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The Significance of Age on Symptoms and Urodynamic and Cystoscopic Findings in Benign Prostatic Hypertrophy
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY
partment of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
1141
Relationship Between Echogram and Histology of Benign Prostatic Hyperplasia
New Engl. J. Med., 317: 599-604 (Sept. 3) 1987
Y. HASEGAWA AND J. KUMAZAWA, Department of Urology,
The authors examined the influence of androgens on benign prostatic hyperplasia using nafarelin acetate, a potent lutein izing hormone-releasing hormone agonist, to achieve reversible androgen deprivation in men with benign prostatic hyperplasia. Nine patients with bladder outlet obstruction owing to benign prostatic hyperplasia were treated with subcutaneous nafarelin acetate (400 µg. per day) in an open trial for 6 months. In all patients serum testosterone decreased to castrate levels. Objective observations included uroflowmetry, measurement ofresidual urine volume, determination of prostatic size by ultrasonography and prostatic biopsy. In all patients the prostate regressed to a mean (± standard error) of 75.8 ± 3 per cent of the initial size (range 52 to 86, p <0.005), with the regression reaching a plateau after 4 months. Morphological analysis of biopsy specimens showed regression of glandular epithelium. Of 9 patients 3 had clinical improvement with treatment. Plasma testosterone levels had returned to normal and the size of the prostate had increased to 99 ± 5.5 per cent of the initial size 6 months after the cessation of treatment. These findings suggest that androgens have an important supportive role in established benign prostatic hyperplasia and that testicular suppression will benefit some patients. However, this form of treatment could be applicable only in carefully selected patients who were not surgical candidates and it would need to be maintained indefinitely. G. P. M. 5 figures, 2 tables, 36 references
Eur. Urol., 13: 378-381 (Nov.-Dec.) 1987
The Significance of Age on Symptoms and Urodynamic and Cystoscopic Findings in Benign Prostatic Hypertrophy 0. SIMONSEN, B. M0LLER-MADSEN, T. D0RFLINGER, J. P. N0RGAARD, H. S. J0RGENSEN, AND E. LUNDHUS, Department of Surgery, Skanderborg Hospital; University Department of Surgery, Aarhus County Hospital; Department of Surgery, Randers Hospital; University Department of Urology, Aarhus Municipality Hospital and Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark Urol. Res., 15: 355-358 (Nov.) 1987 A total of 199 unselected patients underwent subtotal prostatectomy for benign prostatic hypertrophy. The patients were divided into 3 age groups: less than 65, 65 to 74 and greater than 74 years old. There was no significant difference in the estimated prostatic weight (by rectal examination or cystoscopy) in all 3 age groups. Urinary urgency, uninhibited detrusor contractions and bladder trabeculation increased with age. Maximum urine flow and obstructive voiding symptoms decreased with age. These findings suggest that there are agerelated changes in urodynamic findings and symptoms associated with benign prostatic hypertrophy. The authors suggest that age is an important factor in the interpretation of symptoms and urodynamic findings in patients with benign prostatic hypertrophy. D. K. M. 4 tables, 13 references
Faculty of Medicine, Kyushu University, Fukuoka, Japan The authors examined the relationship between echograms and histological findings of prostates involved in benign prostatic hyperplasia to explain the difficulty in distinguishing between internal and external glands in these patients. This constitutes an early study comparing such echograms and the histology of the prostate. Of 112 benign prostatic hyperplasia patients the authors could distinguish between the internal and external glands in 43 (38.4 per cent). The capsules between internal and external glands could be recognized as circular hypoechoic areas in the echograms. However, internal and external glands could not be distinguished in patients with heavy chronic inflammatory infiltrates found in the histological sections. The inside echo patterns also were irregular in these cases. This finding suggests that inflammatory changes have a major role in the difficulty of distinguishing between internal and external glands in these patients. In most cases of prostatic cancer the authors could not distinguish these glands because the membranes separating them were destroyed by tumor invasion. The authors summarize that except for prostatic cancer, the distinction between internal and external glands depends on the inflammatory changes of the prostate, especially in benign prostatic hyperplasia. The authors hope that their work will provide another tool to distinguish benign prostatic hyperplasia from prostatic cancer. W. W. H. 2 figures, 2 tables, 8 references
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Surgical Approach to Generalized Lymphadenopathy in Homosexual Men P. N. BENOTTI, R. L. JENKINS, B. CADY, C. O'HARA AND J. E. GROOPMAN, Harvard Medical School, New England Deaconess Hospital, Boston, Massachusetts J. Surg. Oncol., 36: 231-234 (Dec.) 1987 Because the surgeon often is consulted in the diagnostic evaluation of an individual at risk for the acquired immunodeficiency syndrome (AIDS) with generalized lymphadenopathy, lymph node biopsy is performed in an effort to evaluate the patient for ongoing infectious or neoplastic diseases. A total of 60 men with generalized lymphadenopathy underwent outpatient excisional biopsy of nodes in 2 distinct lymph node areas. All men were positive for antibody to human Tlymphotropic virus type III using the enzyme-linked immunosorbent, western blot or membrane immunofluorescence assays. Absolute decreases in helper OKT4 cells and in the T helperto-T suppressor (OKT4/0KT8) ratio were present in all patients. All lymph node biopsies showed reactive follicular hyperplasia with an increase in germinal centers. Postoperative complications consisted of an easily drained seroma in 2 patients and a temporary accessory nerve palsy in 1. In no instance did the result of a second simultaneous biopsy provide additional clinical information. All procedures were done with appropriate precautions using biohazard safety recommenda-
partment of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
1141
Relationship Between Echogram and Histology of Benign Prostatic Hyperplasia
New Engl. J. Med., 317: 599-604 (Sept. 3) 1987
Y. HASEGAWA AND J. KUMAZAWA, Department of Urology,
The authors examined the influence of androgens on benign prostatic hyperplasia using nafarelin acetate, a potent lutein izing hormone-releasing hormone agonist, to achieve reversible androgen deprivation in men with benign prostatic hyperplasia. Nine patients with bladder outlet obstruction owing to benign prostatic hyperplasia were treated with subcutaneous nafarelin acetate (400 µg. per day) in an open trial for 6 months. In all patients serum testosterone decreased to castrate levels. Objective observations included uroflowmetry, measurement ofresidual urine volume, determination of prostatic size by ultrasonography and prostatic biopsy. In all patients the prostate regressed to a mean (± standard error) of 75.8 ± 3 per cent of the initial size (range 52 to 86, p <0.005), with the regression reaching a plateau after 4 months. Morphological analysis of biopsy specimens showed regression of glandular epithelium. Of 9 patients 3 had clinical improvement with treatment. Plasma testosterone levels had returned to normal and the size of the prostate had increased to 99 ± 5.5 per cent of the initial size 6 months after the cessation of treatment. These findings suggest that androgens have an important supportive role in established benign prostatic hyperplasia and that testicular suppression will benefit some patients. However, this form of treatment could be applicable only in carefully selected patients who were not surgical candidates and it would need to be maintained indefinitely. G. P. M. 5 figures, 2 tables, 36 references
Eur. Urol., 13: 378-381 (Nov.-Dec.) 1987
The Significance of Age on Symptoms and Urodynamic and Cystoscopic Findings in Benign Prostatic Hypertrophy 0. SIMONSEN, B. M0LLER-MADSEN, T. D0RFLINGER, J. P. N0RGAARD, H. S. J0RGENSEN, AND E. LUNDHUS, Department of Surgery, Skanderborg Hospital; University Department of Surgery, Aarhus County Hospital; Department of Surgery, Randers Hospital; University Department of Urology, Aarhus Municipality Hospital and Institute of Experimental Clinical Research, University of Aarhus, Aarhus, Denmark Urol. Res., 15: 355-358 (Nov.) 1987 A total of 199 unselected patients underwent subtotal prostatectomy for benign prostatic hypertrophy. The patients were divided into 3 age groups: less than 65, 65 to 74 and greater than 74 years old. There was no significant difference in the estimated prostatic weight (by rectal examination or cystoscopy) in all 3 age groups. Urinary urgency, uninhibited detrusor contractions and bladder trabeculation increased with age. Maximum urine flow and obstructive voiding symptoms decreased with age. These findings suggest that there are agerelated changes in urodynamic findings and symptoms associated with benign prostatic hypertrophy. The authors suggest that age is an important factor in the interpretation of symptoms and urodynamic findings in patients with benign prostatic hypertrophy. D. K. M. 4 tables, 13 references
Faculty of Medicine, Kyushu University, Fukuoka, Japan The authors examined the relationship between echograms and histological findings of prostates involved in benign prostatic hyperplasia to explain the difficulty in distinguishing between internal and external glands in these patients. This constitutes an early study comparing such echograms and the histology of the prostate. Of 112 benign prostatic hyperplasia patients the authors could distinguish between the internal and external glands in 43 (38.4 per cent). The capsules between internal and external glands could be recognized as circular hypoechoic areas in the echograms. However, internal and external glands could not be distinguished in patients with heavy chronic inflammatory infiltrates found in the histological sections. The inside echo patterns also were irregular in these cases. This finding suggests that inflammatory changes have a major role in the difficulty of distinguishing between internal and external glands in these patients. In most cases of prostatic cancer the authors could not distinguish these glands because the membranes separating them were destroyed by tumor invasion. The authors summarize that except for prostatic cancer, the distinction between internal and external glands depends on the inflammatory changes of the prostate, especially in benign prostatic hyperplasia. The authors hope that their work will provide another tool to distinguish benign prostatic hyperplasia from prostatic cancer. W. W. H. 2 figures, 2 tables, 8 references
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Surgical Approach to Generalized Lymphadenopathy in Homosexual Men P. N. BENOTTI, R. L. JENKINS, B. CADY, C. O'HARA AND J. E. GROOPMAN, Harvard Medical School, New England Deaconess Hospital, Boston, Massachusetts J. Surg. Oncol., 36: 231-234 (Dec.) 1987 Because the surgeon often is consulted in the diagnostic evaluation of an individual at risk for the acquired immunodeficiency syndrome (AIDS) with generalized lymphadenopathy, lymph node biopsy is performed in an effort to evaluate the patient for ongoing infectious or neoplastic diseases. A total of 60 men with generalized lymphadenopathy underwent outpatient excisional biopsy of nodes in 2 distinct lymph node areas. All men were positive for antibody to human Tlymphotropic virus type III using the enzyme-linked immunosorbent, western blot or membrane immunofluorescence assays. Absolute decreases in helper OKT4 cells and in the T helperto-T suppressor (OKT4/0KT8) ratio were present in all patients. All lymph node biopsies showed reactive follicular hyperplasia with an increase in germinal centers. Postoperative complications consisted of an easily drained seroma in 2 patients and a temporary accessory nerve palsy in 1. In no instance did the result of a second simultaneous biopsy provide additional clinical information. All procedures were done with appropriate precautions using biohazard safety recommenda-