Uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos. Hospital Central Universitario Dr. Antonio María Pineda / Use of uroflowmetry in the study of lower urinary tract symptoms in male patients. Central University Hospital Dr. Antonio María Pineda

La uroflujometría es un estudio no invasivo del tracto urinario inferior que entrega información objetiva del flujo urinario y es ampliamente recomendado por las guías europeas en el estudio de pacientes con sintomatología urinaria baja. Se realizó un estudio descriptivo transversal cuyo propósito fue describir el uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos que acudieron a la consulta de Servicio de Urología del Hospital Central Universitario Dr. Antonio María Pineda de la ciudad de Barquisimeto, estado Lara durante el lapso 2018- 2019. La muestra estuvo conformada por 150 pacientes. Los resultados indican que el 62% de la muestra corresponde a pacientes entre 60 y 70 años de edad de los cuales 52% manifestaron síntomas urinarios leves. La uroflujometría evidenció que 56% de los pacientes tienen un flujo máximo entre 10 y 20 ml/seg lo cual sugiere una probable obstrucción al flujo de salida; 78% de los pacientes presentan un flujo promedio entre 0 a 10 ml/seg. El 53% de los pacientes mostró un volumen de vaciado < 300 ml y 49% un tiempo de flujo máximo entre 30 y 50 segundos. En conclusión, la uroflujometría es un examen simple y rápido que proporciona información útil sobre la salud de las vías urinarias inferiores(AU)

Uroflowmetry is a non-invasive study of the lower urinary tract that provides objective information on urinary flow and is widely recommended by European guidelines for the study of patients with lower urinary tract symptoms. We performed a cross-sectional descriptive study to describe the use of uroflowmetry for the study of lower urinary tract symptoms in males who attended the Servicio de Urología of the Hospital Central Universitario Dr. Antonio María Pineda (Barquisimeto, Lara state) during the 2018- 2019 period. The sample was made up of 150 males. The results show that 62% of the sample included males between 60 and 70 years old and 52% complained of mild urinary symptoms. Uroflowmetry results showed that 56% of patients had a maximum flow between 10 and 20 ml/sec suggestive of urinary tract obstruction; 78% had an average flow between 0 and 10 ml/sec while 53% had a micturition volume < 300 ml and 49% had a maximum flow time between 30 and 50 seconds. Uroflowmetry is a simple and fast test which provides useful information about the health of lower urinary tract(AU)

Comparación de los resultados clínicos en pacientes con Hiperplasia prostática benigna con tratamiento inicial Farmacológico, no farmacológico y quirúrgico, atendidos en el Hospital Pablo Arturo Suárez de enero 2014 a diciembre 2016 / Comparison of the clinical results in patients with benign prostatic hyperplasia with initial pharmacological, non-pharmacological and surgical treatment, managed at Pablo Arturo Suárez Hospital from january 2014 to december 2016

Contexto: Al momento existen pocos datos científicos que comparen las tres modalidades de tratamiento en Hiperplasia Prostática Benigna para determinar el mejor resultado clínico, considerando que se trata de una patología cuya incidencia aumenta a medida que aumenta la esperanza de vida poblacional. Objetivo: Comparar los resultados clínicos entre el tratamiento inicial farmacológico, no farmacológico y quirúrgico, basándose en la clínica de prostatismo en pacientes con Hiperplasia Prostática Benigna durante el período de enero 2014 a diciembre 2016. Diseño: Estudio Observacional, tipo Cohorte Retrospectiva. Pacientes y Métodos: Se procedió a dividir a 399 pacientes de acuerdo a la modalidad de tratamiento recibida. Se comparó la disminución del cuadro clínico en la primera consulta postratamiento utilizando una matriz de evaluación de síntomas urinarios elaborada por los autores, basada en la escala IPSS, que estratificó a los pacientes por el grado de severidad de la sintomatología. Se utilizó el software SPSS®. Resultados: Dentro del tratamiento no farmacológico, existió una diferencia de medias de 1,67 (IC 95% 0,49 ­ 2,85, p < 0,05); para el farmacológico fue de 0,21 (IC 95% 0,92 ­ 1,34, p = 0,713) y para el quirúrgico fue de 8,23 (IC 95% 7,19 ­ 9,27, p < 0,05). Se encontraron diferencias significativas entre los tres grupos durante la fase pretratamiento, tras estratificarlos de acuerdo al grado de severidad. Post- intervención, se compararon los resultados clínicos de cada tratamiento hallando que en pacientes con síntomas leves no existieron diferencias significativas (p = 0,087), no así para pacientes con sintomatología moderada y severa en donde se encontró una diferencia estadísticamente significativa. Conclusión: En pacientes con sintomatología urinaria catalogada como moderada y severa dentro de esta muestra, el tratamiento quirúrgico disminuyó la sintomatología urinaria en mayor proporción en comparación con el tratamiento farmacológico y el no farmacológico

Background: Currently there are few scientific data comparing the three therapeutic modalities of Benign Prostatic Hyperplasia to determine the best clinical outcome, considering that it is a pathology whose incidence increases as population life expectancy arise. Objectives: To compare the clinical results between the initial pharmacological, nonpharmacological and surgical treatment, based on clinical signs of prostatism in patients with benign prostatic hyperplasia during the period between January 2014 and December 2016. Study Design: Retrospective Cohort Study. Methods: 399 patients were divided according to the modality of treatment received: nonpharmacological, pharmacological and surgical. The decrease of the symptoms was compared with the first post-treatment consultation by using a matrix of evaluation of urinary symptoms elaborated by the authors, based on SPSS International Score; this tool stratified the patients by the severity of the symptomatology. SPSS® software was used. Results: Within the non-pharmacological treatment, there was a mean difference of 1.67 (95% CI 0.49 - 2.85, p <0.05); for the pharmacological it was 0.21 (95% CI 0.92 - 1.34, p = 0.713) and for the surgical was 8.23 (95% CI 7.19 - 9.27, p <0.05). Significant differences were found between the three groups during the pretreatment phase, after stratifying them according to the degree of severity. Post-intervention, the clinical results of each treatment were compared, finding that in patients with mild symptoms there were no significant differences (p = 0.087), not so for patients with moderate and severe symptoms where a statistically significant difference was found. Conclusion: In patients with urinary symptoms classified as moderate and severe within this sample, surgical treatment decreased urinary symptomatology in greater proportion compared to pharmacological and non-pharmacological treatment

Ketanserin and Naftopidil Enhance the Potentiating Effect of Alpha-Methyl-Serotonin on the Neurally-Induced Contraction of Human Isolated Urinary Bladder Muscle Strips / 대한배뇨장애요실금학회지

PURPOSE: The aim of this study was to assess the potential involvement of a specific subtype of 5-hydroxytryptamine (5-HT), 5HT(2) receptors in neurally-induced contractions of the human detrusor. METHODS: Contractile responses to electrical field stimulation (EFS) were examined in human isolated urinary bladder muscle strips. The potentiation of EFS-induced detrusor contraction was examined by adding cumulative concentrations of a 5-HT and 5-HT(2) receptor agonist, α-methyl-serotonin (α-Me-5-HT) (1nM–100μM) in the presence or absence of a 5-HT₂ antagonist, ketanserin (5-HT(2A)>5-HT(2C)) or naftopidil (5-HT(2B)>5-HT(2A)) (0.3–3μM). RESULTS: 5-HT and α-Me-5-HT potentiated EFS-induced contraction with a maximal effect (E(max)) of 37.6% and 38.6%, respectively, and with pEC(50) (negative logarithm of the concentration required for a half-maximal response to an agonist) values of 8.3 and 6.8, respectively. Neither ketanserin nor naftopidil at any concentration produced a rightward displacement of the α-Me-5-HT concentration response curve. Instead, the E(max) of α-Me-5-HT increased in the presence of ketanserin at 0.3–1μM and in the presence of naftopidil at 1μM to 51% and 56%, respectively, while the E(max) in the presence of vehicle alone was 36%. The highest concentration (3μM) of either drug, however, fully reversed the enhancement. CONCLUSIONS: The potentiating effect of α-Me-5-HT on neurally-induced contraction of human urinary bladder muscle strips was not found to be mediated via any 5-HT(2) receptor subtypes. The underlying mechanism for the enhancement of the α-Me-5-HT potentiating effect on detrusor contractility by ketanserin and naftopidil remains unknown; however, our results suggest that these drugs may be useful for treating contractile dysfunction of the detrusor, as manifested in conditions such as underactive bladder.

Long-term efficacy and safety of tamsulosin hydrochloride for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia: data from China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tamsulosin hydrochloride can significantly improve benign prostatic hyperplasia (BPH) symptoms after the first dose and achieve long-term efficacy in European and American populations; however, the corresponding studies from China are rarely seen. The purpose of this study was to evaluate the long-term efficacy and safety of tamsulosin hydrochloride 0.2 mg once daily in patients with lower urinary tract symptoms (LUTS) suggestive of BPH in China.</p><p><b>METHODS</b>Chinese patients with LUTS suggestive of BPH were enrolled in a 4-week placebo run-in period and subsequent 60-week open-label study. Tamsulosin hydrochloride 0.2 mg was administered daily during the period of the study. The efficacy and safety parameters were evaluated at the end of treatment period I (0 - 12 weeks) and period II (13 - 60 weeks). The BPH patients were divided into tamsulosin monotherapy group and combination therapy group which received concomitant medication of finasteride 5 mg once daily after the evaluation at the end of treatment period I.</p><p><b>RESULTS</b>A total of 113 patients were recruited to the study. Eighty-two patients received tamsulosin monotherapy and twenty-nine received combination therapy during the treatment period II. Tamsulosin hydrochloride produced a great improvement in mean maximum urinary flow rate (Q(max)) (1.7 ml/s, 3 ml/s) and a significant decrease in mean international prostate symptom score (IPSS) (4.1, 6.4) after 12-week and 60-week treatments, respectively. At the end of treatment period II, there were significant improvement in IPSS, quality of life (QOL) score, Q(max) and average flow rate (Q(ave)) for combination therapy group compared with the treatment period I (all P < 0.05). No serious adverse events (SAE) were recorded during the study.</p><p><b>CONCLUSION</b>Long-term tamsulosin hydrochloride therapy is a safe, effective and well-tolerated method for the treatment for LUTS suggestive of BPH in China.</p>

Detection rate of prostate cancer using prostate specific antigen in patients presenting with lower urinary tract symptoms: a retrospective study.

BACKGROUND: Need for undertaking prostate biopsies for detection of prostate cancer is often decided on the basis of serum levels of prostate specific antigen (PSA). AIM: To evaluate the case detection rate of prostate cancer among patients presenting with lower urinary tract symptoms (LUTS) on the basis of PSA levels and to assess the scope of prostate biopsy in these patients. SETTING AND DESIGN: A retrospective study from a tertiary care center. MATERIALS AND METHODS: The clinical and histopathological data of 922 patients presenting with LUTS in the last five years was obtained from the medical record section. They had been screened for prostate cancer using PSA and /or digital rectal examination examination followed by confirmation with prostate biopsy. STATISTICAL ANALYSIS USED: Detection rate and receiver operating characteristic curve were performed using SPSS 16 and Medcalc softwares. RESULTS: The detection rate of prostate cancer according to the PSA levels was 0.6%, 2.3%, 2.5%, 34.1% and 54.9% in the PSA range of 0-4, 4-10, 10-20, 20-50 and> 50 ng/ml, respectively. Maximum prostate cancer cases were detected beyond a PSA value of 20 ng/ml whereas no significant difference in the detection rate was observed in the PSA range of 0-4, 4-10 and 10-20 ng/ml. CONCLUSION: A low detection rate of prostate cancer observed in the PSA range of 4-20 ng/ml in LUTS patients indicates the need for use of higher cutoff values of PSA in such cases. Therefore we recommend a cutoff of 20 ng/ml of PSA for evaluation of detection rate of prostate cancer among patients presenting with LUTS.

Respuesta de la glándula prostática a la inflamación: pastrón morfológico y modulación de moléculas epiteliales de defensa / Response of the prostate gland to the inflammation: pastrón morphologic and modulation of molecules epiteliales of defense

La próstata es el sitio más propenso a desarrollar procesos inflamatorios y alteraciones del crecimiento celular dentro del tracto genital masculino. Las prostatis, sindrome clínico que experimentan los pacientes con inflamación de la próstata, constituyen una importante causa deterioro en la calidad de vida en hombres de todas las edades y un proceso de difícil tratamiento. Estudios recientes han postulado que los epitelios expuestos a injurias poseen mecanismos de defensa propios de la inmunidad innata, con la participación de moléculas específicas tales como TLR4 para reconocimiento bacteriano, los antibacterianos SP-D y defensinas, citocinas proinflamatorias y las inmunomoduladoras UG, PBP y Gal-1.

Double-blind randomized placebo-controlled study of bixa orellana in patients with lower urinary tract symptoms associated to benign prostatic hyperplasia

OBJECTIVE: To determine the efficacy of Bixa Orellana (BO) in patients with benign prostatic hyperplasia (BPH) presenting moderate lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: It is a prospective double-blind randomized placebo-controlled study. One thousand four hundred and seventy eight patients presenting moderate LUTS associated to BPH were interviewed, from whom we selected 136 to fulfill the criteria of inclusion and exclusion. Assignation was performed at random in blocks of four to receive B0 at a dose of 250 mg 3 times a day or placebo (Pbo) for 12 months, 68 patients were assigned to each group. From the patients in the study we obtained data of demographic, epidemiologic, symptom score, uroflowmetry and post void residual urine variables. RESULTS: Basically both groups were compared clinically, demographically and biochemically. Throughout the study variations of symptom score, mean delta symptom score during each visit and the final average delta were similar for both groups (BO - 0.79 ± 1.87 and Pbo - 1.07 ± 1.49) (p = 0.33). Similarly variations of Qmax mean, Qmax average delta and final average delta were similar (BO 0.44 ± 1.07 and Pbo 0.47 ± 1.32) (p = 0.88). Variations of post void residual urine mean, post void residual urine average delta in each visit and the final average delta were similar for both groups (BO 4.24 ± 11.69 and Pbo 9.01 ± 18.66) (p = 0.07). No differences were found in the answers of clinically significant improvement assessed with relative risk and risk differences, even though the proportion of adverse effects was similar for both groups. CONCLUSION: Patients with BPH that present moderate LUTS did not show any benefit receiving BO when compared to placebo.

Pathophysiology of Male Lower Urinary Tract Symptoms / 대한비뇨기과학회지

In the past, older male with frequency, weak stream, hesitancy nocturia has prostatism implying his symptoms are related to benign prostatic hyperplasia (BPH). Recently, it was recognized that such symptoms are not a surrogate for BPH. Lower urinary tract symptoms (LUTS) have many causes, of which BPH is but one. The pathophysiology of LUTS is multifactorial. Bladder outlet obstruction (BOO) is one of the principal causes of LUTS: in addition to BOO, detrusor factors such as detrusor overactivity and detrusor underactivity can contribute to the development of LUTS. Of the men with LUTS, lots of them exhibited non-obstructed causes of LUTS in the urodynamic analysis. Increased awareness that there are multifactorial causes of LUTS became a force in changing the pattern of management. Therefore, relieving BOO such as debulking of the prostate mass may not be crucial for solution of LUTS. Aims of the treatment of LUTS also changed from the reducing obstruction and increasing the flow to the patient quality of life and satisfaction by using medical therapy such as alpha-adrenoceptor blockers. This review summarized the multifactorial causes of LUTS in men based on recent literatures.

effect of acute urinary retention on serum prostate-specific antigen level

Our aim was to evaluate the effect of acute urinary retention on serum prostate-specific antigen [PSA] level. Men aged 50 years and older who presented with acute urinary retention were studied. Patients with urethral stricture, neurogenic bladder, prostate cancer, and those with a history of recent instrumentation or prostate biopsy were excluded. Blood samples for serum PSA measurement were obtained [PSA1], and an indwelling urethral catheter was inserted for 2 weeks. Before catheter removal, a second blood sample for measurement of serum PSA level [PSA2] was obtained. In patients who were able to void, a third sample was obtained 3 weeks later [PSA3]. In the first and second visits, digital rectal examinations [DRE1, DRE2] were performed to assess prostate volume. Mean PSA levels [PSA1, PSA2, and PSA3] and prostate volumes [DRE1, DRE2] were compared. Forty-five patients with a mean age of 70.18 years [range 56 to 85 years] participated in this study. Mean PSA1 and PSA2 levels were 9.8 ng/mL and 5.05 ng/mL, respectively [P<0.001; medians, 6.2 and 4.2 ng/mL]. Mean prostate volumes at the time of retention and 2 weeks later were 43.4 mL and 37.8 mL, respectively [P<0.001; medians, 45 and 40 mL]. PSA3 was measured in 31 patients 2 weeks after catheter removal. In this group of patients, mean PSA2 and PSA3 levels were 5.03 ng/mL and 4.97 ng/mL, respectively [P=0.49; medians, 4.3 and 4.1 ng/mL]. Acute urinary retention can increase serum PSA levels by approximately 2 fold. In this series, we found that this effect may continue up to 2 weeks

Development of Statistical Model for Predicting Prostate Cancer in Patients Requiring Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: Patients with an abnormal digital rectal examination(DRE) or elevated serum prostate specific antigen(PSA) level proceed to a transrectal biopsy of the prostate. However, cancer detection is not predictable. There is a need to develop a statistical model for predicting the likelihood of prostate cancer for there to be confidence about the result of a biopsy. MATERIALS AND METHODS: Patients with prostatism were evaluated based upon the recommendation of the International Consultation on benign prostatic hyperplasia(BPH). Amongst the patients evaluated, 141 revealed an abnormal DRE and/or serum PSA. A transrectal ultrasonography(TRUS) and transrectal biopsy was performed in all the patients. 38 of the above were diagnosed with prostate cancer and 103 with BPH or prostatitis. A logistic regression model was used to identify the variables with the most independent influence on prostate cancer and determine the most parsimonious combination of variables for predicting prostate cancer. RESULTS: Age, hematuria, nocturia and a combination of urinary symptoms (incomplete emptying, frequency, urgency and nocturia), DRE, PSA and TRUS-hypoechoic lesion were significant variables for separately predicting prostate cancer. Among these, age, DRE, PSA and TRUS-hypoechoic lesion were independent predictors. The probability of prostate cancer(P) =exp(-9.7770+0.0807xage+1.4079xDRE+0.0257xPSA+1.0904xTRUS- hypoechoic lesion)/{(1+exp(-9.7770+0.0807xage+1.4079xDRE+0.0257xPSA+1.0904xTRUS-hypoechoic lesion)}. CONCLUSIONS: A useful predictive model of prostate cancer has been developed using logistic regression analysis. This model suggests that patients with a high probability(P), but negative biopsy, would require a repeat biopsy. However, a low probability(P), and negative biopsy, would be suggestive of no hidden disease.

Atypical (Bizarre) Leiomyoma of the Prostate: A Case Report

Atypical (bizarre) leiomyoma of the prostate is a very rare neoplasm. Five cases have been reported in English medical literature. A 60-year-old Korean man with a history of prostatism and slightly elevated serum prostate specific antigen was presented. Microscopically, the transurethral resection specimen consisted of a proliferation of hypercellular spindle cells with intersecting bundles. The nuclei of the tumor cells showed marked pleomorphism and hyperchromasia with occasional multinucleated giant cells. Mitoses were seen in areas of up to 2 per 10 high power fields, but there was no evidence of atypical ones. The tumor cells were immunoreactive against anti-smooth muscle actin and desmin antibodies. The proliferative index (10.0%) of the atypical leiomyoma lay between that of a benign smooth muscle and that of a leiomyosarcoma of the prostate. Flow cytometry showed a diploid pattern with an elevated S phase fraction. To the best of our knowledge, this is the first demonstration of atypical leiomyoma of the prostate in a Korean man.

Técnica hemostática extracapsular en adenomectomía prostática / Extracapsular hemostatic technique in prostatic adenomectomy

Propósito: proponemos una prostatectomía extracapsular aplicando suturas transfictivas capsulares laterales después de la enucleación del adenoma con hemorragia operatoria mínima.Materiales y métodos: 117 pacientes con Hipertrofia Prostática fueron operados. Después de la adenomectomía se colocaron suturas transfictivas en el labio posterior del cuello vesical, en el borde superior de la cápsula prostática y a las 3 y a las 9 en la esfera del reloj de la cápsula prostática (hilios prostáticos). Varias variables indicadoras (hematócrito, hemoglobina, hemorragia intra-operatoria, hemorragia post-operatoria) cuantificaron la hemorragia atribuible a la prostatectomía.Resultados: la pérdida de sangre intra-operatoria promedio fue de 175cc con un descenso promedio del hematócrito y de la hemoglobina de 3.9 por ciento y 2g/dl respectivamente. La mayoría de los pacientes tuvieron escaso sangrado post-operatorio por las sondas uretral y suprapúbica.Conclusiones: la técnica hemostática propuesta, provocó mínima hemorragia operatoria debido al abordaje extracapsular minimizando la injuria quirúrgica a la ricamente vascularizada cápsula prostática y a la ligadura de los hilios prostáticos usando suturas transfictivas capsulares laterales después de la adenomectomía.

Purpose: We propose an extracapsular prostatectomy using lateral capsular transfictive sutures after the adenomectomy with little surgical hemorrhage.Materials and methods: 117 patients with Prostatic Hypertrophy were operated. Transfictive sutures were placed on the posterior edge of the vesical neck, on the superior border of the prostatic capsule and at 3 and 9 clockwise on the prostatic capsule (prostatic hilum) after the adenomectomy. Several indicators (hematocrit, hemoglobine, operatory hemorrhage, post-operatory hemorrhage) measured the surgical hemorrhage.Results: the operatory average blood loss was 175 mililiters with a hematocrit and hemoglobine average decrease of 3.9 percent and 2 g/dl respectively. Most of the patients had scarce post-operatory bleeding through the urethral and suprapubic catheters.Conclusions: the proposed hemostatic technique caused little operatory hemorrhage because of the extracapsular approach reducing the surgical injury to the extensively vascularized prostatic capsule and on account of the lateral capsular transfictive sutures placed on the prostatic hilium after the adenomectomy.

The Lifestyle Factors in Relation to Prostatism in BPH Awareness Program / 대한비뇨기과학회지

No abstract available.

Prevalence of Benign Prostatic Hyperplasia in Jeong-Eup Area: Community-based Study / 대한비뇨기과학회지

PURPOSE: There is no consensus about a definition of benign prostatic hyperplasia, but there are various definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, increase of prostate volume, and bladder outlet obstruction. The prevalence of clinical BPH in Asian was believed to be lower than Caucasian. The lower urinary tract symptoms associated with BPH in Korea was reported by some authors and it was similar to the results of other studies in western countries. We report the prevalence of BPH in Korean men through a community-based study in Jeong-Eup county, Korea. MATERIALS AND METHODS: A total of 653 men aged 50 and over in Jeong-Eup area, Korea was randomly selected for determination of the prevalence of BPH. The definition of BPH in this study was combination of moderate(8-19) to severe(>19) I-PSS, enlargement of the prostate over 30gms on digital rectal examination by one board certified urologist, and decreased peak flow rate below 15ml/sec. Men with abnormal digital rectal examination(DRE) and elevated serum prostate specific antigen(PSA) above 3.5ng/ml were undergone sextant prostate biopsy to exclude the prostate cancer. RESULTS: I-PSS questionnaires were completed in 431 men and the response rate was 66.1%. Based on I-PSS, 162 men(37.6%) had moderate symptoms and 51 men(11.9%) severe symptoms. Of 213 men with moderate to severe symptoms, 35.7% had enlarged prostate by DRE, and 63.1% decreased flow rate. The prevalence of BPH by the definition in this study was 4.3% in their fifties, 13.2% in sixties and 16.3% in seventies and over eighty(overall, 11.1%). The population-adjusted prevalence of BPH in Korean men aged 50 and over was 8.7%. A good correlation was found between the total symptom score and the quality of life score that is included in the I-PSS. CONCLUSIONS: Men with moderate to severe I-PSS was 49.5%, which was similar to the results from other studies in Caucasian and Japanese. The prevalence of BPH in Korea by aforementioned definition was 8.7%, which seems to be lower than Caucasian. This results suggest that approximately 1,600,000 Korean men had moderate to severe urinary symptoms and 300,000 clinical BPH by the definition in this study.

A Crystallographic Analysis of Prostatic Calculi according to the Location on Transrectal Prostatic Ultrasonography / 대한비뇨기과학회지

PURPOSE: We studied the crystallographic component of the prostatic calculi according to the location on the transrectal prostatic ultrasonography to know the mechanism of the formation of the calculus. MATERIALS AND METHODS: From August, 1995 until May, 1997, 33 prostatic calculi from 24 patients(mean age 59 years, mean size 3.1mm) operated on for prostatism were analyzed by polarization microscopy(ZeissR), X-ray diffraction(PW-1720R, Philips) and infrared spectrophotometer(FTIR-205R, Nicolet). Location of calculi was divided two groups under guide of transrectal prostatic ultrasonography; periurethral and periadenoma type. The periurethral type showed hyperechoic density around the prostatic urethra and the periadenoma type showed hyperechoic density between adenoma and false prostatic capsule(peripheral zone). RESULTS: 22 calculi were the periurethral type and 11 were periadenoma type. Thirty stones from 20 periurethral type and 10 periadenoma type consisted two or three of the following calcium phospate, calcium oxalate and tricalcium phospate. These are mixed by the endogenous origin formed from the prostatic fluid and the exogenous origin formed at least in part from urine. Three stones (2 calcium oxalate, 1 uric acid) contained only one compound which participitate from urine. All of 11 calculi of the pericapsular type had an oxalate component. CONCLUSIONS: The calculi around the periadenoma region may be formed from not only endogenous component(calcium apatite stone) but also exogenous component(calcium oxalate) or intraductal precipitation of oxalate component which has never found in the prostatic fluid. These results may suggest the necessity of reevaluation about oxalate component within the prostatic fluid.

Incidence of Detrusor Underactivity in Men with Prostatism Older than 50 years / 대한비뇨기과학회지

PURPOSE: It has been well known that 70-80% of men with prostatism actually manifest bladder outlet obstruction(BOO) and the rest have detrusor underactivity(DU) or other abnormalities. Accordingly, the treatment of BPH by the results of symptom score, or uroflow may be partly incorrect. It is also well known that the pressure-flow study is the gold-standard to define the presence and degree of BOO. Therefore, we investigated pressure-flow study to identify non-obstructed, underactive detrusor function among the patients presented with prostatism. MATERIALS AND METHODS: This study included 96 patients older than 50 years (mean 69.6+/-5.8) with prostatism. All patients were assessed by history taking, symptom score, digital rectal examination, uroflowmetry and pressure-flow study. Patients were divided into irritative and obstructive symptom groups according to their chief complaints. Urodynamic parameters between those two groups were analyzed and compared. RESULTS: Of the total 96 patients, detrusor instability was noted in 45(47%) at the filling cystometry. Of the 53 patients presented with irritative symptoms, 33 showed detrusor instability(62%); Of the 43 patients mainly presented with obstructive symptoms, only 12(28%) showed detrusor instability. Statistically significant correlation was found between irritative symptoms and detrusor instability as well as obstructed symptoms and BOO. In the total patients, BOO was found in 49(51%) and detrusor underactivity(DU) was found in 36(37%) with equivocal cases in 11(12%). Of the 43 patients mainly presented with obstructive symptoms, BOO and DU was found in 23(53%) and 13(30%) respectively. Of the 53 patients presented with irritative symptoms, BOO and DU was found in 26(49%) and 23(43%) respectively. There were no significant differences between irritative and obstructive symptom group as well as BOO and DU group in the clinical parameters as determined by symptom score, prostate size, and uroflowmetry. CONCLUSIONS: In this study, significant proportion(37%) of the whole patient population was classified as detrusor underactivity as diagnosed by urodynamics to which treatment for BPH may not be as effective as for those manifested with BOO. It is suggested that pressure-flow study is to be considered to patients with prostatism who didn`t show any symptomatic improvement despite the treatment for BPH.

Study of Prostatic Disease and Symptom between Special Occupation Groups(Taxi Driver, Barber) / 대한비뇨기과학회지

PURPOSE: To compare symptoms of prostatism and their causes between two occupation groups with different working environment and position: one group of tarsi drivers working mainly in sitting position under constant stress and another group of barbers working mainly in standing position. MATERIALS AND METHOD: 405 taxi drivers and 110 barber participated in prostatic disease screening program. 93 patients with prostatic symptom were also enrolled in this study. All participants underwent IPSS self-assessment, digital rectal examination, urinary flow rate, transrectal ultrasound and prostatic cancer screening test (PSA, and if necessary, prostatic biopsy). RESULTS: IPSS were similar in taxi drivers group and patient group, whereas it was significantly lower in barbers group. Mean maximal flow rate was similar in both taxi drivers and patient groups, but significantly higher in barbers group. Incidence of abnormal voiding pattern was significantly higher in taxi drivers group compared to other groups. TRUS showed higher incidence of calcification and ejaculatory duct abnormality in taxi drivers group compared to other groups. Prostatitis and prostatodynia combined were more prevalent in taxi drivers group than in barbers groups. CONCLUSIONS: Taxi drivers working in a constrained environment of prolonged sitting exposed to a lot of stress, pelvic floor tension and abstinence of urine had more diverse voiding symptoms and greater prevalence of prostatitis and prostatodynia than barbers group.