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Prostatic urethral lift is a minimally invasive procedure used to improve the symptoms of benign prostatic enlargement. It utilizes the UroLift device to insert small implants through occlusive lateral lobes of the prostate, thereby creating an open anterior channel through the prostate. We describe a previously unreported complication of UroLift whereby a patient presented with loin pain post-procedure and was found to have a UroLift clip across the vesico-ureteric junction , leading to ureteric obstruction, hydronephrosis and calyceal rupture.

Management of benign prostatic hyperplasia (BPH) is rapidly changing. Established surgical procedures are being replaced by minimally invasive modalities such as electrovaporization and transurethral needle ablation. Improved understanding of pathophysiology and developments in molecular biology has provided drugs for alleviating the symptoms of prostatic enlargement. Currently, medical therapy is the first-line treatment modality in the management of BPH. There are two types of medical treatment available: alpha-adrenoceptor-blockers and 5-alpha-reductase inhibitors. Alpha-blockers relieve the dynamic component of obstruction whereas 5-alpha-reductase inhibitors relieve the mechanical component of obstruction. At present, alpha-blockers are used most frequently. However, they do have significant cardiovascular side effects. More uroselective alpha-blockers have recently become available and may reduce the risk of cardiovascular side effects. This review summarizes relevant literature on the use of alpha-blockers in the treatment of BPH.

Objectives To determine the relationship between the symptom of intermittency, objective evidence of intermittency on uroflow traces, benign prostatic enlargement, and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). Methods The prevalence of the symptom of intermittency was determined from a symptom questionnaire in 165 men presenting with LUTS. Objective evidence of intermittency during voiding was assessed from uroflow traces, and prostate volume was measured by transrectal ultrasound. Combined pressure-flow studies were performed to determine the presence or absence of BOO. Results There was relatively poor agreement between the symptom of intermittency and objective evidence of its presence. Of the 35 patients who reported intermittency most or all of the time, 21 showed no objective evidence of intermittency on uroflowmetry. The symptom of intermittency was not significantly related to the presence of BOO ( P = 0.42) and the group-specific urethral resistance factor (URA) did not differ significantly ( P = 0.87) between those men who complained of intermittency and those who did not (median URA, 35 versus 32 cm H 2 O). However, objective evidence of intermittency on uroflow traces was significantly related to BOO ( P = 0.016), and those patients with objective evidence of intermittency had higher URA values (median, 43 versus 32 cm H 2 O). Objective evidence of intermittency had a specificity of 98% and positive predictive value of 92% for the presence of BOO. Neither the symptom of intermittency nor objective evidence of its presence was significantly related to prostate size. Conclusions Although the symptom of intermittency does not seem to be related to BOO or prostate size, objective evidence of intermittency on flow curve traces is specific for outflow obstruction, and as such its presence could potentially be of value in the assessment of men with lower urinary tract symptoms.

The natural history of prostatism (clinically diagnosed benignprostatic hyperplasia) is examined based on symptom questionnaires and digital rectal examinations administered periodically to 1,057 men followed prospectively for up to thirty years in the Baltimore Longitudinal Study of Aging (BLSA). Benign prostatic hyperplasia (BPH) was clinically diagnosed in 527 men, 110 had a prostatectomy for BPH, and in 21 prostate cancer developed. Among men aged sixty or older with prostatic enlargement and obstructive symptoms, the twenty-year probability of surgery was 39 percent; for men aged fifty to fifty-nine years this probability was 24 percent; and for men aged forty to forty-nine years, the probability was 13 percent. The age-specific prevalence of clinically diagnosed BPH agreed closely at all ages with the age-specific autopsy prevalence of pathologically defined BPH from a published international compilation of 5 independent autopsy studies involving 1,075 prostates.

Prostate cancer detection is a rare occurrence in patients with Klinefelter syndrome, in whom chronically low circulating androgen levels are common findings. Administration of exogenous testosterone has increasingly been used to treat young adolescents diagnosed with Klinefelter syndrome and documented androgen deficiency. Although testosterone replacement in adult patients has been associated with prostatic enlargement, it remains unknown whether chronic supplementation of exogenous testosterone to pubescent males with hypogonadism results in early prostate carcinogenesis. We report a first case of prostate cancer in a patient with Klinefelter syndrome who had undergone long-term testosterone replacement therapy since childhood for chronically depressed levels of testosterone.

The concept of diagnosing prostatic carcinoma by means of a small probe placed on the index finger of the examining urologist, at the time of rectal examination, after administering a radio pharmaceutical agent, is discussed. A preliminary clinical study in which 23 patients with and without prostatic carcinoma were evaluated with a semiconductor detector after the intravenous injection of Gallium-67 is described. The results suggest that normal men and women have similar Gallium uptake in the anterior rectal wall. This uptake is significantly less than that of men with benign prostatic hypertrophy and carcinoma of the prostate. No difference, however, was noted between those men with prostatic carcinoma and those with benign prostatic enlargement.

A seven-year-old boy was seen with a urodynamically significant, obstructing, posterior urethral mass. It was believed to represent either a fibromuscular prostatic enlargement or a nonpedunculated congenital polyp. The differential diagnosis is discussed. Transurethral resection of the mass resulted in decreased voiding pressure and relief of symptoms.

Massive prostatic enlargement may present with the radiographic appearance of a perivesical mass and pear-shaped bladder. An explanation of this appearance, based on the computed tomographic findings, is offered. We discuss the differential diagnosis.