Category Archives: BPH

The diagnosis and treatment of benign prostatic hypertrophy

Saw palmetto vitamin

Our large practice urology group has partnered with theralogix, a vitamin company to offer patients products that have been shown in study to help with various conditions.

Prostate SR is a pharmaceutical-grade saw palmetto extract and phytosterol blend (beta-sitosterol), designed to promote normal urinary tract function in men.

You can find more information and ordered it through:

Prostate SR Saw palmetto extract

My PRC number for a discount is: 58143

 

Endoscopic simple prostatectomy – Abstract

Endoscopic simple prostatectomy – Abstract.

This review looked at minimally invasive treatments for patients that have urinary obstruction from very large patients.

Traditionally open surgery was done since procedures done through the natural urinary opening often did not have goo long term results.

Laparoscopic adenomectomy (LA) and robotic-assisted simple prostatectomy (RASP) have been performed for about 10 years.  I started performing these operations in 2005 and have one of the worlds largest experiences in removing the middle part of the prostate robotically.  I disagree that the learning curve is short.  It is important to be in the correct plane in the prostate which is often more difficult to find with robotic or laparoscopic surgery than traditional open surgery.

Most of my patients are able to go home the day after surgery when I perform this operation robotically.

 

Radical Prostatectomy May Prevent LUTS Progression – Renal and Urology News

A prospective study of 1,788 men who underwent RP found that men who had clinically significant LUTS preoperatively experienced a decline in LUTS severity and remained stable over a 10-year interval, researchers reported. Prior studies have shown a progressive increase in LUTS for aging men with an intact prostate.

via Radical Prostatectomy May Prevent LUTS Progression – Renal and Urology News.

One of the areas that is affected after prostatectomy is urinary function. Men are counseled that there will be urinary leakage (incontinence) after surgery.

I have been telling men for over 10 years that their urinary stream will improve and bothersome urinary symptoms of frequency and a slow stream would be improved in the long term. This study followed men for 10 years and showed that men have less urinary problems compared to men who never had prostate problems. The reason for this is that men have an enlarging prostate as they get older. This causes a smaller opening for the bladder to empty through. Once the entire prostate is removed, there is a benefit of not having the prostate and resultant obstruction.

FDA committee votes down 5-ARIs for prostate cancer risk reduction – – UrologyTimes

“Although the REDUCE trial demonstrated a risk reduction in a large number of men, the committee chose to focus on a small number of high-grade cancers and determined that this class of drugs is inappropriate for prostate cancer risk reduction, even in the population of men with elevated PSA and previous negative biopsy,” added Dr. Gomella, a co-investigator of the REDUCE trial. “This decision will certainly reduce the enthusiasm for further large-scale, long-term studies of any prostate cancer chemoprevention or risk-reduction strategy.”

via FDA committee votes down 5-ARIs for prostate cancer risk reduction – – UrologyTimes.

This was a disappointing study for me.  Medications such as avodart and proscar have been shown to reduce the risk of prostate cancer.  Early studies revealing a higher percentage of high grade cancers have existed.  These studies were based on biopsy specimens only, which often understage cancer.

Other studies that looked at patients who had removal of the prostate have not revealed a higher incidence of high grade cancers in patients on these medicines.

I will inform patients that the FDA did not approve the indication of prostate cancer reduction for avodart and proscar (finasteride).  I think may patients will still opt for the medication.  Patients with large prostates will also have the benefit of a reduction in BPH symptoms.

 

Testosterone and prostate size

Testosterone makes prostates grow larger and makes prostate cancer grow more quickly.
I came across a study that looks at prostate size and testosterone levels:

clipped from www.urotoday.com

Relationship between Serum Testosterone and Measures of Benign Prostatic Hyperplasia in Aging Men – Abstract

In our study, the serum testosterone levels in aging men did not correlate with the measures of BPH, including prostate volume and IPSS, regardless of whether total, free, or bioavailable testosterone was used. Age correlated with the measures of BPH, especially prostate volume. Additional large studies are needed to confirm these preliminary results.

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To my surprise, patients with higher testosterone levels did not have larger prostates. As expected, patients with higher PSAs and older patients had larger prostates.

Laparoscopy for BPH therapy

Lap technique may play a role in treating BPH – UrologyTimes

Berlin—A laparoscopic preperitoneal approach cannot only serve as a teaching platform for laparoscopic skills for surgeons, but it also demonstrates reproducible outcomes in the treatment of BPH, according to Belgian researchers who presented their results at the European Association of Urology annual congress here.
Researchers from the Institut Jules Bordet, Universite Libre de Bruxelles in Brussels, conducted a 102-patient prospective study comparing a classical open Millin’s retropubic transcapsular adenectomy in 51 patients and a laparoscopic preperitoneal approach in 52 patients according to a step-by-step transposition of Millin’s procedure described in European Urology (2004; 45:103-9).
Preoperative characteristics were comparable between the groups with respect to age, prostate volume measured by trans-rectal ultrasonography, preoperative micturition, post-void residual volume, and International Prostate Symptom Score (IPSS).

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Robotic stories for BPH- Robotic Simple Prostatectomy

I am starting a new blog series where patients can discuss their stories.
Please understand that anyone can view this and as always patient outcomes can be different.
The thoughts shared on this web site are not in any way meant to represent the surgeons, but are a way for people to share their experiences and hopefully help others.
Posts may be edited at the discretion of the moderator or deleted.
This site does not deal with direct medical advice, but rather general principles. All patients should seek advice from their own physicians.
I will leave this entry open for stories about robotic surgery for BPH.