Cases reported "Prostatic Hyperplasia"

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1/15. fluorescence in situ hybridization to assess transitional changes of aneuploidy for chromosomes 7, 8, 10, 12, 16, X and Y in metastatic prostate cancer following anti-androgen therapy.

    There have been few detailed studies conducted on the cell population in relation to cytogenetic changes between the pre- and post-treatment periods in patients with prostate cancer. We investigated numerical chromosome changes associated with anti-androgen therapy, using fluorescence in situ hybridization (FISH). FISH using chromosome-specific centromeric probes was used to assess transitional changes in the frequency of aneuploidy for chromosomes 7, 8, 10, 12, 16, X, and Y in prostate cancer during the pre- and post-treatment periods. Gains of chromosomes 7, 8 and 12 were notable in the pre-treatment samples (8 out of 9 cases in chromosome 7; 8 out of 9 cases in chromosome 8; 7 out of 9 cases in chromosome 12), while a notable reduction in the number of cells with extra copies of these chromosomes was observed in post-treatment specimens. Other chromosomes did not show noticeable change in their FISH signals at each phase of clinical treatment in all 9 cases. Changes in cell number with high ploidies of chromosome 7, 8 and 12 reflect the clinical effects of anti-androgen therapy at the early phase, which might explain the androgen dependency of metastatic prostate cancer cells.
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2/15. Transurethral microwave therapy of the prostate.

    Benign prostatic hypertrophy (BPH) is a medical condition causing obstructive urinary symptoms that will inevitably affect the majority of the male population. Treatments for BPH have traditionally included invasive surgical intervention to resect a portion of the prostate as a relief of obstructive symptoms or medications that act in several ways to open the urinary channel and relieve symptoms. A new, less invasive treatment for BPH has now been developed and approved. Transurethral microwave therapy is discussed in this article. A case study is presented.
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3/15. Virtual reality as an adjunctive pain control during transurethral microwave thermotherapy.

    The management of pain during clinic transurethral microwave thermotherapy (TUMT) can be challenging. pain can lead to increased pelvic blood flow, which dissipates the energy delivered, limiting the amount of heat delivered to the prostate. In this report, we describe the novel use of virtual reality distraction as an adjunctive mechanism for local anesthesia during TUMT in a 67-year-old man. This report is novel in being, to our knowledge, the first to demonstrate the efficacy of virtual reality in an elderly patient and the first documented use for a urologic clinic procedure. We believe it is also the first to demonstrate efficacy for the control of thermally induced pain.
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4/15. Self-management in lower urinary tract symptoms: the next major therapeutic revolution.

    The standard treatments for men with lower urinary tract symptoms (LUTS) range from watchful waiting to medical and finally surgical intervention. However, the role of self-management interventions such as education and reassurance, lifestyle modification and behavioural changes has not been formally investigated, although they are widely advocated and utilised for LUTS. Self-management interventions are well established in other chronic diseases such as diabetes, arthritis and asthma. These interventions, if successfully organised within a structured program for LUTS, could improve patient outcomes as well as reduce the economic burden of LUTS treatment, by replacing or augmenting other treatments. Recent studies showing that long-term urodynamic and symptomatic deterioration of LUTS is minimal suggest that this is a safe and valid treatment option. This is supported by a recent pilot study of a LUTS self-management program which showed significant improvements in I-PSS and frequency-volume parameters. The results of a recently completed randomised controlled trial are awaited.
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5/15. Interstitial temperature measurements during transurethral microwave hyperthermia.

    Microwave hyperthermia is presently being investigated as a treatment for alleviating the symptoms of urinary outlet obstruction associated with benign prostatic hyperplasia. Two clinical techniques using intracavitary microwave applicators are being evaluated for safety and efficacy at various institutions. The transrectal technique uses a directional microwave radiator that is inserted into the rectum adjacent to the prostate. The transurethral approach uses a symmetrically radiating applicator located within the prostatic urethra. Transrectal prostatic heating techniques require surface cooling to prevent hazardous temperatures in the intervening rectal mucosa. Since transurethral applicators radiate from within the prostatic urethra, heating is confined to the obstructive tissue immediately surrounding the applicator. Concern has been expressed regarding the possibility of thermal injury to the prostate and adjacent rectum during transurethral hyperthermia treatment. In this report we present interstitial temperature measurements of prostatic and rectal temperatures in 5 patients. temperature was observed to decrease at a rate of about 6C/cm. outward from the applicator. No clinically significant temperature increase was observed beyond 1 cm, outside the prostatic capsule or in the rectal mucosa.
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6/15. Sclerosing adenosis of the prostate.

    A 76-year-old man with frequency, dysuria, and urinary incontinence underwent a transurethral resection of the prostate. On microscopic examination, three prostatic chips had a proliferation of irregular crowded acini, small nests, and single cells within a cellular stroma, which created an infiltrative pattern that was though by some observers to represent carcinoma. The acini were lined by columnar, and focally, by basal (myoepithelial) cells; the latter were more clearly demonstrated with immunoperoxidase stains for cytokeratin and S100 protein. In our opinion, the lesion represents a rare variant of benign prostatic hyperplasia analogous to sclerosing adenosis of the breast.
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7/15. Effect of a GnRH analogue (leuprolide) on benign prostatic hypertrophy.

    To determine the effects of reversible medical castration on prostatic size in patients with benign prostatic hypertrophy (BPH), 3 patients with BPH were treated with a GnRH analogue, leuprolide, for six months at a dosage of .2ml (1 mg) s.c. daily. serum testosterone, dihydrotestosterone and estradiol fell to castration levels 4-6 weeks after the initiation of treatment and remained low throughout the study period. Transrectal ultrasonography of the prostate demonstrated an average decrease in prostatic volume of 58% at 6 months, with the greatest rate of decrease occurring during the 2nd to 5th months of treatment. One man who had acute urinary retention before treatment was subsequently able to void extremely well. In a second man the symptoms of prostatism diminished but in the third urinary frequency and nocturia persisted in spite of a reduction in prostatic size, presumably because his symptoms were due to renal insufficiency.
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8/15. Steroid abuse in athletes, prostatic enlargement and bladder outflow obstruction--is there a relationship?

    OBJECTIVE: To evaluate the effects of exogenous androgenic-anabolic steroids on the human prostate gland. SUBJECT AND methods: A white male athlete, who was routinely using anabolic steroids, volunteered for the study. He was studied during a 15-week period of steroid self-administration. Both objective and subjective parameters were measured, including: prostatic volume (transrectal ultrasound), digital rectal examination, urine flow rate, serum acid phosphatase and prostate specific antigen, symptom scoring for bladder outflow obstruction and other associated symptoms. RESULTS: During the period of steroid self-administration, prostatic volume increased and urine flow rate decreased. The man also noticed an increase in nocturnal urinary frequency, libido and aggression. CONCLUSION: In this pilot study, the administration of exogenous androgenic-anabolic steroids has been demonstrated to have profound effects on the human prostate gland, including an increase in prostatic volume, reduction in urine flow rate and an alteration in voiding patterns. These findings warrant further investigation.
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9/15. Benign prostatic hyperplasia: diagnosis and treatment options.

    BPH is a complex condition effecting millions of adult male patients. The pathophysiology is a complex interrelated sequence of events involving stromal and epithelial growth changes. Within the past 20 years, major pharmacologic advances have been made that allow reversal of some of the hyperplastic changes and, thereby, improve patients voiding patterns. With this increase in medical options, there has also come an onslaught of other interventions, such as laser, prostatic stents, balloon dilators, and microwave hyperthermia--some of these have shown promise in the early clinical trials. As with all of these treatment options, further long term assessment must be scientifically proven to be of significant benefit to the patient. Would the patient be better off with observation or a TURP?
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keywords = microwave
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10/15. Managing patients with benign prostatic hyperplasia.

    Benign prostatic hyperplasia is the usual cause of prostatism--irritative and obstructive urinary symptoms. Steps in making the diagnosis include a focused neurologic examination, urinalysis, serum creatinine determination and, possibly, catheterization to detect urinary retention. It is difficult to predict the likelihood of future complications, such as complete urinary obstruction, even for patients with severe symptoms. The natural course of prostatism is a waxing and waning of symptoms. Treatment options are watchful waiting, medication, transurethral prostatectomy, and newer surgical treatments such as microwave thermopathy and laser ablation. The family physician can counsel patients about the potential side effects of these treatments as well as the problems incurred by simply adjusting to the disabilities associated with benign prostatic hyperplasia.
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