Efficacy and safety of a hexanic extract of Serenoa repens (Permixon (R)) for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH): systematic review and meta-analysis of randomised controlled trials and observational studies

Objectives To comprehensively evaluate the efficacy and safety of the hexanic extract of Serenoa repens (HESr, Permixon (R); Pierre Fabre Medicament, Castres, France), at a dose of 320 mg daily, as monotherapy for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Materials and methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) and prospective observational studies in patients with LUTS/BPH identified through searches in Medline, Web of Knowledge (Institute for Scientific Information), Scopus, the Cochrane Library, and bibliographic references up to March 2017. Articles studying S. repens extracts other than Permixon were excluded. Data were collected on International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), nocturia, quality of life, prostate volume, sexual function, and adverse drug reactions (ADRs). Data obtained from RCTs and observational studies were analysed jointly and separately using a random effects model. A sub-group analysis was performed of studies that included patients on longer-term treatment (= 1 year). Results Data from 27 studies (15 RCTs and 12 observational studies) were included for meta-analysis (total N = 5 800). Compared with placebo, the HESr was associated with 0.64 (95% confidence interval [CI] -0.98 to -0.31) fewer voids/ night (P < 0.001) and an additional mean increase in Q(max) of 2.75 mL/s (95% CI 0.57 to 4.93; P = 0.01). When compared with a-blockers, the HESr showed similar improvements on IPSS (weighted mean difference [WMD] 0.57, 95% CI -0.27 to 1.42; P = 0.18) and a comparable increase in Q(max) to tamsulosin (WMD -0.02, 95% CI -0.71 to 0.66; P = 0.95). Efficacy assessed using the IPSS was similar after 6 months of treatment between the HESr and 5a-reductase inhibitors (5ARIs). Analysis of all available published data for the HESr showed a mean improvement in IPSS from baseline of -5.73 points (95% CI -6.91 to -4.54; P < 0.001). HESr did not negatively affect sexual function and no clinically relevant effect was observed on prostate-specific antigen. Prostate volume decreased slightly. Similar efficacy results were seen in patients treated for = 1 year (n = 447). The HESr had a favourable safety profile, with gastrointestinal disorders being the most frequent ADR (mean incidence of 3.8%). Conclusion The present meta-analysis, which includes all available RCTs and observational studies, shows that the HESr (Permixon) reduced nocturia and improved Q(max) compared with placebo and had a similar efficacy to tamsulosin and short-term 5ARI in relieving LUTS. HESr (Permixon) appears to be an efficacious and well-tolerated therapeutic option for the longterm medical treatment of LUTS/BPH

Survey on graduate education in the Confederación Americana de Urología: Opinions and reality

Objetivo: La formación médica en el postgrado de calidad es una preocupación en la Confederación Americana de Urología (CAU), tercera sociedad urológica mundial. Es importante analizar la diversidad en los programas estatales de formación y la viabilidad e implicaciones de llevar a cabo un programa CAU común. Materiales y métodos: Se ha distribuido a directivos de sociedades nacionales que componen la CAU un cuestionario de 20 preguntas directas sobre la formación de postgrado urológica en su entorno. Resultados: Un total de 28 presidentes y expresidentes respondieron representando a 21 países, el total de los estados independientes que componen la confederación. En este escenario 664 residentes inician su programa de formación cada año, en un territorio que atiende 645,4 millones de habitantes, con una fuerza profesional activa de 16.752 especialistas. Se presentan datos acerca de la realidad formativa (duración de programas, troncalidad) y laboral (acceso laboral, posible flujo entre países), y sobre cómo se lleva a cabo la acreditación y recertificación de especialistas en estos países. Se presentan también las opiniones acerca de la viabilidad de una titulación conjunta CAU, así como algunas de sus implicaciones. Conclusiones: La formación de postgrado actual en el entorno de la CAU es heterogénea en sus programas, así como en los modos de acreditación y de recertificación. Existe un importante deseo de alcanzar una titulación conjunta, salvo en España y Portugal. Para habilitar una certificación conjunta será necesario intervenir en múltiples aspectos y niveles, redefinir los deseos de cobertura sanitaria en cada país y considerar el posible flujo de especialistas.Objective: Quality graduate medical training is a concern of Confederación Americana de Urología (CAU), the third largest urological society worldwide. It is important to analyse the diversity in the state training programmes and the feasibility and implications of conducting a common CAU programme. Material and methods: A 20-item questionnaire was distributed to the directors of national societies who are members of the CAU concerning the graduate urological training in their institutions. Results: A total of 28 presidents and expresidents representing 21 countries responded, the total number of independent states that constitute the confederation. In this setting, 664 residents start their training programme every year, in an area that treats 645.4 million inhabitants, with an active professional force of 16,752 specialists. We present data on the realities of the training (length of the programme, core curriculum) and occupation (job access, possible flow between countries) and on how accreditation and re-certification of specialists in these countries are conducted. We also present the opinions on the feasibility of a joint CAU degree, as well as a number of its implications. Conclusions: The actual graduate training in the CAU setting is heterogeneous in its programmes and in its accreditation and re-certification methods. There is a strong desire to achieve joint degrees, except in Spain and Portugal. To enable joint certification, there will need to be intervention on numerous aspects and levels, redefining the desire for healthcare coverage in each country and considering the possible flow of specialists.Sin financiación1.260 JCR (2017) Q4, 61/76 Urology and NephrologyUE

Receptores β 3-adr enérgicos: Su papel en la dinámica miccional

The bladder hyperactivity is a pathology where the predominant sign is the urinary incontinence. There is a great interest to investigate the physiology and the action mechanisms that take part in the mictional dynamic, to find an effective pharmacological treatment that does not present marked side effects.La hiperactividad vesical es una patología donde el signo predominante es la incontinencia urinaria. Hay un gran interés en investigar la fisiología y los mecanismos que intervienen en la dinámica miccional, para encontrar un tratamiento farmacológico eficaz que no presente marcados efectos secundarios

Receptor activator of nuclear factor-kB ligand -RANKL- as a novel prognostic marker in prostate carcinoma

Combined immunodetection of parathyroid hormone-related protein (PTHrP) and receptor activator of NF-kB ligand (RANKL) has shown to successfully distinguish poorly- and well-differentiated prostate carcinoma (PCa). In the present study, we aimed to assess whether immunohistochemical evaluation of these factors, and also osteoprotegerin (OPG) and Ki67, in radical prostatectomy specimens can predict biochemical recurrence. Fifty nine PCa cases undergoing radical prostatectomy between 1995 and 1998, without history of neoadjuvant hormonal therapy, were studied. Preoperative serum prostate-specific antigen (PSA), Gleason-sum score, pathologic stage, perineural invasion, seminal vesicle involvement, and positive surgical margins were assessed in these patients. Biochemical recurrence, defined by PSA > 0.4 ng/mL at 90 days or later after prostatectomy, occurred in 32/59 patients. In these patients, positivity for OPG and RANKL in the tumoral epithelium was higher than in those patients with no biochemical recurrence. Using univariate analysis, Gleason-sum score, surgical margins, and seminal vesicle involvement, as well as OPG and RANKL immunostaining (using a score value corresponding to moderate staining as cut-off) were significant predictors of biochemical recurrence (p<0.05). Using the multivariate Cox model, among the evaluated factors only RANKL expression (hazard ratio 11.6; p <0.001) was an independent prognostic indicator. Our findings suggest that immunohistochemical evaluation of RANKL in the primary tumor is a potential risk factor in PCa patients

Immunohistochemical analysis of low‐grade and high‐grade prostate carcinoma: relative changes of parathyroid hormone‐related protein and its parathyroid hormone 1 receptor, osteoprotegerin and receptor activator of nuclear factor‐kB ligand

AIM: To investigate multiple bone cytokines produced by prostate carcinoma (PCa) as a novel strategy to differentiate potential aggressiveness in localised PCa using immunohistochemical analysis. METHODS: A total of 47 cases of PCa undergoing radical prostatectomy or transurethral prostatic resection at our institution (Fundación Jiménez Díaz (Grupo Capio), Madrid, Spain) between January 1991 and June 1998 were identified as low‐grade (⩽4; n = 22) or high‐grade (⩾7, excluding 7 (3+4) cases; n = 25) PCa according to Gleason grade. PCa specimens were immunostained for: parathyroid hormone (PTH)‐related protein (PTHrP), the PTH1 receptor, osteoprotegerin and receptor activator of nuclear factor‐κ B ligand (RANKL), as well as Ki67 (a proliferation marker) and CD34 (an angiogenesis marker). RESULTS: PCa samples showed an increased immunostaining for both osteoprotegerin and RANKL, associated with tumour grade and PTHrP positivity, in the tumoral epithelium. Using a score value of 4—corresponding to moderate staining—as cut‐off, the best sensitivity value was for PTHrP (with C‐terminal antiserum C6; 100 %); wheras the best specificity value was for RANKL (95 %). CONCLUSIONS: All the evaluated factors are overexpressed mainly in the high‐grade tumours. Our findings indicate that, in most patients with PCa (with Ki67 values between 1% and 9%), sequential determination of C‐terminal PTHrP and RANKL immunoreactivities is a useful approach to discriminate low‐grade and high‐grade tumours

Evaluation du bénéfice clinique de Permixon® et de la Tamsulosine dans le traitement de l'hypertrophie bénigne de la prostate (HBP) sévère: Analyse d'un sous-groupe de l'étude Permal

SCOPUS: ar.jinfo:eu-repo/semantics/publishe