Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia: From Research to Bedside

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Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia: From Research to Bedside
Copyright
Contents
Contributors
Preface
Chapter 1: Epidemiology of LUTS and BPH
Economic Impact of BPH and LUTS
Risk Factors for BPH Development
Age
Genetics
Sex Steroid Hormones
Metabolic Syndrome
Cardiovascular Disease
Obesity
Diabetes and Alterations in Glucose Homeostasis
Lipids
Physical Activity
Alcohol
Smoking
Inflammation
Race
References
Chapter 2: Pathologic Triggers Related to LUTS and BPH
Introduction
Etiology
Hyperplasia
Role of Inflammation
Prostatic Immune Cells and Inflammation
BPH and Prostatic Inflammation
Clinical Evidence
Molecular Pathways
Hormonal Pathways
Metabolic Syndrome, Inflammation, and BPH
Inflammation and BPH Progression
Biomarkers of Prostatic Inflammation
References
Further Reading
Chapter 3: The Relationship Between Inflammation and LUTS/BPH
Introduction
Pathophysiology
The Immunochemical Pattern of BPH
The Inflammatory Pattern of BPH
The Origin of Chronic Prostate Inflammation
The Role of Inflammatory Cytokines
Chronic Inflammation and LUTS
Prostate Inflammation and BPH Progression
Prostate Inflammation and LUTS Deterioration
Prostate Inflammation and Acute Urinary Retention
Diagnostic Methods for Chronic Prostate Inflammation
The Role of Biomarkers
Concurrent Prostate Calcifications
Medical History of Chronic Urinary Tract Infections
Metabolic Syndrome-A More Recent Trend in the Etiology of LUTS/BPH. The Connection With Prostatic Inflammation
Prostate Inflammation and Its Impact on LUTS Medication
Conclusions
References
Further Reading
Chapter 4: Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Erectile Dysfunction
Anatomy and Physiology of Erectile Dysfunction
Epidemiology and Risk Factors of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Erectile Dysfunction
Age
Sedentary Lifestyle and Lack of Exercise
Cigarette Smoking
Excessive Alcohol Intake
Depression
Hypertension and Cardiovascular Disease
Hyperlipidemia
Type 2 Diabetes Mellitus
Obesity/Waist Circumference
Hypogonadism
Genetic Predisposition
Pathophysiology of LUTS/BPH and ED
Etiology and Clinical Aspects of LUTS/BPH and ED
Second-Line Evaluation
Treatment of LUTS/BPH and ED
Education and Lifestyle Modifications
Phosphodiesterase Type 5 Inhibitors
Tadalafil
Efficacy of Action of PDE5I Monotherapy in ED-LUTS/BPH
Combined Therapy With α-Adrenergic Antagonists and PDE5i
Other PDE5I Therapies (Not Approved by Current Guidelines for ED-LUTS/BPH)
Sildenafil
Vardenafil
Avanafil
Mirodenafil
Udenafil
Effects of Drugs Used for LUTS on Erectile Function
Conclusive Remarks
References
Chapter 5: Metabolic Syndrome and LUTS/BPH
Introduction
Metabolic Syndrome: Definition and Prevalence
MetS and BPH: Preclinical Evidences and Pathophysiology
MetS and LUTS/BPE: The Role of Inflammation
Prostate Size and Shape: The Influence of MetS
The Correlation Between MetS and LUTS
Diet and Lifestyle in Men With MetS and LUTS Due to BPE
Basis for Medical Treatment in Men With MetS and LUTS/BPE
The Impact of MetS on the Outcomes of BPH Surgery
Conclusions
References
Chapter 6: Diagnostic Work-up of LUTS/BPH: From Standard to New Perspectives
Introduction
Diagnostic Workup of LUTS/BPH
Standard Diagnostic Tests
History
Symptom Questionnaires
Frequency Volume Charts and Bladder Diaries
Physical Examination and Digital-Rectal Examination
Urinalysis
Blood Analysis
PVR Urine
Uroflowmetry
Imaging
Urethro-Cystoscopy
Computer-Urodynamic Investigation
New Diagnostic Perspectives
Ultrasound Measurement of IPP
Ultrasound Measurement of DWT
References
Further Reading
Chapter 7: Phytotherapy in Benign Prostatic Hyperplasia
Introduction
Serenoa Repens
Mechanism of Action
Variability of Products and Extraction Techniques
Clinical Studies
Safety Profile
Conclusion
Pygenum Africanum
Mechanism of Action
Clinical Studies
Safety Profile
Conclusion
Urtica Dioica
Mechanism of Action
Clinical Studies
Safety Profile
Conclusion
Cucurbita Pepo
Mechanism of Action
Clinical Studies
Safety Profile
Hypoxis Rooperi
Mechanism of Action
Clinical Studies
Safety Profile and Conclusion
Rye Grass Pollen
Mechanism of Action
Clinical Studies
Safety Profile and Conclusion
Conclusion
References
Chapter 8: Medical Aspects of the Treatment of LUTS/BPH: Alpha-Blockers
Introduction
Pathophysiology and Mechanisms of Action of Alpha-Blockers in BPH
Pathophysiology of LUTS/BPH/BPO: Reviewing Alpha-Adrenoreceptors as a Valuable Therapeutic Target
Potential Action of Alpha-Blockers on BPO
Potential Effects of Alpha-Blockers on Storage Symptoms and Bladder Function
Potential Effects of Alpha-Blockers on Nocturia
Types of Alpha-Adrenergic Blockers: Family Members
Efficacy
Global Efficacy on LUTS (IPSS), Quality of Life, and Placebo Effect
Effects on BPO (Qmax, Urodynamics, and Postvoid Residuals)
Efficacy on the Long Term and Treatment Adherence
Intermittent Treatment
Dose Adjustments
Safety and Tolerability
Clinical Use
General Indications/Single Therapy
Associations
Conclusion
References
Chapter 9: Medical Aspects of the Treatment of Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: 5-Alpha Reducta ...
Mechanism of Action
Testosterone and Dihydrotestosterone
5-Alpha Reductase Enzyme Family
Rationale for 5-Alpha Reductase Inhibition in BPH
5-Alpha Reductase Inhibitors
Finasteride
Dutasteride
5-ARI for the Treatment of BPH
Indications for Treatment of BPH With 5-ARI
Clinical Effects of BPH Treatment With 5-ARI
Finasteride Versus Dutasteride for the Treatment of BPH
Sexual Side Effects of 5-Alpha Reductase Inhibitor Use
Combination Therapy With 5-ARI and Alpha-1 Adrenergic Receptor Blockers for the Treatment of BPH
5-ARI for Hematuria and Bleeding During Transurethral Resection of the Prostate in Men With BPH
5-ARI for the Prevention and Treatment of Prostate Cancer
5-Alpha Reductase Inhibition for the Prevention of Prostate Cancer
5-Alpha Reductase Inhibition for the Treatment of Prostate Cancer
References
Chapter 10: Medical Aspects of the Treatment of LUTS/BPH: Antimuscarinic and β3-Agonists
Keypoints
Introduction
Antimuscarinics
Mechanism of Action
Efficacy
Adverse Events
β3-Agonists
Mechanism of Action
Efficacy
Adverse Events
Conclusions
References
Chapter 11: Medical Aspects of the Treatment of LUTS/BPH: Combination Therapies
Introduction
AB+5ARI
Anticholinergic Agents and AB
Tolterodine and AB
Solifenacin Succinate and AB
Fesoterodine and AB
β3-Adrenoreceptor Agonist Mirabegron and AB
Phosphodiesterase-Type-5 Inhibitors and 5ARI or AB
Plant Extracts/Phytotherapy and Other Agents
References
Chapter 12: Surgical Management of LUTS/BPH: TURP vs. Open Prostatectomy
History of Surgical Treatment for Benign Prostatic Hyperplasia (BPH)
Pathophysiology of BPH
Epidemiology and Socioeconomic Burden of Surgical Treatment for BPH
Factors Affecting Choice of Surgery Type
Prostate Size
Surgeon Preference and Hospital Setting
Patient Age
Prostatectomy
Simple Prostatectomy
Robot-Assisted Laparoscopic Approaches
TUR of the Prostate
Monopolar TURP
Bipolar TURP
Outcomes
Symptoms
Dysuria
Urgency
IPSS Improvement
Quality of Life
Physiological Measures
Peak Flow Rate Improvement
Residual Urinary Volume Reduction
Perioperative Outcomes
Bleeding
Resected Prostate Weight
Postoperative Fever
Time to Catheter Removal
Hospital Stay and Return Time to Work
Urinary Tract Infection
Epididymitis
Retreatment Rate
Re-operation
Adverse Events
Incontinence
Impotence
Bladder Neck Contracture
TUR Syndrome
Conclusion
References
Chapter 13: Surgical Treatment for LUTS/BPH: Laser Devices
Introduction
Lasers Typically Used for Vaporization
GreenLight Laser
Diode Lasers
Lasers Typically Used for Resection/Enucleation
Thulium Lasers
Holmium:YAG Lasers
Enucleation for BPO: Techniques and Results
Holmium Laser Enucleation of the Prostate
Principles of Surgical Technique
Results
Complications
Thulium Laser Enucleation of the Prostate (ThuLEP)
Principles of Surgical Technique
Results
Complications
Greenlight Laser Enucleation of the Prostate (GreenLEP)
Principles of Surgical Technique
Results
Complications
Learning Curve
Diode Laser Enucleation of the Prostate (DiLEP)
Principles of Surgical Technique
Results
Complications
Learning Curve
Eraser Laser Enucleation of the Prostate (ELEP)
Principles of Surgical Technique
Results
Complications
Laser Ablation for Benign Prostatic Enlargement: Techniques and Results
Holmium Laser Ablation of the Prostate
Thulium Laser Vaporization of the Prostate (ThuVAP)
Diode Laser Vaporization of the Prostate
Greenlight: PVP
Surgical Technique
Results
Complications and Durability
References
Chapter 14: Surgical Management of LUTS/BPH: New Mini-Invasive Techniques
Introduction
New Concepts and Objectives
Improvement Required With Surgical Ablative Techniques
Balancing Efficacy and Morbidity
Pharmacological or Standard Surgical Treatment as Comparator
A Validated Mini-Invasive Technique: UroLift Implants
Technique
Evaluation
Further Questions
An Experimental Mini-Invasive Technique: Prostatic Arteries Embolization
Procedure
Initial Prospective Cohorts
Comparative Randomized Trials
Perspectives
Botulinum NeuroToxin Type A (BoNT-A)
Conclusions
References
Index
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