índice de Gleason. Cuarenta y dos biopsias de pacientes anonimizados, con cáncer prostático confirmados, fueron utilizadas para su análisis histológico para eosinófilos y mastocitos y posterior determinación del índice de Gleason según edad. Los resultados de los análisis histológicos, muestran la presencia de eosinófilos y mastocitos en biopsias de próstata con cáncer confirmado. En los estudios de correlación múltiple, se observó una alta correlación entre la presencia de linfocitos, mastocitos y la edad del paciente diagnosticado con cáncer prostático, igual correlación se observó entre la edad del paciente y mayor índice de Gleason (Pearson y Spearman p<0,05). Se concluyó que en las biopsias de próstata de pacientes chilenos con cáncer confirmado, se observó eosinofilia y mastocitosis tisular. Los análisis de correlación muestran una correlación directa entre pacientes de mayor edad, índice de Gleason más alto y la presencia de mastocitos. Con respecto a la eosinofilia, solo se observó una correlación entre la edad y el índice de Gleason. Se sugieren estudios adicionales para determinar que la presencia de eosinófilos y mastocitos puede usarse como bioindicadores tempranos del cáncer de próstata.


Subject(s)
Humans , Male , Prostatic Neoplasms/pathology , Prostate/pathology , Prostatic Neoplasms/diagnosis , Biopsy , Mastocytosis/pathology , Biomarkers, Tumor/analysis , Chile , Age Factors , Eosinophilia/pathology , Early Detection of Cancer , Neoplasm Grading
5.
Int. braz. j. urol ; 46(1): 60-66, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1056357

ABSTRACT

ABSTRACT Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.


Subject(s)
Humans , Male , Aged , Ornidazole/administration & dosage , Prostatitis/etiology , Biopsy, Needle/adverse effects , Ciprofloxacin/administration & dosage , Antibiotic Prophylaxis/methods , Enema/methods , Anti-Bacterial Agents/administration & dosage , Prostate/pathology , Prostatitis/prevention & control , Time Factors , Biopsy, Needle/methods , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Ultrasonography, Interventional , Drug Combinations , Middle Aged
6.
Braz. j. med. biol. res ; 53(5): e9108, 2020. tab, graf
Article in English | LILACS | ID: biblio-1098110

ABSTRACT

Recent evidence suggests that aerobic physical training may attenuate the deleterious effects of cancer risk factors, including smoking. We investigated the effects of cigarette smoke inhalation and aerobic physical training on the expression of steroid receptors and inflammatory and apoptotic proteins in the prostate. Forty male Wistar rats were distributed in four groups: control (CO), exercise (EXE), cigarette smoke exposure (CS), and cigarette smoke exposure with exercise (CS+EXE). For eight weeks, animals were repeatedly exposed to cigarette smoke for 30 min or performed aerobic physical training either with or without the cigarette smoke inhalation protocol. Following these experiments, we analyzed prostate epithelial morphology and prostatic expression of androgen (AR) and glucocorticoid receptors (GR), insulin-like growth factor (IGF-1), B-cell lymphoma-2 (BCL-2), BCL-2-associated X protein (BAX), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and nuclear factor-kappa B (NF-κB) via immunohistochemistry. Cigarette smoke exposure stimulated the expression of AR, IGF-1, BCL-2, and NF-κB while downregulating BAX, IL-6, and TNF-α labeling in the prostate. In contrast, aerobic physical training attenuated cigarette smoke-induced changes in AR, GR, IGF-1, BCL-2, IL-6, TNF-α, and NF-κB. This suggests that cigarette smoke stimulates inflammation and reduces apoptosis, culminating in increased prostatic epithelial and extracellular matrices, whereas physical training promoted beneficial effects towards maintaining normal prostate morphology and protein levels.


Subject(s)
Animals , Male , Rats , Physical Conditioning, Animal , Prostate/pathology , Smoke/adverse effects , Biomarkers/analysis , Prostate/drug effects , Time Factors , Immunohistochemistry , Rats, Wistar , Disease Models, Animal , Inflammation
7.
Rev. chil. radiol ; 25(4): 119-127, dic. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058212

ABSTRACT

Resumen: Objetivo: Analizar las biopsias realizadas en paciente categorizados PIRADS 3 en nuestra institución desde el segundo semestre del año 2016 al primer semestre del año 2018 y describir la correlación de la densidad de PSA con la incidencia de cáncer de próstata. Evaluar el rol de la densidad de PSA en la indicación de estudio histológico en pacientes PIRADS 3. Método: Trabajo autorizado por el comité de ética de nuestra institución. Se realizó búsqueda en el PACs, de todos los informes de RM multiparamétricas de próstata que incluyeran la categoría ¨PIRADS 3¨ en el periodo señalado. De ellos se calculó la densidad de PSA, con el último valor de PSA registrado en la ficha clínica previo a RM y volumen prostático en RM. Se procedió a buscar los pacientes con estudio histológico. Se correlacionó los resultados de biopsias con el valor de densidad de PSA. Realizamos análisis uni y multivariados, análisis estadísticos con sensibilidad, especificidad y uso de curva ROC. Resultados: De las 2416 RMmp de próstata realizadas en nuestra institución en las fechas ya descritas, se encontraron 424 informes catalogados con score PIRADS 3, y 267 de esos pacientes tenían estudio y seguimiento institucional, de los cuales 134 contaban con biopsia. La muestra tenía un promedio de edad de 60 años, y una mediana de densidad de PSA de 0,10 (RIC 0,07-0,14). Se encontraron 36 biopsias con cáncer clínicamente significativo (Gleason > 6), lo que corresponde a 26,8% de la muestra, valor similar al encontrado en la literuatua. En estos pacientes se obtuvo un punto de corte óptimo de densidad de PSA de 0,11, con una sensibilidad y especificidad de 67% y un AUC de 0,68. Una densidad de PSA de 0,11 presenta un OR de 4,1, con una probabilidad de 4 veces más de encontrar un cáncer de próstata por sobre este valor (IC 95% 1,3-9,8), lo cuál es estadísticamente significativo con un p igual a 0,01. Conclusión: La DAPE sobre 0,11 ng/ml/cc puede considerarse como una herramienta adicional para indicar biopsia en pacientes con RMmp PI-RADS 3, aumentando la precisión para la detección de cáncer de próstata clínicamente significativos ayudando a disminuir estudios histológicos innecesarios.


Abstract: Objective: To analyze the biopsies performed in patients categorized PIRADS 3 in our institution from the second half of 2016 to the first half of 2018 and describe the correlation of PSA density with the incidence of prostate cancer. To evaluate the role of PSA density in the indication of histological study in PIRADS 3 patients. Method: Work authorized by the ethics committee of our institution. The PACs were searched for all multiparameter prostate MRI reports that included the category "PIRADS 3" in the period indicated. The PSA density was calculated, with the last PSA value recorded in the clinical record before MRI and prostate volume in MRI. We proceeded to look for patients with the histological study. The biopsy results were correlated with the PSA density value. We perform uni and multivariate analyzes, statistical analyzes with sensitivity, specificity and use of the ROC curve. Results: Of the 2416 RMmp of the prostate performed in our institution on the dates already described, 424 reports catalogued with PIRADS 3 score were found, and 267 of those patients had study and institutional follow-up, of which 134 had a biopsy. The sample had an average age of 60 years and a median PSA density of 0.10 (RIC 0.075-0.146). We found 36 biopsies with clinically significant cancer (Gleason> 6), which corresponds to 26.8% of the sample, a value similar to that found in the literature. In these patients, an optimal cut-off point of PSA density of 0.11 was obtained, with a sensitivity and specificity of 67% and an AUC of 0.68. A PSA density of 0.11 has an OR of 4.1, with a 4-fold probability of finding prostate cancer above this value (95% CI 1.3-9.8), which It is statistically significant with a p equal to 0.01. Conclusion: DAPE over 0.11 ng/ml/cc can be considered as an additional tool to indicate biopsy in patients with RMmp PI-RADS 3, increasing the accuracy for the detection of clinically significant prostate cancer helping to reduce unnecessary histological studies.


Subject(s)
Humans , Male , Middle Aged , Prostatic Neoplasms/pathology , Prostatic Neoplasms/diagnostic imaging , Prostate/pathology , Prostatic Neoplasms/classification , Prostatic Neoplasms/blood , Biopsy , Multivariate Analysis , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Prostate-Specific Antigen/blood , Risk Assessment , Multiparametric Magnetic Resonance Imaging
8.
Rev. chil. radiol ; 25(4): 128-140, dic. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058213

ABSTRACT

Resumen: La resonancia magnética multiparamétrica (RMmp) de próstata ha tenido un desarrollo importante en los últimos años dado la alta prevalencia del cáncer de próstata y la necesidad de tener información imagenológica concreta para el correcto manejo de los pacientes urológicos. Otras técnicas de imágenes aportan información parcial sobre la morfología de la próstata, pero es la RMmp de próstata la técnica imagenológica que nos entrega mayor información, a través de secuencias morfológicas y funcionales, para detectar lesiones clínicamente significativas y disminuir el número de biopsias, predecir riesgo de agresividad de los tumores, estadificación local y ayudar al urólogo a realizar biopsias dirigidas cognitivas o por fusión RM/US. En este artículo se pretende mostrar casos representativos de errores frecuentes al momento de informar una resonancia magnética de próstata. Damos algunas recomendaciones para evitar estos errores y mejorar los informes radiológicos. Es común al comenzar a realizar informes de RMmp de próstata tener dudas sobre la correcta interpretación de los hallazgos. Ofrecemos a través de este articulo imágenes representativas de los principales errores en la búsqueda de patología neoplásica y algunas sugerencias para evitarlos. Desde el punto de vista académico se pueden dividir en pitfalls de condiciones anatómicas y patologías benignas que pueden simular un tumor. En el caso de pitfalls anatómicos mostramos casos referentes al estroma fibromuscular anterior hipertrófico, cápsula quirúrgica engrosada, plexo venoso peri-prostático, complejo neurovascular y pseudolesión posterior en zona periférica. Dentro de las condiciones benignas se encuentra la hiperplasia prostática benigna, procesos inflamatorios/infecciosos y otras condiciones que pueden simular tumor. Respecto a pitfalls relacionados con la hiperplasia prostática benigna podemos señalar hiperplasia de la zona de transición / central ("moustache-sign"), proliferación estromal en la zona de transición y nódulos adenomatosos ectópicos u extruidos en la zona periférica (ZP). Pitfalls inflamatorios/infecciosos corresponden a casos de prostatitis focal, prostatitis aguda, prostatitis con abscesos y prostatitis granulomatosa. Otros errores frecuentes de dificultad en la interpretación corresponden a casos de calcificaciones y hemorragia.


Abstract: Multiparameter magnetic resonance imaging (RMmp) of the prostate has had an important development in recent years given the high prevalence of prostate cancer and the need to have specific imaging information for the correct management of urological patients. Other imaging techniques provide partial information about the morphology of the prostate, but it is the mp-MRI of the prostate that gives us more information, through morphological and functional sequences, to detect clinically significant lesions and reduce the number of biopsies, predict risk of aggressiveness of the tumors, local staging and help the urologist to perform cognitive biopsies or by MR / US fusion. This article aims to show representative cases of frequent errors when reporting an MRI of the prostate. We give some recommendations to avoid these errors and improve radiological reports. It is common to start making mp-MRI of the prostate reports having doubts about the correct interpretation of the findings. We offer through this article representative images of the main errors in the search for neoplastic pathology and some suggestions to avoid them. From the academic point of view they can be divided into pitfalls of anatomical conditions and benign pathologies that can simulate a tumor. In the case of anatomical pitfalls, we show cases related to the hypertrophic anterior fibromuscular stroma, thickened surgical capsule, peri-prostatic venous plexus, neurovascular complex and posterior pseudo-injury in the peripheral area. Among the benign conditions is benign prostatic hyperplasia, inflammatory / infectious processes and other conditions that can simulate tumor. Regarding pitfalls related to benign prostatic hyperplasia, we can indicate hyperplasia of the transition / central zone ("mustache-sign"), stromal proliferation in the transition zone and ectopic or extruded adenomatous nodules in the peripheral zone. Inflammatory / infectious pitfalls correspond to cases of focal prostatitis, acute prostatitis, prostatitis with abscesses and granulomatous prostatitis. Other frequent errors of difficulty in interpretation correspond to cases of calcifications and hemorrhage.


Subject(s)
Humans , Prostate/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Diagnostic Errors , Multiparametric Magnetic Resonance Imaging , Prostate/pathology , Prostatic Neoplasms/pathology , Diffusion Magnetic Resonance Imaging
9.
Int. braz. j. urol ; 45(4): 775-781, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019893

ABSTRACT

ABSTRACT Purpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry. Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed. Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostatic Hyperplasia/diagnosis , Urinary Bladder Neck Obstruction/diagnosis , Lower Urinary Tract Symptoms/diagnosis , Organ Size , Prostate/pathology , Prostatic Hyperplasia/physiopathology , Prostatic Hyperplasia/pathology , Quality of Life , Reference Standards , Urination/physiology , Urodynamics/physiology , Urinary Bladder Neck Obstruction/physiopathology , Urinary Bladder Neck Obstruction/pathology , Surveys and Questionnaires , Regression Analysis , Ultrasonography/methods , Statistics, Nonparametric , Digital Rectal Examination , Lower Urinary Tract Symptoms/physiopathology , Lower Urinary Tract Symptoms/pathology , Middle Aged
10.
Int. braz. j. urol ; 45(3): 486-494, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012318

ABSTRACT

ABSTRACT Objectives: To identify the group of patients who could safely avoid prostate biopsy based on the findings of multiparametric prostate resonance imaging (MRmp), parameterized with PI-RADS v2, using prostate biopsy as reference test and to assess the sensitivity and specificity of mpMR in identifying clinically significant prostate cancer using prostate biopsy as a reference test. Patients and Methods: Three hundred and forty two patients with suspected prostate cancer were evaluated with mpMR and prostate biopsy. Agreement between imaging findings and histopathological findings was assessed using the Kappa index. The accuracy of mpMR in relation to biopsy was assessed by calculations of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 342 biopsies were performed. In 201 (61.4%), mpMR had a negative result for cancer, which was confirmed on biopsy in 182 (53%) of the cases, 17 (4.9%) presented non-clinically significant cancer and only 2 (0.5%) clinically significant cancer. 131 (38.3%) patients had a positive biopsy. Clinically significant cancer corresponded to 83 (34.2%), of which 81 (97.5%) had a positive result in mpMR. Considering only the clinically significant cancers the mpMR had a sensitivity of 97.6%, specificity of 76.8%, PPV 57.4% and VPN of 99%. Conclusions: mpMR is a useful tool to safely identify which patients at risk for prostate cancer need to undergo biopsy and has high sensitivity and specificity in identifying clinically significant prostate cancer.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Prostate/pathology , Prostate/diagnostic imaging , Prostatic Neoplasms/pathology , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Image-Guided Biopsy/methods , Reference Standards , Reproducibility of Results , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Neoplasm Grading , Middle Aged
11.
Int. braz. j. urol ; 45(2): 262-272, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002213

ABSTRACT

ABSTRACT Background: To date, few series on robot-assisted radical prostatectomy (RARP) in kidney transplant recipients (KTRs) have been published. Purpose: To report the experience of two referral centers adopting two different RARP approaches in KTRs. Surgical, oncological and functional results were primary outcomes evaluated in the study. Material and methods: We retrospectively analyzed data from 9 KTRs who underwent transperitoneal RARP or Retzius-sparing RARP for PCa from October 2012 to April 2016. Data were reported as median and interquartile range (IQR). Pre- and postoperative outcomes were compared by non-parametric Wilcoxon signed-rank test. Significant differences were accepted when p ≤ 0.05. Overall survival was assessed using Kaplan-Meier method. Results: Four KTRs underwent a T-RARP and 5 a RS-RARP. Patient median age was 60 (56-63) years. Charlson comorbidity index was 6 (5-6). Preoperative median PSA was 5.6 (5-15) ng / mL. Preoperative Gleason score (GS) was 6 in 5 patients, 7 (3 + 4) in 3, and 8 (4 + 4) in one. Pre- and postoperative creatinine were 1.17 (1.1; 1.4) and 1.3 (1.07; 1.57) mg / dL (p = 0.237), while eGFR was 66 (60-82) and 62 (54-81) mL / min / 1.73m2 (p = 0.553), respectively. One (11.1%) Clavien-Dindo grade II complication occurred. Two extended template lymphadenectomies were performed, both with nodal invasion. These two patients experienced a biochemical recurrence and were subjected to RT. Two patients (22.2%) had PSMs. Median follow-up was 42 months. Seven patients (77.8%) were continent, 5 (55.6%) were potent. Two (22.2%) patients died during follow-up for oncologic unrelated causes. Conclusions: Our series suggests that both RARP approaches are safe and feasible techniques in KTRs for PCa.


Subject(s)
Humans , Male , Prostatectomy/methods , Prostatic Neoplasms/surgery , Kidney Transplantation/methods , Robotic Surgical Procedures/methods , Postoperative Period , Prostate/pathology , Prostatic Neoplasms/pathology , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Kaplan-Meier Estimate , Neoplasm Grading , Lymph Node Excision , Middle Aged
12.
Int. braz. j. urol ; 45(2): 246-252, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002205

ABSTRACT

ABSTRACT Objectives: To evaluate the frequency of NIH category IV prostatitis, and the use of expressed prostatic secretions tests in an effort to improve the reliability of prostate specific antigen as an indicator, to avoid unnecessary prostate biopsy. Materials and Methods: 178 expressed prostatic secretion positive patients with serum prostate specific antigen levels of ≥ 2.5 ng / mL were included in present prospective study. The diagnostic evaluation included detailed history and physical examination, digital rectal examination, urine analysis, urine culture, and expressed prostatic secretions tests. Transrectal ultrasonography was used both to measure prostate volume and conduct 12 core prostate biopsy. Results: The prevalence of NIH category IV prostatitis was 36.9% (178 / 482) in our population of men. In our study patients (n: 178) prostate biopsy results were classified as; 66 prostatitis, 81 BPH, and 31 Pca. In asymptomatic prostatitis group, expressed prostatic secretion mean leucocyte ratio was higher compared to other two groups (p < 0.0001). The relation between number of expressed prostatic secretion leucocytes and prostatitis, benign prostate hyperplasia, and prostate cancer is analyzed. If 16 is taken as the cut of number for leucocyte presence, its sensitivity is 0.92 (AUC = 0.78 p = 0.01). Conclusions: The number of leucocytes in expressed prostatic secretion is higher in the chronic prostatitis group. If the leukocyte presence of 16 and above is taken as the cut off point, the sensitivity becomes 0.92 (AUC = 0.78). We firmly believe that our new cut off value may be used as to aid prostate specific antigen and derivates while giving biopsy decision.


Subject(s)
Humans , Male , Aged , Prostate/pathology , Prostatic Hyperplasia/metabolism , Prostatic Neoplasms/metabolism , Prostatitis/mortality , Biopsy/standards , Prostate-Specific Antigen/blood , Prostate/metabolism , Prostatic Hyperplasia/diagnosis , Prostatic Neoplasms/diagnosis , Prostatitis/classification , Prostatitis/pathology , Biomarkers, Tumor/metabolism , Chronic Disease , Prospective Studies , Diagnosis, Differential , Digital Rectal Examination , Middle Aged
13.
Int. braz. j. urol ; 45(1): 32-37, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-989985

ABSTRACT

ABSTRACT Introduction: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a "second opinion" to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post - surgical histopathology. Material and methods: Retrospective study based on chart review of patients with PC that attended the Uro - oncology Department of Hospital das Clínicas - UNICAMP - Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis's Kappa concordance coefficient. Results: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post - surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041). Conclusion: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post - surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Prostate/pathology , Prostatic Neoplasms/pathology , Prostate/surgery , Prostatectomy , Prostatic Neoplasms/surgery , Referral and Consultation , Retrospective Studies , Neoplasm Grading , Middle Aged
14.
Pesqui. vet. bras ; 39(1): 40-46, Jan. 2019. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-990239

ABSTRACT

Canine prostate gland is a hormonal dependent organ and its imbalance of estrogen and androgen receptor expressions are directly associated with the development of different diseases. Due to the lack of information regarding the behavior of the aforementioned receptors in canine prostate cancer (PC), this study aimed to identify estrogen receptor alpha (ERα), androgen receptor (AR), Ki67 and phosphatase and tensin homolog (PTEN) protein expressions in canine PC by immunohistochemistry. We found nuclear expression of ERα and AR in the epithelial cells of normal canine samples and a loss of protein expression in PC samples. Normal samples showed Ki67 expression in a few basal cells and the PC samples showed the highest mean of positive cells (253.1). Canine prostate cancer showed a high proliferative index, which was associated with independence of hormonal actuation. PTEN showed positive nuclear and cytoplasmic expression in normal canine samples and a loss in PC. Loss of ERα, AR and PTEN indicated that canine PC exhibits the same immunohistochemical phenotype as in human patients with PC resistant to hormonal therapy. Therefore, canine PC should be considered as a model to study human PC resistant to hormonal therapy.(AU)


A glândula prostática canina é um órgão dependente de hormônio, e o desequilíbrio na expressão dos receptores de estrógeno e andrógeno estão diretamente associados com o desenvolvimento de diferentes doenças. Devido à falta de informação sobre o comportamento desses receptores no câncer prostático canino (PC), este estudo tem por objetivo identificar a expressão proteica através da técnica de imuno-histoquímica do receptor de estrógeno alfa (REα), receptor de andrógeno (RA), Ki67 e fosfatase e tensina homóloga (PTEN). Foi encontrado nas células epiteliais prostáticas normais caninas a expressão nuclear de REα e RA, e perda de expressão proteica nas amostras de PC. As amostras normais apresentaram expressão de Ki67 em poucas células basais e as amostras de PC apresentaram a maior média de células positivas (253,1). O câncer de próstata canino apresentou uma taxa alta de proliferação, o qual foi associado com a atuação independente de hormônio. As amostras de próstatas caninas normais revelaram marcação nuclear e citoplasmática da proteína PTEN e perda nas amostras de PC. A perda de REα, RA e PTEN indicam que as amostras de PC exibem o mesmo fenótipo imuno-histoquímico de pacientes humanos com câncer prostático resistente a terapia hormonal. Sendo assim, o PC canino deve ser considerado um modelo para estudos de câncer prostático humano resistente a terapia hormonal.(AU)


Subject(s)
Animals , Dogs , Prostate/pathology , Prostatic Hyperplasia/veterinary , Prostatic Neoplasms/veterinary , Prostatic Intraepithelial Neoplasia/veterinary , Dogs , Receptors, Androgen , Receptors, Cytoplasmic and Nuclear , Estrogen Receptor alpha , Disease Models, Animal , Prostatic Neoplasms, Castration-Resistant/veterinary
15.
Int. braz. j. urol ; 44(6): 1122-1128, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-975666

ABSTRACT

ABSTRACT Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations. Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound - guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics. Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 - 0.78; P = 0.021). Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Prostate/pathology , Urinary Tract Infections/prevention & control , Sepsis/prevention & control , Enema/methods , Prostatic Neoplasms/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Middle Aged
16.
Int. braz. j. urol ; 44(4): 709-716, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954076

ABSTRACT

ABSTRACT Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 - 10.0 ng/mL and its ability to reduce unnecessary biopsies. Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 - 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001). With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies. Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Prostate/pathology , Prostatic Neoplasms/pathology , Prostatic Neoplasms/blood , Prostate-Specific Antigen/blood , Unnecessary Procedures/statistics & numerical data , Image-Guided Biopsy/statistics & numerical data , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/pathology , Prostatic Hyperplasia/blood , Prostatic Neoplasms/diagnosis , Reference Standards , Reference Values , Prospective Studies , Sensitivity and Specificity , Middle Aged
17.
Int. braz. j. urol ; 44(3): 600-607, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-954052

ABSTRACT

ABSTRACT Objectives: Apoptosis effect of oral alpha-blockers is known in the prostate. Apoptosis index of silodosin has not been proved, yet. Aims are to present apoptosis index of silodosin in prostate and to compare this with other currently used alpha-blocker's apoptosis indexes together with their clinical effects. Materials and Methods: Benign prostatic hyperplasia (BPH) patients were enrolled among those admitted to urology outpatient clinic between June 2014 and June 2015. Study groups were created according to randomly prescribed oral alpha-blocker drugs as silodosin 8mg (Group 1; n=24), tamsulosin 0.4mg (Group 2; n=30), alfuzosin 10mg (Group 3; n=25), doxazosin 8mg (Group 4; n=22), terazosin 5mg (Group 5; n=15). Pa- tients who refused to use any alpha-blocker drug were included into Group 6 as control group (n=16). We investigated apoptosis indexes of the drugs in prostatic tissues that were taken from patient's surgery (transurethral resection of prostate) and/or prostate biopsies. Immunochemical dyeing, light microscope, and Image Processing and Analy- sis in Java were used for evaluations. Statistical significant p was p<0.05. Results: There were 132 patients with mean follow-up of 4.2±2.1 months. Pathologist researched randomly selected 10 areas in each microscope set. Group 1 showed statisti- cal significant difference apoptosis index in immunochemical TUNEL dyeing and im- age software (p<0.001). Moreover, we determined superior significant development in parameters as uroflowmetry, quality of life scores, and international prostate symptom score in Group 1. Conclusions: Silodosin has higher apoptosis effect than other alpha-blockers in prostate. Thus, clinic improvement with silodosin was proved by histologic studies. Besides, static factor of BPH may be overcome with creating apoptosis.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Prostate/drug effects , Prostate/pathology , Prostatic Hyperplasia/pathology , Prostatic Hyperplasia/drug therapy , Apoptosis/drug effects , Adrenergic alpha-1 Receptor Antagonists/pharmacology , Quinazolines/pharmacology , Reference Values , Sulfonamides/pharmacology , Time Factors , Biopsy , Prazosin/analogs & derivatives , Prazosin/pharmacology , Immunohistochemistry , Pilot Projects , Retrospective Studies , Treatment Outcome , Prostate-Specific Antigen/blood , Doxazosin/pharmacology , Tamsulosin , Indoles/pharmacology , Middle Aged
18.
Int. braz. j. urol ; 44(2): 238-247, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-892970

ABSTRACT

ABSTRACT Introduction and objective To determine the association between the anthropometric measurements by magnetic resonance imaging (MRI) and perioperative outcomes of extraperitoneal laparoscopic radical prostatectomy (ELRP). Materials and Methods From 2008 to June 2016, 86 patients underwent preoperative MRI prior to undergoing ELRP for localized prostate cancer. We analyzed the associations between anthropometric measurements of MRI and the perioperative outcomes of patients who underwent ELRP. Results The mean patient age was 69.61±8.30 years. The medians of operating time and blood loss were 2.30 hours and 725.30ml, respectively. The total post-surgical complication rate was 1.16%. The median hospital stay was 6.50 days. The pathological stages for T2 and T3 were 45.74% and 34.04%, respectively. The rate as positive surgical margins (PSMs) was 18.09% (pT2 and pT3; 6.38% and 9.57%). The angles between pubic bone and prostate gland (angle 1&2), were significantly associated with operative time and hospital stay, respectively (p<0.05). There was no correlation between the pelvimetry and positive surgical margin. Conclusions The findings of the present study suggest that anthropometric measurements of the MRI are related to operative difficulties in ELRP. This study confirmed that MRI planning is the key to preventing complications in ELRP.


Subject(s)
Humans , Male , Aged , Prostate/diagnostic imaging , Prostatectomy/methods , Prostatic Neoplasms/surgery , Prostatic Neoplasms/diagnostic imaging , Laparoscopy/methods , Organ Size , Postoperative Complications/prevention & control , Prostate/pathology , Prostatectomy/adverse effects , Prostatic Neoplasms/pathology , Body Composition , Magnetic Resonance Imaging , Blood Loss, Surgical , Treatment Outcome , Laparoscopy/adverse effects , Operative Time , Middle Aged
19.
Int. braz. j. urol ; 43(6): 1068-1074, Nov.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-892916

ABSTRACT

ABSTRACT Purpose: To determine the risk factors and the efficiency of rectal swab samples to prevent infectious complications in prostate biopsy, and compare fosfomycin with ciprofloxacin use in prophylaxis. Materials and Methods: Between May and October 2014, pre-biopsy risk factors and their effect in ciprofloxacin and fosfomycin prophylaxis were determined. Pre-biopsy urinalysis, urine culture and rectal swab samples were obtained from all of the patients. Rectal swabs were obtained upon admission, and biopsy was performed in the following 3-7 days. The place of rectal swab samples and efficiency of fosfomycin use was evaluated. Results: Pre-biopsy rectal swabs were obtained from 110 patients who revealed 60.9% fluoroquinolone resistance (FQR), and 32.7% fluoroquinolone sensitivity (FQS). Fosfomycin resistance was present in 3 patients. Ciprofloxacin use in last 6 months was the only risk factor for FQR. Antibiotic prophylaxis was given to both groups with and without risk factors, according to swab results, and no infective complications were observed. Among the group where fosfomycin was used empirically, one patient had an infection needing hospitalization, however this constitutes no statistical difference between the Group that fosfomycin used empirically or according to swab results (p=0.164). Conclusions: In prostate biopsy prophylaxis, ciprofloxacin may be used liberally in patients without risk factors, but it should be given according to the rectal swab results in the patients with risk, and fosfomycin may be used independently of risk factors and rectal swab results.


Subject(s)
Humans , Male , Prostate/pathology , Prostatic Neoplasms/pathology , Antibiotic Prophylaxis , Image-Guided Biopsy/methods , Fosfomycin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Prostatic Neoplasms/diagnostic imaging , Prospective Studies , Risk Factors , Ultrasonography, Interventional , Image-Guided Biopsy/adverse effects , Middle Aged
20.
Int. braz. j. urol ; 43(6): 1092-1101, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-892918

ABSTRACT

ABSTRACT Aims: To study the ultra structural changes in bladder musculature in cases of BPE and their clinical relevance. Material and Methods: In this descriptive longitudinal, controlled, observational study patients were enrolled into three groups, group 1, group 2A and group 2B. Control group (group-1) consisted of age matched normal male patients, who underwent surveillance or diagnostic cystoscopy for microscopic hematuria or irritative symptoms. Case group (group-2) comprised of patients with BPE, undergoing TURP. Case group (group-2) was further classified into: Category 2A (patients not on catheter) and category 2B (patients on catheter). All relevant clinical parameters like IPSS, prostate size, Qmax, PVR were recorded. Cystoscopy and bladder biopsy were performed in all patients. Various ultrastructural parameters like myocytes, fascicular pattern, interstitial tissue, nerve hypertrophy and cell junction pattern were analyzed under electron microscope and they were clinically correlated using appropriate statistical tests. Results: Control group had significant difference as compared to case group in terms of baseline parameters like IPSS, flow rate and prostate size, both preoperatively and postoperatively, except for PVR, which was seen only preoperatively. There was statistically significant difference in ultrastructural patterns between case and control group in all five electron microscopic patterns. However, no significant difference was found between the subcategories of case groups. Conclusions: BPE is responsible for ultra structural changes in detrusor muscle and these changes remain persistent even after TURP. Nerve hypertrophy, which was not thoroughly discussed in previous studies, is also one of the salient feature of this study.


Subject(s)
Humans , Male , Prostatic Hyperplasia/diagnostic imaging , Urinary Bladder/ultrastructure , Muscle, Smooth/diagnostic imaging , Prostate/pathology , Prostatic Hyperplasia/physiopathology , Urinary Bladder/pathology , Microscopy, Electron, Scanning , Case-Control Studies , Longitudinal Studies , Middle Aged , Muscle, Smooth/physiopathology
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