No abstract

£ 15 mL/s. BII scores were recorded at baseline and each study visit. Clinically and statistically significant changes in BII scores from baseline were investigated for each study visit. Logistical regression analysis was used to assess the significance of baseline prostate volume, symptoms, BII item 3, baseline Q max , serum dihydrotestosterone, testosterone, PSA, age and weight in predicting the BII score at 2 years. RESULTSDutasteride, but not placebo, resulted in clinically and statistically significant improvements in mean BII score from 6 months. Of patients with a baseline BII score of ≥ 5 (greatest symptomatic burden) treatment with dutasteride improved the scores by 2.41, while the scores in placebotreated patients only improved by 1.64. Dutasteride-treated patients with a baseline BII score of <5 (least symptom burden) had a clinically significant improvement in health status, while placebo-treated patients deteriorated. Regression analysis showed that men with a combination of a baseline BII item-3 score of 3 (bothered a lot) and a high symptom score (AUA-SI ≥ 20) were more likely to be bothered by their symptoms at the end of the study. Men receiving placebo were also more likely to be bothered at the end of the study than were those receiving dutasteride. CONCLUSIONSDutasteride treatment is associated with clinically significant improvements in BII score, reflecting improvements in the quality of life of men with BPH. Taken together with previously reported improvements in prostate volume, lower urinary tract symptoms and urinary flow, and diminution of the risk of acute urinary retention and the need for BPH-related surgery, dutasteride offers demonstrable efficacy in the management of BPH. KEYWORDSbenign prostatic hyperplasia, dutasteride, health status, quality of life, bother, BPH Impact Index OBJECTIVESTo examine the effect of the dual-action 5 areductase inhibitor dutasteride on benign prostatic hyperplasia (BPH)-specific health status, as measured by the BPH Impact Index (BII), and to identify baseline and treatment risk factors for those most bothered by their BPH symptoms at the end of the protocol. PATIENTS AND METHODSData were derived from three randomized, double-blind, placebo-controlled, 2-year studies conducted in 4325 men with lower urinary tract symptoms caused by benign prostatic enlargement. Each study comprised a 1-month single-blind placebo run-in period, followed by randomization to oral dutasteride 0.5 mg once daily or placebo for 2 years. Patients eligible for inclusion were consenting men aged ≥ 50 years with moderate to severe symptoms (American Urological Symptom Index, AUA-SI, score ≥ 12), a prostate volume of ≥ 30 mL, a serum prostate-specific antigen (PSA) level of ≥ 1.5 or < 10 ng/mL, and a maximum urinary flow rate (Q max ) of

The contribution of hyperprolactinemia to erectile disorders has not been clarified. Modest elevations of serum prolactin occur after administration of drugs that by themselves affect erectile function. Prolactinomas produce marked elevations of the hormone and invariably are accompanied by hypogonadotropic hypogonadism. Among 1,236 consecutive impotent patients investigated at our center 5.3% had serum levels of prolactin greater than normal. Only 34 of the 66 hyperprolactinemic patients were available for analysis. The etiology of the hyperprolactinemia in this group was pituitary adenoma in 14.7%, drug-induced in 29%, chronic renal failure in 6%, laboratory error in 2.9% and idiopathic in 47.1%. Medical management has a high degree of success but simply lowering the levels of prolactin is not invariably accompanied by restoration of function.

Intravesical MCW appears to invoke a similar inflammatory response in the mouse bladder mucosa as the live BCG organism and retains an antitumor action. It deserves further evaluation as a potential antitumor agent against bladder cancer. A Phase II clinical trial is now underway.

These surveys provide a useful insight into the variations in clinical practice of Canadian urologists and help to determine whether changes are occurring in regard to the development of practice guidelines. They also indicate the need to develop further guidelines, and ensure that these guidelines are widely promoted and accepted by the urological community.