Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

Purpose Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for patients with prostates >80 mL and has demonstrated lower morbidity rates. We sought to evaluate PAE at a single tertiary medical center. Methods A retrospective review of all patients who underwent PAE was completed. Demographic, clinicopathologic, procedure, and outcome data were collected to include international prostatic symptom score (IPSS) and quality of life (QoL) assessments. Results The pre-PAE mean prostate-specific antigen (PSA) was 8.4 ng/mL, mean prostate volume was 146.9 mL (9% >200 mL), and mean postvoid residual (PVR) was 208.2 mL (21.9% 200–300 mL). IPSS mean was 19.8 and QoL was “mostly dissatisfied.” Following PAE, mean PSA was reduced by 3.2 ng/mL (38.1%, p = 0.3014), the mean prostate volume reduction was 59.2 mL (40.3%, n = 19, p < 0.0001), and the average PVR reduction was 150.3 mL (72.2%, n = 27, p = 0.0002). Average IPSS score was also lower (11.9; 60.1%, n = 25, p < 0.0001) and QoL was reduced to “mostly satisfied” (p < 0.0001). Technical success was 100% with 24% minor morbidities. Conclusion PAE is a successful treatment for patients with BPH resulting in large prostates that are not good candidates for simple prostatectomy, providing optimal care with less operative and postoperative complications.

Polysomnography and Nocturia Evaluations after Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome

A higher incidence rate of nocturia in patients with obstructive sleep apnea (OSA) has been observed. We investigated the differences in clinical examinations between OSA patients with and without nocturia, and further compared those with successful and unsuccessful uvulopalatopharyngoplasty (UPPP). This retrospective study enrolled 103 patients with OSA undergoing UPPP. Patients were diagnosed with OSA by following the 2018 American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.5. Patients were divided into two groups depending on if they urinated more than twice per night. The medical data of body mass index (BMI), nocturia frequency per night, apnea–hypopnea index (AHI), Epworth Sleepiness Scale (ESS), International Prostatic Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS) were analyzed before and after uvulopalatopharyngoplasty (UPPP) surgery. All of the measurements were compared between successful and unsuccessful surgery in the non-nocturia or nocturia groups, respectively. Fifty patients (41 males and nine females) without nocturia were assigned to group 1, and 53 patients (43 males and 10 females) with nocturia were assigned to group 2. Nocturia frequency and post-surgery AHI in group 2 were significantly higher than those in group 1 (p < 0.05). Significant decreases in IPSS and OABSS were observed in the successful surgery subgroup of group 2 (p < 0.05). A significant decrease in post-surgery AHI was observed between unsuccessful and successful surgery in patients with nocturia (p < 0.05), but not in the non-nocturia group (p > 0.05). Although AHI had a significant correlation to nocturia frequency in all OSA patients before UPPP, no significant correlation between AHI reduction and nocturia frequency was found. UPPP appeared to be an effective treatment for nocturia associated with OSA. OSA should be taken into consideration for patients who complain of nocturia syndrome. The relationship of AHI reduction and nocturia improvement after OSA treatment with UPPP is still unclear. In addition, it is necessary to establish the existence of nocturia in patients with OSA, as a result of its high prevalence in OSA patients. UPPP could reduce the symptoms of OSA and could also contribute to a reduction of nocturia even in the unsuccessful surgery group.

Add-on treatment with mirabegron may improve quality of life in patients with benign prostatic hyperplasia complaining of persistent storage symptoms after tamsulosin monotherapy

Background: The aim of this study was to evaluate the change in lower urinary tract symptoms and quality of life (QoL) after combination therapy of solifenacin and mirabegron in patients with benign prostatic hyperplasia presenting with persistent storage symptoms after treatment with tamsulosin. Material & Methods: We evaluated the International Prostatic Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), prostate-specific antigen, prostate volume, peak flow rate (Qmax), and post-voided residual volume (PVR) before and after treatment. Patients showing baseline OABSS ⩾3 were included and treated with tamsulosin 0.2 mg as an initial drug for 1 month. After 1 month, add-on treatment with solifenacin 5 mg or mirabegron 50 mg was provided to patients who did not show improvement in OABSS with tamsulosin 0.2 mg. After 2 months, we evaluated changes in OABSS, IPSS, Qmax, and PVR. Results: After combination therapy for 2 months, there were no significant differences between patients receiving add-on treatment with solifenacin and those receiving mirabegron. However, the IPSS QoL score improved in patients treated with mirabegron and tamsulosin more than in those treated with solifenacin and tamsulosin ( p < 0.05). Conclusion: A combination of tamsulosin and mirabegron might improve the QoL of patients presenting with persistent storage symptoms after tamsulosin monotherapy. Better QoL due to mirabegron compared with solifenacin could be associated with fewer adverse effects, such as dry mouth and constipation.

Effectiveness and safety of Tadalafil-SZ (NJSC “Northern Star”) at 5 mg / day in patients with symptoms of voiding dysfunction due to prostatic hyperplasia

The study objective is to evaluate effectiveness and safety of Tadalafil-SZ (NJSC “Northern Star”) at 5 mg / day in treatment of patients with symptoms of voiding dysfunction due to prostatic hyperplasia.Materials and methods. The study was conducted at the “Family Polyclinic No. 4” between January and June of 2019 and included 74 patients. Effectiveness was evaluated using the International Prostatic Symptom Score, International Index of Erectile Function, maximum urine flow rate and transrectal ultrasound examination.Results. After 3 months of therapy with tadalafil, positive dynamics of all characteristics were observed. Symptom severity prior to treatment was 11.50 ± 0.27 points, after treatment it was 10.00 ± 0.31 points. Maximum urine flow rate prior to treatment was 10.80 ± 0.20 ml / s, after treatment it was 11.10 ± 0.19 ml / s. The International Index of Erectile Function increased from 16.60 ± 0.30 prior to treatment to 20.20 ± 0.24 after treatment. Prostate volume before treatment was 43.70 ± 0.87 cm3, after treatment it was 40.30 ± 0.72 cm3.Conclusion. Tadalafil at 5 mg / day significantly decreases symptoms of voiding dysfunction and prostate volume, improves erectile function.

THE EFFECTIVENESS OF TAMSULOSIN, SOLIFENACIN, AND COMBINATIONS THERAPY TAMSULOSIN ADDED SOLIFENACIN ON LOWER URINARY TRACT SYMPTOMS AFTER DOUBLE J STENT INSERTION

Objective: Insertion of DJ Stent is a procedure that is often done by urologist. Insertion of DJ Stent can cause LUTS complaints and greatly affect the physical and psychosocial health of patients. The aim of this study was to determine the effectiveness difference of tamsulosin therapy 0.4 mg/day, solifenacin 5 mg/day and the combination of tamsulosin therapy 0.4 mg/day added solifenacin 5 mg/day to manage LUTS complaint after DJ Stent insertion. Material & Methods: This study was a randomized placebo-controlled trial. There were 4 groups, group I received placebo, group II received tamsulosin 0.4 mg/day, group III received solifenacin 5 mg/day, and group IV received combination therapy of tamsulosin 0.4 mg/day added solifenacin 5 mg/day. Evaluation based on International Prostatic Symptom Score (IPSS) and Ureteral Stent Symptom Questioner (USSQ) score. Data were analyzed using SPSS 21.0. It is said to be significant if p<0.05. Results: There were a total of 32 samples consist of 19 (59.3%) men and 13 (40.6%) women. There were significant improvements in the score of total IPSS, IPSS storage and IPSS quality of life score in patients who received combination therapy (p<0.05) when compared with patients who received monotherapy. The highest decrease in USSQ scores 1, 2, 3, 4, 5 and 6 were in the group that received combination therapy when compared with the monotherapy group. Conclusion: The combination therapy is safe and effective to improve IPSS total, IPSS storage and IPSS Quality of Life scores compared with monotherapy.

Grading Of Prostate Volume And International Prostatic Symptom Score (IPSS) In A Subset Of Karachi Population

Objective: Analyze grading of IPSS (International Prostatic Symptom Score) and PV (Prostate Volume) of BPH patients in a subset of Karachi Population. Methodology: A 103 Benign prostatic hyperplasia(BPH) patients were recruited. A cross-sectional study was done Prostate Volume was recorded along with their IPSS also noted. Result: Among BPH patients 25.2% patients had prostate volume of 25 to 30 ml , 52.5% of patient had prostate volume of 30 to 50ml and 22.3% of patients had prostate volume above 50 ml. In IPSS grading 82.5% patients were under moderate symptom group and 17.5% were under severe symptom group. Conclusion: International Prostatic Symptom Score continues to increase as Prostate volume increases

Efficacy and Safety of Lycoprozen®, a Novel Tomato-Based Food Supplement in Patients with Benign Prostatic Hyperplasia

Objective: To evaluate the efficacy and safety of a novel tomato-based food supplement on the lower urinary tract symptoms (LUTS) of patients with benign prostatic hyperplasia (BPH). Methods: Twenty patients with BPH were enrolled in this observational study. They were assigned to consume daily a sachet of Lycoprozen® (5 grams) dissolved in water for two months. Results: All patients successfully completed the Lycoprozen scheduled regimen and the IPSS (International Prostatic Symptom Score) questionnaire before and after treatment. No side effects due to treatment were noticed. In this preliminary study, we have found that Lycoprozen® significantly reduced the LUTS severity (paired t-test, two-tailed p value < 0.0001). The IPSS mean values before and after the treatment were 16.95+6.0 SD (range 31-6) and 12.2+4.9 SD (range 20-2), respectively. Conclusions: Based on these data, Lycoprozen® may represent a suitable alternative option for the treatment of symptomatic BPH patients which worth of further testing in a phase 2 prospective randomized double blind placebo controlled study. The treatment was without side effects and acceptance among patients was high.

Once-daily 5 mg tadalafil oral treatment for patients with chronic prostatitis/chronic pelvic pain syndrome

Background: Chronic prostatitis/chronic pelvic pain syndrome (IIIB CP/CPPS) is a condition of unclear aetiology. Many approaches have been used without satisfactory results. The aim of this study is to evaluate the efficacy of once-daily 5 mg tadalafil in pain control and improving quality of life in patients affected by CP/CPPS. Methods: Twenty patients affected by chronic prostatitis according EAU (European Association of Urology) guidelines were evaluated for once-daily 5 mg tadalafil; 14 patients were eligible for the study. The validated Italian version of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostatic Symptom Score (IPSS) questionnaires were submitted to all the patients. Every patient underwent uroflowmetry and ultrasound prostatic volume at the beginning and at the end of the study. Results: All 14 patients eligible for the study reported an improvement of symptoms during therapy: statistically significant differences were reported in terms of NIH-CPSI ( p < 0.000002) and IPSS ( p < 0.0001) during follow-up evaluations. No statistically significant improvement of uroflowmetry parameters was reported during the treatment. Conclusions: In our study the daily use of 5 mg tadalafil improves symptoms and quality of life in patients affected by CP/CPPS after 4 weeks of therapy. A larger population of patients is needed to confirm the efficacy of this therapy in CP/CPPS.

Daidzein plus isolase associated with zinc improves clinical symptoms and quality of life in patients with LUTS due to benign prostatic hyperplasia: Results from a phase I-II study

Objective: In the last years there is a growing interest in nutraceutical substances that seems able to improve clinical symptoms in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). In this paper, we evaluated both efficacy and safety of a combination of daidzein with isolase and zinc in patients with LUTS due to BPH. Materials and methods: In a phase I-II study clinical trial we enrolled patients with clinical and instrumental diagnosis of LUTS associated to BPH that received a six-month treatment with a combination of daidzein with isolase and zinc (1 tablet/day). Clinical, laboratory and instrumental analyses were carried out at the time of admission (T0) and 6 months after the ending of the treatment (T1). The Italian version of International Prostatic Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) and Quality of Well-Being (QoL) questionnaires were used. The development of adverse drug reactions (ADRs) and drug interactions (DDIs) were recorded using the Naranjo scale and drug interaction probability scale. Student’s t test and Anova test were used for statistical analysis, and the threshold of statistical significance was set at P &lt; 0.05. Results: We enrolled 71 patients, 62 (87.3%) completed the follow-up and we documented a significant differences between T0 and T1 in terms of IPSS [21.5 ± 1.2 vs 16.2 ± 1.5; (-4.8); p &lt; 0.001], Cmax [9.7 ± 3.7 vs 15.3 ± 2.5; (+5.6); p &lt; 0.001] and QoL [0.56 ± 0.15 vs 0.84 ± 0.19; (+0.28); p &lt; 0.001]. In contrast, no significant difference were recorded in terms of IIEF-5 [p = 0.50] and PSA [p = 0.67]. Finally, we did not record any significant ADRs or DDIs during the study. Conclusions: In this study, we documented that a combination of daidzein with isolase and zinc, reduces the clinical symptoms of LUTS and improves the quality of life in patients with BPH, without the development of ADRs or DDIs.