Benign prostatic hyperplasia: A review of its histogenesis and natural history

Öesterling, Joseph E.

doi:10.1002/(sici)1097-0045(1996)6+<67::aid-pros13>3.3.co;2-e

Cited by 40 publications

(36 citation statements)

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“…Numerous studies have reported a high prevalence of BPH, which affects ≈ 40% of men aged > 50 years [2], with differences between countries [3], and its relationship with age [4]. Two types of treatment coexist, pharmacotherapy and surgery; the increased availability of effective contemporary pharmacotherapy has led to a substantial decrease in the use of surgery [5].…”

Section: Introductionsupporting

confidence: 87%

Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries

Fourcade¹,

Théret²,

Taïeb³

2008

BJU International

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OBJECTIVETo describe the profile and management of patients medically treated for benign prostatic hyperplasia (BPH) in primary care in four European countries, as the diagnosis and management of BPH have developed dramatically in the last decade, and recent information from actual practice is insufficient.PATIENTS AND METHODSThis observational, cross‐sectional study was carried out by general practitioners in France (141 patients), Spain (127) and Portugal (50), and by office‐based urologists in Germany (162 patients) between July 2005 and June 2006. The physicians were unaware of the study sponsor. Patients aged ≥50 years were recruited if a decision for medical treatment of BPH was taken for the first time on that day. The patient and the investigator had to complete one questionnaire each.RESULTSThe physicians included 480 patients, with a mean (sd) age of 65.0 (7.8) years. The mean (sd) International Prostate Symptom Score (IPSS) was 16.0 (7.3). There were geographical differences in age (P = 0.009; patients in Germany being the youngest), IPSS (P = 0.017; patients in Spain having the highest score), quality of life (QoL; IPSS item 8, P < 0.001, the least altered being in Germany), and sexual activity (P = 0.010; the highest proportion of sexually active patients being in Portugal), but not for comorbidities and concomitant medication. The IPSS correlated poorly with age (r = 0.21) and moderately with QoL (r = 0.47). Severe symptoms (IPSS > 19) were not linked with sexual activity (age‐adjusted P = 0.378). Serum prostate specific antigen testing, although not recommended for BPH, was widely used (83.8% overall). All other examinations were carried out disparately depending on the country (P < 0.001 each). Digital rectal examination (DRE) and excluding urinary tract infection (urine culture) were used in ≈75% of study patients, but only half the patients in France had a urine culture, and 52% in Portugal had a DRE. A standardized assessment of symptoms and/or QoL was reported in 45% of study patients, with wide discrepancies among countries, i.e. 77.2% in Germany and 6.0% in Portugal. α‐blocker monotherapy was the most frequently prescribed treatment (62.5% overall, 87.1% in Germany, 46.1% in France), followed by phytotherapy (23.5%), and 5α‐reductase inhibitor monotherapy (3.75%); combinations were rare. Treatment varied according to the severity of the symptoms (P = 0.008), phytotherapy being given to patients with the lowest IPSS, and combinations to those with the highest IPSS.CONCLUSIONThere were geographical discrepancies that could be attributed to either different cultural habits or merely organisational differences, e.g. the presence of office urologists in Germany or diverse modes of access to phytotherapy (prescription vs ‘over the counter’) in the various countries.

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Section: Introductionsupporting

confidence: 87%

Profile and management of patients treated for the first time for lower urinary tract symptoms/benign prostatic hyperplasia in four European countries

Fourcade¹,

Théret²,

Taïeb³

2008

BJU International

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“…In addition, 5a-reductase inhibitors have been shown to reduce the development of acute urinary retention or man the estimated lifetime chance of requiring therapy is 40% [2]. The treatment goal in the vast majority of need for surgery in men with moderate BPH symptoms who have enlarged prostates [6].…”

Section: Introductionmentioning

confidence: 99%

β‐sitosterol for the treatment of benign prostatic hyperplasia:

Wilt¹,

1999

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Objectives To conduct a systematic review of the eviInternational Prostate Symptom Score (IPSS), the weighted mean diCerence (WMD) against placebo was dence for the eBcacy of b-sitosterol in men with symptomatic benign prostatic hyperplasia (BPH).−4.9 IPSS points (95% confidence interval, CI,−6.3 to−3.5). The WMD for peak urinary flow rate was Methods Studies were identified through Medline@ (1966-98), EMBASE@, Phytodok, the Cochrane 3.91 mL/s (95% CI 0.91 to 6.90, four studies) and for residual volume the WMD was −28.62 mL (95% Library, bibliographies of identified trials and review articles, and contact with study authors and pharma-CI−41.42 to−15.83, four studies). b-sitosterol did not reduce prostate size. The trial using pure ceutical companies. Randomized trials were included if: men had symptomatic BPH; plant extract prepb-sitosterol-b-d-glucoside (WA184) showed no improvement in urinary flow measures. Withdrawal arations contained b-sitosterols; a control group received placebo or a pharmacological therapy; and rates for men assigned to b-sitosterol and placebo were 7.8% and 8.0% (not significant), respectively. treatment duration was Á30 days. Study characteristics, demographic information, enrolment criteria Conclusion b-sitosterol improves urological symptoms and flow measures. However, the existing studies are and outcomes were extracted. Results Four trials comprising a total of 519 men met limited by short treatment duration and lack of standardized b-sitosterol preparations. Their long-term the inclusion criteria. All were double-blind and lasted 4-26 weeks. Three studies used nonglucosidic beCectiveness, safety and ability to prevent the complications of BPH are unknown. sitosterols and one used a preparation that contained only b-sitosterol-b-d-glucoside. Compared with plaKeywords b-sitosterol therapy, plant extracts, benign prostatic hyperplasia (BPH), meta-analysis cebo, b-sitosterol improved urinary symptom scores and flow measures. For the two studies reporting the complications resulting from prostatic obstruction, has

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“…The exact etiology of BPH is unknown, however the similarity between BPH and the embryonic morphogenesis of the prostate has led to hypothesis that BPH may result from a reawakening of embryonic induction process in adulthood (Oesterling 1996;McVary 2006).…”

Section: Bph Physiopathology Disease Progression and Renal Failurementioning

confidence: 99%