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

Objective: To investigate the correlation of prostatic parameters of transrectal ultrasonography with age in patients with benign prostatic hyperplasia (BPH) and the patterns of prostatic enlargement in different age groups of the patients. METHODS: We retrospectively studied the reports of transrectal ultrasonography for 1 739 outpatients with BPH from January 2010 to December 2015, who were divided into four age groups, 50－59, 60－69, 70－79, and =≥80 years. We analyzed the patterns of prostatic enlargement in different age groups. RESULTS: The transrectal ultrasonographic prostatic parameters, most significantly the transitional zone index (TZI), of the BPH patients were positively correlated with age. And the prostatic parameters were gradually increased with aging, with statistically significant differences among different age groups (P <0.05). The prostate was enlarged most quickly between 50 and 69 years of age. CONCLUSIONS There is a positive correlation between age and prostatic parameters of transrectal ultrasonography, particularly the transitional zone index, in patients with BPH, which indicates that TZI can serve as one of the best criteria in evaluating BPH. The volume of the prostate, especially that of the transitional zone, is increased with aging, reaching the peak between 50 and 69 years, which is of great significance for further study of the development and progression of BPH.
Age Factors ; Aged ; Aged, 80 and over ; Disease Progression ; Humans ; Male ; Middle Aged ; Organ Size ; Prostate ; diagnostic imaging ; pathology ; Prostatic Hyperplasia ; diagnostic imaging ; pathology ; Retrospective Studies ; Ultrasonography ; methods

ObjectiveTo evaluate the influence of the resected prostate tissue volume (RPV) on the improvement of International Prostate Symptom Score (IPSS), quality of life (QOL), and voiding function after transurethral resection of the prostate (TURP).

METHODSThis study included 82 men with benign prostatic hyperplasia treated by TURP. Before and three months after TURP, we obtained the IPSS, QOL score, post-voiding residual urine volume (PVR), and maximum urinary flow rate (Qmax) from the patients. We measured the total prostate volume (TPV) and transition zone volume (TZV) by transrectal ultrasound preoperatively and investigate the influence of the RPV, RPV/TZV ratio, and RPV/TPV ratio on the efficiency of TURP.

RESULTSAt three months after TURP, the mean Qmax increased by 9.27 ml/s, IPSS decreased by 15.86, QOL score increased by 3.47, PVR decreased by 87.1 ml, and 72.0% of the patients felt satisfied with the surgical results. There was no statistically significant difference in RPV between the patients satisfied and those dissatisfied with the results. Both the RPV/TPV and RPV/TZV ratios significantly increased in the satisfaction group as compared with the dissatisfaction group (P=0.002 and P=0.004). The areas under the ROC curve for the RPV/TPV and RPV/TZV ratios were 0.793 (P=0.001) and 0.687 (P=0.009), respectively.

CONCLUSIONSRPV is closely related to the short-term outcomes of TURP, and the ratios of RPV/TPV and RPV/TZV may be used as new markers to predict the outcomes of TURP.

Aged ; Humans ; Male ; Middle Aged ; Organ Size ; Patient Satisfaction ; Postoperative Period ; Prostate ; diagnostic imaging ; pathology ; surgery ; Prostatic Hyperplasia ; diagnostic imaging ; pathology ; surgery ; Quality of Life ; Transurethral Resection of Prostate ; Treatment Outcome ; Ultrasonography ; Urination ; physiology

PURPOSE: We conducted a prospective single-center study to evaluate the possibility of discontinuation of dutasteride after combination therapy with an alpha blocker for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We prospectively treated BPH patients with an alpha blocker and dutasteride (0.5 mg/d). Patients who had been treated with alpha blockers against BPH for more than 2 months were eligible, and 20 patients were included in the study. After 6 months of combination therapy, dutasteride was discontinued. Patients were followed for 12 months after cessation. Prostate volume, intraprostatic architecture determined by transrectal ultrasound, peak urinary flow rate, postvoid residual urine volume, and the serum prostate-specific antigen level were evaluated every 6 months, and the International Prostate Symptom Score and overactive bladder symptom score (OABSS) every 3 months. Patients were allowed to restart dutasteride during the follow-up period according to their desire. RESULTS: Twelve patients (12/20, 60%) restarted the combination therapy from 6 to 12 months into the follow-up period. For patients who restarted dutasteride, the prostate volume and OABSS had increased and worsened after discontinuation, respectively. A visible transition zone with a clear border on transrectal ultrasound at baseline and regrowth of the prostate after discontinuation of dutasteride were risk factors for restarting the therapy (Mann-Whitney U test: p=0.008, p=0.017). CONCLUSIONS: Prostatic enlargement after discontinuation of dutasteride differs among patients. Rapid regrowth of the prostate leads to deterioration of storage symptoms and a tendency to restart dutasteride. Baseline intraprostatic architecture may be a predictive factor for whether the patient is a good candidate for discontinuation.
5-alpha Reductase Inhibitors/administration & dosage/adverse effects ; *Adrenergic alpha-Antagonists/administration & dosage/adverse effects ; Aged ; Drug Monitoring ; Drug Therapy, Combination/methods ; *Dutasteride/administration & dosage/adverse effects ; Follow-Up Studies ; Humans ; Japan ; Male ; Middle Aged ; Organ Size ; Prospective Studies ; *Prostate/drug effects/pathology/ultrasonography ; Prostate-Specific Antigen/analysis ; *Prostatic Hyperplasia/drug therapy/pathology ; Secondary Prevention/methods/statistics & numerical data ; Treatment Outcome ; Withholding Treatment

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

PURPOSE: The purpose of this study was to compare prostate volume measured by transrectal ultrasonography (TRUS) between transaxial scanning and midsagittal scanning. We tried to determine which method is superior. MATERIALS AND METHODS: A total of 968 patients who underwent TRUS for diagnosis of any diseases related to the prostate were included in this study. When measuring prostate volume by TRUS, we conducted the measurements two ways at the same time in all patients: by use of height obtained by transaxial scanning and by use of height obtained by midsagittal scanning. Prostate volume was calculated by using the ellipsoid formula ([heightxlengthxwidth]xpi/6). RESULTS: For prostate volume measured by TRUS, a paired t-test revealed a significant difference between using height obtained by transaxial scanning and that obtained by midsagittal scanning in all patients (28.5+/-10.1 g vs. 28.7+/-9.9 g, respectively, p=0.004). However, there were no significant differences in the prevalence of prostate volume more than 20 g (known benign prostatic enlargement [BPE]) between the two methods by chi-square test (90.5% [n=876], 90.8% [n=879], respectively; p=0.876). When analyzed in the same way, there were no significant differences in the prevalence of prostate volume more than 30 g (generally, high-risk BPE) between the two methods (34.5% [n=334], 36.3% [n=351], respectively; p=0.447). CONCLUSIONS: Although prostate volume by TRUS differed according to the method used to measure height, that is, transaxial or midsagittal scanning, we conclude that there are no problems in diagnosing BPE clinically by use of either of the two methods.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostate/*pathology/ultrasonography ; Prostatic Hyperplasia/*pathology/ultrasonography ; Reproducibility of Results ; Ultrasonography/methods ; Young Adult

INTRODUCTIONThe objective of this study was to evaluate the accuracy of using intravesical prostatic protrusion (IPP) as a parameter for the diagnosis of prostate adenoma (PA), as well as to determine the relationship between the site of PA and bladder outlet obstruction. IPP was determined with the use of transabdominal ultrasonography (TAUS).

METHODSA total of 77 consecutive adult men aged 30-85 years with haematuria or undergoing checkup for bladder tumour were enrolled. International Prostate Symptom Score (IPSS), and the results of uroflowmetry, TAUS and cystourethroscopy were assessed. All cases of IPP were classified into grades 0 (no IPP), 1 (1-5 mm), 2 (6-10 mm) or 3 (> 10 mm). PA diagnosis was confirmed using flexible cystourethroscopy. The sites of PA were classified as U0 (no adenoma), U1 (lateral lobes), U2 (middle lobe) or U3 (lateral and middle lobes).

RESULTSOf the 77 patients, 11 (14.3%) had no IPP. PA was confirmed using cystourethroscopy for all patients with IPP and for 7 of the 11 patients without IPP. Of the 37 patients with prostate volume < 20 g, 29 (78.4%) had IPP. Sensitivity, specificity, as well as positive and negative predictive values for diagnosing PA using only IPP were 90.4%, 100.0%, 100.0% and 36.4%, respectively. Higher sensitivity (95.9%) and negative predictive value (50.0%) were obtained when PA was used together with peak urinary flow rate (Qmax) < 20.0 mL/s. The mean Qmax of patients classified as U1 (n = 39) was 16.0 mL/s, while the mean Qmax in those classified as U2 (n = 12) and U3 (n = 22) was 11.9 mL/s and 8.9 mL/s, respectively.

CONCLUSIONAll patients with IPP had PA, and PA in the middle lobe was more obstructive than those in lateral lobes. Patients without IPP may still have PA.

Adult ; Aged ; Aged, 80 and over ; Biopsy ; Cystoscopy ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostate ; diagnostic imaging ; pathology ; Prostatic Hyperplasia ; complications ; diagnosis ; Ultrasonography ; Urinary Bladder Neck Obstruction ; diagnosis ; etiology

OBJECTIVETo analyze the correlation between the size of prostatic middle lobe hyperplasia and the degree of bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH).

METHODSThis study included 131 BPH patients who presented with dysuria between May 2008 and June 2010. The prostate volume and intravesical prostatic protrusion (IPP) were measured by transabdominal ultrasound, Qmax and detrusor pressure at Qmax (P(det@ Qmax)) detected by urodynamic examination, the obstruction degree and detrusor contractility judged using the LinPURR Figure, and the AG value calculated (AG = P(det@ Qmax) -2Qmax). The degrees of BOO were compared between different groups of IPP by variance analysis, and the prostate volume, IPP and AG values underwent Bivariate correlation analysis.

RESULTSIPP was highly positively correlated with BOO when it was > 10 mm (r = 0.821, P < 0.01), while PV and BOO had a lower correlation (r = 0.475, P < 0.01). There was also a high positive correlation between IPP and P(det@ Qmax) (r = 0.865, P < 0.01).

CONCLUSIONA close correlation exists between prostatic middle lobe hyperplasia and BOO, and evaluating IPP by ultrasound is a reliable method to determine the degree of BOO.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostate ; diagnostic imaging ; pathology ; Prostatic Hyperplasia ; diagnosis ; diagnostic imaging ; pathology ; Ultrasonography ; Urinary Bladder Neck Obstruction ; diagnosis ; pathology ; Urodynamics

Dystrophic calcification can be defined as a calcification that occurs in degenerated or necrotic tissue. It is associated with multiple clinical conditions, such as collagen vascular diseases. It involves the deposition of calcium in soft tissues despite no generalized disturbance in the calcium or phosphorus metabolism, and this is often seen at sites of previous inflammation or damage. Potassium-titanyl phosphate (KTP) laser vaporization of the prostate is safe and relatively bloodless procedure that results in a shorter catheterization, immediate symptomatic improvement, and less severe postoperative irritative symptoms. However, longer follow-up studies or reports about complications are lacking. Here in we report a case of dystrophic calcification and stone formation on the entire bladder neck after performing KTP laser vaporization of benign prostate hyperplasia. That was treated by lithotripsy and transurethral resection.
Aged ; Calcinosis/*diagnosis/pathology ; Humans ; Lasers, Solid-State/*adverse effects ; Lithotripsy ; Male ; Prostatic Hyperplasia/*surgery ; Urinary Bladder Calculi/*diagnosis/etiology/ultrasonography ; Urinary Bladder Diseases/*diagnosis/etiology/ultrasonography

OBJECTIVETo analyze and evaluate the characteristics of benign prostatic hyperplasia (BPH) on contrast-enhanced ultrasound.

METHODSForty-eight BPH patients confirmed by transrectal ultrasound-guided biopsy underwent contrast-enhanced ultrasound. Contrast pulse sequencing technique (CPS) and quantitative software-ACQ were used, and the parameters of beginning enhancement time, disappearing and transit time and peak intensity (PI) of the inner gland and outer gland were recorded and analyzed.

RESULTSThe prostate was rich with blood and enhanced significantly on contrast-enhanced ultrasound. The beginning enhancement time of the prostatic inner gland, especially the area around the urethra, was much earlier than that of the outer gland, (26.68 +/- 3.76) and (31.24 +/- 5.33) s, respectively (P = 0.000). The contrast disappeared later in the inner gland than in the outer gland, (200.68 +/- 59.40) and (157.56 +/- 50.66) s, respectively (P = 0.000). The transit time of the contrast in the inner gland was much longer than in the outer gland, (173.94 +/- 60.14) and (129.21 +/- 56.91) s, respectively (P = 0.000). PI of the inner gland was much higher than that of the outer gland, (90.45 +/- 42.19) and (65.32 +/- 25.15) dB, respectively (P = 0.000).

CONCLUSIONContrast-enhanced ultrasound makes it possible to continuously observe the blood perfusion process of BPH, and promises to be an effective means for observing the blood supply in BPH.

Aged ; Aged, 80 and over ; Humans ; Image Enhancement ; Male ; Middle Aged ; Prostate ; blood supply ; diagnostic imaging ; pathology ; Prostatic Hyperplasia ; diagnostic imaging ; Regional Blood Flow ; Reproducibility of Results ; Ultrasonography ; methods