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*

BACKGROUNDTamsulosin 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.

METHODSChinese 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.

RESULTSA 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.

CONCLUSIONLong-term tamsulosin hydrochloride therapy is a safe, effective and well-tolerated method for the treatment for LUTS suggestive of BPH in China.

Adrenergic alpha-1 Receptor Antagonists ; adverse effects ; therapeutic use ; Aged ; China ; Humans ; Male ; Middle Aged ; Placebos ; Prostatic Hyperplasia ; drug therapy ; Prostatism ; drug therapy ; Sulfonamides ; adverse effects ; therapeutic use

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.
Humans ; Lower Urinary Tract Symptoms* ; Male* ; Nocturia ; Prostate ; Prostatic Hyperplasia ; Prostatism ; Quality of Life ; Rivers ; Urinary Bladder Neck Obstruction ; 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

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.
Actins ; Antibodies ; Desmin ; Diploidy ; Flow Cytometry ; Giant Cells ; Humans ; Leiomyoma* ; Leiomyosarcoma ; Middle Aged ; Mitosis ; Muscle, Smooth ; Prostate* ; Prostate-Specific Antigen ; Prostatism ; S Phase

No abstract available.
Life Style* ; Prostatism*

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: 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: 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.
Asian Continental Ancestry Group ; Biopsy ; Consensus ; Digital Rectal Examination ; Humans ; Jeollabuk-do* ; Korea ; Lower Urinary Tract Symptoms ; Male ; Prevalence* ; Prostate ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Prostatism ; Quality of Life ; Surveys and Questionnaires ; Urinary Bladder Neck Obstruction

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