Biomedical subjects

J E Oesterling

Publications and source records attributed to J E Oesterling.

219 records · Page 13Linked to original sources

PubMedDate not supplied

LHRH agonists. A nonsurgical treatment for benign prostatic hyperplasia.

Luteinizing hormone-releasing hormone (LHRH) agonist, when administered in a continuous, nonpulsatile manner, causes desensitization of the LHRH receptor complex on the gonadotroph cells in the anterior pituitary gland. Biosynthesis and secretion of luteinizing hormone cease, and testicular androgenic production is inhibited. When used in this capacity, LHRH agonists can be an effective treatment for benign prostatic hyperplasia. After 4 to 6 months of therapy, prostatic volume decreases by 25% to 30%, voiding symptoms improve significantly in approximately 25% to 33% of patients, and the peak urinary flow rate increases substantially (more than 15 ml/second) in approximately 25% to 33% of patients. During the first month of treatment, serum luteinizing hormone, follicle-stimulating hormone, testosterone, dihydrotestosterone, 17 beta-estradiol, and prostate-specific antigen decline to low values and remain low throughout treatment. Prostatic 5 alpha-reductase activity and androgen receptor content also decrease with treatment. Side effects are significant: impotence, decreased libido, and hot flushes are the most common. Because the effect of LHRH agonist therapy on the serum testosterone concentration is reversible, treatment of benign prostatic hyperplasia with an LHRH agonist must be considered life-long therapy. Thus, this therapy should be reserved for patients who are impotent or who are poor surgical risks.

Amino Acid Sequence↗

PubMedDate not supplied

A permanent, epithelializing stent for the treatment of benign prostatic hyperplasia. Preliminary results.

Currently, there is much enthusiasm in the urologic community for the development of alternative treatments to transurethral prostatectomy for management of benign prostatic hyperplasia (BPH). At the Mayo Clinic, the role of a permanently implanted intraurethral stent (UroLume Wallstent) is being examined. It is a biocompatible prosthesis made from a "super" alloy that is woven into a tubular mesh. It is both flexible and self-expanding with no elastic recoil; when fully expanded, it has a large internal diameter of 42 Fr (1.4 cm). Twelve patients (mean age = 67 years; range = 62 to 77 years) with obstructive BPH have been treated with this stent. After 3 months, the decrease in the total symptom score was 65% (mean preoperative score, 13.9 +/- 5.2; mean postoperative score, 4.8 +/- 3.7, P less than 0.001), whereas the increase in peak urinary flow rate was 99% (mean preoperative value, 10.1 +/- 3.3 ml/second; mean postoperative value, 20.1 +/- 6.2 ml/second; P less than 0.001). The postvoid residual urine volume decreased by 76% (mean preoperative value, 133 +/- 68 ml; mean postoperative value, 32 +/- 38 ml, P less than 0.001). There has been no difficulty with infection, encrustation, stent erosion, stent migration, incontinence, or potency. Eight patients (67%), however, did have irritative voiding symptoms after stent placement. These untoward effects subsided markedly during the follow-up period. No patient has required either pain or antispasmodic medications, and as of this time, it has not been necessary to remove any stent because of side effects. These results suggest that the intraurethral stent may be a viable treatment option for patients with BPH.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

The definition and preoperative prediction of clinically insignificant prostate cancer.

OBJECTIVES: To define clinically insignificant prostate cancer according to cancer volume, grade, cancer doubling time, and life expectancy; and to determine how many insignificant cancers are removed by radical prostatectomy. DESIGN AND PATIENTS: Clinically insignificant cancer was defined as a tumor that would give rise to no more than 20 cm3 of cancer within the prostate by the time of expected patient death (1990 life tables) and whose Gleason score was less than 4 in 40- to 49-year-olds, 5 in 50- to 59-year-olds, 6 in 60- to 69-year-olds, and 7 in 70- to 79-year-olds. Four definitions were formulated based on assumed cancer volume doubling times of 2, 3, 4, and 6 years. Using these four definitions, we reviewed 337 totally embedded prostates removed at Mayo Clinic between 1991 and 1993 for clinical stage T1c through T3 cancer to determine how many contained clinically insignificant cancer. MAIN OUTCOME MEASURES: Clinically significant vs clinically insignificant prostate cancer. RESULTS: For cancer volume doubling time of 2, 3, 4, and 6 years, clinically insignificant cancer was identified in one (0.3%), 13 (3.9%), 25 (7.4%), and 49 (14.5%) of 337 prostatectomy specimens, respectively. CONCLUSIONS: Clinically insignificant prostate cancer can be defined by cancer volume, grade, cancer volume doubling time, and life expectancy of the patient. According to our definitions, most men treated with radical prostatectomy have clinically significant cancer.

Adult↗