PURPOSE: Prostaglandin in the urinary bladder could be changed due to pathology of bladder and this change could be noted in the urine. This study was performed to investigate the changes in urinary prostaglandins in male patient with lower urinary tract symptom (LUTS). MATERIALS AND METHODS: The study groups included 60 male LUTS patients and 15 healthy male patients were used as the reference controls. Evaluation included history taking, urinalysis, IPSS and urodynamic study. The urinary concentration of prostaglandin E2 (PGE2) and prostaglandin F2alpha (PGF2alpha) in voided urine were analyzed by enzyme linked immunosorbent assay (ELISA) and these results were compared with control group. RESULTS: The IPSS scores of LUTS patients were higher than those of control patients. Also, detrusor overactivity was found in 30 patients and bladder outlet obstruction was found in 38 patients from urodynamic study. The urinary concentration of PGE2 was significantly increased in LUTS patients compared with control patients. The urinary concentration of PGF2alpha was not statistically significant between LUTS patients and control patients. The urinary concentration of PGE2 was decreased in LUTS patients with detrusor underactivity and negatively correlated to maximal bladder capacity. However, The urinary concentration of PGF2alpha was not correlated with IPSS and urodynamic parameters. CONCLUSION: Prostaglandins may play a role in lower urinary tract symptoms, and these changes can be detected in urine sample. Therefore, urinary PG may be used as a marker to evaluate lower urinary tract symptoms.
Dinoprost ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Pathology ; Prostaglandins ; Urinalysis ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urodynamics

INTRODUCTIONThe objective of this study is to determine the relationships between prostatic volume (PV) and intravesical prostatic protrusion (IPP) with benign prostatic obstruction (BPO).

MATERIALS AND METHODSA total of 408 males (aged 50 years and above) who presented with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) were recruited. All had International Prostate Symptoms Score (IPSS), quality of life (QOL) index, uroflowmetry (Qmax) and postvoid residual urine (PVR) measured by transabdominal ultrasonography (TAUS). The PV and the degree of IPP were also measured by TAUS in the transverse and sagittal planes respectively. The PV is classified as Grade a, (20 ml or less), Grade b, (more than 20 ml to 40 ml) and Grade c, (more than 40 ml), while the IPP is graded as Grade 1 (5 mm or less), Grade 2 (more than 5 mm to 10 mm) and Grade 3 (more than 10 mm).

RESULTSThere was a fair positive correlation between the PV and IPP (Spearman, r(s) = 0.62, P <0.001) with important clinical exceptions. There was negative correlation between the PV and Qmax (rs = -0.20, P = 0.022), IPP and Qmax (r(s) = -0.30, P <0.001). PV and IPP were good predictors of BPO. However, IPP was slightly better (r(s) of -0.30 vs -0.20) than PV.

CONCLUSIONPV is related to IPP with important clinical exceptions. IPP is a better predictor of BPO than PV.

Humans ; Lower Urinary Tract Symptoms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Prostate ; diagnostic imaging ; pathology ; Prostatic Hyperplasia ; diagnostic imaging ; Quality of Life ; Ultrasonography ; Urinary Bladder ; diagnostic imaging

Cowper's syringoceles are uncommon, usually described in children and most commonly limited to the ducts. We describe more complex variants in an adult population affecting with varying degrees of severity, the glands themselves, and the complications they may lead to. One hundred consecutive urethrograms of patients with unreconstructed strictures were reviewed. Twenty-six patients (mean age: 41.1 years) with Cowper's syringoceles who were managed between 2009 and 2016 were subsequently evaluated. Presentation, radiological appearance, treatment (when indicated), and outcomes were assessed. Of 100 urethrograms in patients with strictures, 33.0% demonstrated filling of Cowper's ducts or glands, occurring predominantly in patients with bulbar strictures. Only 1 of 26 patients with non-bulbar strictures had a visible duct/gland. Of 26 symptomatic patients, 15 presented with poor flow. In four patients, a grossly dilated Cowper's duct obstructed the urethra. In the remaining 11 patients, a bulbar stricture caused the symptoms and the syringocele was identified incidentally. Eight patients presented with perineal pain. In six of them, fluoroscopy and magnetic resonance imaging (MRI) revealed complex multicystic lesions within the bulbourethral glands. Four patients developed perineoscrotal abscesses. In the 11 patients with strictures, the syringocele was no longer visible after urethroplasty. In three of four patients with urethral obstruction secondary to a dilated Cowper's duct, this resolved after transperineal excision (n = 2) and endoscopic deroofing (n = 1). Five of six patients with complex syringoceles involving Cowper's glands were excised surgically with symptomatic relief in all. In conclusion, Cowper's syringocele in adults is more common than previously thought and may cause lower urinary tract symptoms or be associated with serious complications which usually require surgical treatment.
Adult ; Bulbourethral Glands/pathology* ; Humans ; Lower Urinary Tract Symptoms/pathology* ; Male ; Middle Aged ; Pelvic Pain/pathology* ; Urethral Stricture/pathology* ; Young Adult

We aimed to develop and validate a clinical nomogram predicting bladder outlet obstruction (BOO) solely using routine clinical parameters in men with refractory nonneurogenic lower urinary tract symptoms (LUTS). A total of 750 eligible patients ≥50 years of age who had previously not responded (International Prostate Symptom Score [IPSS] improvement <4 points) to at least three different kinds of LUTS medications (including a-blocker) for the last 6 months were evaluated as subcohorts for nomogram development (n = 570) and for split-sample validation (n = 180). BOO was defined as Abrams-Griffiths number ≥40, or 20-39.9 with a slope of linear passive urethral resistance ratio >2 cmH₂O ml^-1 s^-1. A stepwise multivariable logistic regression analysis was conducted to determine the predictors of BOO, and b-coefficients of the final model were selected to create a clinical nomogram. The final multivariable logistic regression model showed that age, IPSS, maximum urinary flow rate, postvoid residual volume, total prostate volume, and transitional zone index were significant for predicting BOO; these candidates were used to develop the final nomogram. The discrimination performance of the nomogram was 88.3% (95% CI: 82.7%-93.0%, P < 0.001), and the nomogram was reasonably well-fitted to the ideal line of the calibration plot. Independent split-sample validation revealed 80.9% (95% CI: 75.5%-84.4%, P < 0.001) accuracy. The proposed BOO nomogram based solely on routine clinical parameters was accurate and validated properly. This nomogram may be useful in determining further treatment, primarily focused on prostatic surgery for BOO, without impeding the detection of possible BOO in men with LUTS that is refractory to empirical medications.
Adult ; Aged ; Cohort Studies ; Humans ; Lower Urinary Tract Symptoms/physiopathology* ; Male ; Middle Aged ; Nomograms ; Prostate/pathology* ; ROC Curve ; Reproducibility of Results ; Retrospective Studies ; Urinary Bladder Neck Obstruction/physiopathology* ; Urodynamics

OBJECTIVETo compare the positive rates and complications of ultrasound-guided transrectal and transperineal prostate biopsies.

METHODSWe retrospectively analyzed 156 cases of ultrasound-guided transrectal (n = 97) and transperineal (n = 59) prostate biopsy, and compared the positive rate and post-biopsy complications between the two approaches.

RESULTSThe positive rates in the transrectal and transperineal groups were 48.4% and 44.1%, respectively, with no significant difference between the two approaches according to different PSA levels (P >0.05). No statistically significant differences were observed between the transrectal and transperineal groups in the post-biopsy incidence rates of such complications as hematuria (54.6% vs 42.4%, P >0.05), lower urinary tract symptoms (17.5% vs 22.0%, P >0.05), dysuria (9.3% vs 6.8%, P >0.05), and acute urinary retention (7.2% vs 6.8%, P >0.05). However, the incidence rates of post-biopsy infection and rectal bleeding were remarkably higher (15.5% vs 3.4%, P<0.05 and 50.5% vs 3.4%, P >0.01) while that of perineal swelling markedly lower in the former than in the latter (3.1% vs 13.6%, P <0.05).

CONCLUSIONTransrectal and transperineal biopsies are both effective for the diagnosis of prostate cancer. Since their complications vary, the choice between the two methods depends on the specific condition of the patient.

Biopsy, Needle ; adverse effects ; methods ; Hematuria ; etiology ; Humans ; Lower Urinary Tract Symptoms ; etiology ; Male ; Prostate ; pathology ; Prostatic Neoplasms ; pathology ; Rectum ; Retrospective Studies ; Ultrasonography, Interventional ; methods ; Urination Disorders ; etiology

OBJECTIVETo assess the application value of diagnostic transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) patients with persistently abnormal serum PSA levels.

METHODSWe performed TURP for 71 BPH patients with the PSA level > 4 microg/L, and analyzed the Gleason scores and prognosis of the cases pathologically confirmed as prostate cancer (PCa). We conducted follow-up visits to all the patients, obtained the PSA levels and International Prostate Symptom scores (IPSS) at 6 and 12 months after TURP, analyzed their changes and assessed the value of TURP in the diagnosis and treatment of BPH with serum PSA abnormality.

RESULTSAmong the 40 patients with negative prostate biopsy and persistent serum PSA abnormality, 2 cases were diagnosed as Gleason score 6 prostatic adenocarcinoma by TURP biopsy, and 1 case as Gleason score 6 PCa by repeated biopsy. All the 3 patients underwent radical prostatectomies and were well recovered during the follow-up visits. Of the 31 patients who had refused biopsy, 9 cases were confirmed by postoperative pathology as Gleason score 7 -9 PCa, 1 treated by radical prostatectomy and the other 8 by endocrine therapy. Another 59 cases were pathologically diagnosed as BPH, of which, the serum PSA level was restored to normal in 56 and significantly reduced in the other 3, and IPSS was remarkably increased in 53 and improved in the other 6 following urethral soundings.

CONCLUSIONDiagnostic TURP can increase the early diagnosis rate of PCa, improve lower urinary tract symptoms (LUTS) and help to normalize the serum PSA level. Therefore, it can be chosen for those with persistent serum PSA abnormality, LUTS and negative prostate biopsy.

Adenocarcinoma ; diagnosis ; Biopsy ; Humans ; Lower Urinary Tract Symptoms ; diagnosis ; Male ; Prognosis ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; diagnosis ; Prostatic Neoplasms ; diagnosis ; Transurethral Resection of Prostate

Objective: To investigate the effects of transrectal ultrasound conductance (TRUSC)-guided administration of traditional Chinese medicine on histological prostatitis in men with small-size BPH and low urinary tract symptoms (LUTS) after transurethral resection of the prostate (TURP). METHODS: This study included 167 BPH patients without surgical contraindications. We randomized the patients into an experimental group (n = 84) and a control group (n = 83), with no statistically significant differences between the two groups in age, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QoL) (P >0.05). The patients of the experimental group received TRUSC-guided administration of traditional Chinese medicine, qd, for 7 days before TURP, while those of the control group underwent TURP only. After treatment, we compared the results of postoperative pathological examination of the prostate tissue, the histological grade of inflammation, IPSS, and QoL scores between the two groups of patients. RESULTS: In the experimental group, there were 12 cases of non-inflammation (14.3%), 43 cases of mild inflammation (51.2%), 28 cases of moderate inflammation (33.3%), and 1 case of severe inflammation (1.2%), as compared with 8 cases of non-inflammation (9.6%), 28 cases of mild inflammation (33.7%), 45 cases of moderate inflammation (51.8%), and 2 cases of severe inflammation (2.4%) in the control group (P <0.05). Compared with the baseline, both the experimental and control groups showed significant improvement at 4 weeks after surgery in IPSS (22.20±4.14 vs 4.26±2.64 and 23.05±4.11 vs 7.02±4.15, P <0.05) and QoL scores (4.33±0.83 vs 1.25±1.64 and 4.25±0.91 vs 2.05±1.95, P <0.05). CONCLUSIONS TRUSC-guided administration of traditional Chinese medicine can significantly alleviate histological inflammation and improve QoL in men with small-size BPH and LUTS after TURP.
Drugs, Chinese Herbal ; administration & dosage ; Humans ; Lower Urinary Tract Symptoms ; drug therapy ; Male ; Medicine, Chinese Traditional ; methods ; Prostatic Hyperplasia ; drug therapy ; pathology ; Prostatitis ; drug therapy ; pathology ; Quality of Life ; Transurethral Resection of Prostate ; Treatment Outcome ; Ultrasonography, Interventional ; methods

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 X/*complications ; Middle Aged ; Patient Selection ; Prazosin/*therapeutic use ; Prostatic Hyperplasia/complications/*drug therapy/pathology ; Treatment Outcome ; Urological Agents/*therapeutic use

BACKGROUNDThe clinical failure after prostatic artery embolization (PAE) with conventional particles was relatively high, in treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). We reported the results of PAE with combined polyvinyl alcohol particles 50 μm and 100 μm in size as a primary treatment in 24 patients with severe LUTS secondary to large BPH.

METHODSFrom July 2012 to June 2014, we performed PAE in 24 patients (65-85 years, mean 74.5 years) with severe LUTS due to large BPH (≥80 cm 3 ) and refractory to medical therapy. Embolization was performed using combination of 50 μm and 100 μm in particles size. Clinical follow-up was performed using the International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow (Q max ), postvoid residual (PVR) volume, the International Index of Erectile Function (IIEF), prostatic specific antigen (PSA), and prostatic volume measured by magnetic resonance imaging at 1, 3, 6, and every 6-month thereafter. Technical success was defined when PAE was completed in at least one pelvic side. Clinical success was defined as the improvement of both symptoms and QoL. A Student's t-test for paired samples was used.

RESULTSPAE was technically successful in 22 patients (92%). Bilateral PAE was performed in 19 (86%) patients and unilateral in 3 (14%) patients. Follow-up data were available for 22 patients observed for mean of 14 months. The clinical improvement at 1, 3, 6, and 12-month was 91%, 91%, 88%, and 83%, respectively. At 6-month follow-up, the mean IPSS, QoL, PVR, and Q max were from 27 to 8 (P = 0.001), from 4.5 to 2.0 (P = 0.002), from 140.0 ml to 55.0 ml (P = 0.002), and from 6.0 ml/s to 13.0 ml/s (P = 0.001), respectively. The mean prostate volume decreased from 110 cm 3 to 67.0 cm 3 (mean reduction of 39.1%; P = 0.001). The PSA and IIEF improvements after PAE did not differ from pre-PAE significantly. No major adverse events were noted.

CONCLUSIONSThe combination of 50 μm and 100 μm particles for PAE is a safe and effective treatment method for patients with severe LUTS due to large BPH, which further improves the clinical results of PAE.

Aged ; Aged, 80 and over ; Angiography ; Embolization, Therapeutic ; methods ; Humans ; Lower Urinary Tract Symptoms ; etiology ; metabolism ; therapy ; Male ; Prostate ; pathology ; Prostate-Specific Antigen ; metabolism ; Prostatic Hyperplasia ; complications ; metabolism ; therapy ; Treatment Outcome