ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewProstatic hyperplasia predominantly involves the stromal compartment of the gland and affects more than 70% of men of 70 years or older with or without obstructive symptoms of benign prostatic hyperplasia. A consensus view is emerging concerning the factors and control systems that modulate cell proliferation and connective tissue biology in the prostate. The purpose of this review is to discuss some of the recent work contributing to the latter in the context of the aetiology of benign prostatic hyperplasia.Recent findingsStudies over the last 3-5 years have identified transforming growth factor β, fibroblast growth factor and insulin-like growth factor family members as key regulators of cell proliferation and extracellular matrix turnover with interrelated activities. Recently, oestrogens, adrenergic signalling and inflammatory processes have been shown to impact and potentially perturb the balance between the activities of the above factors. These agents are all subject to alteration with age and as such are candidates for potential triggers of the initiation of stromal hyperplasia.SummaryThe current model for the control and dysregulation of prostatic stromal growth is discussed in relation to the pathogenesis of benign prostatic hyperplasia and future directions for research.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewBenign prostatic hyperplasia is the most common human neoplasm and it is the most frequent tumour requiring surgical treatment in men. Not surprisingly, interest centres on either understanding of prostatic growth during ageing or on various medical or interventional treatments.Recent findingsRecent publications describe the interaction of various 5α-reductase inhibitors on the two 5α-reductase isoforms type 1 and 2, giving a potential new insight into the pathogenesis of benign prostatic hyperplasia. Likewise, chronic inflammation increases growth patterns of fibromuscular tissue in benign prostatic hyperplasia similar to wound healing, and a paracrine loop for chronic inflammation with overexpression of interleukin could be identified. This could be of particular importance in the further understanding of prostatic enlargement. Herbal drug treatment for lower urinary tract symptoms seems to be more effective than previously thought. According to recent publications the effectiveness is well beyond placebo effects. Likewise, α-blockers play an important role in treatment of lower urinary tract symptoms with α-1 adrenoreceptor antagonists preventing cell proliferation and apoptotic imbalances in prostatic tissue. The effect of α-blockers, however, may be limited by severe bladder outlet obstruction with patients at increased risk of treatment failure. Laser prostatectomy and microwave thermotherapy are under consideration as alternative treatments of benign prostatic hyperplasia. The efficacy of urodynamically proven de-obstruction as compared with transurethral resection of the prostate needs to be evaluated. Newer alternative treatments like ethanol installation or bipolar plasma kinetic vaporization have been described, but long-term results and larger patients cohort are still lacking.SummaryNew insights into prostatic growth and pathogenesis of benign prostatic hyperplasia are presented. Medical treatment and interventional therapies are evaluated for their safety and efficacy. Only a few new therapeutical options, however, have been published during this review period.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis is a concise and timely update of the most recent developments in the clinical research on the investigation of benign prostatic hyperplasia.Recent findingsAnalysis of the peer-review literature confirms a high level of consensus as to the management of prostatic hyperplasia; analysis of practice trends suggests a satisfactory degree of adoption of the proposed guidelines. The evaluation of lower urinary tract symptoms remains the mainstay in the investigation of prostatic hyperplasia although problems concerning the evaluation of nocturia and the differential diagnosis between hyperplasia and chronic prostatitis were identified. Lower urinary tract symptoms confirmed their value as predictors of disease progression. The extent of patient involvement in the decision making process is increasing and new tools to elicit patient preference have been developed. A growing consensus as to the concept of disease progression has been reached concerning prostatic hyperplasia. Analysis of patient sexual function is now considered an important part of patient's interview. More sophisticated instruments, such as time trade-off values were successfully tested to elicit patient preference in the management of prostate disease. The value of serum prostate specific antigen as a predictor on prostate volume growth has recently been confirmed also in unselected male population.SummaryCurrent research into the investigation of benign prostatic hyperplasia provides new insight into the pathophysiology of lower urinary tract symptoms and identifies parameters to predict the natural history of the disease in the individual patient, particularly regarding progression of the disease and the onset of adverse events.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review covers recent developments in the classification, epidemiology, aetiology, diagnosis and treatment of patients diagnosed with chronic prostatitis (NIH classification types II, IIIa/IIIb and IV prostatitis) in the period of review (2001-2002).Recent findingsRecent studies highlight some of the problems with the 1995 NIH classification. Epidemiological studies have confirmed that ‘prostatitis’ is common, with a prevalence of 10-15%. Associations of prostatitis include benign prostatic hyperplasia, sexually transmitted disease, lower urinary tract symptoms, stress, and reduced sunlight exposure. Elevated levels of cytokines in the seminal plasma and prostatic secretions have been detected in men with chronic prostatitis compared with normal individuals, suggesting an active inflammatory process in the male genital tract. This inflammatory reaction may be mediated by an adaptive immune response directed against a genital tract antigen(s) (autoimmunity). Increased levels of bacterial 16S ribosomal DNA in the prostates of men with chronic prostatitis compared with controls are compatible with the notion that a bacterial inflammatory event initiates an auto-immune process; however, the role of bacteria in the continuation of symptoms is unknown.SummaryThe aetiology of chronic pelvic pain syndrome is still not certain, although an auto-immune process is favoured. Further research is required to determine the putative auto-antigen, the immune responses of patients, the role of bacteria in the inflammatory process, and the patients' pain response to genitourinary insults. As yet no diagnostic tests (other than to eliminate other pathology) and few treatments for chronic prostatitis can be recommended on the basis of scientific evidence.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewMedical therapy is now the first-line treatment for most men with symptomatic benign prostatic hyperplasia. This review aims to highlight the recent contributions to our understanding of 5 alpha-reductase inhibitor usage.Recent findingsFor the last decade, finasteride has been the only available 5 alpha-reductase inhibitor, acting upon the type 2 isoenzyme of 5-alpha reductase. Dutasteride is the first drug that can inhibit both isoenzymes and is soon to be available. Biochemically it achieves greater and more rapid dihydrotestosterone suppression compared with finasteride. Clinically, it appears to be at least as good in terms of improving symptoms and flow rates, and reducing the risk of acute urinary retention or the requirement for benign prostatic hyperplasia-related surgery. However, until these two drugs are formally compared, the true benefits of additional type 1 isoenzyme inhibition are unknown. The recently reported Medical Therapy of Prostatic Symptoms trial has convincingly demonstrated superior outcomes with combination therapy compared with monotherapy, unlike previous trials of shorter duration. The ability of 5 alpha-reductase inhibitors to prevent disease progression was also confirmed. Newer roles for 5 alpha-reductase inhibitors are also being defined. Finasteride has been shown to reduce and control benign prostatic hyperplasia-related haematuria, although its value in controlling perioperative bleeding is less clear. Their role as chemopreventive agents for prostate cancer is also under investigation.SummaryRecent studies have both clarified and extended the roles of 5 alpha-reductase inhibitors in benign prostatic hyperplasia, and these may expand further if chemopreventive abilities are proved. In addition, dual isoenzyme inhibition will soon be available.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewOver the past 10-15 years a variety of endoscopic laser techniques have evolved for the treatment of benign prostatic hyperplasia. The laser is merely an energy source with the ability to coagulate, incise, vaporize, resect and dissect (enucleate), all fundamentally different procedures. Generalization regarding ‘laser prostatectomy’ is therefore inappropriate. The potential for shorter hospital stays and decreased morbidity while maintaining the efficacy and durability of transurethral resection of the prostate has been the driving force behind the laser techniques that acutely remove tissue, whereas the ideal minimally invasive non-tissue removing laser technique is a well-tolerated office procedure, performed under local anaesthesia. We define the various laser techniques currently available for the treatment of benign prostatic hyperplasia, and review developments reported during the period July 2001 to July 2002.Recent findingsAlthough there are few long-term data available on laser techniques, more medium-term data is emerging. Issues such as cost-effectiveness and applicability to certain sub-groups of patients are being investigated as each laser technique aims to find its own niche in the ever-expanding treatment armamentarium for benign prostatic hyperplasia.SummarySatisfactory moderate term results are now available for several minimally invasive laser techniques including interstitial laser coagulation and visual laser ablation of the prostate. There are promising early results for holmium laser enucleation of the prostate and potassium titanyl-phosphate, which have the potential to rival transurethral resection if proved durable in the long-term. Holmium laser enucleation is currently a serious contender for the ‘gold standard’ for large prostates.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewFrom all the available thermoablative methods for the treatment of symptomatic benign prostatic hyperplasia, transurethral microwave thermotherapy is considered as standard in minimally invasive management. The literature is enriched by several new studies on transurethral microwave thermotherapy, and thus this review presents up-to-date information about thermotherapy.Recent findingsNew studies have provided significant information regarding differences in outcome for devices with different protocols and selection criteria, confirming the superiority of high-energy programmes. Furthermore, monitoring of the intraprostatic temperature promises better clinical results by means of individualization of the treatment. Long-term results have been available and allow the evaluation of the fundamental issue of treatment durability. Improvement after high-energy transurethral microwave thermotherapy remains durable for more than 2.5 years. Randomized studies comparing this treatment with other established therapies for benign prostatic hyperplasia, including medical treatment and transurethral resection of the prostate, have also contributed to an evaluation of the morbidity, and costs of treatment. Clinical outcomes with transurethral microwave thermotherapy are in the range of those obtained with transurethral resection of the prostate and are superior to those of medical management. Retreatment after transurethral resection of the prostate emerges because of complications following the procedure, whereas retreatment after transurethral microwave thermotherapy is as a result of treatment failure. In addition, the rate of failure of medical management is almost seven times higher than that for transurethral microwave thermotherapy. Thus, the latter seems to play a dominant role in the economic models used to assess the cost-efficiency of different treatment modalities for benign prostatic hyperplasia.SummaryThe recent innovations in high-energy transurethral microwave thermotherapy provide better and more durable clinical outcomes and lower morbidity, and strengthen its position as an established treatment for benign prostatic hyperplasia. However, there is always room for improvement, so further research on therapeutic protocols, treatment monitoring and selection criteria are to be welcomed.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe use of an endoprosthesis to maintain lumenal patency is a well-established concept used in a variety of surgical settings, including cardiovascular and gastrointestinal pathologies. However, the utility of self-retaining endoprosthetics and their application in prostatic pathology and benign prostatic hyperplasia is not as clear. This report reviews recent developments in the management of symptomatic benign prostatic hyperplasia, particularly the current role of intraprostatic stenting in the advent of other minimally invasive therapies such as laser prostatectomy.Recent findingsOver the past 5 years, urology has witnessed the proliferation of minimally invasive surgical therapies for benign prostatic hyperplasia. These interventions have enabled the urologist to treat a problem whose management was once limited to medical therapy, transurethral resection of the prostate, or open, relatively morbid surgery. The role of stents as an intermediary in cases of treatment failure, or as definitive therapy for benign prostatic hyperplasia and its associated problems is still not clear, when compared with newer, minimally invasive options. Current literature on stents is relatively sparse. However recent studies demonstrate that permanent and temporary prostatic urethral stenting are effective in relieving obstruction and urinary retention. Nevertheless larger controlled clinical studies are needed to demonstrate the real value of this intervention.SummaryProstatic stenting has a definite role in the management of benign prostatic hypertrophy, but stents must be used with caution because complications are still relatively common, and their true efficacy and utility in the urological setting has not been determined.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo gain new insights into the epidemiology, imaging and conservative management of urinary tract infections based on the peer-reviewed literature of the last year.Recent findingsIt has been estimated that 3% of prepubertal girls and 1% of prepubertal boys are diagnosed with urinary tract infections. Breastfeeding has been shown to offer significant protection against urinary tract infection in infants. Any young child with an acute pyelonephritis should be evaluated by dimercaptosuccinic acid renal scan to confirm or rule out renal scarring. The voiding cystourethrogram can be performed within the first 7 days of diagnosis. Amoxicillin, trimethoprim-sulfamethoxazole and cephalosporin are the first-line antibiotics to treat children with uncomplicated urinary tract infection.SummaryThe incidence of urinary tract infections during infancy and childhood is high and influenced by the age and sex of the patient. Voiding cystourethrogram and dimercaptosuccinic acid renal scan are required for imaging. Short-course treatment is sufficient for children with acute uncomplicated lower urinary tract infections.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID