A higher level of prostaglandin E2 in the urinary bladder in young boys and boys with lower urinary tract obstruction.
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We conducted two studies to examine the hypothesis that lower urinary tract obstruction induces excessive production of prostaglandin E2 (PGE2) in the bladder in young boys, with consequent overactive bladder (OAB) symptoms. The subjects were boys aged less than 15 years old who were scheduled to undergo surgery in our department from October 2006 to March 2008. In study 1 (n=25), the patients were divided into two groups based on the presence or absence of lower urinary tract obstruction. In study 2 (n=38), the patients were classified by age. The PGE2 level in the bladder was determined by washing with saline before the operation and urinary symptoms were evaluated using the Pediatric Lower Urinary Tract Scoring System. In study 1, the PGE2 level in the bladder of patients with lower urinary tract obstruction was higher than in those without obstruction (49.1+/-37.4 vs. 21.5+/-10.1 pg/mL, P=0.0475). In study 2, the PGE2 level in the bladder was negatively correlated with age (r=-0.379, P=0.0207). A higher level of PGE2 is found in boys with bladder outlet obstruction due to urethral stricture and in younger boys, and this elevated level of PGE2 may induce OAB symptoms. (+info)
Non-invasive parameters predicting bladder outlet obstruction in Korean men with lower urinary tract symptoms.
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The effect of alpha-blocker treatment on bladder hypoxia inducible factor-1 alpha regulation during lower urinary tract obstruction.
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AIMS: To determine whether alpha1-blocker treatment, in chronic bladder outlet obstruction (BOO), influences bladder tissue ischemia. MATERIALS AND METHODS: This prospective study included 60 patients with BOO, of which 40 were under alpha1-blocker medication and 20 without treatment. Patients underwent transurethral resection of the prostate (TURP) or suprapubic prostatectomy (SPP). Ten patients with non-muscle invasive bladder cancer underwent transurethral resection of the bladder tumor and served as the control group. Tissue specimens were immunohistochemically stained for hypoxia inducible factor-1alpha (HIF-1alpha). RESULTS: Bladder tissue from obstructed subjects showed high immunoreactivity to HIF-1alpha. The specimens from the control group, showed no or weak, mainly cytoplasmic immunoreactivity to HIF-1alpha. Patients under alpha -blocker treatment did not differ in the number of HIF-1alpha positive cells compared to subjects with no treatment (median number 86.8 [20-150] and 88.6 [0-175], respectively) (p > 0.05). The lowest bladder pressure at which HIF-1alpha was up regulated, was detected at detrusor pressure Qmax (PdetQmax) = 60 cm H2O. CONCLUSIONS: Treatment with alpha-blockers in obstructed patients considered as non-responders, does not result in HIF-1alpha down regulation, thus bladder continues to be under chronic stress. (+info)
The urologist's view of male overactive bladder: discrepancy between reality and belief in practical setting.
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Photoselective vaporization of the prostate in men with a history of chronic oral anti-coagulation.
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PURPOSE: A considerable percentage of patients with benign prostatic hyperplasia (BPH) also have additional cardiac pathologies, which often require anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of photoselective vaporization of the prostate (PVP) for BPH in cardiac patients receiving anticoagulant therapy. MATERIALS AND METHODS: A total of 67 patients suffering from BPH and high risk cardiac pathologies were operated on using laser prostatectomy. All patients had cardiac pathologies with bleeding disorders requiring anticoagulant use, and underwent standard urologic evaluation for BPH. Patients were treated with laser prostatectomy for relief of the obstruction using the KTP/532 laser energy at 80 W. RESULTS: The mean patient age was 71.4 years (range 55-80). Mean prostate volume on transrectal ultrasonography was 73.2 mL (range 44-120). Operation time ranged from 40 to 90 min, with an average value of 55 min. The average hospital stay was 48 hours (range 12-72) and the Foley catheters were removed within 48 hours, with a mean catheterization time of 34.2 +/- 5.9 hours (0-48). No patient required an additional procedure due to severe bleeding necessitating intervention during the early postoperative phase. Mean International symptoms scoring system (IPSS) values and post voiding residual volume decreased and peak urinary flow rate increased (p < 0.001). Our results showed that the mean prostate volume had decreased by 53% at 6 months. CONCLUSIONS: High-power photo selective laser vaporization prostatectomy is a feasible, safe, and effective alternative for the minimal invasive management of BPH, particularly in cardiac patients receiving anticoagulant therapy. (+info)