Hormonal manipulation of benign prostatic hyperplasia

We provide new viewpoints of hormonal control of benign prostatic hyperplasia (BPH). The latest treatment findings with 5-alpha reductase inhibitors (5-ARIs) finasteride and dutasteride, refined indications, efficacy, and safety are discussed and compared. We also discuss potential new 5-ARIs and other hormonal treatments. Finasteride and dutasteride have equal efficacy and safety for the treatment and prevention of progression of BPH. 5-ARIs are especially recommended for prostates greater than 40 ml and PSA greater than 1.5 ng/ml. Combination therapy is the treatment of choice in these patients, but with prostate volume greater than 58 ml or International Prostate Symptom Score of at least 20, combinations have no advantage over 5-ARI monotherapy. Updates on the recent developments on BPH therapy with luteinizing hormone-releasing hormone (LHRH) antagonist are also reviewed and analyzed. Preclinical studies suggest that growth hormone-releasing hormone (GHRH) antagonists effectively shrink experimentally enlarged prostates alone or in combination with LHRH antagonists. New 5-ARIs seem to be the promising agents that need further study. Preclinical studies revealed that GHRH and LHRH antagonists both can cause a reduction in prostate volume. Recent data indicate that prostate shrinkage is induced by the direct inhibitory action of GHRH and of LHRH antagonists exerted through prostatic receptors. The adverse effects of 5ARIs encourage alternative therapy

Long term outcomes of latissimus dorsi flap breast reconstructions. A single centre observational cohort study with up to 12 years of follow up

Introduction The Latissimus Dorsi Myocutaneous Flap (LDMF) is used in post-mastectomy reconstruction. This study has evaluated long-term (up to 12 years) surgical and patient reported outcomes from LDMF procedures. Method Retrospective analysis of consecutive LDMF procedures in two UK hospitals, performed between 2006-2016. Case notes were reviewed for indications and outcomes. Patients were sent the BREAST-Q® survey by post. Outcomes, including surgical adverse events, revision and implant loss rates, were correlated with patient risk factors. Results A BREAST-Q was posted to 199/248 LDMF patients in 2018, (excluding 49 due to death, reduced cognitive function, incorrect coding) of whom 77 responded (38.7%). In 188 cases (representing 208 LDMFs) surgical outcomes were assessable. Median time since LDMF surgery was 7 years (range 2-12). Rates of acute implant loss were 9/139 (6.4%), flap necrosis 7/208 (3.4%), shoulder stiffness 4/208 (1.9%), chronic pain 24/208 (11.5%) and unplanned revision surgery 13/208 (7%). Median satisfaction levels were high with 78% satisfied with treatment outcomes, 65% satisfied with their breasts, 71% satisfied psychosocially and 75% satisfied with their chest. Receipt of radiotherapy was not associated with a higher risk of flap necrosis or capsule formation. Conclusion Long-term follow-up of a large cohort of LDMF reconstruction patients show relatively low levels of adverse events and unplanned revision surgery and high patient satisfaction, demonstrating how temporally robust the technique is. With the rise in popularity of acellular dermal matrix (ADM) reconstructions, the LDMF has relatively fallen out of favour but its potential in primary and delayed reconstruction is demonstrated