No abstract available.
Life Style* ; Prostatism*

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.
Adenoma ; Calcium ; Calcium Oxalate ; Calculi* ; Prostatism ; Ultrasonography* ; Urethra

PURPOSE: Detrusor instability (DI) is a main cause of persistent voiding difficulty after TURP in patients with benign prostatic hyperplasia (BPH). So we retrospectively estimated the effect of TURP in BPH patients with DI. MATERIALS AND METHODS: Of the 81 patients who had undergone TURP due to prostatism, 35 patients with BPH were followed at 3 weeks and 6 months postoperatively (21 without DI cases vs. 14 with DI; 6 persistent DI, 7 resolved DI, 1 missing case at 3 weeks and 4 persistent DI, 7 resolved DI, 2 missing cases at 6 months). We compared each group using symptom score (IPSS) and urodynamic parameters. RESULTS: Each irritative and obstructive symptoms were significantly improved in both group (p<0.05). The maximal flow rate (from 12.2 to 25.4ml/sec), average flow rate (from 8.9 to 15.2ml/ sec), residual urine volume (from 135.9 to 39.1ml) in patients without DI and maximal bladder volume (from 150.0 to 203.7ml), maximal flow rate (from 12.5 to 18.6ml/sec), residual urine volume (from 65.7 to 26.0ml) in patients with DI were improved significantly (p<0.05) after TURP, but other parameters were not improved (p>0.05). There were no significant differences in all parameters between 3 weeks and 6 months postoperative period (p>0.05). The amplitude of improvement had no significant difference between two group. There were no significant differences in IPSS and urodynamic parameters between persistent and resolved DI group. CONCLUSION: We suggest that TURP is good therapeutic option even in BPH patients with DI at short term postoperative period, but attempt to predict which patients would have persistent DI following TURP was failed.
Humans ; Postoperative Period ; Prostatic Hyperplasia ; Prostatism ; Retrospective Studies ; Transurethral Resection of Prostate* ; Urinary Bladder ; Urodynamics*

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.
Biopsy* ; Hematuria ; Humans ; Logistic Models ; Models, Statistical* ; Nocturia ; Prostate* ; Prostatic Neoplasms* ; Prostatism ; Prostatitis

Transrectal ultrasonography is the most effective imaging method of prostate and it is known as an useful mean to detect and evaluate prostatic cancer. We performed transrectal ultrasonography for 200 patients with prostatism, 101 of which were diagnosed subsequently pathologically by prostatic biopsy or operation. Of 27 patients of sonographically suspicious prostatic cancer 10 were confirmed pathologically as cancer, and thered were another 4 patients with prostatic cancer which were classified to benign disease sonographically. The sensitivity and specificity of transrectal ultrasonography in diagnosis of prostatic cancer were 71.4 and 80.5 %. respectively, but the positive predictive value only 37%. The results do not seem that transrectal ultrasonography is superior to digital rectal examination in diagnosis of prostatic cancer. In identifying extracapsular extension of prostatic cancer, transrectal ultrasonography is thought to be potentially valuable, but further experiences are necessary.
Biopsy ; Diagnosis ; Digital Rectal Examination ; Humans ; Prostate ; Prostatic Neoplasms* ; Prostatism ; Sensitivity and Specificity ; Ultrasonography*

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.
Digital Rectal Examination ; Humans ; Incidence* ; Male ; Prostate ; Prostatic Hyperplasia ; Prostatism* ; Urinary Bladder ; Urodynamics

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.
Humans* ; Ketanserin* ; Prostatism ; Receptors, Adrenergic, alpha-1 ; Receptors, Serotonin ; Serotonin ; Urinary Bladder Neck Obstruction ; Urinary Bladder*

Prostatic calculosis is a physiological feature of the aging process, but it plays an important role in prostatic diseases. Recently we have evaluated the size and location of prostatic calculi in 314 patients with prostatic disease during the period from Aug. 1991 to Feb. 1992 using transrectal ultrasonogram. Prostatic calculi over 3 mm in diameter (with strone echo and posterior acoustic shadow) were observed 12% (3/26) in normal control group, 26% (47/170) in BPH and 20% (17/85) in chronic prostatitis. The incidence or size of prostatic calculi were increased with age. We classifed the calculi "central", when calculus located around the verumontanum or prostatic urethra and "peripheral", when calculus located peripherally. 76% of calculi with prostatitis were located centrally but 59% of calculi with BPH were located peripherally. 69% of calculi with symptom group (patients who complain of voiding dysfunction in 60 years or elder age group without BPH or other urologic diseases) were located centally. Prostatic calculi were also observed in four patients with hematospermia (4/6) and in five patients with-ejaculatory duct cyst (5/6). These results indicate that all prostatic calculi were not asymptomatic and transrectal ultrasonogram should be done to evaluate prostatism. The treatment modality can be chosen and the prognosis estimated by knowing the location and size of prostatic calculi.
Acoustics ; Aging ; Calculi* ; Hemospermia ; Humans ; Incidence ; Lithiasis ; Prognosis ; Prostatic Diseases ; Prostatism* ; Prostatitis ; Ultrasonography ; Urethra

PURPOSE: We evaluated the effect of prostatitis on prostatic-specific antigen(PSA) in 79 patients aged under 45 years old complained symptoms of prostatism. MATERIALS AND METHOD: The patients were divided into 2 groups: 61 patients who were diagnosed with prostatitis(group P) and 18 patients with prostatodynia and a history of prostatitis(group PD). As a control(group N) the PSA data obtained in the serial screening program of primary health clinic of 3,992 men under 45 years old were used. PSA was measured by Enzyme Immuno-Assay (AxSYM kit, Abbott Co.) and Tandem-R techniques. Prostate size was measured by the ellipsoidal method using the transrectal ultrasonogram (SonoAce 5000, Medison, Korea). RESULTS: Mean age was 37 years old for both control and patients(Group p,36; Group PD, 39; Group N, 37). Average serum PSA level(ng/ml) was 2.00(Group p, 1.99; Group PD, 2.05; Group N, 0.97). When PSA level was correlated with different age groups (20's; 30's; 40-45), PSA levels were 1.04, 0.96, and 0.96ng/m1 for group N and 1.77, 2.00, and 2.17ng/m1 for groups P & PD, which was significantly higher than group N(p<0.05). The numbers of patients with PSA above 4.0ng/ml were more frequently seen in group P & PD than N(group P & PD 11%, group N 0.88%). The average prostatic volume was 20.9cc (Group p,20.2; Group PD,23.3). The prostatic volume was significantly larger in Group PO but no significant correlations were noted between PSA and PSAD and between PSA and EPS WBC count. There were 19 patients in the first decade,30 in the second decade and 40 between 41-45 years and the average PSA levels were 1.77, 2.00, and 2.17ng/m1, respectively. Average prostate volumes were 18.6, 19.9, and 23.4cc, and the average PSAD 0.10, 0.10, 0.09, respectively; no significant correlation was seen in any of the measurements between the three age groups. Conclusions: These findings indicate that serum PSA level can be elevated in prostatitis and careful consideration be made when PSA is used as a tumor marker.
Adult ; Humans ; Male ; Mass Screening ; Middle Aged* ; Prostate ; Prostatism ; Prostatitis* ; Ultrasonography

BPH is found in 50% of males over the age of 50 and there is increase in incidence with age. But some patients with BPH do not induce bladder outlet obstruction and some patients with prostatism are not caused by bladder outlet obstruction. So, urodynamic study including pressure/flow study was performed in 45 males with prostatism to evaluate the degree of obstruction, and we measured maximal intravesical pressure, maximal detrusor pressure, prostatic urethral length, residual urine, minimal urethral resistance and pressure/flow plots. The 45 males were divided into 3 groups by maximal flow rate(MFR)(A: MFR>=15, B: 10<=MER<=15, C: MFR<10) and there was significant difference between each group only in minimal urethral resistance(P<0.05). The result of pressure/flow plots of A group showed that 93% (13/14) was nonobstructive pattern and the rest one was obstructive pattern which was caused by detrusor hyperreflexia. In B group. we could know the degree of obstruction in 58%(7/12) only with minimal urethral resistance and we could decide the degree of obstruction with pressure/flow plots in rest 5 cases whose minimal urethral resistances were between 0.43 and 0.65 unit. The result of pressure/flow plots of C group showed that 89%(17/19) was obstructive pattern and the rest 2 cases were nonobstructive patterns which were caused by detrusor hyporeflexia. In conclusion, with pressure/flow plots and minimal urethral resistance, we can decide the degree of obstruction in patients with prostatism especially whose MFR are between 10 and 15 ml/sec.
Humans ; Incidence ; Male ; Prostatism ; Reflex, Abnormal ; Urinary Bladder Neck Obstruction ; Urodynamics