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ABSTRACT: Intraprostatic injection therapy is a minimally invasive treatment of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia and could be a therapeutic alternative in increasingly older and co-morbid patients. Nowadays only botulinum neurotoxin A (BoNT/A), absolute ethanol, NX-1207 and PRX302 are of relevance but none of these substances has yet been authorized for treatment use (off-label use). There have been only three randomized, placebo-controlled trials (RCTs) for BoNT/A, whereas none exist for ethanol and the results of existing studies are inconsistent and without convincing proof of efficacy. NX-1207 is a protein with selective pro-apoptotic properties and non-inferiority compared to finasteride has been demonstrated. PRX302 is a modified proaerolysin that can be activated by prostate-specific antigen and is therefore (prostate) cell-specific. Safety and efficacy are well documented; however, intraprostatic injection therapy should presently only be performed in clinical trials, irrespective of the substance used.
Der Urologe 02/2013; · 0.50 Impact Factor
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ABSTRACT: Gynaecomastie is een goedaardige proliferatieve aandoe-ning van het borstweefsel bij mannen en dient te worden onderscheiden van een toegenomen hoeveelheid vetweefsel in de mannelijke borst zoals gezien wordt bij adipositas. Tijdens de puberteit treedt een tijdelijke gynaecomastie bij 40-65% van alle mannen op. 1 In de pathofysiologie van gynaecomastie staat een rela-tieve toename van vrije oestrogenen centraal. Ook wordt een verlaagde testosteron-oestrogeenratio beschreven bij pa-tiënten met gynaecomastie. 2 Bij 25% van de patiënten wordt geen oorzakelijke factor gevonden, bij 10-20% gaat het om een bijwerking van medicatie en bij de overige patiënten blijkt een ander onderliggend lijden de oorzaak. Dat is bij 3% een interstitiële tumor of een sertoli-of granulosaceltu-mor van de testis. 3 Bij ongeveer 2% van de patiënten met gynaecomastie wordt een leydigceltumor gevonden. Van deze tumoren is 10% maligne en 3% wordt bilateraal aangetroffen. 4 5 Onge-veer 80% van de patiënten met een leydigceltumor heeft hormonale afwijkingen in het serum, vooral verhoogde con-centraties van oestrogeen en oestradiol en een verlaagde concentratie van testosteron. Echter, de concentraties van de testistumormarkers β-humaanchoriongonadotrofine (β-HCG), α-foetoproteïne, lactaatdehydrogenase (LDH) en placentair alkalische fosfatase (PLAP) liggen altijd in het re-ferentiegebied. Sommige patiënten met een leydigceltumor hebben bij de initiële presentatie alleen een gynaecomastie; een scrotale tumor wordt soms pas na maanden echogra-fisch zichtbaar. 6 Bij mannen met fertiliteitsproblemen worden vaker testi-culaire afwijkingen gevonden dan in de algemene mannelij-ke populatie. 7 De meeste van die afwijkingen kunnen wor-den vastgesteld door middel van echografisch onderzoek. In dit artikel beschrijven wij een patiënt met gynaeco-mastie en verminderde spermakwaliteit bij wie de diagnose 'testistumor' pas laat werd gesteld.
Nederlands Tijdschrift voor Obstetrie & Gynaecologie. 02/2013;
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ABSTRACT: In some countries plant extracts have belonged to the most popular drugs for the treatment of the benign prostatic syndrome (BPS) for decades; however, only few of the large number of published studies meet the criteria of the WHO benign prostatic hyperplasia (BPH) consensus conference. The few placebo-controlled long-term (study period >6 months) studies suggest a positive effect of some extracts (saw palmetto fruit, β-sitosterol, urtica, rye grass and a saw palmetto/urtica combination) on lower urinary tract symptoms (LUTS), urinary flow rate, post-void residual volume but effects on prostate volume or prostate-specific antigen (PSA) were only inconsistently demonstrable. To date no study has proven an effect on disease progression, such as acute urinary retention or need for surgical interventions. Due to the controversial data various extraction techniques and compositions of various products, neither American, European, British nor German BPH guidelines recommend plant extracts for the indication BPS although some placebo-controlled trials provided encouraging data. Further prospective studies according to WHO standards are required to determine the role of plant extracts for the management of BPS. For the indication of prostate cancer (PCa) plant extracts have been evaluated for disease prevention and management of several tumor stages but none of these studies have provided convincing evidence that plant extracts are superior to placebo and none of the Pica guidelines have recommended their use.Based on current knowledge plant extracts can never supplement evidence-based PCa management and should be used only in addition to the standard treatment. There is no scientific evidence for the use of dietary supplementation with high doses of vitamins or selenium-containing products.
Der Urologe 11/2012; · 0.50 Impact Factor
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R. Berges,
K. Dreikorn,
K. Höfner,
S. Madersbacher,
M.C. Michel,
R. Muschter, M. Oelke,
O. Reich,
W. Rulf,
C. Tschuschke,
U. Tunn
Der Urologe 04/2012; 48(11):1356-1364. · 0.50 Impact Factor
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R. Berges,
K. Dreikorn,
K. Höfner,
S. Madersbacher,
M.C. Michel,
R. Muschter, M. Oelke,
O. Reich,
W. Rulf,
C. Tschuschke,
U. Tunn
Der Urologe 04/2012; 48(12):1503-1516. · 0.50 Impact Factor
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ABSTRACT: Die Mehrheit der Männer mit benignem Prostatasyndrom sucht ärztliche Hilfe aufgrund von Symptomen des unteren Harntraktes
(LUTS). Bei Abwesenheit von absoluten Operationsindikationen oder ausgeprägter Obstruktion (BPO) sowie bei Vorliegen von LUTS
mit Leidensdruck ist die medikamentöse Therapie eine der möglichen Therapieansätze. Phytopharmaka können bei milder bis moderater
Symptomatik eingesetzt werden. α-Blocker reduzieren schnell und effektiv LUTS und die symptomatische Progression. Bei Vorliegen
von Blasenspeichersymptomen ohne BPO und bei kleiner Prostata kann ein Anticholinergikum ebenfalls effektiv LUTS vermindern.
Der kombinierte Einsatz eines α-Blockers mit einem Anticholinergikum ist bei der Behandlung von LUTS effektiver als die Einzelsubstanzen.
5α-Reduktase-Inhibitoren können besonders bei größerer Prostata LUTS sowie die Wahrscheinlichkeit eines Harnverhalts bzw.
die Notwendigkeit einer Prostataoperation vermindern. Die Kombination von α-Blocker plus 5α-Reduktase-Inhibitor ist für die
Reduktion von LUTS und die Verhinderung der Krankheitsprogression effektiver als die Einzelsubstanzen.
The majority of men with benign prostatic hyperplasia (BPH) seek medical help because of lower urinary tract symptoms (LUTS).
Pharmacological treatment of BPH is indicated if the patient has no absolute indications for prostate surgery or benign prostatic
obstruction (BPO), but LUTS with a decrease of quality of life. Plant extracts can be prescribed in men with mild to moderate
symptoms. α-Blockers can quickly and effectively decrease LUTS and symptomatic disease progression. If patients have predominantly
bladder filling symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination
of an α-blocker plus a muscarinic receptor antagonist is more effective than single drugs used alone. Especially in men with
larger prostates, 5α-reductase inhibitors can decrease LUTS and the probability of acute urinary retention as well as need
for prostate surgery. The combination of α-blocker plus 5α-reductase inhibitor can reduce LUTS and disease progression more
effectively than single drugs.
Der Urologe 04/2012; 48(11):1365-1377. · 0.50 Impact Factor
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ABSTRACT: HintergrundKlinische Studien zeigten positive Effekte der Phosphodiesterase- (PDE-)5-Inhibitoren Sildenafil, Tadalafil und Vardenafil
auf die irritative Symptomatik des benigen Prostatasyndroms. Unklar ist bisher, ob diese Substanzen auf die glatte Muskulatur
in der Transitionalzone der Prostata und/oder auf den Detrusormuskel wirken. Das Ziel der Studie war die Darstellung der Expression
der PDE-Isoenzyme1, 4 und 5 in der Detrusormuskulatur und die Untersuchung der Effekte selektiver PDE-Inhibitoren auf die
muskarinerge Tension isolierter glatter Muskulatur des humanen Detrusors.
MethodenDie Darstellung der Expression von PDE-Isoenzymen erfolgte mit immunhistochemischen Methoden. Mit der Organbad-Technik wurden
die Effekte der PDE-Inhibitoren Vinpocetin, Rolipram, Sildenafil, Vardenafil und Tadalafil auf die durch Carbachol induzierte
tonische Kontraktion isolierter Streifenpräparate des Detrusors untersucht.
ErgebnisseImmunreaktionen gegen die PDE-Isoenzyme stellten sich ausschließlich in der glatten Muskulatur dar. Intensiven Signalen, die
spezifisch für die PDE4 und PDE5 waren, standen nur schwache Signale, welche die Expression der PDE1 zeigten, gegenüber. Die
muskarinerge Kontraktion isolierter Streifenpräparate der Detrusormuskulatur wurde lediglich durch supraphysiologische Konzentrationen
der PDE-Inhibitoren antagonisiert.
SchlussfolgerungDie Studie zeigt die Expression der PDE-Isoenzyme1, 4 und 5 im humanen Detrusor. Die relativ schwachen funktionellen Effekte
der PDE-Inhibitoren lässt jedoch nicht zwangsläufig auf eine Bedeutung der PDE-Isoenzyme1, 4 oder 5 in der Kontrolle der
Relaxation der Detrusormuskulatur schließen.
ObjectivesThe use of inhibitors of phosphodiesterase (PDE) isoenzymes 1 and 5 to treat overactive bladder has been suggested. To further
evaluate the significance of PDE isoenzymes in detrusor smooth muscle relaxation, we investigated the effects of selective
PDE inhibitors on the tension induced by carbachol of isolated human detrusor tissue. Using immunohistochemical methods, the
expression of PDE1, PDE4, and PDE5 in human detrusor was also investigated.
Material and MethodsThe expression of PDE1, PDE4, and PDE5 was evaluated by means of conventional immunohistochemistry (IHC). Using the organ
bath technique, the effects of the PDE inhibitors vinpocetine, rolipram, sildenafil, tadalafil, and vardenafil on the tension
induced by the muscarinic agonist carbachol (1µM) were investigated.
ResultsThe tension induced by carbachol was dose-dependently reversed by the PDE inhibitors; the maximum reversal of tension ranged
from 7% (tadalafil) to 34% (vardenafil). IHC revealed that the expression of PDE isoenzymes was limited to the smooth musculature
of the detrusor. While there was prominent expression of PDE4 and PDE5, immunoreactions indicating the presence of PDE1 were
less abundant.
ConclusionDespite the fact that inhibitors of PDE1, PDE4, and PDE5 exerted only a weak relaxant response on detrusor strips precontracted
by carbachol, our findings indicate that both the cAMP and cGMP pathways might be involved in the relaxation mechanism of
human detrusor smooth muscle.
Der Urologe 04/2012; 48(7):764-769. · 0.50 Impact Factor
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ABSTRACT: Histological benign prostatic hyperplasia (BPH) and the BPH disease are frequent, lead to a reduction of quality of life, are both progressive and potentially associated with complications in the lower and upper urinary tract. A PubMed/MEDLINE search was conducted for the years 1990 to 2011. This article summarizes known selective measures of primary and secondary disease prevention.Measures of primary disease prevention aim to inhibit histological BPH and the development of clinically relevant BPH. Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5α-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH. Selective measures of secondary prevention aim to inhibit disease progression and BPH-associated complications. The regular and long-term use of α1-blockers reduces lower urinary tract symptoms (LUTS) and inhibits symptomatic disease progression but cannot prevent BPH-associated complications (e.g. urinary retention or need for prostate surgery). 5α-Reductase inhibitors can reduce the probability of symptomatic disease progression, urinary retention or need for surgery but the combination of α1-blocker and 5α-reductase inhibitor is more efficacious than either monotherapy. Especially older men with enlarged prostates (>40 cm(3)) and elevated serum PSA concentration (>1.6 µg/l) profit from measures of secondary disease prevention.For primary disease prevention, data quality is low and early treatment with 5α-reductase inhibitors is not been approved. For secondary disease prevention, men with risk factors of disease progression should use a treatment containing 5α-reductase inhibitors. Despite several epidemiological and clinical investigations on BPH disease progression no official programme exists in Germany for disease prevention.
Der Urologe 09/2011; 50(10):1257-8, 1260-4. · 0.50 Impact Factor
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ABSTRACT: The clitoris contributes to the normal female sexual response cycle. A significance of cyclic guanosine monophosphate (GMP) has been assumed in the control of clitoral vascular smooth muscle. As only a few investigations on the physiology of the vascular and non-vascular clitoral tissue have been carried out, knowledge on the mechanisms controlling this particular female genital organ is still vague. It has been suggested that human clitoral corpus cavernosum smooth muscle is regulated by nitric oxide (NO)/cyclic GMP and related key enzymes, such as NO synthases (NOSs) and the phosphodiesterase type 5 (PDE5). The present study evaluated in the human clitoris, by means of immunohistochemistry, the expression and distribution of key enzymes of the cyclic GMP pathway, such as the endothelial NOS, PDE2, PDE11 and cyclic GMP-dependent protein kinase type I (cGKI) in relation to the PDE5. Immunohistochemistry revealed the presence of PDE2, PDE5 and cGKI in the smooth muscle wall of blood vessels transversing the supepithelial and stromal space. Immunosignals specific for PDE2 were also identified in interstitial-like cells located in the basal epithelial layer. Staining for PDE11A was observed in single nerve trunks located in the clitoral stroma. The results are in favor of a role of the cyclic GMP signaling in the control of clitoral blood flow. It seems likely that PDE2 and PDE11 are also involved in the mechanism of local (neuro)transmission in the clitoris.
International journal of impotence research 06/2011; 23(5):206-12. · 2.73 Impact Factor
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ABSTRACT: A re-evaluation of established tests and treatments has become necessary after publication of several new guidelines on BPH during the past two years. This article describes the latest developments concerning epidemiology, diagnosis, and treatment of BPH.
Diagnostic and treatment guidelines on BPH of the German, European, or North American urologists as well as UK doctors were reviewed according to key articles and latest modifications.
The only German epidemiological trial on BPH demonstrated that all components of the BPH disease (symptoms - prostate enlargement - bladder outlet obstruction) increase with ageing. 27 % of German men will have disease progression within the next 5 years. Risk factors for disease progression are: age, symptoms, prostate size, PSA, urinary flow rate, and postvoiding residual urine. Diagnosis aims to distinguish BPH from other diseases with similar symptoms, quantify the BPH components, and estimate the individual risk of disease progression. BPH is an exclusion diagnosis. Ultrasonic measurement of detrusor wall thickness at the anterior wall of bladders filled with ≥ 250 mL can securely detect bladder outlet obstruction if the value is ≥ 2 mm. Watchful waiting and lifestyle modifications are suitable for men with mild symptoms and low disease progression risk. All drugs used in BPH treatment reduce symptoms but have no influence on bladder outlet obstruction. α-blockers are first-line drugs and may be combined with muscarinic receptor antagonists or 5α-reductase inhibitors to further increase efficacy. Prostate surgery is indicated when drug treatment is insufficient, the patient develops complications in the upper or lower urinary tract (absolute indications), or has severe bladder outlet obstruction. Standard operations are TURP in small (≤ 80 mL) or open prostatectomy in large prostates (> 80 mL). Minimally invasive, alter-native surgeries may be considered in selected men and -offer advantages with regard to the risk of bleeding, duration of catheterisation, or maintenance of sexual function.
Current guidelines have integrated the latest knowledge and developments on BPH and are likely to improve assessment and treatment.
Aktuelle Urologie 05/2011; 42(3):167-78. · 0.27 Impact Factor
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ABSTRACT: Transurethral removal of prostatic tissue is the treatment choice for benign prostatic enlargement and benign prostatic obstruction. Urodynamic results are directly linked to the amount of removed tissue which, however, is directly associated with intra- and postoperative morbidity. Transurethral laser operations of the prostate offer the advantage of decreased bleeding complications and the possibility to treat patients with bleeding disorders or anticoagulative treatment. The aim of the article is to present a novel technique of complete transurethral removal of the transition zone (enucleation) with the support of the Thulium laser to combine complete anatomical enucleation and maximum urodynamic efficacy with minimal side-effects.
We present five distinct surgical steps for transurethral complete removal of the transition zone of the prostate (Thulium laser enucleation of the prostate, ThuLEP). Surgical steps are presented in chronological order with the help of intraoperative pictures. Laser energy of 70-90 W is only used for the incision at the verumontanum and bladder neck for removal of the middle lobe, whereas laser energy of 30 W was only used for coagulation of small vessel crossing the surgical capsule towards the transition zone and bladder neck for dissection of the lateral lobes. The lobes themselves are liberated by blunt dissection.
ThuLEP offers complete removal of the transition zone no matter what prostatic size. The techniques combine maximum efficacy with minimal side-effects. Clinical results comparing ThuLEP with open prostatectomy or transurethral resection are awaited.
World Journal of Urology 02/2010; 28(1):45-51. · 2.41 Impact Factor
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ABSTRACT: The majority of men with benign prostatic hyperplasia (BPH) seek medical help because of lower urinary tract symptoms (LUTS). Pharmacological treatment of BPH is indicated if the patient has no absolute indications for prostate surgery or benign prostatic obstruction (BPO), but LUTS with a decrease of quality of life. Plant extracts can be prescribed in men with mild to moderate symptoms. alpha-Blockers can quickly and effectively decrease LUTS and symptomatic disease progression. If patients have predominantly bladder filling symptoms and a small prostate, muscarinic receptor antagonists are a viable treatment option. The combination of an alpha-blocker plus a muscarinic receptor antagonist is more effective than single drugs used alone. Especially in men with larger prostates, 5alpha-reductase inhibitors can decrease LUTS and the probability of acute urinary retention as well as need for prostate surgery. The combination of alpha-blocker plus 5alpha-reductase inhibitor can reduce LUTS and disease progression more effectively than single drugs.
Der Urologe 10/2009; 48(11):1365-75; quiz 1376-7. · 0.50 Impact Factor
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R Berges,
K Dreikorn,
K Höfner,
S Madersbacher,
M C Michel,
R Muschter, M Oelke,
O Reich,
W Rulf,
C Tschuschke,
U Tunn
Der Urologe 09/2009; 48(12):1503-16. · 0.50 Impact Factor
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R Berges,
K Dreikorn,
K Höfner,
S Madersbacher,
M C Michel,
R Muschter, M Oelke,
O Reich,
W Rulf,
C Tschuschke,
U Tunn
Der Urologe 09/2009; 48(11):1356-60, 1362-4. · 0.50 Impact Factor
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ABSTRACT: Bladder outlet obstruction (BOO) is believed to be the major component of benign prostatic hyperplasia (BPH) that harms the urinary tract. Therefore, BOO relief is the primary treatment objective in patients with obstructive BPH. This systematic review aims to analyze urodynamic data of laser treatment modalities of the prostate in direct comparison with standard treatment (TURP or open prostatectomy). We systematically searched the literature for randomized-controlled trials (RCTs) of prostate laser treatments in which urodynamic results were compared to TURP or open prostatectomy. The literature search included articles that were published between January 1995 and January 2009. Thirty five RCTs were identified encompassing in total 3669 patients. Of all available laser treatments, only one RCT used pressure-flow data to compare the laser treatment of the prostate (holmium laser enucleation, HoLEP) with standard treatment. Improvement of maximum urinary flow rate (Q(max)) of free uroflowmetry was similar for contact laser ablation (CLAP) with Nd:YAG, interstitial laser coagulation with Nd:YAG, potassium potassium-titanyl-phosphate (KTP)/Nd: YAG hybrid treatment, and HoLEP. Qmax improvement was also similar for holmium laser ablation (HoLAP) with 60-80 Watts, holmium laser resection, and thulium laser resection but limited to only one study each. The laser hybrid therapy with CLAP/visual laser ablation of the prostate (VLAP)/Nd:YAG was inferior to TURP. VLAP and KTP showed inhomogeneous RESULTS: Most contemporary laser treatments modalities provide similar Qmax improvement compared to standard treatment. However, precise differences can only be determined by comparative computer urodynamic investigations. Therefore, new laser techniques (such as thulium laser vapoenucleation of the prostate) should be investigated by urodynamic studies in the future.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology 09/2009; 61(3):309-24.
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[hide abstract]
ABSTRACT: The use of inhibitors of phosphodiesterase (PDE) isoenzymes 1 and 5 to treat overactive bladder has been suggested. To further evaluate the significance of PDE isoenzymes in detrusor smooth muscle relaxation, we investigated the effects of selective PDE inhibitors on the tension induced by carbachol of isolated human detrusor tissue. Using immunohistochemical methods, the expression of PDE1, PDE4, and PDE5 in human detrusor was also investigated.
The expression of PDE1, PDE4, and PDE5 was evaluated by means of conventional immunohistochemistry (IHC). Using the organ bath technique, the effects of the PDE inhibitors vinpocetine, rolipram, sildenafil, tadalafil, and vardenafil on the tension induced by the muscarinic agonist carbachol (1 microM) were investigated.
The tension induced by carbachol was dose-dependently reversed by the PDE inhibitors; the maximum reversal of tension ranged from 7% (tadalafil) to 34% (vardenafil). IHC revealed that the expression of PDE isoenzymes was limited to the smooth musculature of the detrusor. While there was prominent expression of PDE4 and PDE5, immunoreactions indicating the presence of PDE1 were less abundant.
Despite the fact that inhibitors of PDE1, PDE4, and PDE5 exerted only a weak relaxant response on detrusor strips precontracted by carbachol, our findings indicate that both the cAMP and cGMP pathways might be involved in the relaxation mechanism of human detrusor smooth muscle.
Der Urologe 05/2009; 48(7):764-9. · 0.50 Impact Factor
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[hide abstract]
ABSTRACT: To improve the efficacy of medical treatment of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), studies on combination treatment with alpha(1)-blockers and 5alpha-reductase inhibitors, alpha(1)-blockers and muscarinic receptor antagonists, and alpha(1)-blockers and 5-phosphodiesterase inhibitors are increasingly performed. The most substantial data are available on the combination of alpha(1)-blockers and 5alpha-reductase inhibitors. This combination is not suitable for symptom improvement alone but for inhibition of progression. A combination therapy of alpha(1)-blockers and muscarinic receptor antagonists cannot be recommended as routine because of the still limited, although promising, data. Only preliminary data are available for the combination of alpha(1)-blockers and 5-phosphodiesterase inhibitors, which do not show convincing advantages over other combinations.
Der Urologe 03/2009; 48(3):250-6. · 0.50 Impact Factor
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ABSTRACT: Auf der Suche nach Optimierung der medikamentösen Therapie des BPS werden zunehmend Kombinationen von α1-Blockern mit 5α-Reduktasehemmern (5ARI), α1-Blockern mit Muskarinrezeptorantagonisten und α1-Blockern mit Phosphodiesterase-5- (PDE-5-)Hemmern getestet. Die umfangreichsten Daten sind für die Kombination von α1-Blockern mit 5ARI publiziert worden. Eine Kombinationsbehandlung mit einem α1-Blocker und 5α-Reduktasehemmer ist zur alleinigen Symptomreduktion nicht indiziert, allerdings zur Progressionshemmung des
BPS geeignet und hierbei der Monotherapie überlegen. Die routinemäßige Kombinationstherapie aus α1-Blocker und Muskarinrezeptorantagonisten zur Behandlung der Symptome des BPS kann zurzeit aufgrund der unzureichenden Datenlage
nicht empfohlen werden, auch wenn erste viel versprechende Ergebnisse vorliegen. Für die Kombinationstherapie aus α1-Blockern und Phosphodiesterase-5-Hemmern existieren nur erste vorläufige Daten, die überzeugende Vorteile gegenüber anderen
Kombinationen bisher nicht erkennen lassen.
To improve the efficacy of medical treatment of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic
hyperplasia (BPH), studies on combination treatment with α1-blockers and 5α-reductase inhibitors, α1-blockers and muscarinic receptor antagonists, and α1-blockers and 5-phosphodiesterase inhibitors are increasingly performed. The most substantial data are available on the combination
of α1-blockers and 5α-reductase inhibitors. This combination is not suitable for symptom improvement alone but for inhibition of
progression. A combination therapy of α1-blockers and muscarinic receptor antagonists cannot be recommended as routine because of the still limited, although promising,
data. Only preliminary data are available for the combination of α1-blockers and 5-phosphodiesterase inhibitors, which do not show convincing advantages over other combinations.
Der Urologe 02/2009; 48(3):250-256. · 0.50 Impact Factor
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ABSTRACT: In Germany, only duloxetine is registered for treating stress urinary incontinence in adult women; duloxetine treatment for stress urinary incontinence in children or men is poorly investigated and still off-label. Trials in women based on the evidence level 1B and meta-analyses have demonstrated that duloxetine significantly reduced the frequency of incontinence episodes and increased incontinence-related quality of life. However, duloxetine must be used on a regular base to maintain these positive effects. Therefore, duloxetine seems to be especially indicated in women who refuse or cannot be subjected to physical or surgical treatment and are willing to accept the long-term use and possible side effects of the drug. Furthermore, duloxetine could be useful in women to support pelvic floor physiotherapy or in female patients awaiting incontinence surgery.
Der Urologe 02/2009; 48(3):228-32. · 0.50 Impact Factor
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ABSTRACT: Expression of urocortin (Ucn), a 40-amino-acid neuropeptide, was demonstrated in the prostatic tissue of patients with benign prostatic hyperplasia (BPH). Ucn showed a significant role in the regulation of local inflammation, proliferation, and relaxation of smooth muscle tone in different organs through activation of corticotropin releasing factor receptor 2 (CRFR2). However, CRFR2 expression in human benign prostatic tissue remains unknown. Our study therefore aimed to investigate CRFR2 expression in prostatic tissue.
CRFR2 expression was evaluated in tissue samples of human prostate (n=8) by means of reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry.
mRNA of CRFR2 was abundantly present in RT-PCR of prostate lysates. Immunohistochemistry revealed CRFR2 expression in the cytoplasm of basal and luminal epithelial cells as well as in cystic glands. Smooth muscle components of the stroma and vascular endothelial cells also showed extensive staining for CRFR2.
Our study showed for the first time that human prostatic tissue expresses CRFR2. Pharmacological CRFR2 modulation might be a potential medical treatment for clinical BPH.
Der Urologe 10/2008; 47(9):1079-80, 1082-4. · 0.50 Impact Factor
