Objective:This study aims to investigate the potential molecular mechanism of Salvia miltiorrhiza in treating benign prostatic hyperplasia(BPH)based on network pharmacology.Methods:Active components of Salvia miltiorr...Objective:This study aims to investigate the potential molecular mechanism of Salvia miltiorrhiza in treating benign prostatic hyperplasia(BPH)based on network pharmacology.Methods:Active components of Salvia miltiorrhiza were screened via the TCMSP database,and their potential targets were predicted using Swiss Target Prediction.BPH-related targets were obtained from Gene Cards and OMIM databases.Common targets between the herb and BPH were used to con-struct a protein-protein interaction(PPI)network via STRING and visualized using Cytoscape.Core targets were identifi ed,and Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were conducted(P≤0.01).Results:A total of 57 active components and 818 targets of Salvia miltiorrhiza were identifi ed.Intersection analysis yielded 458 potential targets associated with BPH.PPI network analysis revealed core targets including SRC,PIK3R1,and PIK3CA.GO enrichment analysis indicated that the targets were primarily associated with biological processes(BP)such as calcium ion homeostasis,cellular components(CC)including focal adhesions,and molecular functions(MF)such as tyrosine kinase activity.KEGG pathway analysis indicated that Salvia miltiorrhiza may exert therapeutic effects through pathways including MAPK,PI3K-Akt,and calcium signaling(P≤0.01).Conclusion:Salvia miltiorrhiza may regulate BPH through a multi-component,multi-target,and multi-pathway network,providing a theoretical basis for its clinical application.展开更多
Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and ...Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and within specific regions.It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.Methods:We obtained data on incidence,prevalence,mortality,and disability-adjusted life-years(DALYs)for the aforementioned urologic diseases by age,sex,location,and year from the Global Burden of Disease(GBD)2021.We analyzed the burden associated with urologic diseases based on socio-demographic index(SDI)and attributable risk factors.The trends in burden over time were assessed using estimated annual percentage changes(EAPC)along with a 95%confidence interval(CI).Results:In 2021,BPH and UTI were the leading causes of age-standardized incidence rate(ASIR)and age-standardized prevalence rate(ASPR),with rates of 5531.88 and 2782.59 per 100,000 persons,respectively.Prostate cancer was the leading cause of both age-standardized mortality rate(ASMR)and age-standardized DALYs rate(ASDR),with rates of 12.63 and 217.83 per 100,000 persons,respectively.From 1990 to 2021,there was an upward trend in ASIR,ASPR,ASMR,and ASDR for UTI,while urolithiasis showed a downward trend.The middle and low-middle SDI quintile levels exhibited higher incidence,prevalence,mortality,and DALYs related to UTI,urolithiasis,and BPH,while the high and high-middle SDI quintile levels showed higher rates for the three cancers.The burden of these 6 urologic diseases displayed diverse age and sex distribution patterns.In 2021,a high body mass index(BMI)contributed to 20.07%of kidney cancer deaths worldwide,while smoking accounted for 26.48%of bladder cancer deaths and 3.00%of prostate cancer deaths.Conclusions:The global burden of 6 urologic diseases presents a significant public health challenge.Urgent international collaboration is essential to advance the improvement of urologic disease management,encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.展开更多
Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a m...Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.展开更多
Background:Benign prostatic hyperplasia(BPH)is the most common disease in elderly men.There is increasing evidence that periodontitis increases the risk of BPH,but the specific mechanism remains unclear.This study aim...Background:Benign prostatic hyperplasia(BPH)is the most common disease in elderly men.There is increasing evidence that periodontitis increases the risk of BPH,but the specific mechanism remains unclear.This study aimed to explore the role and mechanism of the key periodontal pathogen Porphyromonas gingivalis(P.gingivalis)in the development of BPH.Methods:The subgingival plaque(Sp)and prostatic fluid(Pf)of patients with BPH concurrent periodontitis were extracted and cultured for 16S r DNA sequencing.Ligature-induced periodontitis,testosterone-induced BPH and the composite models in rats were established.The P.gingivalis and its toxic factor P.gingivalis lipopolysaccharide(P.gLPS)were injected into the ventral lobe of prostate in rats to simulate its colonization of prostate.P.g-LPS was used to construct the prostate cell infection model for mechanism exploration.Results:P.gingivalis,Streptococcus oralis,Capnocytophaga ochracea and other oral pathogens were simultaneously detected in the Sp and Pf of patients with BPH concurrent periodontitis,and the average relative abundance of P.gingivalis was found to be the highest.P.gingivalis was detected in both Sp and Pf in 62.5%of patients.Simultaneous periodontitis and BPH synergistically aggravated prostate histological changes.P.gingivalis and P.gLPS infection could induce obvious hyperplasia of the prostate epithelium and stroma(epithelial thickness was 2.97-fold and 3.08-fold that of control group,respectively),and increase of collagen fibrosis(3.81-fold and 5.02-fold that of control group,respectively).P.gingivalis infection promoted prostate cell proliferation,inhibited apoptosis,and upregulated the expression of inflammatory cytokines interleukin-6(IL-6;4.47-fold),interleukin-6 receptor-α(IL-6Rα;5.74-fold)and glycoprotein 130(gp130;4.47-fold)in prostatic tissue.P.g-LPS could significantly inhibit cell apoptosis,promote mitosis and proliferation of cells.P.g-LPS activates the Akt pathway through IL-6/IL-6Rα/gp130 complex,which destroys the imbalance between proliferation and apoptosis of prostate cells,induces BPH.Conclusion:P.gingivalis was abundant in the Pf of patients with BPH concurrent periodontitis.P.gingivalis infection can promote BPH,which may affect the progression of BPH via inflammation and the Akt signaling pathway.展开更多
Objective This study aimed to evaluate the effectiveness of acupuncture for benign prostatic hyperplasia(BPH).Methods We searched PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,Chinese National ...Objective This study aimed to evaluate the effectiveness of acupuncture for benign prostatic hyperplasia(BPH).Methods We searched PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,Chinese National Knowledge Infrastructure,Wanfang Data,and China Science and Technology Journal Database from their inceptions to February 1,2022.The language was restricted to English and Chinese.Two researchers independently screened the literature,extracted data,and evaluated the risk bias of the included study according to the Cochrane Handbook 5.1.0.A meta-analysis was performed using Review Manager version 5.3.Results Twenty-two studies with 1,765 participants were selected to be incorporated in the meta-analysis.The experimental groups(EGs)showed greater benefit on therapeutic effects(relative risk[RR]:1.23,95%CI:1.16,1.3;P<0.00001),International Prostate Score Scale(mean difference[MD]:-2.06,95%CI:-3.17,-0.96;P=0.0002),maximum urinary flow rate(MD:1.7,95%CI:0.89,2.52;P<0.0001),postvoid residual urine volume(MD:-8.25,95%CI:-12.14,-4.36;P<0.0001),quality of life(MD:-0.55,95%CI:-0.8,-0.29;p<0.0001)compared with the control groups,whereas for prostate volume(MD:-0.87,95%CI:-2.66,0.92;P=0.34)was not significantly improved in the EGs.Nevertheless,no statistical variation in the reduction of adverse reactions was observed.Conclusion Acupuncture therapy,a wildly applied complementary–alternative treatment,may help in the management of BPH.展开更多
Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelin...Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.展开更多
Background:Fibrosis constitutes a significant pathophysiological mechanism in the clinical progression of benign prostatic hyperplasia(BPH)and represents a contributing factor to the ineffectiveness of prevailing phar...Background:Fibrosis constitutes a significant pathophysiological mechanism in the clinical progression of benign prostatic hyperplasia(BPH)and represents a contributing factor to the ineffectiveness of prevailing pharmacological treatments.Emerging evidence suggests a close association between microbial presence and the development of fibrosis.Nonetheless,the potential involvement of microbes within prostatic tissue in the pathogenesis of BPH and prostatic fibrosis,along with the underlying mechanisms,remains unexplored.Methods:Utilizing immunohistochemistry and microbial sequencing,we analyzed the microbes of prostate tissues from BPH patients with different degrees of prostate fibrosis and found that Salmonellaenterica(S.enterica)was enriched in the high degree of prostate fibrosis.We developed prostate cell and animal models infected with the lipopolysaccharide of S.enterica(S.e-LPS)to assess its impact on prostate fibrosis.To elucidate the underlying functional mechanisms,we employed molecular biology techniques,including RNA degradation assays,N6-methyladenosine(m6A)dot blotting,RNA immunoprecipitation,and m6A immunoprecipitation.Results:Microbial diversity differed between low-and high-fibrosis groups,with S.enterica showing the highest mean abundance among the 4 species that differed significantly.S.e-LPS was detected in S.enterica-rich prostate tissue and was found to significantly promote cell proliferation,cell contractility,lipid peroxidation,and the induction of ferroptosis.Animal experiments demonstrated that S.e-LPS infection led to pronounced hyperplasia of the prostatic epithelium,with epithelial thickness increasing to 1.57 times that of the sham group,and collagen fibrosis increasing to 2.84 times that of the sham group,thereby exacerbating prostatic tissue fibrosis in rats.Invitro experiments further revealed that S.e-LPS promoted prostate cell fibrosis by inducing ferroptosis.Mechanistically,it was determined that S.e-LPS regulates ferroptosis via AlkB homolog 5(ALKBH5)-mediated m6A modification,which affects the stability of glutathione peroxidase 4(GPX4)mRNA,thereby affecting prostatic fibrosis.Conclusion:The findings of this study suggest that S.enterica promotes prostatic fibrosis through ALKBH5-m6A-GPX4-mediated ferroptosis.This research offers novel insights for the development of new therapeutic targets and personalized strategies for the prevention and treatment of BPH from the perspectives of microbes and epigenetics.展开更多
Benign prostatic hyperplasia(BPH)represents a prevalent etiology of lower urinary tract symptoms(LUTS)in the male population,clinically defined by a nonmalignant proliferation of prostatic tissue.While BPH exhibits a ...Benign prostatic hyperplasia(BPH)represents a prevalent etiology of lower urinary tract symptoms(LUTS)in the male population,clinically defined by a nonmalignant proliferation of prostatic tissue.While BPH exhibits a high prevalence among older male populations globally,the precise underlying mechanisms contributing to its development remain incompletely elucidated.Mitochondria,essential organelles within eukaryotic cells,are critical for cellular bioenergetics,the regulation of reactive oxygen species(ROS)generation,and the modulation of cell death pathways.The maintenance of mitochondrial homeostasis involves a complex interplay of processes.By synthesizing previous literature,this review discusses mitochondrial homeostasis in prostate glands and the role of mitochondrial dysfunction in the context of BPH.Furthermore,the review delved into each dimension of mitochondrial dysfunction in the specific etiology of BPH,highlighting its impact on cell survival,apoptosis,ferroptosis,oxidative stress and androgen receptor(AR).Overall,this review aims to unveil the crosstalk between mitochondrial dysfunction and BPH and identify intrinsic mechanisms.展开更多
Benign prostatic hyperplasia(BPH)is a common condition affecting the quality of life and health status of elderly men.Its incidence increases with age and is often accompanied by symptoms such as urinary frequency,urg...Benign prostatic hyperplasia(BPH)is a common condition affecting the quality of life and health status of elderly men.Its incidence increases with age and is often accompanied by symptoms such as urinary frequency,urgency,nocturia,difficulty voiding,and even urinary retention.While conventional Western medicine can alleviate symptoms,it frequently carries risks of side effects and disease recurrence.Traditional Chinese Medicine approaches this condition based on the characteristic patterns observed in the elderly population:predominantly deficiency and blood stasis,with chronic conditions leading to blood stasis.The Yiqi Huoxue method—aimed at tonifying Qi and activating blood circulation—has been shown to improve urinary symptoms,enhance quality of life,and promote overall health in elderly BPH patients.This article explores the application of the Yiqi Huoxue therapeutic principle in managing benign prostatic hyperplasia.展开更多
Objective To observe the clinical therapeutic effects （BPH） treated with scalp-acupuncture and body-acupuncture. Methods on benign prostate hyperplasia Two hundred and forty patients diagnosed clinically with BPH we...Objective To observe the clinical therapeutic effects （BPH） treated with scalp-acupuncture and body-acupuncture. Methods on benign prostate hyperplasia Two hundred and forty patients diagnosed clinically with BPH were randomly divided into 3 groups. In scalp-acupuncture group （80 cases）, foot-motor-sensory area and reproductive area were selected. In body-acupuncture group （82 cases）, the acupoints were selected, such as Zhengji（中极 CV 3）, Guanyau（关元 CV 4） and Sanyfnjiao （三阴交 SP 6）. In combined therapy group of scalp acupuncture and body acupuncture （78 cases）, scalp acupuncture was applied together with body acupuncture. It was to observe the changes in prostate size, Qmax, IPSS （international prostatic symptom score） and QOL （quality of life） before and after treatment of 3 groups. Results The total effective rate was 72.5% in scalp-acupuncture group, 72.0% in bodyacupuncture group and 85.9% in combined therapy group of scalp acupuncture and body acupuncture. The therapeutic effect in combined therapy group was superior to that in either scalp-acupuncture group or body-acupuncture group （both P〈0. 05）. The improvements had been obtained in Qmax, post-void residual volume （PRV）, IPSS and QOL after treatment in 3 groups, in which, the improvement in combined therapy group was apparent. Conclusion Either scalp acupuncture or body acupuncture relieves clinical symptoms and improves the quality of life in BPH patients. But, the best therapeutic effect has been obtained specially in the treatment with combined therapy of scalp acupuncture and body acupuncture.展开更多
Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethra...Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.展开更多
To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselectiv...To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselective vaporization of the prostate （PVP）. From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time （38.14 ± 23.64 h vs 72.54 ± 28.38 h, P 〈 0.001） and hospitalization （2.32 ± 1.25 days vs 4.07±1.23 days, P 〈 0.001） were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score （IPSS） （4.07 ±2.07 vs 5.00 ±2.10; P〈 0.001）, quality of life （QoL） （1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007）, maximal urinary flow rate （Qmax） （24.75±5.87 ml s^-1 vs 22.03 ±5.04 ml s^-1; P 〈 0.001）, postvoid residual urine volume （PVR） （14,29 ± 6,97 ml vs 17.00±6.11 ml; P = 0,001）, and prostate-specific antigen （PSA） value （0.78 ±0.57 ng ml^-1 vs 1.27 ±1.07 ng ml^-1; P 〈 0.001）. Both PKEP and PVP relieve low urinary tract symptoms （LUTS） due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKER Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.展开更多
Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with...Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with a prevalence of 8%-60% at age 90 years.Some data have suggested that there is decreased risk among the Asians compared to the western white population.Genetics,diet and life style may play a role here.Recent reports suggest the strong relationship of clinical BPH with metabolic syndrome and erectile dysfunction,as well as the possible role of inflammation as a cause of the prostatic hyperplasia.Lifestyle changes including exercise and diet are important strategies in controlling this common ailment.展开更多
In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms （LUTS） in men with benign prostatic hyperplasia （BPH） who underwent transurethral surgery. The study was cond...In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms （LUTS） in men with benign prostatic hyperplasia （BPH） who underwent transurethral surgery. The study was conducted in 158 patients who came to our hospital for surgery. Clinical conditions were assessed by body mass index （BMI）, digital rectal examination, International Prostate Symptom Score （IPSS） and transrectal ultrasound （TRUS）. The levels of sex hormones （including total testosterone （TT）, estradiol （E2）, progesterone （P）, luteinizing hormone （LH）, follicle-stimulating hormone （FSH） and prolactin （PRL）） and prostate-specific antigen （PSA） were reviewed. Correlations were determined through statistical analysis. The mean age was 72.06 _＋ 8.68 years. The total IPSS was significantly associated with the TT level （r = -0.21, P = 0.01）. Other sex hormone levels were not correlated with total IPSS. However, some ratios such as E2/TT （r = 0.23, P = 0o00） and FSH/LH （r = -0.17, P = 0.04） were associated with total IPSS. Further analysis showed that the nocturia was associated with age （r = 0.16, P = 0.04）, BMI （r = 0.21, P = 0.01）, and TT （r = -0.19, P = 0.02）. Moreover, we divided the patients into two subgroups based on IPSS severity （〈20 or 〉20）. The mean TT level was in the normal range, but it was significantly related to the presence of severe LUTS. In summary, our study has shown that the severity of LUTS is associated with TT, EJTT and FSH/LH in men who underwent prostate surgery. Increasing nocturia was observed in lower testosterone patients. Additional larger studies are needed to elucidate the potential mechanisms.展开更多
Aim： To determine the effect of two different extracts of red maca in male rats. Methods： Prostatic hyperplasia was induced in male rats with testosterone enanthate （TE）. The study comprised six groups： one contr...Aim： To determine the effect of two different extracts of red maca in male rats. Methods： Prostatic hyperplasia was induced in male rats with testosterone enanthate （TE）. The study comprised six groups： one control group （group 1）, one group treated with TE （group 2）, two groups treated with TE and aqueous extract of red maca （groups 3 and 4）, one group treated with hydroalcoholic extract of red maca （group 5） and one group treated with finasteride （0.1 mg, group 6）. Differences in the aqueous extract dependent on the length of time of boiling, whether for 2 or 3 hours, for groups 3 and 4 was assessed. Extracts of red maca contained 0.1 mg of benzylglucosinolate. Thereafter, a doseresponse effect of different doses of benzylglucosinolates （0.02-0.08 mg） in red maca extracts was assessed. Results： Prostate weight was similar in rats treated with freeze-dried aqueous extract of red maca prepared after 2 and 3 hours of boiling. Freeze-dried aqueous extract of red maca, hydroalcoholic extract of red maca and finasteride reduced prostate weight in rats with prostatic hyperplasia. No difference was observed between the data obtained from aqueous extract or hydroalcoholic extract of red maca. A dose dependent reduction of prostate weight was observed with the increase of the dose of benzylglucosinolates in red maca extracts. Conclusion： The present study showed that hydroalcoholic or aqueous extract of red maca containing 0.1 mg of benzylglucosinolate can reduce prostate size in male rats in which prostatic hyperplasia had been induced by TE.展开更多
Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, whic...Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.展开更多
This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specime...This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specimens. An immune inflammation score for each specimen was defined by combining three immunohistochemical markers （CD4, CD8 and CD20）. The immunohistochemical markers were CD4 and CD8 for T lymphocytes, CD20 for B lymphocytes and AR antibody for the AR in BPH samples. Rates of CD4, CD8, CD20 and AR expression in BPH were 20 （19.0%）, 21 （20.0%）, 101 （96.2%） and 48 （45.7%）, respectively. Total prostate volume （TPV） was higher in the immune inflammation group than in the non-immune inflammation group （62.7 ml vs. 49.2 ml, t=-2.482, P〈0.05）. Patients in the immune inflammation group had a higher serum prostate-specific antigen （PSA） than those in the non-inflammation group （7.5 ng m1-1 vs. 5.4 ng m1-1, t=-2.771, P〈0.05）. Specifically, the immune inflammation group showed a higher rate of AR expression than the non-inflammation group （56.1% vs. 28.2%, χ2=7.665, P〈0.05）. Our study revealed a strong association between immune inflammation and TPV, serum PSA and AR expression in BPH tissue. Prostate hyperplasia caused by an immune inflammatory process may contribute to BPH progression over time. Therefore, the inflammatory response involved in BPH may be a prime therapeutic target.展开更多
Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprap...Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.展开更多
Aim： To explore the feasibility and safety of greenlight photoselective vaporization of the prostate （PVP） on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplas...Aim： To explore the feasibility and safety of greenlight photoselective vaporization of the prostate （PVP） on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia （BPH） and to evaluate their clinical and voiding outcome. Methods： A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score （IPSS）, quality of life score （QoL）, uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results： All patients got through the perioperative period safely. The chief advantages of PVP were： short operative time （25.6 ± 7.6 min）, little bleeding loss （56.8 ± 14.3 mL） and short indwelling catheterization （1.6 ± 0.8 d）. The IPSS and QoL decreased from （29.6 ± 5.4） and （5.4 ± 0.6） to （9.5 ± 2.6） and （1.3 ± 0.6）, respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data （P 〈 0.05）. No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion： PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.展开更多
Objective:To find out whether warm bladder irrigation fluid can decrease the occurrence of perioperative hypothermia,blood loss and shiver in patients treated with benign prostatic hyperplasia(BPH).Method:A comprehens...Objective:To find out whether warm bladder irrigation fluid can decrease the occurrence of perioperative hypothermia,blood loss and shiver in patients treated with benign prostatic hyperplasia(BPH).Method:A comprehensive literature review and meta-analysis that included randomized controlled trials(RCTs)related to temperature of irrigation fluid in the perioperative treatment for BPH was taken by researchers.The relevant literature were searched in Chinese database,such as Retrieval Chinese Journal Full-text Database,VIP Journal Database,Wanfang database,as well as in English search engine and database,including Embase,Cochrane and Medline till January 2018.The study quality was assessed by recommended standards from Cochrane Handbook(version 5.1.0).Results:A total of 28 RCTs and 3858 patients were included.The results showed that the incidences of shiver(risk ratio[RR]Z 0.32,95%confidence interval[CI]:0.28e0.36,p<0.001,I^2 Z 0%)and hypothermia(RR Z 0.36,95%CI:0.21e0.59,p<0.001,I^2 Z 67%)in the group of warm irrigation fluid were lower than the group having room-temperature fluid.Room-temperature irrigation fluid group caused a greater drop in body temperature compared to warm irrigation fluid group(p<0.001,I^2 Z 96%).We performed a narrative descriptive statistics only because of substantial heterogeneity.Conclusions:Warm bladder irrigation fluid can decrease the drop of body temperature and the incidence of hypothermia and shiver during and after the operation for BPH.Warm irrigation fluid should be considered as a standard practice in BPH surgeries.展开更多
文摘Objective:This study aims to investigate the potential molecular mechanism of Salvia miltiorrhiza in treating benign prostatic hyperplasia(BPH)based on network pharmacology.Methods:Active components of Salvia miltiorrhiza were screened via the TCMSP database,and their potential targets were predicted using Swiss Target Prediction.BPH-related targets were obtained from Gene Cards and OMIM databases.Common targets between the herb and BPH were used to con-struct a protein-protein interaction(PPI)network via STRING and visualized using Cytoscape.Core targets were identifi ed,and Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were conducted(P≤0.01).Results:A total of 57 active components and 818 targets of Salvia miltiorrhiza were identifi ed.Intersection analysis yielded 458 potential targets associated with BPH.PPI network analysis revealed core targets including SRC,PIK3R1,and PIK3CA.GO enrichment analysis indicated that the targets were primarily associated with biological processes(BP)such as calcium ion homeostasis,cellular components(CC)including focal adhesions,and molecular functions(MF)such as tyrosine kinase activity.KEGG pathway analysis indicated that Salvia miltiorrhiza may exert therapeutic effects through pathways including MAPK,PI3K-Akt,and calcium signaling(P≤0.01).Conclusion:Salvia miltiorrhiza may regulate BPH through a multi-component,multi-target,and multi-pathway network,providing a theoretical basis for its clinical application.
基金supported(in part)by the National Key Research and Development Program(2022YFC3600700)the Fundamental Research Funds for the Central Universities(2042024YXA008)the Young Top-Notch Talent Cultivation Program of Hubei Province(for Prof.Xian-Tao Zeng).
文摘Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and within specific regions.It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.Methods:We obtained data on incidence,prevalence,mortality,and disability-adjusted life-years(DALYs)for the aforementioned urologic diseases by age,sex,location,and year from the Global Burden of Disease(GBD)2021.We analyzed the burden associated with urologic diseases based on socio-demographic index(SDI)and attributable risk factors.The trends in burden over time were assessed using estimated annual percentage changes(EAPC)along with a 95%confidence interval(CI).Results:In 2021,BPH and UTI were the leading causes of age-standardized incidence rate(ASIR)and age-standardized prevalence rate(ASPR),with rates of 5531.88 and 2782.59 per 100,000 persons,respectively.Prostate cancer was the leading cause of both age-standardized mortality rate(ASMR)and age-standardized DALYs rate(ASDR),with rates of 12.63 and 217.83 per 100,000 persons,respectively.From 1990 to 2021,there was an upward trend in ASIR,ASPR,ASMR,and ASDR for UTI,while urolithiasis showed a downward trend.The middle and low-middle SDI quintile levels exhibited higher incidence,prevalence,mortality,and DALYs related to UTI,urolithiasis,and BPH,while the high and high-middle SDI quintile levels showed higher rates for the three cancers.The burden of these 6 urologic diseases displayed diverse age and sex distribution patterns.In 2021,a high body mass index(BMI)contributed to 20.07%of kidney cancer deaths worldwide,while smoking accounted for 26.48%of bladder cancer deaths and 3.00%of prostate cancer deaths.Conclusions:The global burden of 6 urologic diseases presents a significant public health challenge.Urgent international collaboration is essential to advance the improvement of urologic disease management,encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.
文摘Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.
基金supported(in part)by the National Natural Science Foundation of China(82200862,82370778)the Hubei Provincial Natural Science Foundation(2022CFB681,2023AFA061,2019CFB760)+4 种基金the Hubei Province Health and Family Planning Scientific Research Project(WJ2023M058,WJ2019H035)the Key Scientific Research Project of Education Department of Henan Province(22A320038)the Fundamental Research Funds for the Central Universities(2042023kf1019,2042023kf0051,2042022kf0072)the Zhongnan Hospital of Wuhan University,Science Technology and Innovation Seed Fund(CXPY2022074)the Young Top-notch Talent Cultivation Program of Hubei Province(for Prof.Zeng XT).
文摘Background:Benign prostatic hyperplasia(BPH)is the most common disease in elderly men.There is increasing evidence that periodontitis increases the risk of BPH,but the specific mechanism remains unclear.This study aimed to explore the role and mechanism of the key periodontal pathogen Porphyromonas gingivalis(P.gingivalis)in the development of BPH.Methods:The subgingival plaque(Sp)and prostatic fluid(Pf)of patients with BPH concurrent periodontitis were extracted and cultured for 16S r DNA sequencing.Ligature-induced periodontitis,testosterone-induced BPH and the composite models in rats were established.The P.gingivalis and its toxic factor P.gingivalis lipopolysaccharide(P.gLPS)were injected into the ventral lobe of prostate in rats to simulate its colonization of prostate.P.g-LPS was used to construct the prostate cell infection model for mechanism exploration.Results:P.gingivalis,Streptococcus oralis,Capnocytophaga ochracea and other oral pathogens were simultaneously detected in the Sp and Pf of patients with BPH concurrent periodontitis,and the average relative abundance of P.gingivalis was found to be the highest.P.gingivalis was detected in both Sp and Pf in 62.5%of patients.Simultaneous periodontitis and BPH synergistically aggravated prostate histological changes.P.gingivalis and P.gLPS infection could induce obvious hyperplasia of the prostate epithelium and stroma(epithelial thickness was 2.97-fold and 3.08-fold that of control group,respectively),and increase of collagen fibrosis(3.81-fold and 5.02-fold that of control group,respectively).P.gingivalis infection promoted prostate cell proliferation,inhibited apoptosis,and upregulated the expression of inflammatory cytokines interleukin-6(IL-6;4.47-fold),interleukin-6 receptor-α(IL-6Rα;5.74-fold)and glycoprotein 130(gp130;4.47-fold)in prostatic tissue.P.g-LPS could significantly inhibit cell apoptosis,promote mitosis and proliferation of cells.P.g-LPS activates the Akt pathway through IL-6/IL-6Rα/gp130 complex,which destroys the imbalance between proliferation and apoptosis of prostate cells,induces BPH.Conclusion:P.gingivalis was abundant in the Pf of patients with BPH concurrent periodontitis.P.gingivalis infection can promote BPH,which may affect the progression of BPH via inflammation and the Akt signaling pathway.
基金supported by Institute level project of the Second Affiliated Hospital of Xi’an Medical University(X2Y-R13)。
文摘Objective This study aimed to evaluate the effectiveness of acupuncture for benign prostatic hyperplasia(BPH).Methods We searched PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,Chinese National Knowledge Infrastructure,Wanfang Data,and China Science and Technology Journal Database from their inceptions to February 1,2022.The language was restricted to English and Chinese.Two researchers independently screened the literature,extracted data,and evaluated the risk bias of the included study according to the Cochrane Handbook 5.1.0.A meta-analysis was performed using Review Manager version 5.3.Results Twenty-two studies with 1,765 participants were selected to be incorporated in the meta-analysis.The experimental groups(EGs)showed greater benefit on therapeutic effects(relative risk[RR]:1.23,95%CI:1.16,1.3;P<0.00001),International Prostate Score Scale(mean difference[MD]:-2.06,95%CI:-3.17,-0.96;P=0.0002),maximum urinary flow rate(MD:1.7,95%CI:0.89,2.52;P<0.0001),postvoid residual urine volume(MD:-8.25,95%CI:-12.14,-4.36;P<0.0001),quality of life(MD:-0.55,95%CI:-0.8,-0.29;p<0.0001)compared with the control groups,whereas for prostate volume(MD:-0.87,95%CI:-2.66,0.92;P=0.34)was not significantly improved in the EGs.Nevertheless,no statistical variation in the reduction of adverse reactions was observed.Conclusion Acupuncture therapy,a wildly applied complementary–alternative treatment,may help in the management of BPH.
基金funded by National Natural Science Foundation of China(82072846 to Xu B).
文摘Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.
基金supported by the National Key Research and Development Program of China(2022YFC3600700)the National Natural Science Foundation of China(82370778)+2 种基金the Hubei Provincial Natural Science Foundation of China(2023AFA061)the Fundamental Research Funds for the Central Universities(2042024kf1043)the Young Top-Notch Talent Cultivation Program of Hubei Province(for Prof.Zeng XT).
文摘Background:Fibrosis constitutes a significant pathophysiological mechanism in the clinical progression of benign prostatic hyperplasia(BPH)and represents a contributing factor to the ineffectiveness of prevailing pharmacological treatments.Emerging evidence suggests a close association between microbial presence and the development of fibrosis.Nonetheless,the potential involvement of microbes within prostatic tissue in the pathogenesis of BPH and prostatic fibrosis,along with the underlying mechanisms,remains unexplored.Methods:Utilizing immunohistochemistry and microbial sequencing,we analyzed the microbes of prostate tissues from BPH patients with different degrees of prostate fibrosis and found that Salmonellaenterica(S.enterica)was enriched in the high degree of prostate fibrosis.We developed prostate cell and animal models infected with the lipopolysaccharide of S.enterica(S.e-LPS)to assess its impact on prostate fibrosis.To elucidate the underlying functional mechanisms,we employed molecular biology techniques,including RNA degradation assays,N6-methyladenosine(m6A)dot blotting,RNA immunoprecipitation,and m6A immunoprecipitation.Results:Microbial diversity differed between low-and high-fibrosis groups,with S.enterica showing the highest mean abundance among the 4 species that differed significantly.S.e-LPS was detected in S.enterica-rich prostate tissue and was found to significantly promote cell proliferation,cell contractility,lipid peroxidation,and the induction of ferroptosis.Animal experiments demonstrated that S.e-LPS infection led to pronounced hyperplasia of the prostatic epithelium,with epithelial thickness increasing to 1.57 times that of the sham group,and collagen fibrosis increasing to 2.84 times that of the sham group,thereby exacerbating prostatic tissue fibrosis in rats.Invitro experiments further revealed that S.e-LPS promoted prostate cell fibrosis by inducing ferroptosis.Mechanistically,it was determined that S.e-LPS regulates ferroptosis via AlkB homolog 5(ALKBH5)-mediated m6A modification,which affects the stability of glutathione peroxidase 4(GPX4)mRNA,thereby affecting prostatic fibrosis.Conclusion:The findings of this study suggest that S.enterica promotes prostatic fibrosis through ALKBH5-m6A-GPX4-mediated ferroptosis.This research offers novel insights for the development of new therapeutic targets and personalized strategies for the prevention and treatment of BPH from the perspectives of microbes and epigenetics.
文摘Benign prostatic hyperplasia(BPH)represents a prevalent etiology of lower urinary tract symptoms(LUTS)in the male population,clinically defined by a nonmalignant proliferation of prostatic tissue.While BPH exhibits a high prevalence among older male populations globally,the precise underlying mechanisms contributing to its development remain incompletely elucidated.Mitochondria,essential organelles within eukaryotic cells,are critical for cellular bioenergetics,the regulation of reactive oxygen species(ROS)generation,and the modulation of cell death pathways.The maintenance of mitochondrial homeostasis involves a complex interplay of processes.By synthesizing previous literature,this review discusses mitochondrial homeostasis in prostate glands and the role of mitochondrial dysfunction in the context of BPH.Furthermore,the review delved into each dimension of mitochondrial dysfunction in the specific etiology of BPH,highlighting its impact on cell survival,apoptosis,ferroptosis,oxidative stress and androgen receptor(AR).Overall,this review aims to unveil the crosstalk between mitochondrial dysfunction and BPH and identify intrinsic mechanisms.
基金Hebei Provincial Administration of Traditional Chinese Medicine Scientific Research Project (2025576).
文摘Benign prostatic hyperplasia(BPH)is a common condition affecting the quality of life and health status of elderly men.Its incidence increases with age and is often accompanied by symptoms such as urinary frequency,urgency,nocturia,difficulty voiding,and even urinary retention.While conventional Western medicine can alleviate symptoms,it frequently carries risks of side effects and disease recurrence.Traditional Chinese Medicine approaches this condition based on the characteristic patterns observed in the elderly population:predominantly deficiency and blood stasis,with chronic conditions leading to blood stasis.The Yiqi Huoxue method—aimed at tonifying Qi and activating blood circulation—has been shown to improve urinary symptoms,enhance quality of life,and promote overall health in elderly BPH patients.This article explores the application of the Yiqi Huoxue therapeutic principle in managing benign prostatic hyperplasia.
文摘Objective To observe the clinical therapeutic effects （BPH） treated with scalp-acupuncture and body-acupuncture. Methods on benign prostate hyperplasia Two hundred and forty patients diagnosed clinically with BPH were randomly divided into 3 groups. In scalp-acupuncture group （80 cases）, foot-motor-sensory area and reproductive area were selected. In body-acupuncture group （82 cases）, the acupoints were selected, such as Zhengji（中极 CV 3）, Guanyau（关元 CV 4） and Sanyfnjiao （三阴交 SP 6）. In combined therapy group of scalp acupuncture and body acupuncture （78 cases）, scalp acupuncture was applied together with body acupuncture. It was to observe the changes in prostate size, Qmax, IPSS （international prostatic symptom score） and QOL （quality of life） before and after treatment of 3 groups. Results The total effective rate was 72.5% in scalp-acupuncture group, 72.0% in bodyacupuncture group and 85.9% in combined therapy group of scalp acupuncture and body acupuncture. The therapeutic effect in combined therapy group was superior to that in either scalp-acupuncture group or body-acupuncture group （both P〈0. 05）. The improvements had been obtained in Qmax, post-void residual volume （PRV）, IPSS and QOL after treatment in 3 groups, in which, the improvement in combined therapy group was apparent. Conclusion Either scalp acupuncture or body acupuncture relieves clinical symptoms and improves the quality of life in BPH patients. But, the best therapeutic effect has been obtained specially in the treatment with combined therapy of scalp acupuncture and body acupuncture.
基金the National Key Research and Development Plan of China(Technology helps Economy 20202016YFC0106300)+1 种基金the National Natural Science Foundation of China(82174230)Major Program Fund of Technical Innovation Project of Department of Science and Technology of Hubei Province(2016ACAl52).
文摘Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
文摘To evaluate the safety and efficacy of plasmakinetic enucleation of the prostate （PKEP） for the treatment of symptomatic benign prostatic hyperplasia （BPH） compared with 160-W lithium triboride laser photoselective vaporization of the prostate （PVP）. From February 2011 to July 2012, a prospective nonrandomized study was performed. One-hundred one patients underwent PKEP, and 110 underwent PVP. No severe intraoperative complications were recorded, and none of the patients in either group required a blood transfusion. Shorter catheterization time （38.14 ± 23.64 h vs 72.54 ± 28.38 h, P 〈 0.001） and hospitalization （2.32 ± 1.25 days vs 4.07±1.23 days, P 〈 0.001） were recorded in the PVP group. At 12-month postoperatively, the PKEP group had a maintained and statistically improvement in International Prostate Symptom Score （IPSS） （4.07 ±2.07 vs 5.00 ±2.10; P〈 0.001）, quality of life （QoL） （1.08 ± 0.72 vs 1.35 ± 0.72; P= 0.007）, maximal urinary flow rate （Qmax） （24.75±5.87 ml s^-1 vs 22.03 ±5.04 ml s^-1; P 〈 0.001）, postvoid residual urine volume （PVR） （14,29 ± 6,97 ml vs 17.00±6.11 ml; P = 0,001）, and prostate-specific antigen （PSA） value （0.78 ±0.57 ng ml^-1 vs 1.27 ±1.07 ng ml^-1; P 〈 0.001）. Both PKEP and PVP relieve low urinary tract symptoms （LUTS） due to BPH with low complication rates. PKEP can completely remove prostatic adenoma while the total amount of tissue removed by PVP is less than that can be removed by PKER Based on our study of the follow-up, PKEP provides better postoperative outcomes than PVP.
文摘Clinical benign prostatic hyperplasia(BPH)is one of the most common diseases in ageing men and the most common cause of lower urinary tract symptoms(LUTS).The prevalence of BPH increases after the age of 40 years,with a prevalence of 8%-60% at age 90 years.Some data have suggested that there is decreased risk among the Asians compared to the western white population.Genetics,diet and life style may play a role here.Recent reports suggest the strong relationship of clinical BPH with metabolic syndrome and erectile dysfunction,as well as the possible role of inflammation as a cause of the prostatic hyperplasia.Lifestyle changes including exercise and diet are important strategies in controlling this common ailment.
文摘In this study, we examined the relationship between sex hormone levels and lower urinary tract symptoms （LUTS） in men with benign prostatic hyperplasia （BPH） who underwent transurethral surgery. The study was conducted in 158 patients who came to our hospital for surgery. Clinical conditions were assessed by body mass index （BMI）, digital rectal examination, International Prostate Symptom Score （IPSS） and transrectal ultrasound （TRUS）. The levels of sex hormones （including total testosterone （TT）, estradiol （E2）, progesterone （P）, luteinizing hormone （LH）, follicle-stimulating hormone （FSH） and prolactin （PRL）） and prostate-specific antigen （PSA） were reviewed. Correlations were determined through statistical analysis. The mean age was 72.06 _＋ 8.68 years. The total IPSS was significantly associated with the TT level （r = -0.21, P = 0.01）. Other sex hormone levels were not correlated with total IPSS. However, some ratios such as E2/TT （r = 0.23, P = 0o00） and FSH/LH （r = -0.17, P = 0.04） were associated with total IPSS. Further analysis showed that the nocturia was associated with age （r = 0.16, P = 0.04）, BMI （r = 0.21, P = 0.01）, and TT （r = -0.19, P = 0.02）. Moreover, we divided the patients into two subgroups based on IPSS severity （〈20 or 〉20）. The mean TT level was in the normal range, but it was significantly related to the presence of severe LUTS. In summary, our study has shown that the severity of LUTS is associated with TT, EJTT and FSH/LH in men who underwent prostate surgery. Increasing nocturia was observed in lower testosterone patients. Additional larger studies are needed to elucidate the potential mechanisms.
文摘Aim： To determine the effect of two different extracts of red maca in male rats. Methods： Prostatic hyperplasia was induced in male rats with testosterone enanthate （TE）. The study comprised six groups： one control group （group 1）, one group treated with TE （group 2）, two groups treated with TE and aqueous extract of red maca （groups 3 and 4）, one group treated with hydroalcoholic extract of red maca （group 5） and one group treated with finasteride （0.1 mg, group 6）. Differences in the aqueous extract dependent on the length of time of boiling, whether for 2 or 3 hours, for groups 3 and 4 was assessed. Extracts of red maca contained 0.1 mg of benzylglucosinolate. Thereafter, a doseresponse effect of different doses of benzylglucosinolates （0.02-0.08 mg） in red maca extracts was assessed. Results： Prostate weight was similar in rats treated with freeze-dried aqueous extract of red maca prepared after 2 and 3 hours of boiling. Freeze-dried aqueous extract of red maca, hydroalcoholic extract of red maca and finasteride reduced prostate weight in rats with prostatic hyperplasia. No difference was observed between the data obtained from aqueous extract or hydroalcoholic extract of red maca. A dose dependent reduction of prostate weight was observed with the increase of the dose of benzylglucosinolates in red maca extracts. Conclusion： The present study showed that hydroalcoholic or aqueous extract of red maca containing 0.1 mg of benzylglucosinolate can reduce prostate size in male rats in which prostatic hyperplasia had been induced by TE.
文摘Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.
文摘This study was designed to investigate the association between immune inflammation and androgen receptor （AR） expression in benign prostatic hyperplasia （BPH）. We retrospectively analyzed 105 prostatectomy specimens. An immune inflammation score for each specimen was defined by combining three immunohistochemical markers （CD4, CD8 and CD20）. The immunohistochemical markers were CD4 and CD8 for T lymphocytes, CD20 for B lymphocytes and AR antibody for the AR in BPH samples. Rates of CD4, CD8, CD20 and AR expression in BPH were 20 （19.0%）, 21 （20.0%）, 101 （96.2%） and 48 （45.7%）, respectively. Total prostate volume （TPV） was higher in the immune inflammation group than in the non-immune inflammation group （62.7 ml vs. 49.2 ml, t=-2.482, P〈0.05）. Patients in the immune inflammation group had a higher serum prostate-specific antigen （PSA） than those in the non-inflammation group （7.5 ng m1-1 vs. 5.4 ng m1-1, t=-2.771, P〈0.05）. Specifically, the immune inflammation group showed a higher rate of AR expression than the non-inflammation group （56.1% vs. 28.2%, χ2=7.665, P〈0.05）. Our study revealed a strong association between immune inflammation and TPV, serum PSA and AR expression in BPH tissue. Prostate hyperplasia caused by an immune inflammatory process may contribute to BPH progression over time. Therefore, the inflammatory response involved in BPH may be a prime therapeutic target.
文摘Transurethral resection of the prostate(TURP)became the gold standard surgical treatment for benign prostatic obstruction without undergoing randomized controlled trials against the predecessor standard in open suprapubic prostatectomy.TURP has historically been associated with significant morbidity and this has fuelled the development of minimally invasive surgical treatment options.Improvements in perioperative morbidity for TURP has been creating an ever increasing standard that must be met by any new technologies that are to be compared to this gold standard.Over recent years,there has been the emergence of novel minimally invasive treatments such as the prostatic urethral lift(PUL;UroLift System),convective WAter Vapor Energy(WAVE;Rezum System),Aquablation(AQUABEAM System),Histotripsy(Vortx Rx System)and temporary implantable nitinol device(TIND).Intraprostatic injections(NX-1207,PRX-302,botulinum toxin A,ethanol)have mostly been used with limited efficacy,but may be suitable for selected patients.This review evaluates these novel minimally invasive surgical options with special reference to the literature published in the past 5 years.
文摘Aim： To explore the feasibility and safety of greenlight photoselective vaporization of the prostate （PVP） on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia （BPH） and to evaluate their clinical and voiding outcome. Methods： A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score （IPSS）, quality of life score （QoL）, uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results： All patients got through the perioperative period safely. The chief advantages of PVP were： short operative time （25.6 ± 7.6 min）, little bleeding loss （56.8 ± 14.3 mL） and short indwelling catheterization （1.6 ± 0.8 d）. The IPSS and QoL decreased from （29.6 ± 5.4） and （5.4 ± 0.6） to （9.5 ± 2.6） and （1.3 ± 0.6）, respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data （P 〈 0.05）. No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion： PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.
文摘Objective:To find out whether warm bladder irrigation fluid can decrease the occurrence of perioperative hypothermia,blood loss and shiver in patients treated with benign prostatic hyperplasia(BPH).Method:A comprehensive literature review and meta-analysis that included randomized controlled trials(RCTs)related to temperature of irrigation fluid in the perioperative treatment for BPH was taken by researchers.The relevant literature were searched in Chinese database,such as Retrieval Chinese Journal Full-text Database,VIP Journal Database,Wanfang database,as well as in English search engine and database,including Embase,Cochrane and Medline till January 2018.The study quality was assessed by recommended standards from Cochrane Handbook(version 5.1.0).Results:A total of 28 RCTs and 3858 patients were included.The results showed that the incidences of shiver(risk ratio[RR]Z 0.32,95%confidence interval[CI]:0.28e0.36,p<0.001,I^2 Z 0%)and hypothermia(RR Z 0.36,95%CI:0.21e0.59,p<0.001,I^2 Z 67%)in the group of warm irrigation fluid were lower than the group having room-temperature fluid.Room-temperature irrigation fluid group caused a greater drop in body temperature compared to warm irrigation fluid group(p<0.001,I^2 Z 96%).We performed a narrative descriptive statistics only because of substantial heterogeneity.Conclusions:Warm bladder irrigation fluid can decrease the drop of body temperature and the incidence of hypothermia and shiver during and after the operation for BPH.Warm irrigation fluid should be considered as a standard practice in BPH surgeries.
