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Int. braz. j. urol ; 48(2): 328-335, March-Apr. 2022. tab
Article in English | LILACS | ID: biblio-1364937


ABSTRACT Objectives: To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: Data of patients who underwent surgery for "large" BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Qmax, post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hb-drop, complications) were compared. Functional (Qmax, PVR, %ΔQmax) and patient-reported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up. Results: 80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Qmax 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. −0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Qmax improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches. Conclusions: Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.

Humans , Male , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Laparoscopy , Laser Therapy , Lasers, Solid-State/therapeutic use , Prostate/surgery , Prostatectomy , Quality of Life , Thulium/therapeutic use , Treatment Outcome
Rev. Assoc. Med. Bras. (1992) ; 68(1): 50-55, Jan. 2022. tab
Article in English | LILACS | ID: biblio-1360703


SUMMARY OBJECTIVE: We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. METHODS: A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. RESULTS: Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. CONCLUSION: Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.

Humans , Male , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Urethral Stricture/surgery , Urethral Stricture/etiology , Transurethral Resection of Prostate/adverse effects , Reproducibility of Results , Retrospective Studies
Int. braz. j. urol ; 45(6): 1279-1280, Nov.-Dec. 2019.
Article in English | LILACS | ID: biblio-1056342


ABSTRACT Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove beneficial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defined as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1). Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His findings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made. Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue. Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2-5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.

Humans , Male , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Urinary Bladder Neck Obstruction/surgery , Prostatic Hyperplasia/complications , Urinary Bladder Neck Obstruction/etiology , Reproducibility of Results , Treatment Outcome , Middle Aged
Säo Paulo med. j ; 137(5): 446-453, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1059096


ABSTRACT BACKGROUND: Lower urinary tract symptoms significantly worsen quality of life. The hypothesis that they might lead to serious systolic blood pressure alterations through inducing sympathetic nervous activity has not been studied so far. OBJECTIVES: To investigate the relationship between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure. DESIGN AND SETTING: Cross-sectional single-center study on data from a hospital patient record system. METHODS: We evaluated the medical records of all consecutive patients with benign prostate enlargement-related lower urinary tract symptoms admitted between January 2012 and December 2017. Storage and voiding symptoms were assessed separately. International Prostate Symptom Score, uroflowmetry, postvoiding residual urine volume and systolic blood pressure were recorded. Pearson correlation and linear regression analysis were used. RESULTS: Positive correlations were found between systolic blood pressure and all of the storage symptoms. Among these, urgency had the most significant effect. There were 166 patients (41.4%) with urgency for urination, which increased mean systolic blood pressure from 124.88 mmHg (average value in elevated blood pressure group) to 132.28 mmHg (average value in stage-1 hypertension group). Hesitancy in urinating and feeling of incomplete bladder emptying had weak positive correlations with systolic blood pressure. There was a negative correlation between systolic blood pressure and intermittency of urination. CONCLUSIONS: With increasing numbers of urine storage symptoms, systolic blood pressure also increases, while the opposite occurs for voiding symptoms in patients with benign prostate enlargement. We conjecture that storage symptoms may lead to this increase through inducing sympathetic hyperactivity. Further prospective studies with larger groups are needed to confirm these findings.

Male , Middle Aged , Aged , Prostatic Hyperplasia/complications , Urination/physiology , Blood Pressure/physiology , Lower Urinary Tract Symptoms/complications , Hypertension/complications , Organ Size , Prostate/physiopathology , Severity of Illness Index , Cross-Sectional Studies , Lower Urinary Tract Symptoms/physiopathology , Hypertension/physiopathology
Int. braz. j. urol ; 45(2): 306-314, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-1002215


ABSTRACT Purpose: Non - muscle - invasive bladder cancer (NMIBC) can recur despite transurethral resection (TURBT) and adjuvant intravesical therapy. Tobacco products excreted in the urine are hypothesized to cause tumor - promoting effects on urothelial cells through direct contact. We determined if moderate or severe lower urinary tract symptoms (LUTS) (defined as International Prostate Symptom Score [IPSS] ≥ 8) was associated with increased tumor recurrence. Materials and Methods: We retrospectively identified 70 consecutive men initially diagnosed with NMIBC at our institution from 2010 - 2016. Means were compared with independent T - test and proportions with chi - square analysis. Multivariate logistic regression was performed to determine independent predictors of recurrence. Results: The majority of patients had Ta disease (58.6%) followed by T1 (28.6%) and Tis (12.9%). Forty - one (58.6%) patients had moderate or severe LUTS upon presentation within 30 days of initial TURBT with mean IPSS of 13.2 vs. 5.2 in the control group (p < 0.01). Biopsy - proven tumor recurrence occurred in 24 (34.3%) patients at mean follow-up of 31.7 months. Mean time to recurrence was 14.6 months. Moderate or severe LUTS was an independent predictor of tumor recurrence (odds ratio [OR]: 19.1, 95% confidence interval [CI]: 2.86 - 127; p = 0.002). Voiding or storage symptoms based on the IPSS did not independently correlate with tumor recurrence (p = 0.08 and p = 0.31, respectively) although total mean IPSS score did (OR: 1.26, 95% CI: 1.07 - 1.47, p = 0.005). Conclusions: The presence of moderate or severe LUTS may be an important prognostic factor in NMIBC. Patients with significant urinary symptoms could be monitored more aggressively due to higher recurrence risk.

Humans , Male , Aged , Prostatic Hyperplasia/complications , Urinary Bladder/pathology , Urinary Bladder Neoplasms/pathology , Lower Urinary Tract Symptoms/etiology , Neoplasm Recurrence, Local/pathology , Quality of Life , Biopsy , Retrospective Studies , Risk Factors , Follow-Up Studies , Disease Progression , Middle Aged
Int. braz. j. urol ; 44(5): 1023-1031, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-975621


ABSTRACT Objective: To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra. Materials and Methods: Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery. Results: Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively. Conclusion: In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.

Humans , Male , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Urinary Bladder Neck Obstruction/surgery , Prostatic Hyperplasia/complications , Urinary Bladder Neck Obstruction/etiology , Treatment Outcome
Rev. medica electron ; 40(5): 1577-1584, set.-oct. 2018. graf
Article in Spanish | LILACS, CUMED | ID: biblio-978688


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).

Humans , Male , Aged , Prostatic Hyperplasia/epidemiology , Adenocarcinoma/epidemiology , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnosis , Urination Disorders/complications , Aged/physiology , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Diabetes Mellitus/diagnosis
Rev. cuba. hematol. inmunol. hemoter ; 34(3): 1-5, jul.-set. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-985534


La hemofilia A adquirida es un trastorno hemorrágico poco frecuente caracterizado por la presencia de autoanticuerpos contra el factor VIII (FVIII) circulante. Se ha observado en un grupo heterogéneo de entidades que incluyen, entre otros, enfermedades malignas; de ellas el 32 por ciento asociada a procesos urológicos, donde el cáncer de próstata tiene la mayor prevalencia. Se presenta un paciente que fue atendido en el servicio de Oncología del Hospital Universitario Celestino Hernández Robau con el diagnóstico de hemofilia A adquirida en la evolución de un adenocarcinoma prostático. Se realizó estudio de coagulación en el Instituto de Hematología e Inmunología donde se comprobó la presencia de inhibidor del factor VIII, lo que confirmó el diagnóstico. Se puso tratamiento inmunosupresor con prednisona 1 mg/kg de peso, con una evolución favorable(AU)

Acquired hemophilia A is a rare bleeding disorder characterized by the presence of autoantibodies against circulating factor VIII (FVIII). It has been observed in a heterogeneous group of entities that include, among others, malignant diseases; 32 percent associated with urological processes, where prostate cancer has the highest prevalence. We present a patient who was treated at the Oncology Service of the Celestino Hernández Robau University Hospital with the diagnosis of acquired hemophilia A in the course of a prostatic adenocarcinoma. A coagulation study was carried out at the Institute of Hematology and Immunology where the presence of factor VIII inhibitor was confirmed, confirming the diagnosis. Immunosuppressive treatment was given with prednisone 1 mg/kg of weight, with a favorable evolution(AU)

Humans , Male , Middle Aged , Prednisone/therapeutic use , Hemophilia A/complications , Hemophilia A/drug therapy , Prostatic Hyperplasia/complications , Hemophilia A/diagnosis , Hemorrhagic Disorders/complications
Int. braz. j. urol ; 44(4): 765-770, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954087


ABSTRACT Introduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood. Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery. Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis. Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012). Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

Humans , Male , Aged , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Urinary Bladder/abnormalities , Urinary Retention/etiology , Diverticulum/complications , Diverticulum/pathology , Reference Values , Urinary Bladder/pathology , Urinary Bladder/diagnostic imaging , Severity of Illness Index , Tomography, X-Ray Computed , Acute Disease , Retrospective Studies , Risk Factors , ROC Curve , Diverticulum/diagnostic imaging , Risk Assessment , Middle Aged
Yonsei Medical Journal ; : 407-418, 2016.
Article in English | WPRIM | ID: wpr-21015


PURPOSE: Tamsulosin 0.2 mg is used widely in Asian people, but the low dose has been studied less than tamsulosin 0.4 mg or other alpha blockers of standard dose. This study investigated the efficacy and safety of tamsulosin 0.2 mg by a meta-analysis and meta-regression. MATERIALS AND METHODS: We conducted a meta-analysis of efficacy of tamsulosin 0.2 mg using International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), post-voided residual volume (PVR), and quality of life (QoL). Safety was analyzed using adverse events. Relevant studies were searched using MEDLINE, EMBASE, and Cochrane library from January 1980 to June 2013. RESULTS: Ten studies were included with a total sample size of 1418 subjects [722 tamsulosin 0.2 mg group and 696 other alpha-blockers (terazosin, doxazosin, naftopidil, silodosin) group]. Study duration ranged from 4 to 24 weeks. The pooled overall standardized mean differences (SMD) in the mean change of IPSS from baseline for the tamsulosin group versus the control group was 0.02 [95% confidence interval (CI); -0.20, 0.25]. The pooled overall SMD in the mean change of QoL from baseline for the tamsulosin group versus the control group was 0.16 (95% CI; -0.16, 0.48). The regression analysis with the continuous variables (number of patients, study duration) revealed no significance in all outcomes as IPSS, QoL, and Qmax. CONCLUSION: This study clarifies that tamsulosin 0.2 mg has similar efficacy and fewer adverse events compared with other alpha-blockers as an initial treatment strategy for men with lower urinary tract symptoms.

Adrenergic alpha-1 Receptor Antagonists/administration & dosage , Adrenergic alpha-Antagonists , Dose-Response Relationship, Drug , Humans , Male , Middle Aged , Prostatic Hyperplasia/complications , Quality of Life , Sulfonamides/administration & dosage
Einstein (Säo Paulo) ; 13(3): 420-422, July-Sep. 2015. graf
Article in English | LILACS | ID: lil-761961


Giant prostatic hyperplasia is a rare condition characterized by very high volume benign prostatic enlargement (>500g). Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We report the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a 720g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.

A hiperplasia prostática gigante é uma condição rara caracterizada por aumento benigno prostático significativo, com volume maior que 500g. Existem poucos casos relatados e, em sua maioria deles está associada a sintomas graves do trato urinário inferior. Relatamos aqui o primeiro caso de hiperplasia prostática benigna assintomática em paciente idoso com próstata de 720g, hematúria macroscópica de início súbito e choque hipovolêmico. O paciente foi submetido com sucesso à prostatectomia suprapúbica, sem intercorrências no intra e pós-operatório.

Aged, 80 and over , Humans , Male , Hematuria/etiology , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/pathology , Shock/etiology , Hematuria/enzymology , Prostatectomy , Prostatic Hyperplasia/surgery
Korean Journal of Urology ; : 814-820, 2014.
Article in English | WPRIM | ID: wpr-219570


PURPOSE: To investigate the effect of metabolic syndrome (MetS) on the response to medical therapy of benign prostatic hyperplasia (BPH) after a 3-month period of treatment. MATERIALS AND METHODS: This was a cohort study of 100 patients, 47 with MetS and 53 without MetS, referred to either the primary care unit or referral hospital with BPH who had moderate lower urinary tract symptoms of prostate involvement and were candidates for medical treatment. Our main outcome was response to medical treatment with prazosin 1 mg twice a day and finasteride 5 mg daily in patients with BPH on the basis of International Prostate Symptom Score (IPSS). Multivariate analysis of covariance was used to compare BPH treatment response in patients with and without MetS before and after receiving treatment. RESULTS: The mean volume of the prostate was significantly higher in MetS patients than in patients without MetS (57+/-32.65 mL compared with 46.00+/-20.19 mL, p=0.036). The control group demonstrated an 11-unit reduction in IPSS, whereas those with MetS showed a reduction in the symptom score of only 6 units (p<0.001). Regarding the components of MetS separately, triglyceride (p<0.001), fasting blood sugar (p=0.001), and waist circumference (p=0.028) significantly affected the clinical progression of BPH. The observational nature of this study may be a limitation in comparison with an interventional study. CONCLUSIONS: The results of the present study showed that MetS can negatively affect the response to medical treatment of BPH. Therefore, it is necessary to consider MetS in selecting patients with BPH for drug therapy.

Aged , Case-Control Studies , Finasteride/therapeutic use , Humans , Lower Urinary Tract Symptoms/etiology , Male , Metabolic Syndrome/complications , Middle Aged , Patient Selection , Prazosin/therapeutic use , Prostatic Hyperplasia/complications , Treatment Outcome , Urological Agents/therapeutic use
Lima; s.n; 2013. 34 p. tab, graf.
Thesis in Spanish | LILACS, LIPECS | ID: biblio-1113147


La sintomatología miccional secundaria a Hiperplasia Prostática Benigna (HBP) y la Disfunción Eréctil (DE) son 2 entidades altamente prevalentes en al varón a partir de los 50 años. Ambas entidades tienen un impacto negativo sobre la calidad de vida. OBJETIVO: La finalidad de éste artículo es describir las relaciones encontradas entre el grado de Disfunción Eréctil y la severidad de los Síntomas del Tracto Urinario Bajo (LUTS) en pacientes con diagnóstico de Hiperplasia Prostática Benigna. MATERIAL Y METODO: Estudio descriptivo, transversal. La investigación se desarrolló en el Hospital Guillermo Almenara - EsSALUD, en una muestra de 147 pacientes. Para identificar la presencia y severidad de Disfunción Eréctil, se aplicó la Encuesta SHIM y para medir la severidad de los Síntomas del Tracto Urinario Bajo, el cuestionario IPSS. RESULTADOS: La edad promedio del grupo encuestado fue de 71.4 años±10.2 años. Se encontró LUTS severo en 65 por ciento de los pacientes, moderado en un 17 por ciento y leve en un 18 por ciento. Casi la totalidad de pacientes (92 por ciento) presentaron algún grado de Disfunción Eréctil, de los cuales en más de la mitad (52 por ciento) el grado fue severo. CONCLUSIONES: El análisis estadístico sugirió una asociación lineal y positiva entre la severidad de los síntomas de DE y LUTS; tanto para los datos globales (Tau-b Kendall, p<0,04) así como para los datos estratificados por edad (Mantel-Haenszel <.0001).

The voiding symptoms secondary to Benign Prostatic Hyperplasia (BPH) and Erectile Dysfunction (ED) are 2 highly prevalent entities to men from age 50. Both entities have a negative impact on quality of life. OBJECTlVE: The purpose of this article is to describe the relationships found between the degree of erectile dysfunction and severity of lower urinary tract symptoms (LUTS) in patients with BPH. MATERIAL AND METHOD: Descriptive, transversal. The research was conducted at the Hospital Guillermo Almenara - EsSALUD in a sample of 147 patients. To identify the presence and severity of erectile dysfunction, we applied the SHIM survey and measure the severity of lower urinary tract symptoms, the IPSS. RESULTS: Mean age was 71.4 years respondent ± 10.2 years. Severe LUTS was found in 65 per cent of patients, moderate in 17 per cent and mild in 18 per cent. Almost all patients (92 per cent) had some degree of erectile dysfunction, of which more than half (52 per cent) the degree was severe. CONCLUSIONS: Statistical analysis suggested a positive linear association between the severity of the symptoms of ED and LUTS, both for the global data (Kendall Tau-b, p<0.04) and for data stratified by age (Mantel-Haenszel <.0001).

Male , Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Erectile Dysfunction , Prostatic Hyperplasia/complications , Lower Urinary Tract Symptoms , Cross-Sectional Studies
Lima; s.n; 2013. 31 p. ilus, tab, graf.
Thesis in Spanish | LILACS, LIPECS | ID: biblio-1113349


La hiperplasia prostática benigna es una de las enfermedades benignas más comunes en el hombre y puede derivar en una hipertrofia benigna de la próstata, en una obstrucción benigna de la próstata y/o en síntomas del tracto urinario inferior. El Cáncer de próstata es actualmente reconocido como uno de los principales problemas médicos de la población masculina y constituye la segunda causa de muerte por cáncer en la población adulta masculina. La HBP es considerada, como su nombre lo dice, como una enfermedad benigna de la próstata, sin embargo, hay pacientes con diagnóstico clínico de HBP que pueden tener focos de cáncer de próstata, el cual es diagnosticado con la anatomía patológica de la muestra, y no se conoce la incidencia de estos casos en el Hospital Nacional Dos de Mayo, por lo que estos pacientes podrían ser evaluados de forma integral para el posterior manejo de la neoplasia. Justificación: En diversas revisiones acerca de la relación entre la HBP y el Cáncer de Próstata, no se ha evidenciado una relación causal entre estas patologías, sin embargo, se ha logrado comprobar que ambas enfermedades pueden coexistir en la misma glándula prostática. Es por eso que la presente investigación es conveniente y necesaria ya que en la actualidad no existen cifras exactas de pacientes con cáncer de próstata incidental que fueron sometidos a manejo quirúrgico por hiperplasia prostática benigna. Objetivo: Determinar la incidencia de cáncer de próstata en pacientes con diagnóstico clínico de Hiperplasia Prostática Benigna sometidos a manejo quirúrgico. Metodología: La evaluación del problema se realizará revisando historias clínicas donde se evaluará, el valor inicial de PSA, examen digitorectal, ecografía prostática y el resultado de la anatomía patológica de la muestra de pacientes con diagnóstico clínico de HBP que fueron sometidos a tratamiento quirúrgico. Resultados: Se encontró que el 5 por ciento de los pacientes con diagnostico clínico de HBP tuvo...

Summary: BPH is a common benign disease in men and can result in benign prostatic hypertrophy and/or lower urinary tract symptoms. Prostate cancer is now recognized as one of the major medical problems of the male population and is the second leading cause of cancer death in the adult male population. BPH is considered, as its name implies, as a benign prostate disease, however, there are patients with a clinical diagnosis of BPH that may have foci of prostate cancer, which is diagnosed with the pathology of the sample, and we don’t know the incidence of such cases in the HNDM, so that's why these patients could be evaluated comprehensively for the subsequent management of the neoplasm. Justification: In several reviews about the relationship between BPH and prostate cancer, has not shown a causal connection between these conditions, however, it has been proved that both diseases can coexist in the same gland. That is why this research is timely and necessary because currently there are no exact numbers of patients with incidental prostate cancer who underwent surgical treatment for benign prostatic hyperplasia. Objective: To determine the incidence of prostate cancer in patients with a clinical diagnosis of benign prostatic hyperplasia undergoing surgical management. Methodology: The evaluation of the problem will be reviewing the baseline PSA, digital rectal examination, prostate ultrasound and the result of the pathology sample of medical records of patients with a clinical diagnosis of BPH who underwent surgical treatment. Results: We found that 5 per cent of patients with clinical diagnosis of BPH had prostate cancer in pathological anatomy, also not all patients with PSA greater than 4 ng/dl had prostate cancer diagnosis, one patient over than 60 years had prostate cancer.

Male , Female , Humans , Adult , Middle Aged , Aged , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Prostatic Neoplasms/epidemiology , Longitudinal Studies , Retrospective Studies
Int. braz. j. urol ; 37(4): 566-576, July-Aug. 2011. ilus, tab
Article in English | LILACS | ID: lil-600811


AIMS: Tamsulosin, a superselective subtype alpha 1a and 1d blocker, is used for the treatment of male lower urinary tract symptoms (LUTS) commonly caused by benign prostatic hyperplasia (BPH). This prospective study evaluated the efficacy and safety of a new formulation, Tamsulosin OCAS® (Oral Controlled Absorption System), for LUTS associated with BPH in Thai patients. MATERIALS AND METHODS: Fifty one patients over 40 years old with complaints of LUTS associated with BPH were recruited. Patients received an 8 week course of once daily 0.4 mg tamsulosin OCAS®, and were followed up at 2 (visit 3), 4 (visit 4) and 8 (visit 5) weeks post-treatment. At each visit, patients were assessed using the International Prostate Symptom Score (IPSS), Nocturia Quality of Life (N-QoL) Questionnaire, QoL Assessment Index (IPSS-QoL), and International Index of Erectile Function (IIEF). The primary outcome was efficacy of Tamsulosin. The secondary outcomes included change in the mean number of nocturia episodes, hours of undisturbed sleep (HUS) and uroflowmetry measurements. RESULTS: Total IPSS significantly decreased at week 8 from baseline (from 19.52 to 6.08; p < 0.001). Similarly, the voiding and storage subscores of IPSS also continued to improve significantly starting from the second and third visits, respectively (p < 0.001 versus baseline). The IPSS-QoL and N-QoL scores significantly improved at visit 3 through end of study. In addition, we observed significant nocturia and HUS improvement in their last clinic visit. Uroflowmetry parameters, Qmax and Qave, improved significantly at 3rd clinic visit . Three patients experienced mild dizziness. CONCLUSION: Tamsulosin OCAS® treatment led to significant improvements in LUTS, HUS and QoL in Thai patients with bladder outlet obstruction from BPH with few side effects.

Aged , Aged, 80 and over , Humans , Male , Middle Aged , Adrenergic alpha-1 Receptor Antagonists/therapeutic use , Lower Urinary Tract Symptoms/drug therapy , Prostatic Hyperplasia/complications , Sulfonamides/therapeutic use , Urinary Bladder Neck Obstruction/complications , Administration, Oral , Analysis of Variance , Adrenergic alpha-1 Receptor Antagonists/adverse effects , Follow-Up Studies , Lower Urinary Tract Symptoms/etiology , Quality of Life , Sulfonamides/adverse effects , Time Factors , Treatment Outcome
Int. braz. j. urol ; 37(2): 223-230, Mar.-Apr. 2011. graf, tab
Article in English | LILACS | ID: lil-588995


PURPOSE: The accuracy of prostate specific antigen (PSA) to detect prostate cancer has not yet been determined. Autopsy evidence suggests one-third of men have evidence of prostate cancer. Correlation between prostate cancer and sexually transmitted infection is indeterminate. MATERIALS AND METHODS: A retrospective database was created of all men who underwent transrectal ultrasound guided prostate biopsy over 3 years. Men were 49 percent African or African Caribbean, and 51 percent Central or South American. Information about prostate specific antigen, cholesterol, hepatitis A, B and C, human immunodeficiency virus, syphilis, tuberculin skin testing and histology were collected. RESULTS: Hepatitis C antibody detection correlated with prostate cancer OR 11.2 (95 percent CI 3.0 to 72.4). The odds of prostate cancer increased annually (p = 0.0003). However, no correlation was found between prostate cancer and the following: PSA, biopsy date, repeat biopsy, more than 12 cores at biopsy, total cholesterol, high density lipoprotein, triglycerides, low density lipoprotein, risk measure reported with free and total PSA, hepatitis B surface antibody, high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. Histologic prostatitis and basal cell hyperplasia were inversely correlated with prostate cancer. Syphilis of unknown duration occurred in 17 percent of men with indeterminate correlation to prostate cancer. CONCLUSION: In inner city men of African and African-Caribbean, or Central and South American descent, prostate specific antigen levels did not correlate with prostate cancer. Hepatitis C antibody detection correlates significantly with prostate cancer. One prostate biopsy is sufficient to diagnose statistically significant prostate cancer. Histologic prostatitis and basal cell hyperplasia decrease odds of prostate cancer. Atypical small acinar proliferation may not correlate to prostate cancer and is pending further investigation. Men should be screened for epidemic syphilis of unknown duration.

Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Hepatitis C/complications , Prostatic Hyperplasia , Prostatic Neoplasms , Prostatitis/complications , Syphilis/complications , Biopsy , Neoplasm Staging , Prostatectomy , Prostate-Specific Antigen/blood , Prostatic Hyperplasia/blood , Prostatic Hyperplasia/complications , Prostatic Hyperplasia , Prostatic Neoplasms/blood , Prostatic Neoplasms/complications , Prostatic Neoplasms , Retrospective Studies , Risk Factors , Ultrasonography, Interventional
Acta cir. bras ; 26(supl.2): 125-128, 2011. tab
Article in English | LILACS | ID: lil-602657


PURPOSE: To verify the correlation between the presence of IH and the intensity of LUTS related to BPH quantified through the International Prostate Symptom Score (IPSS). METHODS: We prospectively selected 52 patients over the age of 55years; Patients were divided into 2 groups. Group 1: composed of 32 patients with IH; Group 2 (control group): composed of 20 patients with no clinical evidence of IH. All patients were assessed using the IPSS, uroflowmetry (Qmax), post-void residual urine volume (PVR) and prostate volume (PV). RESULTS: Groups 1 and 2 presented no difference in PV (p>0.05) and uroflowmetry (Qmax) (p>0.05). There was a statistical significant difference between the PVR mean values between groups 1 and 2. The presence of IH correlated with a higher IPSS score (r=0.38 p<0.05) despite the fact the no difference was detected between the incidence of patients with mild, moderate and severe LUTS in groups 1 and 2. CONCLUSION: Patients with IH present higher IPSS. The role of IPSS as a marker to predict the development of clinical IH still to be determined.

OBJETIVO: Verificar a correlação entre a presença de HI e a intensidade dos STUI quantificados através do escore internacional de sintomas prostáticos (IPSS). MÉTODOS: Foram selecionados prospectivamente 52 pacientes com idade superior a 55 anos; os pacientes foram divididos em 2 grupos. Grupo 1: composto por 32 pacientes portadores de IH, Grupo 2 (grupo controle): composto por 20 pacientes sem evidência clínica de IH. Os parâmetros avaliados foram: sintomas urinários, quantificados através do IPSS; fluxo urinário máximo (Qmax), obtido através da fluxometria livre; resíduo pós miccional (RM) e volume prostático (VP), obtido através do ultrassom transretal. RESULTADOS: Os grupos 1 e 2 não apresentaram diferença significativa em relação ao Qmax e VP (p>0.05). Foi detectada diferença estatística significativa entre em relação ao VR entre os grupos 1 e 2 (p<0.05). A presença de HI se correlacionou com o aumento da intensidade dos STUI (r=0,38; p<0.05). Não foi detectada diferença estatisticamente significativa entre a incidência de pacientes portadores de STUI, leve, moderado ou intenso entre os grupos 1 e 2. CONCLUSÃO: Pacientes portadores de HI apresentam escore de sintomas (IPSS) mais elevados, entretanto o papel dos sintomas urinários como um dos possíveis fatores causadores do aparecimento de HI ainda não foi determinado.

Aged , Aged, 80 and over , Humans , Male , Middle Aged , Hernia, Inguinal/complications , Lower Urinary Tract Symptoms/complications , Prostatic Hyperplasia/complications , Case-Control Studies , Chi-Square Distribution , Lower Urinary Tract Symptoms/diagnosis , Predictive Value of Tests , Prospective Studies , Prostate/pathology , Prostate/physiopathology , Prostatic Hyperplasia/diagnosis , Severity of Illness Index , Surveys and Questionnaires , Urodynamics/physiology
Rev. cuba. cir ; 49(3)jul.-sep. 2010.
Article in Spanish | LILACS, CUMED | ID: lil-584317


Se documenta el caso de un paciente de 78 años de edad con antecedentes de haber sido operado de hiperplasia prostática benigna a través de una adenomectomía retropúbica y, después de retirada la sonda uretral, comenzó a tener salida involuntaria de orina en las posiciones de pie y sentado. Después de 6 meses los síntomas se mantuvieron e intensificaron, y múltiples estudios confirmaron una lesión iatrogénica del esfínter externo. Se realizó una transposición perineal de los cuerpos cavernosos y se creó una uretra funcional de aproximadamente 2,5 cm. Se observó mejoría clínica inmediata que inicialmente solucionó por completo la incontinencia urinaria posquirúrgica. A los 4 años de la operación, el paciente presenta solo escaso goteo posmiccional y ligera salida de orina con los grandes esfuerzos, que mejora con tratamiento médico(AU)

This is the case of a male patient aged 78 with a history of benign prostatic hyperplasia surgery through a retropubic adenomectomy and after the urethral stent withdrawal he had an involuntary urine output in standing and sitting down positions. After 6 months the symptoms remained and intensified and multiple studies confirmed an iatrogenic lesion of external sphincter. A perineal transposition of cavernous bodies and a approximately 2,5 cm functional urethra was created. There was an immediate clinical improvement that initially solved completely the postsurgical urinary incontinence. At four year after surgery, patient presents only a low postmicturition dripping and slight urine output with great efforts improving the medical treatment(AU)

Humans , Male , Aged , Prostatic Hyperplasia/complications , Urinary Incontinence/etiology
Int. braz. j. urol ; 36(2): 190-197, Mar.-Apr. 2010. tab
Article in English | LILACS | ID: lil-548379


PURPOSE: A considerable percentage of patients with benign prostatic hyperplasia (BPH) also have additional cardiac pathologies, which often require anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of photoselective vaporization of the prostate (PVP) for BPH in cardiac patients receiving anticoagulant therapy. MATERIALS AND METHODS: A total of 67 patients suffering from BPH and high risk cardiac pathologies were operated on using laser prostatectomy. All patients had cardiac pathologies with bleeding disorders requiring anticoagulant use, and underwent standard urologic evaluation for BPH. Patients were treated with laser prostatectomy for relief of the obstruction using the KTP/532 laser energy at 80 W. RESULTS: The mean patient age was 71.4 years (range 55-80). Mean prostate volume on transrectal ultrasonography was 73.2 mL (range 44-120). Operation time ranged from 40 to 90 min, with an average value of 55 min. The average hospital stay was 48 hours (range 12-72) and the Foley catheters were removed within 48 hours, with a mean catheterization time of 34.2 ± 5.9 hours (0-48). No patient required an additional procedure due to severe bleeding necessitating intervention during the early postoperative phase. Mean International symptoms scoring system (IPSS) values and post voiding residual volume decreased and peak urinary flow rate increased (p < 0.001). Our results showed that the mean prostate volume had decreased by 53 percent at 6 months. CONCLUSIONS: High-power photo selective laser vaporization prostatectomy is a feasible, safe, and effective alternative for the minimal invasive management of BPH, particularly in cardiac patients receiving anticoagulant therapy.

Aged , Aged, 80 and over , Humans , Male , Middle Aged , Anticoagulants/administration & dosage , Laser Therapy/methods , Postoperative Complications/prevention & control , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Urinary Bladder Neck Obstruction/surgery , Administration, Oral , Feasibility Studies , Follow-Up Studies , Prospective Studies , Prostate/surgery , Prostatic Hyperplasia/complications , Treatment Outcome , Thromboembolism/prevention & control , Transurethral Resection of Prostate/standards , Urinary Bladder Neck Obstruction/etiology