What Is the Interaction between Urine C-Reactive Protein, Prostatic Inflammation, and Doxazosin Treatment in Patients with Benign Prostatic Hyperplasia? A Pilot Study

<b><i>Introduction:</i></b> It was aimed to show the relationship between benign prostatic hyperplasia and inflammation by measuring urinary C-reactive protein values before and after alpha-blocker treatment. <b><i>Methods:</i></b> A total of 71 patients with a total prostate-specific antigen &#x3c;3.5 ng/mL, International Prostate Symptom Score &#x3e;7, and maximum urinary flow rate &#x3c;15 mL/s were included in the study. Doxazosin 4 mg p.o. once daily was started orally as an alpha-blocker treatment. Serum and urine C-reactive protein values, International Prostate Symptom Score, maximum urinary flow rate, and the post-void residual volume of patients were recorded at the first admission and in the first month of alpha-blocker treatment. <b><i>Results:</i></b> The mean age of the patients was 59.2 ± 7.5 years. The mean serum C-reactive protein values of the patients at the first admission and follow-up were 2.62 ± 1.8 (range, 0–5) mg/L and 2.83 ± 1.6 (0–6) mg/L, respectively. The mean urine C-reactive protein values of the patients at the first admission and follow-up were 0.45 ± 0.11 (range, 0.28–0.99) mg/L and 0.14 ± 0.04 (range, 0.79–0.328) mg/L, respectively, which was statistically significantly different. In the subgroup analysis, the urine C-reactive protein level change was more prominent in severely symptomatic patients than in moderately symptomatic patients. <b><i>Conclusion:</i></b> Our results showed that C-reactive protein was detectable in urine, alpha-blocker treatment significantly reduced urine C-reactive protein levels, and the decrease was more prominent in severely symptomatic patients.

Chinese Medicine Therapies for Neurogenic Bladder after Spinal Cord Injury: A protocol for systematic review and network meta-analysis

Neurogenic bladder (NB), a refractory disease, is characterized by voiding dysfunction of bladder and/or urethra, and spinal cord injury (SCI) is a common cause. Chinese medicine therapies have been applied extensively in the treatment of neurogenic bladder, especially in China, and the results are promising but varying. Thus, the aim of this work is to assess the efficacy and safety of various Chinese medicine therapies for neurogenic bladder after spinal cord injury. Condition being studied: Chinese medicine therapies; Neurogenic bladder after spinal cord injury. Main outcome(s): The primary outcome of our NMA will be measured by overall response rate and urodynamic tests, which includes postvoiding residual urine volume, maximum urinary flow rate, and maximal detrusor pressure.

RETROSPECTIVE MULTICENTRIC STUDY ON THE POST-SURGERY SYMPTOMATIC AND OBJECTIVE IMPROVEMENT OF BENIGN PROSTATIC HYPERPLASIA PATIENTS

Objectives: To evaluate patients of benign prostatic hyperplasia (BPH) preoperatively and identify those who would benefit from surgery, to evaluate outcome of surgery for BPH with respect to symptomatic and objective improvement of patients, and to compare the results of different surgeries for BPH being done different hospitals at Bhopal, which included transurethral resection of the prostate (TURP), transurethral incision of prostate (TUIP)/bladder neck incision (BNI), and Freyer’s prostatectomy? Methods: The present study was carried out at different hospitals of Bhopal. Patients presenting to the surgery outpatient department with symptoms of obstruction, namely, weak urinary stream, frequency hesitancy, intermittency, urgency, nocturia, etc., were included in the study. Some of the subjects included were patients presenting during emergency timings with complaints of retention of urine or occasionally other symptoms. The American Urological Association (AUA) Symptom Index questionnaire was administered to all such patients. They were also evaluated by ultrasound examination and patients having BPH on ultrasound (USG) were further evaluated by uroflowmetry. Results: Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship. Both maximum and average urinary flow rates (Q max and Qav) were improved by all the three surgeries However, TURP and Freyer’s prostatectomy showed greater improvement as compared to TUIP/BNI. Combination of AUA scoring, USG, and uroflowmetry helped us document improvement in our BPH patients and compared it favorably with other studies. Conclusion: Uroflowmetry was a simple assessment tool easy to learn and use. It was also inexpensive and formed a useful extension to clinical examination providing objective evidence of obstruction. It also helped to indirectly quantity the severity of obstruction. Symptom severity did not correlate with prostate size. Small prostates caused symptoms in the severe range also while even large prostates sometimes caused little symptoms. Prostatic weight correlated well with the maximum urinary flow rates with an inverse relationship.

The LOWER URINARY TRACT SYMPTOMS IN ANURIA AND NON-ANURIA PATIENTS AFTER RENAL TRANSPLANTATION: A COMPARATIVE STUDY

Objective: The purpose of this study is to examine the difference of lower urinary tract (LUT) symptoms in anuric and non-anuric individuals after renal transplantation (RT). Material & Methods: LUT function and symptoms were assessed in subjects who had undergone RT at Cipto Mangunkusumo General Hospital, Jakarta, from November 2016 to June 2017. Subjects were divided into anuric and non-anuric groups. We excluded patients with surgical complications that could not undergo uroflowmetry. Results: Thirty-two (21 male, 11 female) subjects were recruited in this study. The anuric subjects were younger than the non-anuric ones (47 ± 12.82 vs. 51.31 ± 16.33, p < 0.001) There were no significant differences in the International Prostate Symptoms Score (IPSS) (6.5 ± 3.67 vs. 6.25 ± 2.95, p = 0.567), Overactive Bladder Symptoms Score (OABSS) (4.06 ± 2.01 vs 4.12 ± 2.39, p = 1.000), maximum urinary flow rate (Qmax) (20.32 ± 9.04 vs. 22.32 ± 10.31, p = 0.956), post-void residual (PVR) (41.12 ± 37.63 vs. 47.62 ± 38.63, p = 0.361) and voided volume (227.88 ± 112.30 vs 251.06 ± 126.75, p = 0.588) between anuric and non-anuric subjects, respectively. IPSS-voiding symptom, IPSS-storage symptom, and OAB symptom did not differ significantly between both groups (p > 0.05). Thirteen (13/16) and seven (7/16) subjects of the anuric and non-anuric groups were both pleased with their quality of life, respectively. Conclusion: LUT symptoms do not differ between anuric and non-anuric patients.

Clinical Significance of Intravesical Prostatic Protrusion Index in Patients with Clinical Diagnosis of Benign Prostatic Hyperplasia.

Purpose: To investigate the clinical significance of the intravesical prostatic protrusion (IPP) index in benign prostatic hyperplasia (BPH) patients to clarify its diagnostic value in predicting the clinical and structural abnormalities of the prostate. Materials and Methods: In this descriptive and analytical cross-sectional study, we include every man older than 50 years old with lower urinary tract symptoms (LUTS), predominantly voiding or obstructive, suggestive of BPH. The patients were evaluated to determine the following indices: IPSS (International Prostate Symptom Score) Index, QoL (quality of life), prostate volume (PV) and postvoid residual urine (PVR), serum PSA level, and the maximum urinary flow rate (Qmax) obtained by uroflowmetry. Subsequently, the assessment of the IPP index was undertaken by transabdominal ultrasonography. The categorization of the IPP index was done into 3 grades: grade one (below 5 mm), grade two (between 5 and 10 mm), and grade three (greater than 10 mm). Results: The significant direct correlation between the intravesical prostatic protrusion and international prostate symptom score, quality of life, prostate volume, postvoid residual urine, and serum PSA as well as inversely with the maximum urinary flow rate was confirmed both before and after the medical treatment. Also, the need for surgical intervention increased significantly with increasing IPP levels. Conclusion: The intravesical prostatic protrusion can be used to evaluate and predict the severity of symptoms and outcomes in patients with clinical BPH.

Photoselective Laser Vaporization of the Prostate in Benign Prostatic Obstruction: Sexual Function in Focus

The objective: to determine the effect of photoselective laser vaporization (FVP) on individual IIEF domains (sexual activity, libido, erection, ejaculation, ograzm, satisfaction with intercourse) in sexually active men with BPO, as well as the factors on which this effect depends. Materials and methods. 95 sexually active patients with benign prostatic obstruction (BPO) (prostate volume >40 cm3, maximum urinary flow rate Qmax <10 ml/s; QoL≥4) at the age of 45 to 60 years underwent FP (GreenLight XPS, MoxyFiber) ... Sexual function (IIEF), urination parameters (PSS/QoL, PVR, Qmax), prostate volume, intravesical prostate protrusion, PSA were assessed before the intervention and 3 months after. Results. PVP had a statistically significant and clinically significant effect on micturition parameters characterizing obstruction, prostate size and QoL. The median IPSSobstructive decreased by 6 (4–7) points (W=7.6; P<0.01), PVR by 48 (38–60) ml (W=6.2; P<0.01), IPP by 0.9 (0.5–1.5) cm (W=9.4; P<0.01) Vprostate at 31 (22–42) cm3 (W=8.5; P<0.01), QoL by 3 (2–4) points (W=11.2; P<0.01). The median Qmax increased by 23 (15–29) ml/s (W=13.3; P<0.01). The median values of the IPSSirritative and IPSSnocturia domains did not change significantly (P<0.8 and P<0.6, respectively). At 3 months after PVP, 84 (94.6 %) patients restored sexual activity. In 33 (39.28 %) of them, an improvement in erection and 15 (17.85 %) deterioration were found. 61 (72.26 %) lost emission. Conclusions. The most significant effect of PVP on ejaculatory function is the loss of emission. The effect of PVP on erection is multidirectional and manifests itself in its improvement and deterioration. Further research is needed to determine the mechanisms by which PVP affects erection and ejaculation in order to prevent negative effects.

A Comparative Study Between Standard Monopolar Versus Bipolar Saline Turp: Our Experience in Armed Forces Hospital

Objective: To-evaluate the outcome of bipolar Versus conventional monopolar transurethral resection of the prostate (TURP) on urinary function. Material and Methods: A total of 300 patients with benign prostatic hyperplasia (BPH) were randomized to bipolar or monopolar conventional TURP treatment groups. Operative and early postoperative variables and complications were recorded and all patients were re-evaluated at 1, 3, 6 and 12 months after surgery using the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume (PVR). Results: The operating time was shorter in the monopolar TURP group. Postoperative bleeding and blood transfusion requirements did not significantly differ between the two groups. Sodium levels were significantly lower in the monopolar group than in the bipolar group. Transuretheral resection syndrome developed in two (1.4%) patients in the monopolar group. Both groups had similar and significantly improved IPSS values, maximum urinary flow rate values and PVRmeasurement. Conclusion: Bipolar TURP is a safe and effective procedure that is associated with a relatively longer operating time, a smaller reduction in serum sodium levels and a similar efficacy compared with conventional monopolar TURP. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 66-70

Comparison of Outcome of Transurethral Resection of Prostate Between Patients With Preoperative Low or Normal and High Voiding Pressure

Objective: T0 compare the outcome of Transurethral Resecton of Prostate between Patients with Preoperative Low or Normal and High Voiding Pressure. Methods: This hospital based prospective observational study was conducted in the Department of Urology of Dhaka Medical college Hospital from July 2008 to June 2010 on male patients aging >59 years having Lower urinary tract symptoms (LUTS) attending to urology OPD& IPD were evaluated by history, physical examination including DRE and necessary investigations like USG of KUB and prostate with MCC & PVR, Q max, IPSS score to identify the potential candidates for TURP. Potential participants were counseled for urodynamic study. Who fulfilled the selection criteria included in this study in outpatient basis or admitted in the urology ward and numbered chronologically and performed urodynamic study and then patients underwent TURP, after 12 weeks of completion of TURP again a follow-up urodynamic study performed in all patients to compare the outcome between two groups. Sample size was 65, high pressure voiding group were 36 in number and Normal or low pressure voiding group were 29 in number. Data were collected on variables of interest using a structural data collection format. Data were processed and analyzed using SPSS (Statistical package for social science) software program. The test of significant employed to analyze the data was descriptive statistics and Student’s t-test, Paired and unpaired t- test, Fisher exact test. Probability value (P value < 0.05) was considered significant. Results: In this study the age ranges were 59 and 88 years and mean age was 70.7 ± 6.7 years. the maximum urinary flow rate, residual urine volume and maximum intravesical pressure 3 months after transurethral prostatic resection were significantly better in patients with high detrusor pressure compared to those with normal/low normal/low detrusor pressure (15.9±0.7 vs. 21.3±2.2ml/sec, p<0.001, 18.1±11.8 vs. 2.9±0.7 ml, p<0.001 and 48.3±6.2 vs. 71.9±15.2 cmH2O, p<0.001 respectively).The maximum urinary flow rate ( Q max ), residual urine volume, maximum intravesical pressure and detrusor pressure at peak urinary flow rate and also IPSS score were significantly improved 3 months after operation in both groups, more improvement was observed in preoperative high voiding pressure group. Post-voiding residual urine is a clear indication of poor outcome, and also the maximum urinary flow rate, maximum intravesical pressure and detrusor pressure at peak urinary flow rate all factors may precipitate decompensation of bladder and in low voiding pressure group decompensation of bladder occurs more than the high voiding pressure group as the preoperative and postoperative residual urine develops more in low voiding pressure group. Conclusion: The high voiding pressures (detrusor pressure) may influence in good postoperative outcome and helps in resolution of a significant outflow obstruction, there are good urodynamic reasons for avoiding unwanted TURP rather it could be justified by using urodynamic study which may predict outcome of TURP. So, we may assess properly the patient for prostatectomy by urodynamic study. As if we do this type of evaluation before TURP it may reduce the unwanted operation. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p 111-119

Urtica dioica in the Management of Benign Prostate Hyperplasia (BPH)

Background:: Benign Prostatic hyperplasia (BPH) is known as a disease prevalent in men after the age of 50 years old. Ninety percent of men with the age of 80 years and over have BPH. BPH is associated with functional problems like dysuria, nocturia, polyuria, urinary incontinence and recurrent urinary tract infections. Urtica dioica or nettle is a popular medicinal plant for management of BPH in men. Objective:: This article evaluates the efficacy and safety of nettle and its related possible mechanisms in the management of BPH. Methods:: For the preparation of this manuscript, all the information was gathered from accessible and inaccessible resources (Web, Books, Thesis, etc.). Results:: The results of preclinical and clinical studies confirmed the efficacy of nettle roots extracts (methanol, ethanol, and petroleum ether) in the improvement of BPH in term of IPSS score, and patient's life quality. An increase in mean and maximum urinary flow rates and a reduction in prostate volume and residual urine level were observed after treatment with nettle extract. Nettle roots should be used for 6-12 months as its use is possible for a long time without any serious adverse effects. Conclusion:: Designing the clinical trials to compare the efficacy of different extracts from roots or leaves and investigation of molecular mechanisms of action could be the approaches for future.

Combination therapy in the integrated treatment of recurrent chronic cystitis

Aim. To assess the results of the integrated treatment of women with recurrent chronic cystitis using the selective 3-adrenoreceptor (AR) agonist, mirabegron. Methods. The results of the treatment of women diagnosed with recurrent chronic cystitis in the urological clinic of KSMU were analyzed. The average age of patients was 31.53.4 years. To assess the effectiveness of integrated treatment, women with recurrent chronic cystitis were randomly divided into two groups: the first group (30 patients) who received antibiotic therapy in combination with the drug mirabegron at a dose of 50 mg once a day and the second (control) group (30 patients), who received antibiotic therapy taking into account their susceptibility. All patients underwent ultrasonography of the genitourinary system, urodynamic studies with assessment of the maximum urinary flow, average urinary flow, bacterial urine cultures. Results. Analysis of the research results showed a greater reduction in the number of urinations per day (up to 7 times) in the first group. The frequency of urinary urgency decreased in 82.6% of the first group patients compared to 64% of the second group (p 0.05). In the combination therapy versus control groups, there was reduced hospital stay by an average of 4 days (11.2 vs 15 days; p 0.05). On the 15th day of treatment, control cystoscopy revealed no changes in the bladder mucosa in all patients of the first group. Also, in the first group of patients, there was a greater improvement in urodynamic parameters compared to the control group (p 0.05). Conclusion. The selective 3-AR agonist mirabegron used in the integrated treatment of recurrent chronic cystitis increases the effectiveness of the therapy.