Prostatic diseases and erectile dysfunction (ED) are common diseases in urology and andrology. Basic and clinical studies have proved that there is a close relationship between the two. This article reviews the mechanism, diagnosis and treatment of ED caused by several prostatic diseases, such as acute prostatitis, chronic prostatitis, benign prostate hyperplasia and prostate cancer.
Chronic Disease ; Erectile Dysfunction ; diagnosis ; etiology ; therapy ; Humans ; Male ; Prostatic Diseases ; complications ; Prostatic Hyperplasia ; complications ; Prostatic Neoplasms ; complications ; Prostatitis ; complications

OBJECTIVETo study the etiology, clinical manifestation, diagnosis and treatment of giant prostatic calculus with neurogenic bladder disease and prostate diverticulum.

METHODSWe retrospectively analyzed the clinical data of a case of giant prostatic calculus with neurogenic bladder disease and prostate diverticulum and reviewed the relevant literature. The patient was a 37-year-old man, with urinary incontinence for 22 years and intermittent dysuria with frequent micturition for 9 years, aggravated in the past 3 months. He had received surgery for spina bifida and giant vesico-prostatic calculus. The results of preoperative routine urinary examination were as follows: WBC 17 -20/HPF, RBC 12 - 15/HPF. KUB, IVU and pelvic CT revealed spina bifida occulta, neurogenic bladder and giant prostatic calculus.

RESULTSThe patient underwent TURP and transurethral lithotripsy with holmium-YAG laser. The prostatic calculus was carbonate apatite in composition. Urinary dynamic images at 2 weeks after surgery exhibited significant improvement in the highest urine flow rate and residual urine volume. Seventeen months of postoperative follow-up showed dramatically improved urinary incontinence and thicker urine stream.

CONCLUSIONProstate diverticulum with prostatic giant calculus is very rare, and neurogenic bladder may play a role in its etiology. Cystoscopy is an accurate screening method for its diagnosis. For the young patients and those who wish to retain sexual function, TURP combined with holmium laser lithotripsy can be employed, and intraoperative rectal examination should be taken to ensure complete removal of calculi.

Adult ; Calculi ; complications ; Diverticulum ; complications ; Humans ; Male ; Prostatic Diseases ; complications ; Urinary Bladder, Neurogenic ; complications

We report a case of symptomatic intraurethral prostatic cyst in a 42-yr-old man without clinical evidence of benign prostatic hyperplasia. The intraurethral cyst makes it unique from the all previously reported cases of prostatic cysts located medially within the prostate. Transurethral resection of the cyst with limited resection of the prostatic tissue at the base of the cyst was performed with successful resolution of voiding symptoms.
Adult ; Bladder Neck Obstruction/etiology ; Cysts/complications* ; Cysts/surgery ; Human ; Male ; Prostatic Diseases/complications* ; Prostatic Diseases/surgery

Nephrogenic diabetes insipidus (DI) secondary to chronic urinary tract obstruction is a rare disease. The exact cause is unknown but it is likely that increased collecting duct pressures cause damage to the tubular epithelium, resulting in insensitivity to the action of arginine-vasopressin (AVP). A 77-year-old man complaining of polyuria and polydipsia was treated with alpha glucosidase inhibitor under the impression of polyuria due to diabetes mellitus. But his symptoms did not improve. Water deprivation and AVP administration study revealed that the patient had nephrogenic DI. Urinary tract obstruction due to an enlarged prostate was suggested as a principal cause of nephrogenic DI. The patient underwent transurethral resection of the prostate and bilateral subcapsular orchiectomy. After surgery, the urine osmolarity was normalized and the patient became symptom-free. We report a case of nephrogenic DI due to obstructive uropathy which was cured by surgery eliminating obstruction.
Adenocarcinoma/ultrasonography ; Adenocarcinoma/radionuclide imaging ; Adenocarcinoma/pathology ; Adenocarcinoma/complications* ; Aged ; Case Report ; Constriction, Pathologic/etiology ; Diabetes Insipidus, Nephrogenic/etiology* ; Human ; Male ; Prostatic Neoplasms/ultrasonography ; Prostatic Neoplasms/radionuclide imaging ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/complications* ; Urologic Diseases/etiology*

A clinical study was made on 117 cases of benign prostatic hyperplasia admitted to the Department of Urology, Chungnam University Hospital during the period from January 1974 to August 1982. The results were summarized as follows: 1. Common symptoms were dysuria (82.1%) and urinary retention (41.0%). 2. Gross or microscopic hematuria was noticed in 48 cases (41.0%). 3. The degree of prostatic enlargement by rectal palpation was not related to the severity of symptoms. 4. Pulmonary disease (19.5%) and cardiac disease (12.8%) were frequently associated with B.P.H. 5. Treatment consisted of suprapubic of retropubic prostatectomy in 94 cases, TUR in 7 cases and cystostomy in 10 cases. 6. Postoperative complications were urinary incontinence (34%), wound problem (9.7%), delayed bleeding (8.7%), and urinary tract infection (4.8%). 7. Mean weight of removed prostatic tissue was 31.3gm.
Chungcheongnam-do ; Cystostomy ; Digital Rectal Examination ; Dysuria ; Heart Diseases ; Hematuria ; Hemorrhage ; Lung Diseases ; Postoperative Complications ; Prostatectomy ; Prostatic Hyperplasia* ; Urinary Incontinence ; Urinary Retention ; Urinary Tract Infections ; Urology ; Wounds and Injuries

OBJECTIVETo evaluate the clinical significance of prostatic-specific antigen (PSA) levels in patients with benign prostatic hyperplasia (BPH) complicated by low urinary tract syndrome( LUTS).

METHODSThe levels of tPSA, fPSA and fPSA/tPSA ratio were detected and compared in 520 cases of BPH with LUTS and 196 cases without LUTS.

RESULTSThe mean levels of tPSA in the cases of BPH with LUTS and without LUTS were (5.13 +/- 2.49) microg/L and (1.73 +/- 1.26) microg/L respectively (P<0.01). The mean levels fPSA were (1.57 +/- 0.80) microg/L and (0.54 +/- 0.38) microg/L respectively (P < 0.01). The mean ratios of fPSA/tPSA were (0.31 +/- 0.09) and (0.30 +/- 0.11) respectively ( P > 0.05).

CONCLUSIONThe levels of tPSA, fPSA are significantly higher in the cases of BPH with LUTS than those in the cases without LUTS, but the ratio of fPSA/tPSA is stable in BPH.

Aged ; Aged, 80 and over ; Enzyme-Linked Immunosorbent Assay ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; blood ; complications ; Sensitivity and Specificity ; Urethral Diseases ; etiology

OBJECTIVETo investigate the etiology and treatment of bladder spasm associated with benign prostatic hyperplasia (BPH).

METHODSUrodynamic tests were performed in 102 cases of BPH before operation. The correlation of bladder spasm with aging, international prostate symptom score (IPSS), quality of life, prostatic volume, operation methods and urodynamic indexes was studied by t and chi2 tests.

RESULTSThe incidences of bladder spasm in the lower compliant bladder and unstable bladder were 32.1% (9/28) and 42.5% (13/20), and those after suprapubic prostatectomy and transurethral resection of the prostate (TURP) were 50.9% (26/51) and 23.3% (12/51). There was significant difference between operation methods (P < 0.05).

CONCLUSIONBladder spasm easily develops in the lower compliant bladder and unstable bladder, especially after suprapubic prostatectomy. TURP might decrease the incidence of bladder spasm after BPH operation.

Aged ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prostatic Hyperplasia ; surgery ; Spasm ; etiology ; prevention & control ; Transurethral Resection of Prostate ; Urinary Bladder Diseases ; etiology ; prevention & control ; Urodynamics

OBJECTIVETo explore the clinical efficacy of acupoint catgut embedding therapy on chronic pelvic cavity pain syndrome differentiated as kidney deficiency and stagnation of damp heat, and explore the impacts on plasma P substance (SP), plasma beta-endorphin (β-EP).

METHODSOne hundred and eighty cases were randomly divided into a catgut embedding group (90 cases) and a western medication group (90 cases). In the western medication group, tamsulosin capsules 0. 2 mg were prescribed for oral administration, once a day; indometacin sustained release tablets, 25 mg, three times a day. Totally, the oral administration for 8 weeks was required. In the catgut embedding group, the acupoint catgut embedding therapy was applied to Qugu (CV 2), Shenshu (BL 23), Zhibian (BL 54), Huiyin (CV 1) and Sanyinjiao (SP 6), once every two weeks; the treatment of 4 weeks made one session, and two sessions were required. Before and after treatment, TCM symptom score, NIH-CPSI (the National Institute of Health Chronic Prostatitis Symptom Index) score, lecithin body numbers in prostatic fluid, score in SAS (self-rating anxiety scale), score in SDS (self-rating depression scale), the levels of SP and β-EP, etc. were observed in the two groups, and the clinical efficacy was assessed in the two groups.

RESULTS(1) Ten cases were dropped in either group. The total effective rate was 91. 25% (73/80) in the catgut embedding group, higher than 78. 75% (63/80) in the western medication group (P<0. 05). (2) After treatment, TCM symptom score, total score in NIH-CPSI, pain score and the scores in SAS and SDS were all reduced as compared with those before treatment in the two groups (all P<0. 05). After treatment, TCM symptom score, total score and pain score in NIH-CPSI, and the scores in SAS and SDS in the catgut embedding group were both lower than those in the western medication group (all P<0. 05). (3) After treatment, the lecithin body numbers were both increased as compared with those before treatment in the two groups (both P<0. 05), and the result in the catgut embedding group was higher than that in the western medication group (P<0. 05). (4)After treatment, the SP level was lower than that before treatment in the two groups (both P<0. 05); the level of p-EP was increased as compared with that before treatment (both P<0. 05). The SP level in the catgut embedding group was lower than that in the western medication group (P<0. 05); the level of β-EP was higher than that in the western medication group (P<0. 05).

CONCLUSIONThe acupoint catgut embedding therapy apparently relieves the clinical symptoms of chronic pelvic cavity pain syndrome differentiated as kidney deficiency and stagnation of damp heat as well as the condition of anxiety and depression, increases lecithin body numbers in prostatic fluid and β-EP level and reduces SP level.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Catgut ; utilization ; Chronic Disease ; therapy ; Humans ; Male ; Pelvic Pain ; etiology ; metabolism ; therapy ; Prostatic Diseases ; complications ; metabolism ; Young Adult ; beta-Endorphin ; metabolism

The present paper serves as a review of the associations between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), with a focus on common and combined pathways for treatment. LUTS and ED are common conditions seen in general urologic practice. Research has started to establish epidemiologic and pathophysiologic links between the two conditions and a strong association confirmed across multiple studies. Men seeking care for one condition should always be interviewed for complaints of the other condition. Proposed common pathways include alpha-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of alpha-adrenergic receptor antagonists (alpha-ARAs) and 5-alpha-reductase inhibitors (5-ARIs) into everyday practice. Treatment with alpha-ARAs contributes to some improvement in ED, whereas use of 5-ARIs results in worsened sexual function in some patients. Phosphodiesterase-5 (PDE-5) inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE-5 inhibitors and alpha-ARAs. The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations. The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future therapies and possible preventative strategies.
5-alpha Reductase Inhibitors ; Adrenergic alpha-Antagonists ; therapeutic use ; Atherosclerosis ; complications ; Endothelium, Vascular ; Erectile Dysfunction ; etiology ; therapy ; Humans ; Male ; Phosphodiesterase Inhibitors ; therapeutic use ; Prostatic Hyperplasia ; complications ; surgery ; Receptors, Adrenergic, alpha ; physiology ; Urologic Diseases ; etiology ; therapy ; rho-Associated Kinases ; metabolism

Benign prostsatic hypertrophy is a common disease of middle-aged and elderly men that nacessitates surgical resection of ths prostatic gland, and tranaurethral resetion is the second most common surgical procedure in men over the age 65. This geriatric patient population generally carries greater anesthetic risk than the young because of greater prevalenee of coexisting cardiovascular or pulmonary diseases. Futhermore,because transurethral resection carries a number of complications such as bleeding requiring transfusion, TURP syndrome, arrhythmia, hemolysis, coagulopathy, sepsis, bladder perforation, and pulmonary edems, transurethral resection is of concern to anesthesiologists. Thus, we had reviewed clinical records of 40lcases of benign prostatic hypertrophy and performed clinical and statistical analysis according to sge, ASA physical status, preoperative abnormal laboratory findings, combined disesses, anesthetic techniques, resection time of prostate, volume of irrigation fluid, weight of resected prostate, transfusion, intraoperative and postoperative complications. The results were as follows. 1) Of the 401 cases, 175 cases(43.6% ) were 61-70 years of age. 2) The most common ASA physical status was class 2(73.6%). 3) Of the operative methods, most common was TURP(89.5% ). 4) Preoperative cheat X-ray evaluation showed abnormalities in 167 cases(41.6%); 52 cases(31.1% ) had hypertensive heart configuration, 40 cases(24.0% ) had inactive pulmonary tuberculosisnd 39 case(23.4%) had pleural thickening. 5) Preoperative abnormal ECG findings were found in 150 casee(37.4%); 52 cases(34.7 %) had LVH, 43 cases(28.7%) had heart block,and 35 csses(23.3%) had myocardial ische-mia. 6) Preoperative pulmonary function test showed abnormalities in 101 cases(25.2%), most common abnormal finding was small airway obstruction disease(22.8% ). 7) The sssociated diseases were 146 cases(36.4%) snd most commonly associated disease was hypertension(36.3%). 8) The number of epidural anesthesia was performed in 218 cases(54.4%); general anesthesia, in 118(29.4%) and spinal anesthesia,in 65(16.2%). The duration of resection time was less than 1 hour in 315 cases(87.8%). 9) The mean value of the volume of irrigation fluid was 15.6+/-8.2L, and the mean value of weight of resected prostate was 22.4+/-16.9g. 10) Total number of intraoperative complications were 60 cases; 6 cases were ECG abnormalities, 32 cases were bleeding, and 12 csses were intraoperative hypotension. Postoperative complications were bleeding and acute myocardial infarction, but there was no death.
Aged ; Airway Obstruction ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Arrhythmias, Cardiac ; Electrocardiography ; Heart ; Hemolysis ; Hemorrhage ; Humans ; Hypertrophy ; Hypotension ; Intraoperative Complications ; Lung Diseases ; Male ; Myocardial Infarction ; Postoperative Complications ; Prostate ; Prostatic Hyperplasia* ; Respiratory Function Tests ; Sepsis ; Transurethral Resection of Prostate ; Urinary Bladder