Management of Benign Prostatic Hypertrophy - part 1 pptx

Edited by Kevin T. McVary, MD Management of Benign Prostatic Hypertrophy Humana Press M ANAGEMENT OF B ENIGN P ROSTATIC H YPERTROPHY CURRENT CLINICAL UROLOGY Eric A. Klein, SERIES EDITOR Essential Urology: A Guide to Clinical Practice, edited by Jeannette M. Potts, 2004 Management of Benign Prostatic Hypertrophy, edited by Kevin T. McVary, 2004 Laparoscopic Urologic Oncology, edited by Jeffrey A. Cadeddu, 2004 Essential Urologic Laparoscopy: The Complete Clinical Guide, edited by Stephen Y. Nakada, 2003 Urologic Prostheses: The Complete Practical Guide to Devices, Their Implantation, and Patient Followup, edited by Culley C. Carson, III, 2002 Male Sexual Function: A Guide to Clinical Management, edited by John J. Mulcahy, 2001 Prostate Cancer Screening, edited by Ian M. Thompson, Martin I. Resnick, and Eric A. Klein, 2001 Bladder Cancer: Current Diagnosis and Treatment, edited by Michael J. Droller, 2001 Office Urology: The Clinician’s Guide, edited by Elroy D. Kursh and James C. Ulchaker, 2001 Voiding Dysfunction: Diagnosis and Treatment, edited by Rodney A. Appell, 2000 Management of Prostate Cancer, edited by Eric A. Klein, 2000 MANAGEMENT OF BENIGN PROSTATIC HYPERTROPHY Edited by KEVIN T. MCVARY, MD Northwestern University Feinberg School of Medicine, Chicago, IL HUMANA PRESS TOTOWA, NEW JERSEY © 2004 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8341, E-mail: humana@humanapr.com; or visit our Website: http://humanapr.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All articles, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Production Editor: Mark J. Breaugh. Cover design by Patricia F. Cleary. This publication is printed on acid-free paper. ∞ ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $25.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [1-58829-155-3/04 $25.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 E-ISBN: 1-59259-644-4 Library of Congress Cataloging-in-Publication Data Management of benign prostatic hypertrophy / edited by Kevin T. McVary. p. ; cm. (Current clinical urology) Includes bibliographical references and index. ISBN 1-58829-155-3 (alk. paper) 1. Benign prostatic hyperplasia. [DNLM: 1. Prostatic Hyperplasia therapy. 2. Bladder Diseases etiology. 3. Prostatic Hyperplasia complications. 4. Prostatic Hyperplasia diagnosis. WJ 752 M2673 2004] I. McVary, Kevin T. II. Series. RC899.M36 2004 616.6'5 dc21 2003007891 Preface v Benign prostatic hyperplasia (BPH) is the most common neoplastic con- dition afflicting men and constitutes a major health factor impacting patients in every part of the world. Bladder neck obstruction secondary to BPH can result in significant medical complications including renal fail- ure, urinary retention, recurrent urinary tract infection, bladder stones, sig- nificant hematuria, and marked and disruptive bladder symptoms. Current studies estimate that upwards of 30% of males will require some type of surgical or other significant intervention to correct this problem sometime in their lives. Because there is a major restructuring of the treatment algo- rithms used to manage this important clinical problem and because of new medications and advances in technology, a great need for Management of Benign Prostatic Hypertrophy has arisen. How best to approach patients is a common question posed by urologists. What is to be made of these newer therapies, and what are their roles vis- a-vis our more established treatments? Management of Benign Prostatic Hypertrophy is designed to address those needs for the practicing urologist who is often caught in the middle of these newer therapies and confused by the significant hype. Despite this clear need for interpretation of new data, a text that is not grounded in the principles and hallmarks of our specialty will offer little to budding urologists; rather, this text serves as a single source for quick reference on most aspects of this broad spectrum of BPH treatments. Management of Benign Prostatic Hypertrophy is divided into three main categories: (1) pathophysiology and natural history of BPH, (2) epidemi- ology: definitions and prevalence of the disease, and (3) the urodynamic evaluation of lower urinary tract symptoms. The first category is also but- tressed by a more current understanding and treatment of postobstructive diuresis, a significant medical complication and frequent source of uro- logic consultation. A second component of the text addresses medical thera- pies for BPH, namely α-adrenergic antagonists, 5α-reductase inhibitors, and their combination in the treatment of BPH. The most extensive portion of the text is an up-to-date, concise evaluation of each of the minimally invasive therapies as well as the time-tested surgical treatments. I think you will find Management of Benign Prostatic Hypertrophy concise, readable, and up-to-date. Kevin T. McVary, MD ` vii Preface v List of Contributors ix 1 Prostate Anatomy and Causative Theories, Pathophysiology, and Natural History of Benign Prostatic Hyperplasia 1 Jeffrey A. Stern, John M. Fitzpatrick, and Kevin T. McVary 2 The Definition of Benign Prostatic Hyperplasia: Epidemiology and Prevalence 21 Glenn S. Gerber 3 Pathophysiology, Diagnosis, and Treatment of the Postobstructive Diuresis 35 Chris M. Gonzalez 4 Urodynamics and the Evaluation of Male Lower Urinary Tract Symptoms 47 J. Quentin Clemens 5 α-Adrenergic Antagonists in the Treatment of Benign Prostatic Hypertrophy-Associated Lower Urinary Tract Symptoms 61 Ross A. Rames and David C. Horger 65α-Reductase Inhibitors 79 Robert E. Brannigan and John T. Grayhack 7 Transurethral Needle Ablation of the Prostate 97 Timothy F. Donahue and Joseph A. Costa 8 Transurethral Microwave Thermotherapy 109 Jonathan N. Rubenstein and Kevin T. McVary 9 Transurethral Incision of the Prostate 125 Robert F. Donnell 10 Interstitial Laser Coagulation and High-Intensity Focused Ultrasound for the Treatment of Benign Prostatic Hyperplasia 141 Christopher M. Dixon 11 Transurethral Resection of the Prostate 163 Harris E. Foster, Jr. and Micah Jacobs 12 Transurethral Vaporization of the Prostate 195 Joe O. Littlejohn, Young M. Kang, and Steven A. Kaplan Contents viii Contents 13 Treatment of Benign Prostatic Hyperplasia with Ethanol Injections, Water-Induced Thermotherapy, and Prostatic Urethral Luminal Stents 211 Jay Y. Gillenwater 14 Suprapubic Transvesical Prostatectomy and Simple Perineal Prostatectomy for the Treatment of Benign Prostatic Hyperplasia 221 James M. Kozlowski, Norm D. Smith, and John T. Grayhack Index 263 Contributors ix ROBERT E. BRANNIGAN, MD • Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL J. Q UENTIN CLEMENS, MD, MSCI • Section of Voiding Dysfunction and Female Urology, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL J OSEPH A. COSTA, DO • Department of Urology, National Naval Medical Center; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD C HRISTOPHER M. DIXON, MD • Division of Urology, New York University School of Medicine, New York, NY T IMOTHY F. DONAHUE, MD • Department of Urology, National Naval Medical Center; Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD R OBERT F. DONNELL, MD, FACS • Prostate Center, Clinical Trials (Urology), The Medical College of Wisconsin, Milwaukee, WI J OHN M. FITZPATRICK, MD • Department of Surgery, Mater Misericordiae Hospital; University College of Dublin, Dublin, Ireland H ARRIS E. FOSTER, JR., MD • Section of Urology, Yale University School of Medicine, New Haven, CT G LENN S. GERBER, MD • Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL J AY Y. GILLENWATER, MD • Department of Urology, University of Virginia Health Sciences Center, Charlottesville, VA C HRIS M. GONZALEZ, MD • Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL J OHN T. GRAYHACK, MD • Section of Urologic Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL D AVID C. HORGER, MD • Department of Urology, Medical University of South Carolina, Charleston, SC M ICAH JACOBS, BA • Yale University School of Medicine, New Haven, CT Y OUNG M. KANG, MD • Department of Urology, College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital, New York, NY [...]... benign prostatic hyperplasia/ total no (%) No with benign prostatic hyperplasia/ total no (%) No with benign prostatic hyperplasia/ total no (%) 1 10 11 –20 21 30 31 40 41 50 51 60 61 70 71 80 81 >90 0 /11 (0) 0/ 21 (0) 0/37 (0) 7/38 (18 ) 6 /19 ( 31) 9 /17 (53) 7 /12 (58) 3/4 (75) 2/2 (10 0) 0 /16 (0) 0 /13 (0) 0/ 21 (0) 0/ 31 (0) 2/28 (7) 11 /33 (33) 23/33 (69) 14 /17 (82) Totals 34 /16 50 /19 2 4/6 (67) 21/ 38 (5)... 0 /1 (0) 0/4 (0) 0/8 (0) 3 /18 (17 ) 16 /38 (42) 40/54 (74) 57/70 ( 81) 16 /19 (84) 0/24 (0) 1/ 28 (4) 7/23 (30) 24/65 (37) 52/77 (67) 43/63 (68) 18 /24 (75) 16 5/206 13 2/ 212 14 5/304 Prevalence of human benign prostatic hyperplasia No with benign prostatic hyperplasia/ total no (%) 0/27 (0) 0/35 (0) 0/86 (0) 8 /10 5 (8) 22/94 (23) 81/ 1 91 (42) 17 1/242 ( 71) 18 1/2 21 (82) 65/74 (88) % Mean ± standard and error of. .. Mosby, 19 91, pp 12 11 12 76 13 Franks LM Atrophy and hyperplasia in the prostate proper J Pathol Bacteriol 19 54a;68: 617 –6 21 14 Franks LM Benign prostatic hyperplasia: gross and microscopic anatomy In: Grayhack JT, Wilson JD, Scherbenske MJ, eds., Benign Prostatic Hyperplasia: NIAMDD Workshop Proceedings, Feb 2 0-2 1, 19 75 US Department of Health, Education, and Welfare publication no (NIH) 7 6 -1 11 3, 19 76,... 63 15 McNeal JE Developmental and comparative anatomy of the prostate In: Grayhack JT, Wilson JD, Scherbenske MJ, eds., Benign Prostatic Hyperplasia, NIAMDD Workshop Proceedings, Feb 20– 21, 19 75 US Department of Health, Education, and Welfare publication no (NIH) 7 6 -1 11 3, 19 76, pp 1 10 16 Tisell LE, Salander H The lobes of the human prostate Scand J Urol Nephrol 19 75;9 :18 5 19 1 17 McNeal J Pathology of. .. and risk factors Prostate 19 89;suppl 2:23– 31 27 Berry SJ, Coffey DS, Walsh PC, et al The development of human benign prostatic hyperplasia with age J Urol 19 84 ;13 2:474–479 28 Girman CJ Population-based studies of the epidemiology of benign prostatic hyperplasia Br J Urol 19 98;suppl 1: 34–44 29 Lytton B, Emery JM, Harvard BW The incidence of benign prostatic obstruction J Urol 19 68;99:639–645 ... urinary bladder Am J Anat 19 12 ;13 :299–349 9 Lowsley OS The gross anatomy of the human prostate gland and contiguous structures Surg Gynecol Obstet 19 15;20 :18 3 19 2 10 Aumuller G Prostate Gland and Seminal Vesicles New York: Springer-Verlag, 19 79 11 Xia TG, Blackburn WR, Gardner WA Jr Fetal prostate growth and development Pediatr Pathol 19 90 ;10 :527–537 12 Grayhack JT, Kozlowski JM Benign prostatic hyperplasia... 0 8 23 42 71 82 88 ± ± ± ± ± ± ± ± ± Chapter 1 / Prostate Anatomy Table 1 Prevalence of Pathologic BPH with Age in 10 75 Human Prostates Collected at Autopsy 0 0 0 8.5 30.4 9.7 7.2 11 .1 10.9 528 /10 75 11 12 Stern et al area proximal to the verumontanum Although descriptions of the ductal and glandular structure of this area vary, it is generally agreed that BPH arises from an inner set of prostatic ducts... 17 McNeal J Pathology of benign prostatic hyperplasia: insight into etiology Urol Clin N Am 19 90 ;17 :477–486 18 Mostofi FK, Price EB Tumors of the male genital system In: Atlas Tumor Pathology, series 2, fascicle 8 Washington, DC, Armed Forces Institute of Pathology, 19 73, pp 19 6– 219 19 Manley CB Jr The striated muscle of the prostate J Urol 19 66;95:234–240 20 Swyer GI Post-natal growth changes in the... not a unique stromal process Prostate 19 97;33 :17 7 18 2 23 Morgagni GB The Seats and Causes of Disease Investigated by Anatomy, book 3, London: Johnson & Paine, 17 60, p 460 24 Randall A Surgical Pathology of Prostatic Obstruction, Baltimore, MD: Williams & Wilkins Co, 19 31 25 Isaacs JT, Coffey DS Etiology and disease process of benign prostatic hyperplasia Prostate 19 89;suppl 2:33–50 26 Ekman P BPH epidemiology... degree of development of mass-producing BPH Natural History of Anatomic BPH The first pathologic evidence of BPH occurs in less than 10 % of men in the 3 1- to 40-yr-old group (Table 1) Thus, either the initiating factor is present in most men of this age and only clinically evident in a few, or young men with recognizable BPH have a discrepancy between physiologic and chronologic aging Evidence of histologic . in the United States of America. 10 9 8 7 6 5 4 3 2 1 E-ISBN: 1- 5 925 9-6 4 4-4 Library of Congress Cataloging-in-Publication Data Management of benign prostatic hypertrophy / edited by Kevin T index. ISBN 1- 5 882 9 -1 5 5-3 (alk. paper) 1. Benign prostatic hyperplasia. [DNLM: 1. Prostatic Hyperplasia therapy. 2. Bladder Diseases etiology. 3. Prostatic Hyperplasia complications. 4. Prostatic. Donnell 10 Interstitial Laser Coagulation and High-Intensity Focused Ultrasound for the Treatment of Benign Prostatic Hyperplasia 14 1 Christopher M. Dixon 11 Transurethral Resection of the Prostate 16 3 Harris