Advances in benign prostatic hyperplasia:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
1995
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| Series: | The urologic clinics of North America
22,2 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XII S., S. 237 - 479 Ill., graph. Darst. |
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| adam_text | ADVANCES IN BENIGN PROSTATIC HYPERPLASIA
CONTENTS
Preface xiii
Herbert Lepor
Etiology of Benign Prostatic Hyperplasia 237
Chung Lee, James M. Kozlowski, and John T. Grayhack
Benign Prostatic Hyperplasia (BPH) is the most common neoplastic condi¬
tion that afflicts men, and it constitutes a major factor impacting the health
of the American male. This article reviews voiding dysfunction and the
role of aging, the testis, and androgen in the development of BPH. Empha¬
sis is placed on new concepts in the basic aspects of BPH etiology as a
result of recent investigations.
Epidemiology and Natural History of Benign Prostatic Hyperplasia 247
Harry A. Guess
Clinical manifestations of BPH include the symptoms, signs, and sequelae
of urinary obstruction caused by the abnormal growth of non malignant
nodules that arise in a small region around the proximal segment of the
prostatic urethra. Although the pathologic diagnostic criteria are relatively
specific, clinical diagnostic criteria are much less specific, and no single
BPH case definition has gained wide acceptance for use in epidemiologic
studies.
Genetic and Cellular Characteristics of Bladder Outlet Obstruction 263
Robert M. Levin, Frederick C. Monson, Niels Haugaard, Ralph Buttyan,
Alan Hudson, Marleen Roelofs, Saverio Santore, and Alan J. Wein
Urinary bladder outlet obstruction is a common medical problem. In order
to understand the effects of outlet obstruction on bladder morphology,
physiology, and pharmacology, several animal models of obstruction have
been developed using a variety of species. Although there are marked
differences in bladder size, capacity, compliance, physiology, and pharma¬
cology among these species, responses to outlet obstruction have many
common characteristics. This article will be separated into six areas: intro¬
duction, genetic factors mediating the response during the initial period
of partial outlet obstruction and overdistension, cytostructural alterations
UROLOGIC CLINICS OF NORTH AMERICA
VOLUME 22 • NUMBER 2 • MAY 1995 vii
that accompany compensated bladder function, alterations in innervation
accompanying bladder hypertrophy secondary to partial outlet obstruc¬
tion, alterations in calcium translocation during bladder hypertrophy, and
metabolic factors involved in the response to partial outlet obstruction.
Pathophysiology of Clinical Benign Prostatic Hyperplasia 285
Ellen Shapiro and Herbert Lepor
The pathophysiology of clinical BPH has been attributed to bladder outlet
obstruction resulting from the enlarged prostate. A direct relationship
does not exist between prostate size, symptom severity, or bladder outlet
obstruction. The pathophysiology of prostatism is most likely multifacto
rial. Elucidating the factors contributing to symptoms will likely provide
the foundation for the development of new pharmacological alternatives
for the medical treatment of BPH.
Clinical Manifestations of Benign Prostatic Hyperplasia 291
Finn A. Madsen and Reginald C. Bruskewitz
The clinical diagnosis of BPH is usually established after completing the
initial evaluation of patients who present with symptoms of prostatism.
The steps recommended in the initial evaluation include a medical history,
symptom assessment using a Symptom Score Index, a digital rectal exami¬
nation, a focused neurological examination, urinalysis, measurement of
serum creatinine, and an optional PSA measurement. Further examina¬
tions such as uroflowmetry and cystoscopy are indicated only if the
diagnosis is uncertain, or to determine the feasibility of specific invasive
therapies.
The Development and Clinical Utility of Symptom Scores 299
Michael J. Barry and Michael P. O Leary
Urinary symptom severity can be documented objectively among men
with BPH using validated instruments such as the AUA Symptom Index.
The AUA Index was developed to discriminate among BPH patients who
are more or less bothered by their condition, and to measure change in
symptom levels over time or with treatment. The AUA Index is reliable
and valid for these purposes, and can be useful in both clinical practice
and research. The role of symptom measurement in general and the AUA
Index in particular in the diagnosis of BPH is unclear, and may be limited.
Additional research is needed to maximize the utility of symptom mea¬
surement in urology.
Uroflowmetry and Urodynamics 309
Steven A. Kaplan and Alexis E. Te
The ability to define and understand the relationship and significance of
bladder outlet obstruction to the diagnosis and treatment of BPH continues
to be a clinical problem that needs examination. Urodynamics remain the
best tool to diagnose bladder outlet obstruction. However, controversies
exist in its role as a diagnostic tool for therapeutic intervention. This article
reviews the various issues and state of the art urodynamic modalities that
pertain to the application of urodynamics to BPH. Specifically, a critical
review is provided for the various urodynamic modalities such as uro¬
flowmetry and multichannel urodynamics as it pertains to its clinical
application and study of BPH.
Imaging of the Prostate: Benign Prostatic Hyperplasia 321
Edward M. Scheckowitz and Martin I. Resnick
Imaging studies of the prostate and urinary tract in patients with BPH
include ultrasonography, intravenous urography, urethrography, CT
viii CONTENTS
scans, and MR imaging. Ultrasound can assess for upper tract changes,
determine post void residuals, estimate prostatic volume, and demonstrate
zonal anatomy and internal changes within the prostate. Intravenous urog
raphy is indicated for patients with hematuria, urinary tract stones, and
other atypical histories. Urethrography provides information in the post
prostatectomy patients with residual symptoms. CT scans and MR im¬
aging are expensive and have no routine use in evaluating patients with
BPH.
The Role of Prostate Specific Antigen in the Evaluation of Benign
Prostatic Hyperplasia 333
Marie Blanche Tchetgen and Joseph E. Oesterling
This article reviews the role of prostate specific antigen (PSA) in the
evaluation of BPH. Efficacy of the PSA test in differentiating patients
with BPH from patients with early, potentially curable prostate cancer is
discussed. In addition, this complete overview provides a critical analysis
of various concepts (PSA density, PSA velocity, age specific reference
ranges, and free versus complexed serum PSA), that are devised to opti¬
mize the diagnostic value of the serum PSA concentration in a population
in which prostate cancer and BPH are almost equally prevalent. A clinical
algorithm, useful to the practicing clinician for the early detection of
prostate cancer in the BPH patient, is also proposed.
Assessing Treatment Results in Benign Prostatic Hyperplasia 345
Alan J. Wein
This article discusses general and specific principles for the evaluation of
BPH. General principles include bias elimination; sample size; appropriate
and sensitive parameters of evaluation; blind, double blind, controlled,
and placebo controlled studies; and statistical versus clinical significance.
Specific considerations include prostate volume and size; flowmetry; resid¬
ual urine volume; cystometry and pressure flow studies; and symptomatic
versus urodynamic improvement.
Transurethral Prostatectomy 357
H. Logan Holtgrewe
Performed on properly selected patients, transurethral prostatectomy
(TURP) is unmatched for long term beneficial outcomes and symptom
improvement. Despite the advanced average age and compromised gen¬
eral health of most men undergoing this operation, its mortality and
morbidity is remarkably low. While this operation is being challenged by
new emerging strategies of management, the efficacy and durability of
which remain to be defined, TURP currently remains the standard against
which all other therapies must be judged.
Transurethral Incision of the Prostate 369
Finn A. Madsen and Reginald C. Bruskewitz
Transurethral incision of the prostate (TUIP) is a safe and effective thera¬
peutic modality for treating symptoms of bladder outlet obstruction in
patients whose prostates have an estimated weight loss of less than 30 g.
New minimal invasive techniques should be compared with TUIP instead
of with transurethral resection of the prostate (TURP).
Alpha Blockade for the Treatment of Benign Prostatic Hyperplasia 375
Herbert Lepor
Randomized double blind placebo controlled studies have consistently
demonstrated the safety and effectiveness of selective a, blockers for the
CONTENTS ix
treatment of clinical BPH. Selective a, blockers relieve the symptoms of
prostatism and decrease bladder outlet obstruction. The advantages of this
class of drugs for the medical treatment of BPH include the extremely
rapid onset of action, statistically and clinically significant effects on rele¬
vant outcome measures, adverse experiences that are generally infrequent,
mild, and reversible, serum PSA levels are not affected, and hypertension
is also effectively treated. The long term effectiveness of selective a, block¬
ers has recently been reported. Prostate smooth muscle tension is mediated
by the au, (previously defined as ak.) AR. The pharmaceutical industry
is aggressively pursuing development of ala prostate selective AR
antagonists.
Benign Prostatic Hyperplasia: Hormonal Treatment 387
John D. McConnell
Since the development of BPH requires testicular androgens, it is reason¬
able to assume that androgen withdrawal therapy would have a beneficial
effect on prostatic growth. Clinical series utilizing androgen withdrawal
demonstrate a reduction in prostatic size that averages 20% to 30%, with
modest improvement in symptoms and uroflow. Of the available forms of
hormonal therapy, only a 5a reductase inhibitor therapy has an appro¬
priate safety profile to offset this limited clinical improvement. Finasteride,
the only FDA approved agent in this class, produces acceptable clinical
improvement with short term risks limited to a 3% to 4% probability of
sexual dysfunction. Clinical improvement appears to be maintained up to
four years, but prevention of disease progression has not been clearly
established.
Combination Medical Therapy for Benign Prostatic Hyperplasia 401
Herbert Lepor
Preliminary clinical observations suggest that the efficacy of combination
therapy (a, blockade + androgen suppression) is superior to the individual
monotherapies. Several randomized double blind multicenter placebo con¬
trolled studies are being done to define the efficacy and safety of combina¬
tion therapy relative to the monotherapies. The ultimate role of combina¬
tion therapy in clinical practice depends on a critical assessment of relative
efficacy, safety, and cost.
Phytotherapeutic Agents in the Management of Symptomatic Benign
Prostatic Hyperplasia 407
John M. Fitzpatrick and Thomas J. Lynch
Phytotherapeutic agents constitute a large part of the market for the
pharmacological treatment of symptomatic BPH. At present, these agents
are being used on an empirical basis with some success in relieving
symptoms. They have not been shown to have any effect on objective
indices. Several agents are presently undergoing randomized trials.
Lasers for the Treatment of Benign Prostatic Hyperplasia 413
Christopher M. Dixon
Laser delivery systems have received much attention over the past several
years. Laser techniques continue to rapidly evolve. This article critically
reviews the common delivery systems and the current clinical data.
Prostatic Stents: Current Perspectives for the Management of Benign
Prostatic Hyperplasia 423
Bruce A. Kletscher and Joseph E. Oesterling
As minimally invasive technologies are developed for the treatment of
BPH, prostatic stents appear to be an attractive treatment modality. While
X CONTENTS
more long term data must be acquired in order to make definitive state¬
ments, current results appear quite promising. Intensive investigation into
new designs and material composition for prostatic endoprostheses is
underway in both Europe and the United States.
Microwave Therapy of Benign Prostatic Hyperplasia 431
Bernard Goldfarb, Tania Bartkiw, and John Trachtenberg
The use of microwave energy has been explored as a mode for treating
symptomatic BPH. Hyperthermia involves heating the prostate to less
than 45° C. Multiple treatments are required and clinical results have
been mixed. Thermotherapy involves heating the prostate to temperatures
greater than 45°C in order to produce tissue necrosis. These treatment
regimens yield results intermediate between drug therapy and prostatec¬
tomy. Further enhancements should optimize this form of therapy and
produce clinical results similar to those seen with surgery.
Transurethral Needle Ablation (TUNA) for the Treatment of Benign
Prostatic Hyperplasia 441
Christopher M. Dixon
The transurethral needle ablation (TUNA) device is a unique system that
uses radio frequency energy to ablate the obstructing prostate adenoma.
Although the clinical data are preliminary, they appear to provide im¬
provement in symptom scores and peak flow rates, although somewhat
less than TURP. A prospective, randomized trial comparing TUNA and
TURP is underway, which should answer many of the questions regarding
the safety and efficacy of this device for BPH.
The Agency for Health Care Policy and Research: Clinical Guidelines
for the Diagnosis and Treatment of Benign Prostatic Hyperplasia 445
Claus G. Roehrborn
The Agency for Health Care Policy and Research (AHCPR) Guidelines for
the diagnosis and treatment of BPH have been developed by a multidisci
plinary panel of experts using the explicit approach to guidelines described
by Dr. David Eddy. They are the result of a comprehensive review of the
literature and a critical analysis of all relevant outcomes associated with
the diagnosis and treatment of BPH. This article describes the rationale
behind the guidelines and their development. The two most important
integral parts of the document, the balance sheet of benefits and harms
and the decision diagram, are also discussed.
The Treatment of Benign Prostatic Hyperplasia: A Glimpse into
the Future 455
Herbert Lepor
Medical and surgical therapies for clinical BPH are currently targeted to
decrease bladder outlet obstruction. Pharmaceutical companies are devel¬
oping more prostate selective alpha, blockers (a,,, AR antagonists), non
selective inhibitors of the isoforms of DHT, and LHRH antagonists. Future
strategies will be to develop nonadrenergic inhibitors of prostate smooth
muscle. Industry is attempting to achieve greater tissue destruction using
microwave thermotherapy and laser energy. Vaporization of the prostate
will be a hot topic this year. The optimal treatment of BPH will require
both new technology and a better understanding of the pathophysiology
of clinical BPH.
CONTENTS Xi
The Craft of Urologic Surgery
Anatomic Approach to Radical Perineal Prostatectomy 461
Bruce I. Carlin and Martin I. Resnick
Radical perineal prostatectomy is an effective cancer operation with a low
associated morbidity and mortality. Recent studies of pelvic anatomy have
elucidated important relationships with regard to the perineal approach
to prostate surgery. In this article, the authors integrate an anatomic
discussion of pelvic anatomy with the surgical technique of radical peri¬
neal prostatectomy.
Index 475
Subscription Information Inside back cover
Xii CONTENTS
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| physical | XII S., S. 237 - 479 Ill., graph. Darst. |
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| spelling | Advances in benign prostatic hyperplasia Herbert Lepor guest ed. Philadelphia [u.a.] Saunders 1995 XII S., S. 237 - 479 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier The urologic clinics of North America 22,2 Hyperplasie de la prostate Prostaathypertrofie gtt Prostatectomie gtt Prostate Hypertrophy Prostatic Hyperplasia trends Prostatahypertrophie (DE-588)4137018-1 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Prostatahypertrophie (DE-588)4137018-1 s DE-604 Lepor, Herbert Sonstige oth The urologic clinics of North America 22,2 (DE-604)BV000001584 22,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=006850645&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Advances in benign prostatic hyperplasia The urologic clinics of North America Hyperplasie de la prostate Prostaathypertrofie gtt Prostatectomie gtt Prostate Hypertrophy Prostatic Hyperplasia trends Prostatahypertrophie (DE-588)4137018-1 gnd |
| subject_GND | (DE-588)4137018-1 (DE-588)4143413-4 |
| title | Advances in benign prostatic hyperplasia |
| title_auth | Advances in benign prostatic hyperplasia |
| title_exact_search | Advances in benign prostatic hyperplasia |
| title_full | Advances in benign prostatic hyperplasia Herbert Lepor guest ed. |
| title_fullStr | Advances in benign prostatic hyperplasia Herbert Lepor guest ed. |
| title_full_unstemmed | Advances in benign prostatic hyperplasia Herbert Lepor guest ed. |
| title_short | Advances in benign prostatic hyperplasia |
| title_sort | advances in benign prostatic hyperplasia |
| topic | Hyperplasie de la prostate Prostaathypertrofie gtt Prostatectomie gtt Prostate Hypertrophy Prostatic Hyperplasia trends Prostatahypertrophie (DE-588)4137018-1 gnd |
| topic_facet | Hyperplasie de la prostate Prostaathypertrofie Prostatectomie Prostate Hypertrophy Prostatic Hyperplasia trends Prostatahypertrophie Aufsatzsammlung |
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| volume_link | (DE-604)BV000001584 |
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