Comparison of androgen-independent growth and androgen-dependent growth in BPH and cancer tissue from the same radical prostatectomies in sponge-gel matrix histoculture.

Geller J; Partido C; Sionit L; Youngkin T; Nachtsheim D; Espanol M; Tan Y; Hoffman R
Department of Medical Education, Mercy Hospital and Medical Center, San Diego, CA 92103-2180, USA.
Prostate (United States) Jun 1 1997, 31 (4) p250-4

BACKGROUND: In order to determine androgen sensitivities of prostate cancer and benign prostatic hypertrophy (BPH) tissues from the same patient in vitro, we used a histoculture technique to measure androgen-independent and androgen-dependent growth and compared them in paired specimens of BPH and prostate cancer from 23 radical prostatectomies. Both androgen-independent growth and androgen-dependent growth are measures of important biological characteristics of benign and malignant prostate tissue.

METHODS: The effect of hydroxyflutamide and antiandrogens on dihydrotestosterone (DHT)-stimulated incorporation of 3H-thymidine into both paired specimens of BPH and cancer was utilized to measure androgen-independent and androgen-dependent growth. The percentage decrease in 3H-thymidine incorporation/microgram protein in the flutamide-treated specimen compared to the DHT-treated specimen represented androgen-dependent growth. Residual 3H-thymidine incorporation/microgram protein during hydroxyflutamide administration represented androgen-independent growth.

RESULTS: Androgen-independent growth was significantly greater (P = 0.015) in the BPH compared to the cancer paired tissue. Androgen-dependent growth was significantly higher in 23 paired specimens of cancer compared to BPH (P < 0.03).

CONCLUSIONS: In paired specimens of BPH and prostate cancer from the same radical prostatectomy specimen, androgen-independent growth appeared greater in BPH compared to cancer specimens; androgen-dependent growth, however, was greater in prostate cancer than in BPH. There was no correlation of either growth parameter with Gleason tumor grade. Future clinical correlations will indicate whether either growth parameter represents an important prognostic factor for prostate cancer aggressiveness stimulated 3H-thymidine incorporation into DNA.

Alpha-1 adrenoceptor subtypes (high, low) in human benign prostatic hypertrophy tissue according to the affinities for prazosin.

Takeda M; Hatano A; Komeyama T; Koizumi T; Mizusawa T; Kanai T; Tomita Y; Maruyama K; Nagatomo T
Department of Urology, Niigata University, School of Medicine, Japan.
Prostate (United States) Jun 1 1997, 31 (4) p216-22

BACKGROUND: A novel classification of alpha-1 adrenoceptor subtypes (High, Low) was applied to human benign prostatic hypertrophy (BPH) tissue.

METHODS: Human BPH specimens were examined by a radioligand binding assay method using 3H-prazosin, and those data were compared with preoperative therapies.

RESULTS: (1) Scatchard analysis showed a high-affinity site (Kd:27.18 +/- 6.41 pM; Bmax:9.29 +/- 0.98 fM/mg protein; mean +/- SE) as alpha 1H, and a low-affinity site (Kd: 4088.0 +/- 744.34 pM, Bmax: 140.81 +/- 19.98 fM/mg protein) as alpha 1L subtype, for prazosin. (2) The Kd and Bmax were not different in the nontreated group (n = 5), alpha 1 blocker group (n = 5), and antiandrogen group (n = 5), in either alpha 1-high affinity or alpha 1-low affinity subtype. (3) Phenoxybenzamine had different pKi values for the above two adrenoceptor subtypes. Scatchard analysis showed that alpha 1-high affinity binding site disappeared in the presence of 1 microM of phenoxybenzamine, and the Kd and Bmax values in the presence of 1 microM of phenoxybenzamine were almost identical to the alpha 1-low affinity site of the two subtypes.

CONCLUSIONS: Human BPH tissue possesses both alpha 1H- and alpha 1L-adrenoceptor subtypes according to the affinities for prazosin, and only the alpha 1H subtype can be completely inhibited by some concentration of phenoxybenzamine. Treatment by alpha 1 blocker may not change the conditions of alpha 1-adrenoceptors in prostatic tissue.

[Urethral opening pressure: its clinical significance in prostatic obstruction]

Ameda K; Kobayashi S; Matsuura S; Sasaki Y; Shibata T; Koyanagi T
Department of Urology, Hokkaido University School of Medicine.
Nippon Hinyokika Gakkai Zasshi (Japan) Apr 1997, 88 (4) p496-502

BACKGROUND: In the evaluation of prostatic obstruction by using the pressure-flow study (PFS), we defined intravesical pressure at initiation of voiding as urethral opening pressure. This simple parameter could reflect the degree of compressive prostatic obstruction to some extent. The aim of this study is to analyze if a correlation exsists between clinical signs and urethral opening pressure, and if they bear any prognostic value in postoperative outcome of the patients.

METHODS: We analyzed 46 patients with clinical benign prostatic hypertrophy who underwent urodynamic evaluations including PFS. They were divided into 2 groups according to their urethral opening pressure. The high opening pressure was defined as greater than 70 cm water, which was noted in 24 patients (group A). Twenty-two patients had lower opening pressure (group B). Comparison of the clinical findings in these patients were reviewed. Medium-filling cystometry and PFS were performed transurethrally, by using a microtip transducer and rectal balloon. Cystoscopy was performed when possible, wherein we could examined the presence or absence of detrusor trabeculation. Transurethral prostatectomy was indicated in a total of 26 patients (16 in group A and 10 in group B), in whom postoperative clinical findings were analyzed with regard to the difference in preoperative urethral opening pressure. The patients who void with straining or who void following uninhibited detrusor contraction were excluded from this study.

RESULTS: International Prostatic Symptoms Score (I-PSS) revealed no significant difference in both groups, however, patients in group A were often suffering from urge incontinence preoperatively. Significant correlation was found among the incidence of detrusor instability, detrusor trabeculation and increased opening pressure. In PFS the patients with high opening pressure tended to have higher detrusor pressure at maximum flow and greater contractile power of the detrusor in voiding. There were no difference in Qmax and residual volume both groups. Postoperatively, symptomatic improvement was significant in both groups. There was no statistical difference in postoperative I-PSS between group A and B. Although 6 patients in group A demonstrated poor urinary control at 1 month, only two patients remained incontinent at 6 months postoperatively. As to urodynamic findings, the difference in PFS were markedly reduced between both groups. No difference was noted in postoperative Qmax as well.

CONCLUSION: Significant difference was found in preoperative objective findings except the flow rate between the patients with and without high urethral opening pressure, while no symptomatic difference was noted except urege incontinence in both groups. No prognostic value was demonstrated in urethral opening pressure, however, poor postoperative urinary control was often associated with initial high opening pressure in the short term. It was suggested that 1) compensatory detrusor hyperactivity improved voiding efficacy in the patients with prostatic obstruction, which was gradually normalized after the relief of obstruction, 2) symptomatic improvement was highly related to the relative improvement of the obstructive findings on PFS.

Free and total serum PSA values in patients with prostatic intraepithelial neoplasia (PIN), prostate cancer and BPH. Is F/T PSA a potential probe for dormant and manifest cancer?

Tarle M; Kraljic I
Department of Oncology and Nuclear Medicine University Hospital Sestre Milosrdnice, Zagreb, Croatia.
Anticancer Res (Greece) May-Jun 1997, 17 (3A) p1531-4

Free and total PSA serum concentrations were retrospectively measured in 106 subjects: 45 patients with intraepithelial prostatic neoplasia (PIN), 30 subjects with benign prostatic hypertrophy (BPH) and 31 subjects with untreated prostatic carcinoma. The (F/T) x 100 PSA value is recorded in subjects with the elevated total PSA level (> 4 ng/ml). PIN patients were divided into two groups: a low grade PIN (PIN 1) and high grade PIN (PIN II-III) patients. The mean (F/T) x 100 PSA value in low grade PIN patients was 27.9 +/- 16.2 (range 17.1-41.2, median 25.1) and has been numerically similar to the respective value in BPH subjects (29.1 +/- 13.2, 15.8-48.0, 27.7). These parameters differed markedly (P < 0.01) from the mean (F/T) x 100 PSA value in high grade PIN patients (16.9 +/- 9.0, range 9.9-24.9, median 16.5). The later values were in turn comparable (P > > 0.05) with the respective value measured in untreated prostate cancer patients (14.4 +/- 10.8, 6.6-21.4, 12.6). Hence, values derived from the measurement of free and total serum PSA level may distinguish low grade PIN that prevailingly remains latent disease from high grade PIN that is in most cases not only early prostatic carcinoma but that is often a precursor of an aggressive neoplasm. The published literature is incoherent regarding the influence of tumor spread on F/T PSA level. The cutoff point that divides BPH from cancer may depend on tumor stage. We have not investigated F/T PSA values related to different stages and grades of prostate cancer. The cutoff point of (F/T) x 100 PSA in our study that divides malignant from benign prostate, or latent from manifest cancer, was tentatively assigned as 18 with a specificity of 91% and selectivity of 69%. Our data are based on the application of the CIS assay that, according to the literature, gives higher F-PSA % compared to other respective kits.

Optimising the medical management of benign prostatic hyperplasia.

McDermott T
Department of Urology, Meath Hospital, Dublin, Eire.
Br J Clin Pract (England) Mar 1997, 51 (2) p116-8

The ageing population is presenting an increasing demand on future healthcare services. In males, prostatic disease is one of the commonest disorders contributing to this. Alternatives to surgical intervention have to be considered as the preferred option for individuals and whether this be a therapeutic or a financial option to be taken. Two major medical alternatives are alpha-blockers and 5-alpha reductase inhibitors. The results of such treatment can be very beneficial in selected groups of patients. Side-effects with improved drugs electivity are reducing. Overall, while surgery still holds the gold standard, medical therapy has a significant role in the treatment of benign prostatic hypertrophy. Cost analysis may be a factor in deciding which treatment to have.

[Inferior vena cava obstruction syndrome caused by urinary retention]

Arruti A; Plazaola I; Mata J; Amato E
Arch Esp Urol (Spain) Jan-Feb 1997, 50 (1) p61-2

OBJECTIVE: To report an unusual case of inferior vena cava obstruction secondary to urinary retention.

METHODS/RESULTS: A 72-year-old male patient with a history of bilateral inguinal hernia and a recent hip surgery, presented with deep venous thrombosis in the left leg. A CT scan disclosed significant thickening of the bladder wall and grade III-IV hypertrophy of the prostate. Abdominal ultrasound disclosed a cystic mass compressing the vena cava and moderate ureterohydronephrosis. Edema spontaneously resolved following insertion of a urethral catheter and renal function returned to normal.

CONCLUSION: Obstruction of the inferior vena cava secondary to an enlarged bladder is rare. To our knowledge only two such cases have been reported in the literature. In the case described herein, urinary retention may have been exacerbated by prostatic hypertrophy, anesthesia and bed confinement due to hip surgery.

[Diagnostic efficacy of free PSA/total PSA ratio in the diagnosis of prostatic carcinoma]

Minardi D; Recchioni A; Baldassari M; Governatori D; Giammarco L; De Sio G; Muzzonigro G; Polito M
Clinica Urologica, Universita degli Studi, Ancona.
Arch Ital Urol Androl (Italy) Feb 1997, 69 Suppl 1 p93-5

Prostate specific antigen, specific organ and tissue marker, is a glycoprotein present in serum in different molecular forms, i.e. not protein bound and bound to proteins (PSA-ACT and PSA-AMG). The total PSA is expressed by the sum of the non protein bound value (free-PSA) and PSA-ACT. The aim of our study was to evaluate the hypothesis that measurement of free/total PSA ratio may be helpful in the differential diagnosis of prostatic pathology. Our study was conducted on 350 patients, to whom the total-PSA, free-PSA and f/t PSA had been performed; 250 patients showed a total PSA between 2.5 and 10 ng/ml and 185 of them had symptoms of bladder out-flow obstruction. In all of the 250 patients digital rectal examination, transrectal ultrasound and prostatic biopsy were performed. 100 patients were controls. The cut-off to differentiate between benign and malignant prostatic disease was 16%. The pathologic diagnosis was related to the f/t PSA ratio, and in particular those patients with a f/t PSA lower than 16% were expected to be prostatic carcinoma, while those with a f/t PSA higher than 16% were expected to be benign prostatic hypertrophy. The diagnostic accuracy of the ratio was calculated, and it was observed that it was 88.65% in the diagnosis of benign prostatic hypertrophy, while in the diagnosis of prostatic carcinoma it was 84.5%. We can therefore assume that f/t PSA can add useful information on prostatic pathology, eventually sparing unnecessary prostatic biopsies.

[Laser-assisted endoscopic resection: a new surgical technique for the treatment of benign prostatic hypertrophy. Preliminary results of a study involving 100 patients]

Albert P; Bretheau D; Taverna GL; Aimino R; Morin N; Salvo A
Reparto di Urologia, Fondazione S. Joseph, Marsiglia, Francia.
Arch Ital Urol Androl (Italy) Feb 1997, 69 (1) p15-21

This study was designed to assess the efficiency of 2 kind of laser prostatectomy devices in the treatment of Benign Prostatic Hyperplasia: a non contact technique versus a contact technique versus a contact one. From January 1994 to September 1994, 100 patients were included in a randomized comparison of 2 laser prostatectomy devices with right angle firing laser fibers: a non contact technique with Urolase fiber (Bard) (50 patients) versus a contact technique with Fibertom fiber (Dornier) (50 patients). The Urolase fiber was used at 60 Watts power setting for 60 seconds and administered to each lobe at 2, 4, 8 and 10 o'clock positions. The Fibertom fiber was used by dragging or the so called "painting" technique at 3 and 6 months with 3 parameters: Madsen symptom scores, peak urinary flow rates and post-void residual urine volumes. Operative morbidity rate was 9%. No difference in morbidity between both fibers. No blood transfusion was required in any case. Statistical analysis of the aforementioned parameters shows a p-value of < 0.001 for all parameters. Comparing the 2 different fibers, there was no statistical difference in outcome for any of these parameters. From this study we conclude that the preliminary results achieved, using the Urolase and the Fibertom fiber, are equivocal and interesting. However, a long term follow-up is necessary to evaluate the definitive efficiency of laser prostatectomy and to determine the optimal procedure.

Blood haemoglobin and the long-term incidence of acute myocardial infarction after transurethral resection of the prostate.

Hahn RG; Nilsson A; Farahmand BY; Persson PG
Department of Anaesthesia, South Hospital, Stockholm, Sweden.
Eur Urol (Switzerland) 1997, 31 (2) p199-203

OBJECTIVES: To study risk factors for acute myocardial infarction (AMI) in men suffering from benign prostatic hypertrophy.

METHODS: We followed 811 patients who underwent transurethral resection of the prostate (TURP) between 1983 and 1992 until the end of 1993 with regard to the incidence of AMI. The association between AMI and various potential risk factors was evaluated by epidemiological methods.

RESULTS: Fifty-two patients developed a first-time AMI after TURP. A pre-operative blood haemoglobin concentration in the range of 100-129 g/l (normal range 130-165 g/l) was associated with an increased long-term relative risk of a first-time AMI, which was estimated to be 2.0 (95% confidence interval = 1.0-4.1). This estimate became slightly stronger when we also included the 76 patients with a first AMI before surgery, 10 of whom developed a re-infarction after TURP. Furthermore, it was largely unchanged on adjusting for impaired health status and age > or = 75 years (patient factors) and for fluid absorption > or = 500 ml and a blood loss > or = 275 ml (operative factors), which had been reported to increase the long-term risk of AMI in a previous study.

CONCLUSION: A moderately reduced blood haemoglobin level before TURP is associated with a doubled risk of developing AMI in later life.

Insulin-like growth factor-binding protein-2 in patients with prostate carcinoma and benign prostatic hyperplasia.

Ho PJ; Baxter RC
Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, NSW, Australia.
Clin Endocrinol (Oxf) (England) Feb 1997, 46 (2) p145-54

OBJECTIVE: Insulin-like growth factor-binding protein (IGFBP)-2 is a major prostatic IGFBP and may be involved in regulating prostate growth. Patients with prostate carcinoma (PC) have elevated serum IGFBP-2 levels which correlate with the specific PC marker, prostate-specific antigen (PSA). The aims of this study were to investigate whether elevated serum IGFBP-2 is unique to PC or also occurs in benign prostatic hyperplasia (BPH), to examine the relations among age, PSA and IGFBP-2 levels, and to examine longitudinal changes in serum IGFBP-2 with PSA in prostate carcinoma.

DESIGN AND PATIENTS: Sixteen patients (61-83 years) with inoperable PC attending the oncology unit at a tertiary referral hospital were studied. Some serum samples were obtained retrospectively while the majority were collected prospectively over 13 months of treatment. The patients with PC were compared to 8 patients (66-73 years) with histologically proven BPH and 7 male control subjects (61-82 years) with no known prostate abnormality.

MEASUREMENTS: A new IGFBP-2 RIA was developed. Serum PSA (by EIA), and IGFBP-2, IGFBP-3, IGF-I and IGF-II (by RIA) were measured in all subjects, and serially in patients with PC.

RESULTS: Serum IGFBP-2 was significantly higher in PC with high PSA (560 +/- 66 micrograms/l, n = 12) than PC with normal PSA (292 +/- 65 micrograms/l, n = 4, P = 0.02), BPH (364 +/- 61 micrograms/l, P = 0.03) and controls (367 +/- 44 micrograms/l, P = 0.04). Mean IGFBP-2 in BPH was not different from controls. IGFBP-2 and PSA were significantly correlated with age (r = 0.543 and r = 0.433 respectively) and with each other even when the age effect was removed. Serum IGFBP-2 and PSA levels changed concordantly in all 7 PC patients who had serial sampling. Serum IGF-II but not IGF-I or IGFBP-3 was higher in PC and BPH than in controls (PC 332 +/- 23 micrograms/l), BPH 359 +/- 26 micrograms/l vs controls 241 +/- 37 micrograms/l; P = 0.03 and 0.02 respectively).

CONCLUSIONS: Serum IGFBP-2 levels are uniquely elevated in active prostate carcinoma but not in benign prostatic hypertrophy. In PC, serum IGFBP-2 levels closely parallel those of PSA and probably reflect tumour burden. The relation between PSA and IGFBP-2 is partially independent of their individual relations with age. Although serum IGFBP-2 is less sensitive than PSA in PC, it may have adjunctive value in the management of prostate carcinoma.

[Ureteral jet in patients with benign prostatic hypertrophy: prognostic evaluation during single and combined therapy]

Sperandeo M; Sperandeo G; Carella M; Bianco G; Cera A; Scarale MG; Viola M
Divisione di Medicina Interna, IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG.
Arch Ital Urol Androl (Italy) Dec 1996, 68 (5 Suppl) p175-8

By color-Doppler ultrasound it's possible to visualize urine flow jet from ureter into the bladder. Aim of the study was to evaluate of ureteral jet in patients with benign prostatic hyperplasia before, during and after with one or two drugs medical therapy. Thirteen patients, aged 51-63 years, were studied; they were not affected by metabolic, hepatic, renal diseases and by prostate inflammation. Eco color Doppler p.w. (Toshiba SSA 270A) with a convex probe of 3.5 MHz was used. A transabdominal ultrasound study was performed, prostate volume measured and ureteral jet visualized before and along treatment (at six months interval) with Finasteride and at the end of treatment. Successively, in four patients, with relapse of prostatic synptomatology, a transabdominal ultrasound study was performed, before and along a treatment with Finasteride, 5 mg/die (Finastid, Neopharmed) and Terazosin hydrochloride, 5 mg/die (Teraprost, Malesci), and at the end of treatment.

[Laser treatment of benign prostatic hypertrophy: the correlation of histologic results to nuclear magnetic resonance imaging]

Sulser T; Jochum W; Huch Boni RA; Briner J; Krestin GP; Hauri D
Urologische Klinik and Poliklinik, Universitatsspital Zurich.
Ann Urol (Paris) (France) 1997, 31 (1) p19-26

Minimally invasive treatments for benign prostatic hyperplasia (BPH) are currently very controversial. Nd:YAG laser transurethral thermocoagulation of the prostate is the technique most frequently used. The objective of this study was to assess the correlation between the morphological effects observed and the changes visible on magnetic resonance imaging during this type or treatment in the human prostate, in order to evaluate the tissue effects obtained according to the power and the interaction time applied. In 10 patients requiring radical prostatectomy for urological cancer, visual laser ablation of the prostate (VLAP) was performed during the 10 days preceding the radical operation (range: 1 to 9 days). The entire gland was submitted to pathological examination in order to correlate the histological result with contrast magnetic resonance imaging performed in 6 patients, using a standard transrectal coil, 12 to 24 hours before complete resection of the prostate. The morphological examination showed zones of periurethral necrosis of variable volume, accompanied by extensive peripheral haemorrhage, containing vessels with a partially obliterated lumen. Contrast magnetic resonance imaging (T1) showed that laser-induced lesions had a low density appearance and were perfectly demarcated with peripheral heterogeneous and hyperdense zones. In contrast with the experimental investigations performed to date, we demonstrated a clearly delayed tissue effect. Our experience demonstrates that a period of several hours between laser treatment and removal of the operative specimen is not sufficient to evaluate the extent of laser-induced lesions. High resolution magnetic resonance imaging with a standard transrectal coil, sometimes combined with a multiple coil, is very valuable to assess the effects of laser.

[Laser-tissue interactions in urology]

Mordon S
INSERM U279, Pavillon Vancostenobel, CHU de Lille.
Ann Urol (Paris) (France) 1997, 31 (1) p11-8

The laser-tissue interaction is a complex phenomenon which is usually classified into 4 distinct mechanisms: electro-mechanical action, photoablative action, thermal action and photochemical action. Fragmentation of calculi by means of a pulsed dye laser is a good example of the electro-mechanical action. The thermal action can induce coagulation and/or volatilisation of tissues. Treatments of bladder tumors, urethral strictures and more recently benign prostatic hypertrophy are based on the laser terminal action.

Effect of Serenoa repens extract (Permixon) on estradiol/testosterone-induced experimental prostate enlargement in the rat.

Paubert-Braquet M; Richardson FO; Servent-Saez N; Gordon WC; Monge MC; Bazan NG; Authie D; Braquet P
BIO-Inova EuroLab Research Labs, Plaisir, France.
Pharmacol Res (England) Sep-Oct 1996, 34 (3-4) p171-9

The effect of the lipidosterolic extract of Serenoa repens (LSESR) on experimental prostate enlargement was investigated in three groups of rats: shams treated with LSESR (sham rats), castrated animals treated with estradiol and testosterone (castrated rats), castrated animals treated with estradiol/testosterone and treated with LSESR (castrated and treated rats). Following three months of continuous hormonal treatment, the weight of prostates in estradiol/testosterone-treated castrated rats was significantly increased in comparison with sham-operated rats. Such an increase started rapidly, reached a maximum by 30 days and remained at a plateau or slightly declined thereafter. The increase of prostate total weight induced by the hormone treatment was inhibited by administration of LSESR. Indeed, the weight was significantly lower at day 60 and day 90 for the dorsal and lateral regions of the prostate. The weight of the ventral region of the prostate was significantly lower after 30 and 60 days treatment with LSESR. These results demonstrate that administering LSESR to hormone-treated castrated rats inhibits the increase in prostate wet weight. This effect of LSESR may explain the beneficial effect of this extract in human benign prostatic hypertrophy.

Immunohistochemical analysis of beta-tubulin isotypes in human prostate carcinoma and benign prostatic hypertrophy.

Ranganathan S; Salazar H; Benetatos CA; Hudes GR
Department of Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Prostate (United States) Mar 1 1997, 30 (4) p263-8

BACKGROUND: beta-tubulin, the intracellular target of several antimicrotubule agents, is encoded by at least six genes and exists as multiple isotypes with tissue-specific expression. Previous in vitro studies indicated that tubulin isotype composition may affect polymerization properties, dynamics, and sensitivity to drugs.

METHODS: To investigate the isotype composition of beta-tubulin in human prostate, tissues were collected from 26 patients after radical prostatectomy and sections were stained with isotype-specific antibodies.

RESULTS: beta IV tubulin is the predominant isotype in benign prostatic hyperplasia (BPH) and adenocarcinoma, showing significantly stronger immunohistochemical expression than beta II and beta III, particularly in Gleason's grade 3 and 4 cancers. Staining for the beta II isotype was invariably weak and often absent in BPH and normal glands. There was a marked increase in beta II isotype stain from BPH to cancer in 77% of the patients, suggesting that the expression of this isotype is related to malignant status.

CONCLUSIONS: The beta II tubulin isotype is a potential marker for prostate adenocarcinoma. The possibility that tumor beta-tubulin isotype composition may effect the response to antimicrotubule drug therapy in prostate cancer and other tumors merit investigation.

[LH-RH agonists as therapeutic alternative in patients with benign prostatic hyperplasia (BPH) and surgical contraindication. Long term follow up]

Granados Loarca EA; Chechile Toniolo G; Villavicencio Mavrich H
Servicio de Urologia., Fundacion Puigvert, IUNA, Barcelona, Espana.
Arch Esp Urol (Spain) Nov 1996, 49 (9) p923-7

OBJECTIVES: The purpose of this study is to describe the benefits afforded by treatment with LH-RH analogues to patients with physical or mental disorders that consult for acute urinary retention or urinary symptomatology secondary to benign prostatic hypertrophy (BPH).

METHODS: 52 patients with BPH in whom surgery was contraindicated due to poor mental or physical condition were treated with LH-RH analogue for six consecutive months a year for a period of three years. Thirty-eight patients had acute urinary retention and 14 had prostatic symptomatology.

RESULTS: Serum testosterone fell below 11 nmol/l. No significant changes in PSA levels were observed. Assessment of the prostate by DRE and US showed prostatic size had diminished. Voiding and postvoid residual urine improved and the bladder catheter could be withdrawn.

CONCLUSIONS: Our results show that treatment with LH-RH analogue can reduce the urinary symptoms and improve the quality of life of patients with BPH in whom surgery is contraindicated.

c-erbB-2 oncoprotein: a potential biomarker of advanced prostate cancer.

Arai Y; Yoshiki T; Yoshida O
Department of Urology, Kyoto Universit, Japan.
Prostate (United States) Feb 15 1997, 30 (3) p195-201

BACKGROUND: Overexpression of the c-erbB-2 oncogene has been implicated in the development and/or prognosis of several human carcinomas, including that of the prostate. Recently, c-erbB-2 protein was found to be released in the circulation. The present study was undertaken to study the significance of serum c-erbB-2 protein determination in men with prostate cancer.

METHODS: Serum c-erbB-2 protein determination was performed via immunoradiometric assay using two monoclonal antibodies that react with the extracellular domain of the protein. The study population consisted of 71 untreated prostate cancer patients. Of those, 33 with stage D2 disease entered a follow-up study. As control, serum c-erbB-2 protein levels were determined in 92 patients with benign prostatic hypertrophy. In addition, elevations of c-erbB-2 protein were examined in patients with various disease statuses: clinically well controlled (28 patients), disease progression (24 patients), and end-stage disease (17 patients).

RESULTS: Elevation of serum c-erbB-2 protein level was observed in patients in advanced stages, such as stage D2 disease (30%), disease progression (42%), and end-stage disease (82.4%). In the follow-up study, patients with an elevated c-erbB-2 level had a significantly shorter interval to disease progression than did those with a normal level.

CONCLUSIONS: The results suggest that c-erbB-2 can be used as a biomarker to identify a malignant subgroup in prostate cancer.

Role of m1 receptor-G protein coupling in cell proliferation in the prostate.

Luthin GR; Wang P; Zhou H; Dhanasekaran D; Ruggieri MR
Allegheny University, Department of Physiology and Biophysics, Philadelphia, PA 19102, USA.
Life Sci (England) 1997, 60 (13-14) p963-8

The prostate gland from several animal species contains variable levels of muscarinic subtypes, but only the human prostate expresses significant levels of the m1 subtype. We studied muscarinic receptor activity in human benign prostatic hypertrophy (BPH) as well as several cell lines derived from prostate cancer. The BPH we studied expresses approximately 75% of the m1 receptor and undetectable levels of the other receptor subtypes whereas PC3 cells express only the m3 receptor subtype. DU145 and LnCaP cells express approximately equal levels of m1 and m3 receptor subtypes. Only the PC3 cells responded to carbachol with an increase in turnover of polyphosphoinositides, and none of the cell lines responded with effects on cAMP metabolism. Co-precipitation of receptors with heterotrimeric guanine nucleotide-binding regulatory proteins demonstrated interactions of the m1 receptors with Gi, Gq and G16 in BPH tissue and of the m1 and m3 receptors with Gi, Gq and G12 in PC3 and DU145 cells. Mitogen activated protein kinase (ERK) activity was seen in response to carbachol in PC3 and DU145 but not LnCaP cells. Finally, carbachol promoted cell proliferation in all three cell lines. Thus, there appears to be no consistent relationship between ERK activity, cell proliferation, and the subtype mediating the proliferative response, amongst these prostate cancer cell lines.

Transurethral prostatectomy--new trends.

Churchill JA
Northern Kentucky University, Highland Heights, USA.
Geriatr Nurs (United States) Mar-Apr 1997, 18 (2) p78-80

Treatment for benign prostatic hypertrophy has changed drastically within the past 3 years. Two new procedures-visual laser ablation of the prostate and transurethral electrovaporization prostatectomy, as well as improvements in the transurethral prostatectomy-have resulted in decreased recovery time and early discharge. Postoperative nursing observations for the visual laser ablation of the prostate and transurethral electrovaporization prostatectomy are quite different than for the transurethral prostatectomy. Discharge teaching has become extremely important because patients are now being discharged within 24 hours and most often with a Foley catheter. Patient response to the new procedures has been positive even though there are some disadvantages. (10 Refs.)

[Sabal serrulata extract in the management of symptoms of prostatic hypertrophy]

Kondas J; Philipp V; Dioszeghy G
Fovarosi Onkormanyzat Peterfy Sandor utcai Korhaz-Rendelointezet, Urologiai-sebeszeti Osztaly, Budapest.
Orv Hetil (Hungary) Feb 16 1997, 138 (7) p419-21

The effectiveness of Sabal serrulata (dwarf palm) extract was evaluated in the treatment of 38 patients with symptomatic prostatic hyperplasia. During a 12-month treatment controlled by investigations the subjective symptoms decreased in nearly three fourth of the patients. Side effects were not observed. According to uroflowmetric investigations the average peak flow value increased from 10.36 ml/sec to 14.44 ml/sec (p < 0.0001) and the average mean flow value from 0.02 ml/sec to 7.45 ml/sec (p < 0.001). After treatment residual urine volume decreased or was nil in more than 9/10 of the cases. The average decrease of residue was 47 ml (p < 0.001). The average decrease in prostatic volume was 10.6% (p < 0.02). On the basis of their favorable experience the authors recommend the administration of Sabal serrulata extract in the treatment of patients with mild or moderate symptoms of prostatic hyperplasia.

[Comparative effects of transurethral incision (TUIP) and the combination of TUIP and LHRH agonists in the treatment of benign prostatic hypertrophy]

Di Silverio F; D'Eramo G; Flammia GP; De Vico A; Casale P; Sciarra A
Service d'Urologie U. Bracci, Universite La Sapienza, V. Le Policlino, Rome, Italie.
J Urol (Paris) (France) 1996, 102 (3) p111-6

Between December 1991 and December 1993, 74 BPH patients with an increased operative risk and concomitant diseases such as diabetes mellitus and hypertension were submitted to a transurethral incision of the prostate (TUIP). After TUIP, patients were randomized to two different groups: group 1 was followed without additional treatment and group 2 received an LHRH analogue for the first 6 months of follow-up. With respect to transurethral resection of the prostate (TURP), TUIP has been shown to demonstrate a lower perioperative morbidity. This advantage has lent further support to this technique as a valid alternative for patients in poor general conditions who are at high risk with more invasive procedures. One of the limits of TUIP is the long-term effectiveness. Aim of this study was to ascertain whether in patients with BPH and an increased operative risk who require immediate and definitive treatment but with a low perioperative morbidity, the long-term effectiveness of TUIP can be stabilized by the administration of an LHRH analogue. At present postoperative follow-up ranges from a minimum of 24 months to a maximum 48 months (mean 38.4 months). Perioperative morbidity rate associated with TUIP was 8.1%. In the group randomized to combination therapy (TUIP + LHRH analogue), the clinical condition of the patients was not modified by LHRH analogue treatment and none of the patients withdrew from treatment. Loss of sexual potency occurred in all patients on LHRH analogue, however, none of these patients discontinued treatment for this reason. At the end of the cycle of hormone treatment, sexual potency returned to pretreatment values in 69.5% of patients after a mean of 3.2 months. In this study the objective efficacy of the treatment was evaluated using flow rate measurements, and the subjective assessment of outcomes, using the International Prostate Symptom Score. Statistically significant differences between the two groups (TUIP alone or TUIP + LHRH analogue) (p < 0.01) were reported at 6 months and were still maintained at 24 months of follow up. Results emerging from this investigation confirm that TUIP may be considered extremely safe procedure with low operative risk. In selected BPH patients who are at high risk, with a more invasive procedure and who must be submitted to immediate and definitive treatment, the association of an LHRH analogue seems to increase the long-term effectiveness of TUIP. Five year follow-up studies are still in progress.

Immunochemical detection of 5 alpha-reductase in human serum.

Lombardo ME; Hudson PB
Urology Section/Surgical Service, Department of Veterans Affairs Medical Center, Bay Pines, Florida 33504, USA.
Steroids (United States) Nov 1996, 61 (11) p651-6

This study represents a continuing effort to find a new biomarker for the diagnosis and management of prostatic cancer. Polyclonal antibodies were prepared to a peptide (CAKP) representing amino acids 28 to 43 of the 5 alpha-reductase type 2 isozyme. Using immunoaffinity-purified antibodies, the sera of 62 patients were examined by Western blot following polyacrylamide gel electrophoresis. A positive band was detected in the sera of several patients at 42 kDa compatible with the purified native glycosylated 5 alpha-reductase type 2. These bands were nullified on coincubation of the antibody with the CAKP peptide. Analysis by high-performance liquid chromatography and amino acid sequencing by N-terminal Edman degradation of the immunoaffinity-purified antigen to the antipeptide antibodies of a patient with adenocarcinoma of the prostate suggests that the 5 alpha-reductase type 2 isozyme may be linked to an immunoglobulin. An identical immunoaffinity-purified antigen to the CAKP peptide was isolated from a section of prostatic tissue from a different patient showing benign prostatic hypertrophy with severe dysplasia. It is suggested that an immunological response to the 5 alpha-reductase type 2 isozyme was elicited in both instances.

Nd:YAG laser transurethral evaporation of the prostate (TUEP) for urinary retention.

Fournier GR Jr; Tewari A; Induhara R; Gajenderan V; Narayan P
Department of Veterans Affairs, Division of Urology, San Francisco, California 94121, USA.
Lasers Surg Med (United States) 1996, 19 (4) p480-6

BACKGROUND AND OBJECTIVE: Little information is available regarding the effectiveness of laser prostatectomy in patients with urinary retention from benign prostatic hyperplasia since there is no paper specifically dealing with laser prostatectomy in patients in urinary retention.

STUDY DESIGN/MATERIALS AND METHODS: Twenty two unselected consecutive patients presenting with urinary retention due to benign prostatic hypertrophy underwent transurethral evaporation of the prostate (TUEP) using a neodymium:YAG laser and total internally reflecting side-firing free beam quartz fiber. All patients failed at least one voiding trial and averaged > 30 days of urinary catheter drainage preoperatively. A contact evaporation technique was used to evaporate a "TURP-like" channel in the prostatic fossa by means of a series of parallel evaporation troughs.

RESULTS: Eighteen of 22 patients completed 6 months of follow up. Two patients were lost to follow up and two failed TUEP. The average AUA score dropped from 26 to 9 at 1 month and to 3.4 by 6 months postoperatively. All patients who successfully underwent TUEP were urinating spontaneously by 10 days. Average time to catheter removal was 3.5 days. Maximal uroflow was 15.7 ml/sec at 1 month and 20.3 ml/sec by 6 months. Postvoid residual preoperatively averaged 784 ml and decreased to 76 ml by 1 month. Pre- and postoperative hematocrit and serum sodium values did not vary by more than 5%.

CONCLUSION: From this preliminary series we conclude that aggressive evaporation of prostatic tissue is feasible endoscopically and provides a reliable method of near bloodless removal of tissue.

Possible mechanisms of action of transurethral needle ablation of the prostate on benign prostatic hyperplasia symptoms: a neurohistochemical study

Zlotta AR; Raviv G; Peny MO; Noel JC; Haot J; Schulman CC
Department of Urology, Erasme University Hospital, Brussels, Belgium.
J Urol (United States) Mar 1997, 157 (3) p894-9

PURPOSE: Transurethral needle ablation of benign prostatic hypertrophy (BPH) is a rapid, anesthesia-free outpatient procedure using low level radiofrequency energy that produces coagulative necrosis lesions at temperatures of approximately 100C. Clinically, significant improvement in objective and subjective parameters has been observed in BPH patients. Transurethral needle ablation has also been shown to be effective in relieving urinary retention. However, the precise mechanism of action of this procedure remains to be clarified. Ablation could produce its action on the dynamic component of the infravesical outlet obstruction. We analyzed the possible effects of transurethral needle ablation on the intraprostatic innervation.

MATERIALS AND METHODS: Histological sections from 10 open prostatectomy specimens (BPH) recovered 1 to 46 days after transurethral needle ablation were stained with hematoxylin and eosin and an immunohistochemical technique, using antibodies against S100 proteins and nonspecific enolase as specific nerve markers, and against anti-prostate specific antigen and anti-desmin for glandular and muscle cells, respectively. We used 5 BPH specimens as controls.

RESULTS: Microscopic examination of the treated areas showed necrotic lesions affecting epithelial and smooth muscle cells in the transition zone at a depth of 0.3 to 1.0 cm, from the preserved urethra. Nerve fibers in the control specimens and untreated prostatic areas were predominant in the urethral submucosal layer and in the stroma surrounding the epithelial nodules. No staining of any axon or isolated nerve cell was observed in any specimen treated by transurethral needle ablation, and there was a sharp and clear delineation between treated and untreated areas.

CONCLUSIONS: Our study demonstrated severe thermal damage to intraprostatic nerve fibers caused by transurethral needle ablation. A long-term denervation of alpha-receptors and/or sensory nerves could explain the clinical effects of transurethral needle ablation of the prostate. Theoretically, the best location to produce necrotic lesions should include submucosal and subcapsular nerve endings. Differences in the distribution of the adrenoreceptors and morphometry of the prostate transition zone could partly explain differences in clinical outcome observed after transurethral needle ablation of the prostate.

Histopathologic evaluation of the canine prostate following electrovaporization

Benjamin DS; Oberg KC; Saukel GW; Ruckle HC; Stewart SC
Loma Linda University School of Medicine, Department of Urology, California, USA.
J Urol (United States) Mar 1997, 157 (3) p1144-8

PURPOSE: Transurethral electrovaporization of the prostate (TVP) for symptomatic benign prostatic hypertrophy (BPH) has proven to be efficacious with minimal patient morbidity. When compared to transurethral resection of the prostate (TURP), TVP demonstrates comparable postoperative flow rates, American Urologic Association (AUA) symptom score indices, and a potential cost savings. However, in the human studies it has not been possible to correlate these clinical parameters with procedure-related histopathologic changes in the prostate immediately postoperative or during wound healing. The following study was done using a canine model in an effort to evaluate these histopathologic changes.

METHODS AND MATERIALS: Fifteen hounds (25-35 kg.) underwent antegrade electrovaporization of the prostate, via an open cystotomy, using a Circon ACMI USA series resectoscope and video equipment. The dogs were sacrificed and the prostates harvested at various intervals postoperatively (0-11 weeks). The prostates were evaluated grossly as well as histologically for cavitary defects, depth of necrosis, and cellular response.

RESULTS: Prostates examined immediately following the procedure demonstrated superficial necrosis (less than 2 mm.) in the region of vaporized tissue. One week postoperatively, the vaporized regions demonstrated an intense acute inflammation amidst superficial necrosis with focal hemorrhage and dystrophic calcification. Transient glandular cystic changes developed, but were resolving by seven weeks postoperatively. Re-epithelialization was underway by the third postoperative week and epithelial stratification underway by the fifth week. There was no extension of the initial two millimeter zone of necrosis at any time point examined.

CONCLUSION: TVP in the canine model vaporizes prostatic tissue at the site of contact. Only a shallow remnant of necrosis remains at the site of vaporization, indicating the highly localized effect of this technique. Healing at the site of vaporization occurs in a rapid and expected manner. These data provide a histopathologic rationale for the minimal morbidity and the efficacious nature of this technique demonstrated in clinical studies.

Transurethral vaporization of the prostate: a promising new technique.

Thomas KJ; Cornaby AJ; Hammadeh M; Philp T; Matthews PN
Department of Urology, University Hospital of Wales, Cardiff, UK.
Br J Urol (England) Feb 1997, 79 (2) p186-9

OBJECTIVE: To evaluate the efficacy and safety of transurethral electrovaporization of the prostate (TUVP), using a grooved roller electrode, for the surgical treatment of symptomatic benign prostatic hypertrophy (BPH).

PATIENTS AND METHODS: TUVP was carried out using a grooved roller electrode, pure-cutting diathermy and a standard irrigating resectoscope to rapidly heat prostatic tissue to > 100 degrees C, resulting in vaporization and cavitation of the prostatic adenoma. Over a 10 month period, 116 patients (mean age 69.8 years, range 51-93) with symptomatic BPH (confirmed by a symptom score, urinary flow rate and an ultrasonographic estimate of residual volume) were treated by TUVP. Patients with carcinoma of the prostate, an elevated level of prostate-specific antigen or those in chronic urinary retention were excluded from the study. Each patient was followed up every 4 months during the first post-operative year, assessing their flow rate, residual volume and symptom score.

RESULTS: Symptom scores improved by 67% and residual volumes by 72%; the mean maximal flow rate increased from 8.5 mL/s (range 3.5-14) before treatment to 20.5 mL/s (range 4.5-39.0) at the same 4 month review. The procedure was simple and safe, with a mean operative duration of 35 min (range 20-65), and no patients required a blood transfusion. Most patients had their catheters removed within 24 h and were discharged on the second day after treatment.

CONCLUSION: The effectiveness of TUVP in improving symptoms and flow rates in patients with BPH was established. With minimal capital expenditure and a reduced in-patient stay. TUVP appears to have several advantages over other surgical treatments for BPH, although continued follow-up is needed to establish the long-term results.

Early experience with high-intensity focused ultrasound for the treatment of benign prostatic hypertrophy.

Sullivan LD; McLoughlin MG; Goldenberg LG; Gleave ME; Marich KW
Department of Surgery, Vancouver Hospital.
Br J Urol (England) Feb 1997, 79 (2) p172-6

OBJECTIVE: To evaluate the safety and effectiveness of high-intensity focused ultrasound (HIFU) in patients with benign prostatic hypertrophy (BPH).

PATIENTS AND METHODS: The study comprised 25 patients (mean age 67 years: range 47-84) with BPH treated using the Sonoblate HIFU device. Patients were evaluated before and after one treatment of HIFU using the American Urological Association (AUA) symptom score, peak urinary flow rate (Qmax) and a quality-of-life (QOL) score, and any complications were noted.

RESULTS: Five patients with large glands were withdrawn because the failure rate was high in these patients. The remaining 20 patients showed a mean improvements in the AUA symptom score (20.25 to 9.56), Qmax (9.2 to 13.7 mL/s) and QOL score (4.75 to 2.50). There were no major complications.

CONCLUSIONS: HIFU is safe, produces minimal side-effects or complications and relieves the symptoms of prostatism.

Detection of bladder tumor by urine cytology in cases of prostatic hypertrophy.

Rammou-Kinia R; Anagnostopoulou I
Department of Cytology, Tzanio General Hospital, Piraeus, Greece.
Diagn Cytopathol (United States) Dec 1996, 15 (5) p409-11

Routine urine cytology has been performed for 809 male patients presenting with symptoms due to prostatic hypertrophy. In 6.42% of the cases, bladder tumor was revealed incidentally diagnosed by urine cytology. Cystoscopy and bladder biopsies were performed to confirm malignancy. The age of these patients ranged from 48-84 years (mean 65.2) and they complained mainly of irritative bladder symptoms. It is therefore strongly indicated that all patients with prostatic disease should have routine cytological examination of urine sediments.

Quantification and distribution of alpha 1-adrenoceptor subtype mRNAs in human prostate: comparison of benign hypertrophied tissue and non-hypertrophied tissue.

Nasu K; Moriyama N; Kawabe K; Tsujimoto G; Murai M; Tanaka T; Yano J
Molecular Biology Department, Nippon Shinyaku Co., Ltd., Kyoto, Japan.
Br J Pharmacol (England) Nov 1996, 119 (5) p797-803

1. There are at least three alpha 1-adrenoceptor subtypes, alpha 1a, alpha 1b and alpha 1d, in human tissues. Using an RNase protection assay, we have now determined the amount of each subtype mRNA in human prostatic tissue, for both benign prostatic hypertrophy (BPH) and non-BPH. In all tissue samples examined, the predominant subtype mRNA was alpha 1a. The total abundance of alpha 1-adrenoceptor mRNA in BPH samples was over six times that in non-BPH samples. This increase was mostly accounted for by alpha 1a, which was almost nine times as abundant in BPH samples as in non-BPH samples. The abundance of alpha 1b was almost the same between BPH and non-BPH samples, and the abundance of alpha 1d in BPH samples was about three times that in non-BPH samples. The ratio of the numbers of the subtype mRNAs, alpha 1a: alpha 1b: alpha 1d, was 85:1:14 in BPH samples and 63:6:31 in non-BPH samples.

2. In situ hybridization studies showed no significant differences in the tissue localization of alpha 1-adrenoceptor subtype mRNAs between BPH and non-BPH samples. alpha 1a and alpha 1d were clearly detected in the interstitium of the prostate, where alpha 1a was stained more intensely than alpha 1d, and the positive sites were primarily smooth muscle cells. In contrast, alpha 1b staining was very faint.

3. This increase in mRNA abundance may be directly related to the contraction of prostatic tissue that leads to obstruction of the urinary tract in BPH patients. Specifically, our data suggest that increased expression of the alpha 1a subtype may be primarily responsible for the contraction of the prostate.

Prostate-specific antigen and age. Is there a correlation? And why does it seem to vary?

Kirollos MM
Urology Department, South Devon Health Care Trust, Torquay, UK.
Eur Urol (Switzerland) 1996, 30 (3) p296-300

OBJECTIVES: To determine whether there is a significant correlation between age and prostate-specific antigen (PSA) and to explain the wide literature variations in its value.

METHODS: Two different groups were studied; the first (n = 403) consisted of patients undergoing prostatectomies for symptomatic benign prostatic hypertrophy (BPH) and the second (n = 192) of patients with no evidence of prostate cancer who required no treatment.

RESULTS: The correlation coefficient found in the surgical group was low (0.09) and was statistically insignificant while in the second group it was much higher (0.36) and had a high statistical significance (p < 0.001). This reflected the age difference between the two groups rather than the difference in clinical characteristics as proved by the gradual decrease in the value of the coefficient by the gradual exclusion of the younger age groups. The correlation became statistically insignificant for those older than 60 years.

CONCLUSIONS: It is concluded that the correlation between age and PSA is a variable one showing a gradual decline in its coefficient with the gradual increase in the age of the population studied. This implies a relatively orderly rise in PSA with age up to a limit of 60 years. Beyond this age, the relationship between age and PSA becomes disorderly. This pattern of relationship can easily be explained by the known rate of growth of BPH and would explain the literature variations.

Colocalization of immunoglobulin binding factor and prostate specific antigen in human prostate gland.

Maegawa M; Kamada M; Maeda N; Aono T; Izumi K; Kagawa S; Koide SS
Department of Obstetrics and Gynecology, School of Medicine, University of Tokushima, Japan.
Arch Androl (United States) Nov-Dec 1996, 37 (3) p149-54

Immunoglobulin binding factor (IgBF) produced in the prostate is a useful marker for the diagnosis of prostatic tumor. IgBF was localized in the majority of epithelial cells of benign prostatic hypertrophy by an immunohistochemical technique. Prostate specific antigen (PSA), a known marker for prostatic cancer, was localized to all epithelial cells. Double immunolabeling of IgBF and PSA using fluorescent methods revealed that all epithelial cells producing IgBF were also immunopositive for PSA and some cells were positive only for PSA. The present findings suggest that the prostatic glands consist of two types of epithelial cells, one producing both IgBF and PSA and the other producing PSA alone.

A study of the efficacy and safety of transurethral needle ablation (TUNA) treatment for benign prostatic hyperplasia.

Millard RJ; Harewood LM; Tamaddon K
New South Wales University, Sydney, Australia.
Neurourol Urodyn (United States) 1996, 15 (6) p619-28

The objective of this early phase III study was to determine the efficacy and safety of transurethral needle ablation (TUNA) in patients presenting in acute urinary retention due to benign prostatic hyperplasia (BPH). Between September 1993 and August 1994, 20 patients of mean age 68.8 years were entered into a two-center study and treated with TUNA after presenting in acute urinary retention and having failed at least one trial of voiding. A mean of 5.4 lesions at shield temperatures of 54.6 degrees C were produced. Patients were reviewed at 1, 3, 6, and 12 months (mean, 6.2 months). In 17 of 20 patients, voiding was reestablished in a mean of 2.6 days. Three patients required TURP for persistent retention, and 2 patients had delayed TURP for bothersome symptoms. Two voiders died later of unrelated causes. Five patients were lost to follow-up at 6 months but were voiding when last reviewed. Symptom scores decreased from a mean of 19.0 (range 4-35) to 8.25 (range 1-20) at 12 months (p = 0.06). Mean peak flow rate was 11.4 ml/sec (range 6.6-16.8) at 12 months (p = 0.001). Mean prostatic volume at baseline was 65.8 cc and decreased to 56 cc at 12 months (p = 0.111). The treatment was well tolerated by all patients, and side effects were mild, including urinary tract infection and epididymo-orchitis. This study demonstrates the safety and effectiveness of TUNA procedure in patients with urinary retention due to benign prostatic hypertrophy.

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