Male Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia (eBook)

Steven A. Kaplan, Kevin T. McVary (Herausgeber)

eBook Download: EPUB

2014
John Wiley & Sons (Verlag)
978-1-118-43794-0 (ISBN)

Infos

Male Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia provides urologists of all levels with a practical, highly clinical guide to the variety of different symptoms and problems concerning the male lower urinary tract, including benign prostatic hyperplasia, one of the conditions that urologists most regularly encounter.  

 

Evidence-based throughout and written by the world's leading experts in the topic, it comprehensively reviews the very latest in diagnostics and imaging, patient phenotyping, genetic studies, medical and surgical therapies, and lifestyle management in order to help clinicians best manage their patients.
Highlights include chapters on:

 

• Alpha-Adrenergic Antagonists for Lower Urinary Symptoms Secondary to Benign Prostatic Hyperplasia
• Phosphodiesterase Type 5 inhibitors for Male LUTS
• Combination Medical Therapy for Male LUTS
• Open Simple Prostatectomy
• Minimally Invasive Therapies
• Monopolar and Bipolar Transurethral Resection of the Prostate
• GreenLight Laser Therapy

 

Containing pitfall boxes and key points throughout to aid quick and easy understanding of the key information, this excellent book is an essential read for the modern-day urologist.

 

 

Autor

Steven A. Kaplan, MD, E. Darracott Vaughan Jr. Professor of Urology, Director, Iris Cantor Men's Health Center, New York Presbyterian Hospital, New York, NY, USA Dr. Kaplan has had over 725 articles and 170 abstracts published and has made over 300 presentations in more than 35 countries. He is the author of two books and is on the Editorial Board of Urology, Journal of Urology, Wiley's BJUI and Urology Times. A member of more than 30 professional organizations, he is also a member of the WHO Committee on treating BPH, has been awarded 5 NIH grants and has received over 13 million dollars in research funding. He was awarded the John K. Lattimer Award for Lifetime Achievement in Urology by the National Kidney Foundation. Kevin T. McVary, MD, FACS, Professor and Chair, Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA Dr. McVary is Chairman of both the AUA BPH Clinical Guidelines Committee and the Special Emphasis Urology Study Section for the NIDDK. He is Co-Chairman of the Clinical Section of the NIDDK Strategic Pathway for Prostate Basic and Clinical Science, and the AUA Honorary Speaker at the European Association of Urology (EAU). Dr. McVary has been principal investigator for more than 75 clinical trials and his research has generated more than 120 publications including journal articles, book chapters, and abstracts. His work has appeared in prominent journals such as the Journal of Urology, Journal of the American Medical Association (JAMA), New England Journal of Medicine, International Journal of Impotence Research, and Urology. He is an editorial consultant for the Journal of Andrology, Journal of Urology, Urology, Journal of Investigative Urology, Current Opinion in Urology, and Prostate Diseases.

Inhalt

Contributors, vii

1 Etiology and Pathogenesis, 1

Robert H. Getzenberg & Prakash Kulkarni

2 Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia:
Epidemiology, Correlates, and Risk Factors, 10

Raymond C. Rosen & Benjamin N. Breyer

3 Clinical Assessment and Diagnosis of Lower Urinary Tract
Dysfunction: United States, 22

Christopher P. Filson & John T. Wei

4 Clinical Assessment and Diagnosis of Lower Urinary Tract
Symptoms/Benign Prostatic Hyperplasia: Europe, 37

Stavros Gravas & Jean J. M. C. H. de la Rosette

5 Clinical Assessment and Diagnosis of Lower Urinary Tract
Symptoms/Benign Prostatic Hyperplasia: Primary Care, 47

Matt T. Rosenberg, John B. Riley & Marty M. Miner

6 Watchful Waiting, 59

Reginald Bruskewitz

7 alpha-Adrenergic Antagonists for Lower Urinary Symptoms
Secondary to Benign Prostatic Hyperplasia, 70

Nathaly François, Raunak D. Patel & Kevin T.
McVary

8 5alpha-Reductase Inhibitors, 90

Claudius Füllhase & Roberto Soler

9 Antimuscarinics, 100

Nadir I. Osman & Christopher R. Chapple

10 The Use of Phosphodiesterase Type 5 Inhibitors in the
Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic
Hyperplasia, 113

Casey Lythgoe & Kevin T. McVary

11 Combination Medical Therapy for Male Lower Urinary Tract
Symptoms, 129

Claus G. Roehrborn

12 Complementary Therapy, 154

Aaron E. Katz & Anne Darves-Bornoz

13 Open Simple Prostatectomy, 164

Annika Herlemann, Matthias Oelke & Christian Gratzke

14 Minimally Invasive Therapies, 175

Mauro Gacci, Matteo Salvi and Arcangelo Sebastianelli

15 Holmium Laser Prostatectomy, 184

Simon van Rij & Peter J. Gilling

16 Benign Prostatic Hyperplasia: GreenLight Laser Therapy,
191

Alexis E. Te & Bilal Chughtai

17 Principles of Electrocautery-Based Techniques, 201

Aaron M. Bernie & Richard Lee

Index, 211

Textauszug

Chapter 1
Etiology and Pathogenesis

Robert H. Getzenberg1 & Prakash Kulkarni2

1 GTx Inc., Memphis, TN, USA

2 James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Key points

• Lower urinary tract symptoms (LUTS) corresponding to benign prostatic hyperplasia (BPH) are a complex disease that may represent distinct etiologies.
• By deciphering the molecular underpinnings, we can begin to delineate the distinct causes and identify different readouts, and therefore formulate and individualize therapies.
• BPH/LUTS involves the cellular components of the prostate including the epithelial and stromal cells.
• A number of steroid hormones including androgens, estrogens, and progesterone, along with various growth factors and chemokines have been demonstrated to contribute to the abnormal regulation of prostatic growth.
• Although inflammation has been demonstrated to be associated with BPH/LUTS, anti-inflammatory treatment approaches have, in general, not been shown to be effective.
• Cancer/testis antigens have been shown to be associated with BPH with more severe symptoms and therefore may serve as novel biomarkers thereof.

Introduction

Diseases of the prostate are some of the most common and devastating diseases in men, especially as they age. Indeed, the prevalence of BPH is estimated to begin its increase in the third decade of life from 5–10% to greater than 90% for men above 85 years of age [1]. One in four males will undergo surgery at some time in their life to relieve symptoms of BPH, which compresses the urethra and produces urinary-outflow obstruction. Although the use of pharmacologic agents has increased in the treatment of this disease, transurethral resection of the prostate (TURP) is still a leading surgical procedure in the United States, second only to cataract extraction, with an annual cost to the health-care system in excess of $5 billion [2].

Although we currently have a great deal of knowledge regarding the prostate, there are still many questions that need to be answered. Several of these questions, relating to clinically relevant prostatic diseases, such as prostatitis, BPH, and so on, involve normal prostate growth, differentiation, and aging, or aberrations in these processes, or both. Indeed, the earliest manifestation of BPH is the appearance of the mesenchyme in periurethral nodules, which has a similar morphology to the prostatic mesenchyme during embryogenesis [3]. In later stages of BPH development, glandular budding and branching toward a central focus lead to further nodule growth [3]. Such morphological evidence suggests that BPH is intrinsically a mesenchymal disease that results from a reawakening of embryonic inductive interactions between the prostatic stroma and epithelium [3]. Therefore, it is critical to understand the elements of prostatic regulation that play a role in the normal growth and differentiation of the prostate that can then be applied to the diseased gland.

What is BPH/LUTS? The biology

In this chapter, we will focus on the disease known historically as BPH but perhaps more appropriately termed LUTS. BPH or LUTS is one of the most common diseases occurring in aging men in the United States. Pathologically diagnosed BPH is characterized by the nonmalignant proliferation of the epithelial and stromal components of the prostate. Such histological BPH may or may not be associated with clinical BPH, which is characterized by the progressive development of LUTS. LUTS primarily results from constriction of the urethra and resulting resistance to urinary flow, and may take the form of urgency, frequency, nocturia, and a weak urine stream with incomplete emptying. If left untreated, LUTS can result in acute urinary retention, urinary incontinence, recurrent urinary-tract infections, and or obstructed uropathy [4]. Interestingly, some men with significantly enlarged prostates do not present with LUTS, while some men with normally sized prostates experience severe LUTS.

BPH is a chronic condition that increases in its prevalence and severity with age. The presence of histological BPH in men is estimated to be 8%, 50%, 70%, and 90% in their fourth, sixth, seventh, and eighth (and older) decades of life, respectively. The presence of moderate to severe LUTS (i.e. clinical BPH) is estimated to be 26%, 33%, 41%, and nearly 50% for the same respective age groups [5]. The extremely high prevalence of BPH and its associated symptoms can lead to a severe impact on quality of life, making it one of the nation’s major health expenditures. In 2006, the management of BPH/LUTS was estimated to cost $4 billion/year in the United States alone [6]. Inclusion of prescription and nonprescription medication costs, and in-direct costs associated with morbidity (e.g. work limitations), increases this estimate significantly.

Medical treatment for clinical BPH has evolved over the last decade with a growing focus on pharmacological management of LUTS over more invasive therapies. A steady decline in surgical treatments for clinical BPH has been reported since the 1990s and is concomitant with an increase in nonsurgical interventions designed to manage symptoms [7,8]. This is likely due, at least in part, to the increased use of two largely effective drug categories in the treatment of LUTS, 5α-reductase inhibitors, which in effect shrink the prostate by inducing prostatic epithelial apoptosis and atrophy, and α1-adrenergic receptor antagonists, which reduce prostatic urethral smooth muscle tone [9]. A number of short-duration clinical trials have compared the relative efficacy of these drug modalities individually and in combination. In these trials, 5α-reductase inhibitors and α1-adrenergic receptor antagonists proved effective in treating clinical BPH symptoms but in combination showed no increased effect in alleviating symptoms or improving flow rate [7].

A relatively recent trial was performed to fully determine the efficacy of these approaches. To further investigate the effectiveness of individual and combination drug therapy for the medical management of clinical BPH, the National Institute of Diabetes and Digestive and Kidney Diseases conducted a long-term, randomized trial known as the Medical Therapy of Prostatic Symptoms (MTOPS) study. The MTOPS trial investigated whether finasteride, a 5α-reductase inhibitor, and doxazosin, an α1-adrenergic receptor blocker, alone or in combination would specifically delay or prevent clinical progression of BPH. The results demonstrate that dual-drug therapy significantly reduced the risk of overall BPH clinical progression more than either drug monotherapy alone or placebo with a mean follow-up of 4.5 years [8]. Importantly as a component of the study protocol, serum samples were collected from MTOPS patients prior to randomization and at yearly intervals during the trial as well as at the end of the study. Prostate biopsy samples were also collected at baseline at year 1 and at the end of the study from a patient subgroup. These bio-samples were collected and banked in anticipation of analyses of potential molecular changes associated with patient responses to the MTOPS clinical protocol.

A number of theories have been proposed to explain the biology of the prostatic changes associated with BPH/LUTS. These include embryonic awakening, as described above [3], hormonal changes, and inflammation. Although there are significant data to support each of these that are summarized in this chapter, today, we still do not understand the full etiology of the prostatic changes and their associated symptoms. In all likelihood, it appears to be a combination of these changes that contribute to BPH/LUTS.

Regulation of the normal prostate

The human prostate is a walnut-sized gland, located at the base of the bladder and surrounding the urethra. The prostatic epithelial cells contribute secretions that empty through ducts into the urethra to form a major component of seminal plasma. There are 15–30 excretory ducts from the prostate that enter the urethra as it passes through the prostate, and each of these is surrounded by four to six prostatic lobules that contain acini lined by tall columnar epithelial cells. The endocrine system has been extensively documented to affect the prostate via testosterone, which is the major serum androgen that stimulates prostatic growth. During development, androgens and the androgen receptor regulate several key events that include development and differentiation of major target tissues such as the prostate, seminal vesicles, and epididymis [10]. Furthermore, it is generally held that androgens are not only required for normal function of the prostate gland but also implicated in prostate disease. Thus, identifying novel target genes, particularly those that are androgen regulated, may help to better understand the molecular basis of prostate physiology during health and disease.

Androgen regulation of the prostate

The prostate is composed principally of stromal and epithelial cells that are in close proximity to one another. BPH is a disease that is thought to involve stromally induced hyperplastic changes in the epithelium [1] and clearly demonstrates the interrelationships between stromal and epithelial cells. Interactions between the stroma and the epithelium have been shown by a number of investigators...

Produkt-Details

• Erscheint lt. Verlag: 7.10.2014
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Urologie
• Schlagworte: Chirurgie u. chirurgische Spezialgebiete • Clinical • Conditions • Different • Encounter • evidencebased • Guide • highly • hyperplasia • levels • lower urinary • Male • Medical Science • Medizin • Practical • Prostatic • provides • regularly • Sexual Medicine • Sexualmedizin • Surgery & Surgical Specialities • Symptoms • tract • Urologie • urologists • Urology • variety
• ISBN-10: 1-118-43794-2 / 1118437942
• ISBN-13: 978-1-118-43794-0 / 9781118437940