Amir Kazzazi

Correlation between benign prostatic hyperplasia and inflammation.

Purpose of reviewThis review aims to evaluate the available evidence on the role of prostatic inflammation in the pathogenesis and progression of benign prostatic hyperplasia (BPH). Recent findingsAlthough there is still no evidence of a causal relation, accumulating evidence suggests that inflammation may contribute to the development of BPH and lower urinary tract symptoms (LUTS). Inflammatory infiltrates are frequently observed in prostate tissue specimens from men with BPH and the presence or degree of inflammation has been found to be correlated with prostate volume and weight. The inflammatory injury may contribute to cytokine production by inflammatory cells driving local growth factor production and angiogenesis in the prostatic tissue. This proinflammatory microenvironment is closely related to BPH stromal hyperproliferation and tissue remodeling with a local hypoxia induced by increased oxygen demands by proliferating cells which supports chronic inflammation as a source of oxidative stress leading to tissue injury in infiltrating area. SummaryAlthough the pathogenesis of BPH is not yet fully understood and several mechanisms seem to be involved in the development and progression, recent studies strongly suggest that BPH is an immune inflammatory disease. The T-cell activity and associated autoimmune reaction seem to induce epithelial and stromal cell proliferation. Further understanding of the role of inflammation in BPH and clinical detection of this inflammation will expand the understanding of BPH pathogenesis and its histologic and clinical progression, allow risk stratification for patients presenting with BPH-related LUTS, and suggest novel treatment strategies.

α-Blockers for benign prostatic hyperplasia: the new era.

Purpose of review &agr;1-Adrenoceptor blockers are the most frequently prescribed medical therapy in the treatment of lower urinary tract symptom suggestive of benign prostatic hyperplasia (LUTS/BPH). The purpose of this review is to highlight the evolution of adrenoceptor blockers with emphasis on newly approved drugs. Recent findings Over the past years new formulations of several &agr;1-adrenoceptor blockers were introduced to the market. Five long-acting &agr;1-blockers are currently approved by the Food and Drug Administration for treatment of symptomatic LUTS/BPH: terazosin, doxazosin, tamsulosin, alfuzosin and silodosin. Silodosin is the only adrenoceptor blocker that exhibits true selectivity for the &agr;1-adrenoceptor subtypes. This unique adrenoceptor selectivity profile likely accounts for the very favorable cardiovascular safety profile. Summary Tamsulosin, alfuzosin slow release and silodosin do not require dose titration. Alfuzosin, terazosin, doxazosin and silodosin have all been shown to be effective in relieving LUTS/BPH independent of prostate size. Low incidence of orthostatic hypotension has been reported for silodosin, but abnormal ejaculation is the most commonly reported adverse effect.

American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy: revisited.

Purpose of review The purpose of this review is to provide a complete revision of two of the most widely used clinical guidelines in the management of lower urinary tract symptoms induced by benign prostatic hyperplasia and their importance and compliance among urologists. Recent findings Updates of the American Association of Urology and European Association of Urology clinical practice guidelines (CPGs) were reviewed and analyzed. Literature concerning compliance and application of these two CPGs in the different working scenarios of practicing has been evaluated. Summary Urology has moved to an era in which costs and quality of care are being scrutinized, and compliance to CPGs will be assessed. Practicing urologists do not have the time to keep up to date with the continuous incoming literature and CPGs are a great tool to give the highest quality of care to our patients.

Hormonal manipulation of benign prostatic hyperplasia.

Purpose of reviewWe provide new viewpoints of hormonal control of benign prostatic hyperplasia (BPH). The latest treatment findings with 5-alpha reductase inhibitors (5-ARIs) finasteride and dutasteride, refined indications, efficacy, and safety are discussed and compared. We also discuss potential new 5-ARIs and other hormonal treatments. Recent findingsFinasteride and dutasteride have equal efficacy and safety for the treatment and prevention of progression of BPH. 5-ARIs are especially recommended for prostates greater than 40 ml and PSA greater than 1.5 ng/ml. Combination therapy is the treatment of choice in these patients, but with prostate volume greater than 58 ml or International Prostate Symptom Score of at least 20, combinations have no advantage over 5-ARI monotherapy. Updates on the recent developments on BPH therapy with luteinizing hormone-releasing hormone (LHRH) antagonist are also reviewed and analyzed. Preclinical studies suggest that growth hormone-releasing hormone (GHRH) antagonists effectively shrink experimentally enlarged prostates alone or in combination with LHRH antagonists. SummaryNew 5-ARIs seem to be the promising agents that need further study. Preclinical studies revealed that GHRH and LHRH antagonists both can cause a reduction in prostate volume. Recent data indicate that prostate shrinkage is induced by the direct inhibitory action of GHRH and of LHRH antagonists exerted through prostatic receptors. The adverse effects of 5ARIs encourage alternative therapy.

Blood loss during radical prostatectomy: impact on clinical, oncological and functional outcomes and complication rates

Study Type – Outcomes (cohort)

Testosterone in prostate cancer: the Bethesda consensus.

Whats known on the subject? and What does the study add?

Revival of thermotherapy for benign prostatic hyperplasia.

Purpose of review Transurethral resection of the prostate (TURP) has long been held as the gold standard for treatment of benign prostatic hyperplasia (BPH); however, there has been significant innovation in other less invasive alternative treatments for BPH in recent years. BPH treatment guidelines now recommend minimally invasive therapy be considered as a treatment option alongside TURP and medical management. Our purpose is to review the current evidence supporting the safety, effectiveness, and durability of transurethral microwave thermotherapy (TUMT) as a minimal invasive technique. Recent findings Recent clinical studies of TUMT have provided significant evidence regarding safety, efficacy, and durability. TUMT has now become a minimally invasive office-based alternative to both standard TURP and medical therapy in the treatment of bladder outlet obstruction and lower urinatry tract symptoms due to BPH. Summary TUMT treatment has improved with the advent of later generation devices. This well tolerated, effective, and durable therapy for the treatment of BPH has definitively found its place as one of the alternatives to TURP. Anestheisa-free outpatient capability, lack of sexual side-effects, and avoidance of actual surgery are attractive to patient and clinician alike. TUMT deserves reconsideration in clinical practices as a suitable treatment alternative to TURP and medical therapy.

Imaging in benign prostatic hyperplasia: what is new?

Purpose of reviewThis article discusses the new imaging techniques in diagnosis and treatment of benign prostatic hyperplasia by reviewing the most recent publications. Recent findingsImaging study for the evaluation of patients with lower urinary tract symptoms is not suggested by American Urology Association guidelines; however, European Association of Urology recommends the assessment of the upper urinary tract by modalities like ultrasound. Several new imaging indices like resistive index of capsular artery, presumed circle area ratio, prostatic urethral angle, intraprostatic protrusion, and detrusor wall thickness are used to find a noninvasive way for bladder outlet obstruction diagnosis. In addition to them, 3D transrectal ultrasound, near infrared spectroscopy, and MRI are used to add more practical findings in patient management. SummaryUrologists have requested more imaging studies than expected for benign prostatic hyperplasia patients in recent years, and several studies have been done to find a noninvasive way to diagnose bladder outlet obstruction. However, none of them could play the urodynamic studies role in bladder outlet obstruction diagnosis.

Effect of combination treatment on patient-related outcome measures in benign prostatic hyperplasia: clinical utility of dutasteride and tamsulosin

Background: Benign prostatic hyperplasia, the fourth most commonly diagnosed medical condition in the elderly, is a major underlying cause of lower urinary tract symptoms in men. Medical therapy is usually the first therapeutic option. Combination therapy is increasingly used for better symptom relief and outcome. Methods: We searched the literature using the MEDLINE database for the efficacy of combination therapy in men with benign prostatic hyperplasia in terms of symptom improvement and impact on quality of life. Results: Combination therapy with dutasteride and tamsulosin not only provides better symptom improvement and improved urinary flow rate, but is also associated with a more favorable impact on quality of life and patient satisfaction with treatment than monotherapy. Combination therapy also reduces the risk of events related to disease progression, such as acute urinary retention and benign prostatic hyperplasia-related surgery. Conclusion: Combination therapy with dutasteride and tamsulosin is highly efficacious as medical therapy for benign prostatic hyperplasia in patients with moderate-to-severe lower urinary tract symptoms.

BPH: Predicting TWOC failure in acute urinary retention

Acute urinary retention (AUR) remains one of the greatest challenges faced by a clinician when treating BPH and bladder outlet obstruction. Most importantly, bladder outlet obstruction can be extremely distressing for the patient. A number of therapeutic options are available.