sodium-ethylxanthate and Prostatic-Hyperplasia

Benign prostatic hyperplasia (BPH) is a common histologic condition among older men, which conveys its morbidity through lower urinary tract symptoms and complications, such as acute urinary retention, obstructive uropathy, and urinary tract infections. The mechanisms linking the histologic process and lower urinary tract symptoms remain uncertain; prostatic enlargement and bladder outlet obstruction are involved. However, measurements of prostate size and the severity of bladder outlet obstruction correlate poorly with the severity of lower urinary tract symptoms. The severity of lower urinary tract symptoms associated with BPH can be measured reliably, from the patient's perspective, with a number of validated questionnaires, including the International Prostate Symptom Score, the Danish Prostate Symptom Score, and the International Continence Society (ICS)male questionnaire. In the clinical setting, these questionnaires can be used (1) to assess the severity of symptoms in men with lower urinary tract symptoms that may be attributable to BPH, based on their age and clinical characteristics; and (2) to follow changes in symptoms over time and with treatment. None of these questionnaires can accurately determine whether a symptomatic patient has underlying bladder outlet obstruction. Additional questionnaires are available to measure the impact of lower urinary tract symptoms on men's lives, as well as associated phenomena, such as continence and sexual function, which may be affected by BPH and its treatments. Men with a severe burden of lower urinary tract symptoms often have measurable decrements in overall health-related quality of life, which can be ameliorated by treatment.

Topics: Aged; Health Status Indicators; Humans; Male; Prostatic Hyperplasia; Quality of Life; Reproducibility of Results; Severity of Illness Index; Sex; Sex Factors; Surveys and Questionnaires; Urethral Obstruction; Urination Disorders

Lower urinary tract symptoms (LUTS), benign prostatic obstruction (BPO), and the overactive bladder have increasing prevalence with age in both men and women (with the obvious exception). The question is, are they interrelated or independently related to age? The specific issue is whether BPO causes the overactive bladder. There are two pieces of evidence that might appear to suggest such a cause and effect. First, the overactive bladder is more common in men than in women of the same age, although physiologically, men are 5-10 years older at the same biological age. Second, the overactive bladder resolves in two-thirds of individuals after surgical interventions such as transurethral prostatectomy. The symptoms suggestive of an overactive bladder are the most troublesome, even though they may not be the most prevalent. Long-term follow-up studies with repeated urodynamic investigations have shown that the incidence of the overactive bladder and its attendant symptoms increases despite there being no deterioration in outlet obstruction over follow-up periods of 10 and 20 years. These data, and others, indicate that the situation is not as straightforward as some believe. The statement that 'the overactive bladder is secondary to BPO' cannot be made, as there are too many unanswered questions and pieces of the puzzle that do not fit. The overactive bladder is undoubtedly associated with BPO, and it leads to the most troublesome LUTS in older men. Epidemiological research, coupled with urodynamic evaluation, may provide further evidence. We also need better and more relevant models (e.g. ageing animals), together with further histological and other biological data before the waters become crystal clear.

Topics: Aging; Health Status; Humans; Male; Medical Records; Prostatic Hyperplasia; Quality of Life; Severity of Illness Index; Sex; Surveys and Questionnaires; Urination Disorders; Urodynamics

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Creatinine; Ejaculation; Humans; Male; Middle Aged; Postoperative Complications; Prostate; Prostate-Specific Antigen; Prostatic Hyperplasia; Quality of Life; Risk Factors; Sex; Treatment Outcome; Urination

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Humans; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms; Sex; Sexual Dysfunction, Physiological

The aim of this study was to evaluate patient outcome 1 to 2 1/2 years after aggressive neodymium: yttrium-aluminum-garnet (Nd:YAG) laser prostatectomy alone or combined with potassium titanyl phosphate (KTP/532) laser therapy.. In 32 men with symptomatic bladder outlet obstruction caused by benign prostatic hyperplasia, Nd:YAG laser energy (40 W) was delivered to six or more locations on the prostatic lateral lobes and one or more on the median lobe. In a subgroup of 15 of these patients, the prostate was also incised and sculpted with KTP/532 laser to create a better channel.. In the 32 men, voiding parameters improved: mean peak flow rate increased from 10 to 21 mL/s (110%), residual volume decreased from 167 to 64 mL (62%), and American Urological Association (AUA) symptom score decreased from 24 to 9 (63%). Catheters were removed after 3 days. Of the 17 patients treated with the Nd:YAG laser alone, 12 (70.5%) required recatheterization, whereas only 5 of the 15 (33%) who received KTP/532 laser therapy after Nd:YAG treatment required recatheterization (P < 0.001). In the entire group of 32 patients, complications included predictably prolonged retention (14 to 60 days) in 4 patients (12.5%) with hypotonic bladders, prolonged dysuria in 4 (12.5%), vesical neck contracture in 2 (6%), and significant hematuria in 1; none had incontinence. All 25 sexually active men remained potent (100%), but among these patients retrograde ejaculation developed in 5 (20%).. Aggressive Nd:YAG laser prostatectomy is safe and effective for obstructive prostates up to 70 mL in volume and produces good results that are sustained for up to 2 1/2 years. Adjunctive KTP/532 laser therapy apparently creates an unobstructed channel more quickly and reduces the rate of postoperative retention, but it does not alter other voiding parameters.

Topics: Adult; Aged; Aged, 80 and over; Follow-Up Studies; Hospitalization; Humans; Laser Coagulation; Male; Middle Aged; Patient Satisfaction; Postoperative Care; Postoperative Complications; Prostate-Specific Antigen; Prostatectomy; Prostatic Hyperplasia; Sex; Time Factors; Urinary Bladder Neck Obstruction; Urinary Catheterization; Urination

Using chlormadinone acetate (CMA) as the control drug, a double-blind study was carried out to examine not only the effects of 17 alpha-acetoxy-6-chloro-2-oxa-4,6-pregnadiene-3,20-dione (TZP-4238;) on subjective urinary symptoms but also, especially, that on the sexual function in patients with benign prostatic hypertrophy (BPH). The clinical efficacy rate in relation to the subjective urinary symptoms was about the same in the two treatment groups; 45.9% in the TZP-4238 group and 50.0% in the CMA group. However, the incidence of adverse effects on the sexual function showed a marked difference between the two groups. The TZP-4238 group revealed a lower suppressive effect on the function than the CMA group (45.1% vs. 71.4%). In relation to their causation of other adverse effects, there were no differences between the two drugs. Accordingly, in consideration of the facts that TZP-4238 with less influence on the sexual function affords a superior quality of life to elderly patients, while achieving effective treatment by means of a convenient single daily administration, TZP-4238 was surmised to be a more useful drug than CMA as an antiandrogen for the treatment of BPH.

Topics: Aged; Aged, 80 and over; Androgen Antagonists; Chlormadinone Acetate; Double-Blind Method; Ejaculation; Humans; Male; Middle Aged; Penile Erection; Prostatic Hyperplasia; Sex; Sexual Behavior

Allylestrenol (ALE) and chlormadinone acetate (CMA) were administered to patients with prostatomegaly by the double-blind method, and a self-assessment questionnaire method developed by the authors was used to study the influence of these two antiandrogens on their sexual function. Each test drug was orally administered to 58 patients, in a daily dosage of 50 mg for 12 consecutive weeks. The questionnaires consisted of 6 categories each consisting of 5 questions, or 30 questions in total. The 6 categories were "sexual desire," "erectile capacity" and "ejaculation," which relate to the sexual function, and "living environment (including the frequency of sex)," "dysuria" and "dummy (personality)." Each question was graded into 0-10 points, and each patient was requested to circle the number which best described his status. The scores were compiled and statistically analyzed. Many patients were senile. Evaluable answers were obtained for 99 (85.3%) of the 116 patients. Factor analysis based on the preadministration scores confirmed the contents of the questionnaires to be appropriate for the objectives of the present study. Multiple regression analysis revealed a high correlation between the self-assessment scores and objective data (nocturnal penile tumescence values; NPT values) when dropout cases due to a decrease in the sexual function and non-replying cases were excluded. The self-assessment questionnaire method was concluded to be as useful an objective test method as the NPT measurement for examining the sexual function. Aggravation of the "frequency of urination during night" was conspicuous in the CMA group, and there was a significant difference (p less than 0.05) in this parameter between the two groups. Except for this parameter, dysuria was improved in both administration groups, and there was no significant difference in the efficacy of the two drugs. Both drugs tended to suppress overall sexual function, but the suppression was less severe in the ALE group. Especially the suppression was significantly (p less than 0.05) lower in the ALE group regarding the 3 parameters of "contact sexual arousal," "contact erection" and "morning erection", which are included in the category of "sexual desire" or "erectile capacity." Also, suppression of "frequency of sex" and "intensity of sexual desire" tended to be lower in the ALE group at a level of significance of p less than 0.1. Regarding questions in the category of "ejaculation," the incidence of non-

Topics: Adult; Aged; Allylestrenol; Chlormadinone Acetate; Clinical Trials as Topic; Double-Blind Method; Estrenes; Humans; Male; Middle Aged; Multicenter Studies as Topic; Prostatic Hyperplasia; Self-Assessment; Sex; Surveys and Questionnaires

The purpose of this prospective study was to evaluate the sexual function of patients with benign prostatic hyperplasia (BPH) before and after transurethral resection of the prostate (TURP). The sexual functions of 155 patients with BPH were evaluated before TURP and 6 and 12 months afterwards. The mean age of the patients was 69 years (range 49-86 years). The only significant change in sexual function after TURP was improvement in early morning erections (P < 0.01). Sixty-eight per cent of the patients were satisfied with their sex life before TURP, 69% after 6 months and 67% after 12 months. The corresponding percentages of patients satisfied with their libido were 60%, 59% and 54%. Only 26% of the patients had completely satisfactory erections before TURP, while 22% had them 6 months later and 24% 12 months later. The proportion of fully impotent patients was 11% before the procedure, 13% after 6 months and 16% after 12 months. In 84% of the patients ejaculation was retrograde 6 months and 12 months after TURP. We conclude that TURP does not affect the sexual function of patients with BPH, with the exception of retrograde ejaculation.

Topics: Aged; Aged, 80 and over; Ejaculation; Humans; Libido; Male; Middle Aged; Orgasm; Patient Satisfaction; Penile Erection; Postoperative Period; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Sex

300 VLAP procedures are reported with no mortality and very little morbidity. The results are comparable to TURP with lower incidence of impotence, preservation of ejaculation, little blood loss, less chance of scarring and higher acceptance of the public undergo a laser procedure.

Topics: Aged; Aged, 80 and over; Ejaculation; Humans; Laser Therapy; Male; Middle Aged; Patient Acceptance of Health Care; Penile Erection; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Sex

Topics: Age Factors; Aged; Diabetes Complications; Female; Humans; Male; Postoperative Complications; Prostatic Hyperplasia; Sex; Sexual Dysfunction, Physiological

Topics: Aging; Bacteria; Bacteriuria; California; Epidemiology; Geriatrics; Humans; Male; Prostatic Hyperplasia; Sex; Statistics as Topic; Urinary Calculi; Urinary Tract Infections; Urine

Topics: Aging; Arteriosclerosis; Asthma; Blindness; Dementia; Emphysema; Geriatrics; Hexosamines; Humans; Hypertension; Leukemia; Lung Neoplasms; Lymphogranuloma Venereum; Male; Neoplasms; Prostatic Hyperplasia; Psychotic Disorders; Scoliosis; Sex; Stomach Neoplasms; Stomach Ulcer; Urine