The Official Patient's Sourcebook on Prostate Enlargement: A Revised and Updated Directory for the Internet Age

THE OFFICIAL PATIENT’S SOURCEBOOK on PROSTATE ENLARGEMENT J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D.,...

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THE OFFICIAL PATIENT’S SOURCEBOOK

on

PROSTATE

ENLARGEMENT

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

ii

ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Prostate Enlargement: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83247-1 1. Prostate Enlargement-Popular works. I. Title.

iii

Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

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Dedication To the healthcare professionals dedicating their time and efforts to the study of prostate enlargement.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to the study of prostate enlargement. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.

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About ICON Health Publications In addition to prostate enlargement, Official Patient’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Cystocele

·

The Official Patient's Sourcebook on Glomerular Disease

·

The Official Patient's Sourcebook on Goodpasture Syndrome

·

The Official Patient's Sourcebook on Hematuria

·

The Official Patient's Sourcebook on Hemochromatosis

·

The Official Patient's Sourcebook on Immune Thrombocytopenic Purpura

·

The Official Patient's Sourcebook on Impotence

·

The Official Patient's Sourcebook on Interstitial Cystitis

·

The Official Patient's Sourcebook on Kidney Failure

·

The Official Patient's Sourcebook on Kidney Stones

·

The Official Patient's Sourcebook on Lupus Nephritis

·

The Official Patient's Sourcebook on Nephrotic Syndrome

·

The Official Patient's Sourcebook on Peyronie

·

The Official Patient's Sourcebook on Polycystic Kidney Disease

·

The Official Patient's Sourcebook on Prostatitis

·

The Official Patient's Sourcebook on Proteinuria

·

The Official Patient's Sourcebook on Pyelonephritis

·

The Official Patient's Sourcebook on Renal Osteodystrophy

·

The Official Patient's Sourcebook on Renal Tubular Acidosis

·

The Official Patient's Sourcebook on Simple Kidney Cysts

·

The Official Patient's Sourcebook on Urinary Incontinence

·

The Official Patient's Sourcebook on Urinary Incontinence for Women

·

The Official Patient's Sourcebook on Urinary Incontinence with Children

·

The Official Patient's Sourcebook on Urinary Tract Infection in Children

·

The Official Patient's Sourcebook on Urinary Tract Infections in Adults

·

The Official Patient's Sourcebook on Vasectomy

·

The Official Patient's Sourcebook on Vesicoureteral Reflux

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents vii

Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON PROSTATE ENLARGEMENT: GUIDELINES ................................... 9 Overview ....................................................................................................................................... 9 What Is the Prostate? .................................................................................................................. 11 Benign Prostatic Hyperplasia (BPH): A Common Part of Aging............................................... 11 Cause of BPH............................................................................................................................... 13 Symptoms .................................................................................................................................... 14 Diagnosis ..................................................................................................................................... 15 Common Treatment Methods for Prostate Enlargement ............................................................ 17 Drug Treatment .......................................................................................................................... 17 Nonsurgical Treatment ............................................................................................................... 18 Surgical Treatment...................................................................................................................... 19 Your Recovery after Surgery in the Hospital .............................................................................. 21 Do’s and Don’ts........................................................................................................................... 22 Getting Back to Normal............................................................................................................... 22 Sexual Function after Surgery .................................................................................................... 23 Is Further Treatment Needed? .................................................................................................... 24 Prostatic Stents ........................................................................................................................... 25 BPH and Prostate Cancer: No Apparent Relation ...................................................................... 25 Research in BPH.......................................................................................................................... 25 More Guideline Sources .............................................................................................................. 26 Vocabulary Builder...................................................................................................................... 31 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 37 Overview ..................................................................................................................................... 37 Associations and Prostate Enlargement ...................................................................................... 37 Finding More Associations ......................................................................................................... 39 Finding Doctors........................................................................................................................... 41 Finding a Urologist ..................................................................................................................... 42 Selecting Your Doctor ................................................................................................................. 43 Working with Your Doctor ......................................................................................................... 43 Broader Health-Related Resources .............................................................................................. 45 Vocabulary Builder...................................................................................................................... 45 CHAPTER 3. CLINICAL TRIALS AND PROSTATE ENLARGEMENT ................................................... 47 Overview ..................................................................................................................................... 47 Recent Trials on Prostate Enlargement....................................................................................... 50 Benefits and Risks........................................................................................................................ 53 Keeping Current on Clinical Trials ............................................................................................. 56 General References....................................................................................................................... 57 Vocabulary Builder...................................................................................................................... 58 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 59 CHAPTER 4. STUDIES ON PROSTATE ENLARGEMENT ..................................................................... 61 Overview ..................................................................................................................................... 61 The Combined Health Information Database .............................................................................. 61 Federally-Funded Research on Prostate Enlargement................................................................. 64

viii Contents

E-Journals: PubMed Central ....................................................................................................... 67 The National Library of Medicine: PubMed................................................................................ 67 Vocabulary Builder...................................................................................................................... 68 CHAPTER 5. BOOKS ON PROSTATE ENLARGEMENT ....................................................................... 69 Overview ..................................................................................................................................... 69 Book Summaries: Federal Agencies ............................................................................................. 69 Book Summaries: Online Booksellers .......................................................................................... 70 The National Library of Medicine Book Index............................................................................. 71 Chapters on Prostate Enlargement.............................................................................................. 74 General Home References ............................................................................................................ 76 Vocabulary Builder...................................................................................................................... 77 CHAPTER 6. MULTIMEDIA ON PROSTATE ENLARGEMENT ............................................................ 79 Overview ..................................................................................................................................... 79 Video Recordings......................................................................................................................... 79 Bibliography: Multimedia on Prostate Enlargement................................................................... 80 Vocabulary Builder...................................................................................................................... 83 CHAPTER 7. PERIODICALS AND NEWS ON PROSTATE ENLARGEMENT ......................................... 85 Overview ..................................................................................................................................... 85 News Services & Press Releases .................................................................................................. 85 Newsletters on Prostate Enlargement ......................................................................................... 89 Newsletter Articles ...................................................................................................................... 90 Academic Periodicals covering Prostate Enlargement ................................................................ 92 Vocabulary Builder...................................................................................................................... 92 CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ................................................................ 95 Overview ..................................................................................................................................... 95 NIH Guidelines ........................................................................................................................... 95 NIH Databases ............................................................................................................................ 96 Other Commercial Databases .................................................................................................... 103 The Genome Project and Prostate Enlargement ........................................................................ 104 Specialized References ............................................................................................................... 109 Vocabulary Builder.................................................................................................................... 110 PART III. APPENDICES .............................................................................................................. 111 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 113 Overview ................................................................................................................................... 113 Your Medications: The Basics ................................................................................................... 114 Learning More about Your Medications ................................................................................... 116 Commercial Databases............................................................................................................... 117 Contraindications and Interactions (Hidden Dangers)............................................................. 120 A Final Warning ....................................................................................................................... 121 General References..................................................................................................................... 122 Vocabulary Builder.................................................................................................................... 123 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 125 Overview ................................................................................................................................... 125 What Is CAM? .......................................................................................................................... 125 What Are the Domains of Alternative Medicine? ..................................................................... 126 Can Alternatives Affect My Treatment?................................................................................... 129 Finding CAM References on Prostate Enlargement ................................................................. 130 Additional Web Resources......................................................................................................... 138 General References..................................................................................................................... 145 Vocabulary Builder.................................................................................................................... 147 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 149 Overview ................................................................................................................................... 149 Food and Nutrition: General Principles .................................................................................... 150

Contents

ix

Finding Studies on Prostate Enlargement ................................................................................ 154 Federal Resources on Nutrition................................................................................................. 155 Additional Web Resources......................................................................................................... 156 Vocabulary Builder.................................................................................................................... 158 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 161 Overview ................................................................................................................................... 161 Preparation ................................................................................................................................ 161 Finding a Local Medical Library ............................................................................................... 162 Medical Libraries Open to the Public ........................................................................................ 162 APPENDIX E. NIH CONSENSUS STATEMENT ON URINARY INCONTINENCE IN ADULTS ........... 169 Overview ................................................................................................................................... 169 What Is Urinary Incontinence in Adults? ................................................................................ 170 Occurrence and Risk of Urinary Incontinence.......................................................................... 172 Clinical, Psychological, and Social Impact ................................................................................ 172 Pathophysiological and Functional Factors............................................................................... 173 Subtypes of Urinary Incontinence............................................................................................. 174 Evaluation and Therapy ............................................................................................................ 175 General Principles of Treatment................................................................................................ 177 Pharmacologic Treatment.......................................................................................................... 178 Behavioral Techniques ............................................................................................................... 180 Management Techniques........................................................................................................... 182 Improving Public and Professional Knowledge......................................................................... 183 Need for Future Research Related to Urinary Incontinence ..................................................... 185 Directions for Future Research.................................................................................................. 185 Conclusions ............................................................................................................................... 185 Vocabulary Builder.................................................................................................................... 186 ONLINE GLOSSARIES ............................................................................................................... 189 Online Dictionary Directories................................................................................................... 190 PROSTATE ENLARGEMENT GLOSSARY ............................................................................ 191 General Dictionaries and Glossaries ......................................................................................... 203 INDEX.............................................................................................................................................. 205

Introduction

1

INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3

Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

2

Prostate Enlargement

Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Prostate Enlargement has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to prostate enlargement, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on prostate enlargement. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on prostate enlargement should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on

Introduction

3

appropriate options is always up to the patient in consultation with their physician and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching prostate enlargement (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to prostate enlargement. It also gives you sources of information that can help you find a doctor in your local area specializing in diagnosing and treating prostate enlargement. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with prostate enlargement. Part II moves on to advanced research dedicated to prostate enlargement. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on prostate enlargement. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with prostate enlargement or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with prostate enlargement. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with prostate enlargement.

Scope While this sourcebook covers prostate enlargement, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that prostate enlargement is often considered a synonym or a condition closely related to the following: ·

Benign Prostatic Hypertrophy

4

Prostate Enlargement

·

Prostatic Hyperplasia

·

Prostatic Hypertrophy

In addition to synonyms and related conditions, physicians may refer to prostate enlargement using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for prostate enlargement:4 ·

600 benign prostatic hyperplasia

·

600 hyperplasia of prostate

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to prostate enlargement. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses and conditions. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian.

4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”

Introduction

5

Why “Internet age”? All too often, patients with prostate enlargement will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with prostate enlargement is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of prostate enlargement, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors

7

PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on prostate enlargement. The essentials of a symptom typically include the definition or description of the symptom, a discussion of who it affects, the diseases that are associated with a given symptom, tests or diagnostic procedures that might be specific to the symptom, and treatments for the symptom. Your doctor or healthcare provider may have already explained the essentials of prostate enlargement to you or even given you a pamphlet or brochure describing prostate enlargement. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

CHAPTER 1. THE ESSENTIALS ENLARGEMENT: GUIDELINES

ON

9

PROSTATE

Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on prostate enlargement. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on prostate enlargement can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on prostate enlargement. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Prostate Enlargement

There is no guarantee that any one Institute will have a guideline on a specific condition or disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare conditions and disorders. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with prostate enlargement and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·

Division of Diabetes, Endocrinology, and Metabolic Diseases

·

Division of Digestive Diseases and Nutrition

·

Division of Kidney, Urologic, and Hematologic Diseases

The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6

Guidelines 11

Institute supports basic and clinical research through investigator-initiated grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on prostate enlargement.

What Is the Prostate?7 The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body. Scientists do not know all the prostate’s functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.

Benign Prostatic Hyperplasia (BPH): A Common Part of Aging It is common for the prostate gland to become enlarged as a man ages. Doctors call the condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/urolog/pubs/prostate/index.htm. 7


Normal urine flow.

Urine flow with BPH.

As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties

Guidelines 13

and as many as 90 percent in their seventies and eighties have some symptoms of BPH. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH. Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States alone, 375,000 hospital stays each year involve a diagnosis of BPH. It is not clear whether certain groups face a greater risk of getting BPH. Studies done over the years suggest that BPH occurs more often among married men than single men and is more common in the United States and Europe than in other parts of the world. However, these findings have been debated, and no definite information on risk factors exists.

Cause of BPH The cause of BPH is not well understood. For centuries, it has been known that BPH occurs mainly in older men and that it doesn’t develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH. Throughout their lives, men produce both testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done with animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth. Another theory focuses on dihydrotes-tosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most


animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood’s testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH. Some researchers suggest that BPH may develop as a result of “instructions” given to cells early in life. According to this theory, BPH occurs because cells in one section of the gland follow these instructions and “reawaken” later in life. These “reawakened” cells then deliver signals to other cells in the gland, instructing them to grow or making them more sensitive to hormones that influence growth.

Symptoms Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as ·

A hesitant, interrupted, weak stream.

·

Urgency and leaking or dribbling.

·

More frequent urination, especially at night.

The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems. Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may be to prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility. It is important to tell your doctor about urinary problems such as those described above. In 8 out of 10 cases, these symptoms suggest BPH, but they

Guidelines 15

also can signal other, more serious conditions that require prompt treatment. These conditions, including prostate cancer, can be ruled out only by a doctor’s exam. Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications.

Diagnosis You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide whether surgery is needed. The tests vary from patient to patient, but the following are the most common.

Digital Rectal Exam (DRE) This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This exam gives the doctor a general idea of the size and condition of the gland.

Prostate Specific Antigen (PSA) Blood Test In order to rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer. The U.S. Food and Drug Administration has approved a PSA test for use in conjunction with a digital rectal exam to help detect prostate cancer in men age 50 or older and for monitoring prostate cancer patients after treatment. However, much remains unknown about the interpretation of PSA levels, the test’s ability to discriminate cancer from benign prostate conditions, and the best course of action following a finding of elevated PSA. Because many unanswered questions surround the issue of PSA screening, the relative magnitude of its potential risks and benefits is unknown. Both


PSA and ultrasound tests enhance detection when added to DRE screening. But they are known to have relatively high false-positive rates, and they may identify a greater number of medically insignificant tumors. Thus, PSA screening might lead to treatment of unproven benefit that could result in morbidity (including impotence and incontinence) and mortality. It cannot be determined from earlier studies whether PSA screening will reduce prostate cancer mortality. Ongoing studies are addressing this issue. Rectal Ultrasound If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen.

Urine Flow Study Sometimes the doctor will ask a patient to urinate into a special device which measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Intravenous Pyelogram (IVP) IVP is an x-ray of the urinary tract. In this test, a dye is injected into a vein, and the x-ray is taken. The dye makes the urine visible on the x-ray and shows any obstruction or blockage in the urinary tract.

Cystoscopy In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Guidelines 17

Common Treatment Methods for Prostate Enlargement Men who have BPH with symptoms usually need some kind of treatment at some time. However, a number of recent studies have questioned the need for early treatment when the gland is just mildly enlarged. These studies report that early treatment may not be needed because the symptoms of BPH clear up without treatment in as many as one-third of all mild cases. Instead of immediate treatment, they suggest regular checkups to watch for early problems. If the condition begins to pose a danger to the patient’s health or causes a major inconvenience to him, treatment is usually recommended. Since BPH may cause urinary tract infections, a doctor will usually clear up any infection with antibiotics before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk. The following section describes the types of treatment that are most commonly used for BPH.

Drug Treatment Over the years, researchers have tried to find a way to shrink or at least stop the growth of the prostate without using surgery. Recently, several new medications have been tested in clinical trials, and the Food and Drug Administration (FDA) has approved four drugs to treat BPH. These drugs may relieve common symptoms associated with an enlarged prostate.

Finasteride Finasteride (marketed under the name Proscar), FDA-approved in 1992, inhibits production of the hormone DHT, which is involved with prostate enlargement. Its use can actually shrink the prostate in some men.

Terazosin, Doxazosin, and Tamsulosin FDA also approved the drugs terazosin (marketed as Hytrin) in 1993, doxazosin (marketed as Cardura) in 1995, and tamsulosin (marketed as Flomax) in 1997 for the treatment of BPH. All three drugs act by relaxing the


smooth muscle of the prostate and bladder neck to improve urine flow and to reduce bladder outlet obstruction. Terazosin, doxazosin, and tamsulosin belong to the class of drugs known as alpha blockers. Terazosin and doxazosin were developed first to treat high blood pressure. Tamsulosin is the first alpha blocker developed specifically to treat BPH.

Nonsurgical Treatment Because drug treatment is not effective in all cases, researchers in recent years have developed a number of procedures that relieve BPH symptoms but are less invasive than surgery.

Transurethral Microwave Procedures In May 1996, FDA approved the Prostatron, a device that uses microwaves to heat and destroy excess prostate tissue. In the procedure called transurethral microwave thermotherapy (TUMT), the Prostatron sends computerregulated microwaves through a catheter to heat selected portions of the prostate to at least 111 degrees Fahrenheit. A cooling system protects the urinary tract during the procedure. A similar microwave device, the Targis System, received FDA approval in September 1997. Like the Prostatron, the Targis System delivers microwaves to destroy selected portions of the prostate and uses a cooling system to protect the urethra. A heat-sensing device inserted in the rectum helps monitor the therapy. Both procedures take about 1 hour and can be performed on an outpatient basis without general anesthesia. Neither procedure has been reported to lead to impotence or incontinence. While microwave therapy does not cure BPH, it reduces urinary frequency, urgency, straining, and intermittent flow. It does not correct the problem of incomplete emptying of the bladder. Ongoing research will determine any long-term effects of microwave therapy and who might benefit most from this therapy.

Guidelines 19

Transurethral Needle Ablation In October 1996, FDA approved Vidamed’s minimally invasive Transurethral Needle Ablation (TUNA) System for the treatment of BPH. The TUNA System delivers low-level radiofrequency energy through twin needles to burn away a well-defined region of the enlarged prostate. Shields protect the urethra from heat damage. The TUNA System improves urine flow and relieves symptoms with fewer side effects when compared with transurethral resection of the prostate (TURP). No incontinence or impotence has been observed.

Surgical Treatment Most doctors recommend removal of the enlarged part of the prostate as the best long-term solution for patients with BPH. With surgery for BPH, only the enlarged tissue that is pressing against the urethra is removed; the rest of the inside tissue and the outside capsule are left intact. Surgery usually relieves the obstruction and incomplete emptying caused by BPH. The following section describes the types of surgery that are used.

Transurethral Surgery In this type of surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an instrument through the urethra. A procedure called TURP (transurethral resection of the prostate) is used for 90 percent of all prostate surgeries done for BPH. With TURP, an instrument called a resectoscope is inserted through the penis. The resectoscope, which is about 12 inches long and 1/2 inch in diameter, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. During the 90-minute operation, the surgeon uses the resectoscope’s wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.


Most doctors suggest using TURP whenever possible. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period. Another surgical procedure is called transurethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this procedure widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself. Although some people believe that TUIP gives the same relief as TURP with less risk of side effects such as retrograde ejaculation, its advantages and long-term side effects have not been clearly established. Open Surgery In the few cases when a transurethral procedure cannot be used, open surgery, which requires an external incision, may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. The location of the enlargement within the gland and the patient’s general health help the surgeon decide which of the three open procedures to use. With all the open procedures, anesthesia is given and an incision is made. Once the surgeon reaches the prostate capsule, he scoops out the enlarged tissue from inside the gland.

Laser Surgery In March 1996, FDA approved a surgical procedure that employs side-firing laser fibers and Nd: YAG lasers to vaporize obstructing prostate tissue. The doctor passes the laser fiber through the urethra into the prostate using a cystoscope and then delivers several bursts of energy lasting 30 to 60 seconds. The laser energy destroys prostate tissue and causes shrinkage. Like TURP, laser surgery requires anesthesia and a hospital stay. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. Laser surgery also allows for a quicker recovery time. But laser surgery may not be effective on larger prostates. The long-term effectiveness of laser surgery is not known.

Guidelines 21

Your Recovery after Surgery in the Hospital If you have surgery, you’ll probably stay in the hospital from 3 to 10 days depending on the type of surgery you had and how quickly you recover.

Foley Catheter

At the end of surgery, a special catheter is inserted through the opening of the penis to drain urine from the bladder into a collection bag. Called a Foley catheter, this device has a water-filled balloon on the end that is placed in the bladder, which keeps it in place. This catheter is usually left in place for several days. Sometimes, the catheter causes recurring painful bladder spasms the day after surgery. These may be difficult to control, but they will eventually disappear. You may also be given antibiotics while you are in the hospital. Many doctors start giving this medicine before or soon after surgery to prevent infection. However, some recent studies suggest that antibiotics may not be needed in every case, and your doctor may prefer to wait until an infection is present to give them. After surgery, you will probably notice some blood or clots in your urine as the wound starts to heal. If your bladder is being irrigated (flushed with water), you may notice that your urine becomes red once the irrigation is stopped. Some bleeding is normal, and it should clear up by the time you leave the hospital. During your recovery, it is important to drink a lot of water (up to 8 cups a day) to help flush out the bladder and speed healing.


Do’s and Don’ts Take it easy the first few weeks after you get home. You may not have any pain, but you still have an incision that is healing, even with transurethral surgery, where the incision can’t be seen. Since many people try to do too much at the beginning and then have a setback, it is a good idea to talk to your doctor before resuming your normal routine. During this initial period of recovery at home, avoid any straining or sudden movements that could tear the incision. Here are some guidelines: ·

Continue drinking a lot of water to flush the bladder.

·

Avoid straining when moving your bowel.

·

Eat a balanced diet to prevent constipation. If constipation occurs, ask your doctor if you can take a laxative.

·

Don’t do any heavy lifting.

·

Don’t drive or operate machinery.

Getting Back to Normal Even though you should feel much better by the time you leave the hospital, it will probably take a couple of months for you to heal completely. During the recovery period, the following are some common problems that can occur:

Problems Urinating You may notice that your urinary stream is stronger right after surgery, but it may take awhile before you can urinate completely normally again. After the catheter is removed, urine will pass over the surgical wound on the prostate, and you may initially have some discomfort or feel a sense of urgency when you urinate. This problem will gradually lessen, though, and after a couple of months you should be able to urinate less frequently and more easily.

Inability to Control Urination (Incontinence) As the bladder returns to normal, you may have some temporary problems controlling urination, but long-term incontinence rarely occurs. Doctors find

Guidelines 23

that the longer problems existed before surgery, the longer it will take for the bladder to regain its full function after the operation.

Bleeding In the first few weeks after transurethral surgery, the scab inside the bladder may loosen, and blood may suddenly appear in the urine. Although this can be alarming, the bleeding usually stops with a short period of resting in bed and drinking fluids. However, if your urine is so red that it is difficult to see through or if it contains clots or if you feel any discomfort, be sure to contact your doctor.

Sexual Function after Surgery Many men worry about whether surgery for BPH will affect their ability to enjoy sex. Some sources state that sexual function is rarely affected, while others claim that it can cause problems in up to 30 percent of all cases. However, most doctors say that even though it takes awhile for sexual function to return fully, with time, most men are able to enjoy sex again. Complete recovery of sexual function may take up to 1 year, lagging behind a person’s general recovery. The exact length of time depends on how long after symptoms appeared that BPH surgery was done and on the type of surgery. Following is a summary of how surgery is likely to affect the following aspects of sexual function.

Erections Most doctors agree that if you were potent (able to maintain an erection) shortly before surgery, you will probably be able to have erections afterward. Surgery rarely causes a loss of potency. However, surgery cannot usually restore potency that was lost before the operation.

Ejaculation Although most men are able to continue having erections after surgery, a prostatectomy frequently makes them sterile (unable to father children) by causing a condition called “retrograde ejaculation” or “dry climax.”


During sexual activity, sperm from the testes enters the urethra near the opening of the bladder. Normally, a muscle blocks off the entrance to the bladder, and the semen is expelled through the penis. However, the coring action of prostate surgery cuts this muscle as it widens the neck of the bladder. Following surgery, the semen takes the path of least resistance and enters the wider opening to the bladder rather than being expelled through the penis. Later it is harmlessly flushed out with urine. Orgasm Most men find little or no difference in the sensation of orgasm, or sexual climax, before and after surgery. Although it may take some time to get used to retrograde ejaculation, you should eventually find sex as pleasurable after surgery as before. Many people have found that concerns about sexual function can interfere with sex as much as the operation itself. Understanding the surgical procedure and talking over any worries with the doctor before surgery often help men regain sexual function earlier. Many men also find it helpful to talk to a counselor during the adjustment period after surgery.

Is Further Treatment Needed? In the years after your surgery, it is important to continue having a rectal exam once a year and to have any symptoms checked by your doctor. Since surgery for BPH leaves behind a good part of the gland, it is still possible for prostate problems, including BPH, to develop again. However, surgery usually offers relief from BPH for at least 15 years. Only 10 percent of the men who have surgery for BPH eventually need a second operation for enlargement. Usually these are men who had the first surgery at an early age. Sometimes, scar tissue resulting from surgery requires treatment in the year after surgery. Rarely, the opening of the bladder becomes scarred and shrinks, causing obstruction. This problem may require a surgical procedure similar to transurethral incision (see section on surgery). More often, scar tissue may form in the urethra and cause narrowing. This problem can usually be solved during an office visit when the doctor stretches the urethra.

Guidelines 25

Prostatic Stents Stents are small devices inserted through the urethra to the narrowed area and allowed to expand, like a spring. The stent pushes back the prostatic tissue, widening the urethra. FDA approved the Urolume Endoprosthesis in 1996 to relieve urinary obstruction in men and improve ability to urinate. The device is approved for use in men for whom other standard surgical procedures to correct urinary obstruction have failed.

BPH and Prostate Cancer: No Apparent Relation Although some of the signs of BPH and prostate cancer are the same, having BPH does not seem to increase the chances of getting prostate cancer. Nevertheless, a man who has BPH may have undetected prostate cancer at the same time or may develop prostate cancer in the future. For this reason, the National Cancer Institute and the American Cancer Society recommend that all men over 40 have a rectal exam once a year to screen for prostate cancer. After BPH surgery, the tissue removed is routinely checked for hidden cancer cells. In about 1 out of 10 cases, some cancer tissue is found, but often it is limited to a few cells of a nonaggressive type of cancer, and no treatment is needed.

Research in BPH The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) was established by Congress in 1950 as one of the National Institutes of Health (NIH), whose mission is to improve human health through biomedical research. NIH is the research branch of the U.S. Department of Health and Human Services. NIDDK conducts and supports a variety of research in diseases of the kidney and urinary tract. Much of the research targets disorders of the lower urinary tract, including BPH, urinary tract infection, interstitial cystitis, urinary obstruction, prostatitis, and urinary stones. The knowledge gained from these studies is advancing scientific understanding of why BPH develops and may lead to improved methods of diagnosing and treating prostate enlargement. One such study is the Medical Therapy of Prostatic Symptoms Trial.


More Guideline Sources The guideline above on prostate enlargement is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to prostate enlargement. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with prostate enlargement. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on prostate enlargement and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to

Guidelines 27

http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Prostatitis: Patient Education Source: Tarrytown, NY: Bayer Corporation. 1999. 11 p. Contact: Available from Bayer Corporation. Diagnostics Division, 511 Benedict Avenue, Tarrytown, NY 10591-5097. (800) 445-5901. Price: Single copy free. Summary: This patient education brochure reviews prostatitis, inflammation or infection of the prostate gland. The brochure defines the condition, describes risk factors and causes, outlines the diagnostic approaches that may be used, reviews treatment options, and offers suggestions for prevention. In most men, the prostate gland begins a gradual process of enlargement at about 40 years of age; benign prostatic hyperplasia (BPH) does not always cause problems, although it can result in problems with urination. Prostatitis is a different condition, usually caused by infections by bacteria or other organisms. Prostatitis can be a secondary problem related to the urinary retention (urine remaining in the bladder or urethra after urination) caused by BPH; a chemical in the urine (urate) can irritate the tissues of the prostate gland and cause inflammation. There are three major types of prostatitis: bacterial, nonbacterial, and prostatodynia (pain in the area of the prostate gland). Symptoms of bacterial prostatitis are often severe and therefore quickly diagnosed; they include fever, chills, pain in the lower back, aching muscles, fatigue, and frequent or painful urination. Nonbacterial prostatitis (occurring in about 10 percent of cases) is harder to diagnose and often presents with occasional vague discomfort in the testicles, urethra, lower abdomen, and back, discharge from the urethra, blood or urine in the ejaculate, low sperm count, sexual difficulties, and frequent urination. Diagnosis includes the digital rectal exam (DRE) to reveal the size, shape, and texture of the prostate; prostate massage; sequential urine test; needle biopsy; prostate specific antigen (PSA) test; and imaging tests, such as ultrasound, x rays, magnetic resonance imaging (MRI), and computed tomography (CT scan). Treatment often includes antibiotics and other drugs to combat urinary problems; thermotherapy (heating the prostate gland) may also be used. Alternative or adjunctive therapies include topical heat and cold therapy, zinc supplemenation, and antianxiety medications. The brochure concludes with a brief glossary of terms and a short list of resources for readers wishing to obtain additional information. A tear-off section lists the topics covered in the booklet; readers are encouraged to check off the items


corresponding to issues they would like to discuss with their health care provider, to use the checklist as a reminder tool. ·

Benign Prostatic Hyperplasia (BPH): A Guide for Men Source: San Ramon, CA: HIN, Inc., The Health Information Network. 1996. 25 p. Contact: Available from HIN, Inc. 231 Market Place, Number 331, San Ramon, CA 94583. (800) HIN-1121. Fax (925) 358-4377. Website: www.hinbooks.com. Price: $36.25 plus shipping per set of 25 booklets; quantity discounts available. Order number 0302. ISBN: 1885274289. Summary: This educational booklet provides information about benign prostatic enlargement, a common enlargement of the prostate gland that affects two out of three men by the time they are 65 years old. Topics covered include the role of the prostate; growth of the prostate; seeing the doctor and what to expect from a prostate examination; deciding about treatment; treatment options; medication; minimally invasive treatments; surgery; and postoperative care. The booklet includes full-color illustrations and a brief glossary of related terms. 7 figures. 2 tables.

·

To Treat Symptomatic Benign Prostate Enlargement: Only One Medicine Can Shrink the Prostate Source: Rahway, NJ: Merck and Co., Inc. 1994. 9 p. Contact: Available from Merck and Co., Inc. P.O. Box 2000, RY7-220, Rahway, NJ 07065. (908) 594-4600. Price: Single copy free. Distribution may be limited to health professionals. Summary: Finasteride (Proscar) is an oral drug indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH). This brochure provides patient education for men who are considering finasteride. Topics include the symptoms of prostate enlargement; the prevalence of prostate enlargement; the importance of seeking health care for BPH; medical options for the treatment of BPH; how finasteride works and for whom; and patient leaflet information from the drug insert sheet. The brochure includes a self-evaluation test that can be used in screening for BPH.

·

Prostatism: Prostate Enlargement (BPH) Source: Marietta, GA: GU Logic. 1994. 2 p. Contact: Available from GU Logic. 2470 Windy Hill Road, Suite 108, Marietta, GA 30067. (800) 451-8107. Price: $35 for 50 copies. Order Number: GU80.

Guidelines 29

Summary: This patient education brochure describes prostatism, defined as difficulty urinating caused by benign enlargement of the prostate gland (benign prostatic hyperplasia, or BPH). Topics include the causes of prostatism; the symptoms of the condition; diagnostic considerations; and the treatment of prostatism. One chart depicts the World Health Organization Symptom Score for BPH. 1 figure. 1 table. ·

Tratamientos para la Inflamacion de la Prostata. [Treatment of Prostate Enlargement] Source: Rockville, MD: Agency for Health Care Policy and Research. 1994. 26 p. Contact: Available from AHCPR Publications Clearinghouse. P.O. Box 8547, Silver Spring, MD 20907. (800) 358-9295. Price: Single copy free. Publication number: 94-0585. Summary: This Spanish-language brochure provides patients with information about benign prostatic hyperplasia (BPH). Topics include a description of the anatomy and function of the prostate gland; symptoms of BPH; the causes of BPH symptoms; how BPH is diagnosed; how to know when to consult a health care provider; deciding when treatment is necessary; treatment options, including watchful waiting, drug therapy, balloon dilatation, and surgery; the success rate of each treatment option; and potential complications associated with each treatment option, including urinary incontinence and sexual impotence. One table summarizes the different treatment options and their benefits and disadvantages. The brochure concludes with resource organizations through which the reader can get more information.

Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:


·

Prostate Enlargement: Benign Prostatic Hyperplasia Summary: This document gives basic information about the prostate gland and the condition called prostate enlargement, or benign prostatic hyperplasia (BPH). Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=831

·

Understanding Prostate Changes: A Health Guide for All Men Summary: Written especially for men, this brochure presents facts about prostate enlargement and prostate cancer, including screening and treatment. Source: Federal Consumer Information Center, U.S. General Services Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5970

The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to prostate enlargement. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific conditions or disorders, or when using highly targeted searches. To use the NIH search utility, visit http://search.nih.gov/index.html.

Guidelines 31

Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells;


however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Constipation: Infrequent or difficult evacuation of the faeces. [EU] Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Decongestant: An agent that reduces congestion or swelling. [EU] Dilatation: The condition, as of an orifice or tubular structure, of being dilated or stretched beyond the normal dimensions. [EU] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Ejaculation: A sudden act of expulsion, as of the semen. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH]

Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the

Guidelines 33

bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intravenous: Within a vein or veins. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Irrigation: Washing by a stream of water or other fluid. [EU] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Orgasm: The apex and culmination of sexual excitement. [EU] Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU]


Postoperative: Occurring after a surgical operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatism: A symptom complex resulting from compression or obstruction of the urethra, due most commonly to hyperplasia of the prostate; symptoms include diminution in the calibre and force of the urinary stream, hesitancy in initiating voiding, inability to terminate micturition abruptly (with postvoiding dribbling), a sensation of incomplete bladder emptying, and, occasionally, urinary retention. [EU] Prostatitis: Inflammation of the prostate. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Sympathomimetic: 1. mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. an agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of

Guidelines 35

symptoms, as symptomatic treatment. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]

Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]

Seeking Guidance 37

CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with prostate enlargement. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with prostate enlargement. The chapter ends with a discussion on how to find a doctor that is right for you.

Associations and Prostate Enlargement As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of a condition or disorder can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8


condition can all influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·

Robert Mathews Foundation Address: Telephone: (916) 567-1400 Toll-free: (800) 234-6284 Fax: (916) 927-5218 Email: [email protected] Web Site: http://www.mathews.or Background: The Mathews Foundation for Prostate Cancer Research is a nonprofit health organization dedicated to providing information and support to individuals affected by prostate cancer and their families. Prostate cancer is characterized by malignant cell development arising in the prostate gland. Symptoms may include increased frequency of urination, poor flow of urine, and difficulties beginning urination due to enlargement of the prostate. Established in 1988, the Mathews Foundation provides affected individuals and their families with information pertinent to prostate cancer so that they can make informed treatment choices. The Foundation also works to raise funds for research into the cause(s), treatment, and ultimate cure of prostate cancer. Educational materials produced by the organization include a regular newsletter entitled 'BreakThrough,' brochures, pamphlets, books, videos, and reprints of pertinent medical literature.

·

US TOO International, Inc., Prostate Cancer Survivor SupportGroups Address: US TOO International, Inc., Prostate Cancer Survivor Support Groups 930 North York Road, Suite 50, Hinsdale, IL 60521-2993 Telephone: (630) 323-1002 Toll-free: (800) 808-7866 Fax: (630) 323-1003 Email: [email protected]

Seeking Guidance 39

Web Site: http://www.ustoo.co Background: US TOO International, Inc., an international voluntary notfor- profit self-help organization, is dedicated to helping survivors of prostate cancer and BPH and their families lead healthy and productive lives, physically, mentally, and spiritually, by offering fellowship, shared counseling, and discussions pertaining to current medical options and a positive mental outlook. Prostate cancer is characterized by malignant cell development arising in the prostate gland. Symptoms may include increased frequency of urination, poor flow of urine, and difficulties beginning urination due to enlargement of the prostate. Benign Prostatic Hypertrophy (BPH), meaning enlargement of the prostate gland, refers to a benign, noninflammatory condition common in men over the age of 50 years. BPH is, however, a progressive condition that may cause increased frequency of urination, pain during urination, and urinary tract infections. US TOO was established in 1990 by five men, each of whom had been diagnosed and treated for prostate cancer and were interested in discussing their common situations and concerns with others. US TOO consists of approximately 550 support groups throughout the United States and other countries including Canada that each function as independent chapters and, together, form a network under the aegis of the parent group, US TOO International, Inc. Each chapter holds regular meetings for prostate cancer survivors and their families. At such meetings, members of the medical profession speak on some phase of diagnosis, stages, treatment options, or other related topics. Participants have the opportunity to discuss individual experiences that may be of interest to the group and receive various sources of information on prostate cancer and BPH. These shared experiences may be beneficial in understanding the disease, communicating with physicians, and making informed decisions. US TOO provides a variety of educational materials including brochures, pamphlets, monthly 'Hot Sheets' containing information on clinical trials and current issues, and a regular newsletter entitled 'US TOO Prostate Cancer Communicator.' US TOO International also has a web site on the Internet at http://www.ustoo.com.

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.


The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about prostate enlargement. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “prostate enlargement” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “prostate enlargement”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “prostate enlargement” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with prostate enlargement. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific conditions and diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option

Seeking Guidance 41

called “Organizational Database (ODB)” and type “prostate enlargement” (or a synonym) in the search box.

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.

Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with prostate enlargement must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·

If you are in a managed care plan, check the plan’s list of doctors first.

·

Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.

·

Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.

·

Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.

Additional steps you can take to locate doctors include the following: ·

10

Check with the associations listed earlier in this chapter.

This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.


·

Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.

·

The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.

·

You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.

Finding a Urologist The American Urological Association (AUA) provides the public with a freeto-use “Find A Urologist” service to help patients find member urologists in their area. The database can be searched by physician name, city, U.S. State, or country and is available via the AUA’s Web site located at http://www.auanet.org/patient_info/find_urologist/index.cfm. According to the AUA: “The American Urological Association is the professional association for urologists. As the premier professional association for the advancement of urologic patient care, the AUA is pleased to provide Find A Urologist, an on-line referral service for patients to use when looking for a urologist. All of our active members are certified by the American Board of Urology, which is an important distinction of the urologist’s commitment to continuing education and superior patient care.”12 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare conditions and diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases. While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 12 Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php. 11

Seeking Guidance 43

Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·

Give me a chance to ask questions about prostate enlargement?

·

Really listen to my questions?

·

Answer in terms I understood?

·

Show respect for me?

·

Ask me questions?

·

Make me feel comfortable?

·

Address the health problem(s) I came with?

·

Ask me my preferences about different kinds of treatments for prostate enlargement?

·

Spend enough time with me?

Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.

Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·

You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.

·

It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.

13 This

section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 14 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.


·

Bring a “health history” list with you (and keep it up to date).

·

Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.

·

Tell your doctor about any natural or alternative medicines you are taking.

·

Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don’t, your doctor will assume that you understood everything that was said.

·

Write down your questions before your visit. List the most important ones first to make sure that they are addressed.

·

Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.

·

Ask your doctor to draw pictures if you think that this would help you understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.

·

Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.

·

After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment. By following these steps, you will enhance the relationship you will have with your physician.

Seeking Guidance 45

Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU]

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

15

Clinical Trials 47

CHAPTER 3. CLINICAL ENLARGEMENT

TRIALS

AND

PROSTATE

Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning prostate enlargement.

What Is a Clinical Trial?16 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for prostate enlargement is to try it on patients in a clinical trial.

The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.

16


What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·

Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.

·

Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on prostate enlargement.

·

Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for prostate enlargement compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?

Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on prostate enlargement carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on prostate enlargement. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham

Clinical Trials 49

treatment.” This treatment, like a placebo, has no effect on prostate enlargement and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how prostate enlargement develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for prostate enlargement. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a condition or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific condition or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of a condition or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo


surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.

Recent Trials on Prostate Enlargement The National Institutes of Health and other organizations sponsor trials on various conditions and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to prostate enlargement.17 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·

Clinical Trial in Males with BPH (Enlarged Prostate) Condition(s): Urinary Retention; Prostatic Hyperplasia; Benign Prostatic Hypertrophy Study Status: This study is currently recruiting patients. Sponsor(s): Sanofi-Synthelabo Purpose - Excerpt: A study to determine the effect on prevention of Acute Urinary Retention (inability to urinate) in males with an enlarged prostate, also known as BPH. * Free study-related medical care provided. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00029822

17

These are listed at www.ClinicalTrials.gov.

Clinical Trials 51

·

Safety/tolerability study of Alcohol Injection for Treatment of BPH (enlarged prostate) Condition(s): Prostate Disease; BPH; Benign Prostatic Hyperplasia; Benign Prostatic Hypertrophy Study Status: This study is currently recruiting patients. Sponsor(s): American Medical Systems Purpose - Excerpt: Multi-center, prospective randomized dosing and safety research study. A maximum of 150 men will be enrolled in the study. Qualifying patients will receive one of three possible doses of the study drug. Symptoms will be evaluated before treatment, and then 1week, 1-month, 3-months, and 6-months following treatment. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037141

·

Saw Palmetto Extract in Benign Prostatic Hyperplasia Condition(s): Benign Prostatic Hyperplasia Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of this study is to test whether an extract of the saw palmetto plant is effective for relieving symptoms of Benign Prostatic Hyperplasia (BPH). Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037154

·

Medical Therapy of Prostatic Symptoms (MTOPS) Condition(s): Prostatic Hyperplasia; Prostatic Hypertrophy, Benign Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The Medical Therapy of Prostatic Symptoms (MTOPS) is a clinical research study sponsored by the National Institutes of Health


(NIH). The study will test whether the oral drugs finasteride (Proscar) and doxazosin (Cardura), alone or together, can delay or prevent further worsening of symptoms in men with Benign Prostatic Hyperplasia (BPH). MTOPS is the largest and longest study to simultaneously test whether these drugs can delay or prevent the clinical progression (symptom worsening) of BPH. Seventeen U.S. medical centers recruited 2,931 men diagnosed with symptomatic BPH between December 1995 and March 1998. Study doctors will continue to follow these men through November 2001 on a quarterly basis. In addition to the clinical progression of BPH, MTOPS will include evaluations of prostate volume by ultrasound, prostate biopsies among a subgroup of volunteers, and quality of life. Phase(s): Phase III Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00021814 ·

Testosterone Replacement for Elderly Men Condition(s): Healthy Study Status: This study is not yet open for patient recruitment. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program; National Institute on Aging (NIA); Unimed Pharmaceuticals Purpose - Excerpt: The study will be a seven-year, randomized, placebocontrolled, double-blind multi-center trial. The proposal is to treat 6000 hypogonadal men 65 years of age and older with replacement doses of testosterone or placebo for an average of five years. While there is good evidence that testosterone treatment will increase bone mineral density (BMD) and lean body mass, it is not known if it will decrease the incidence of fractures and improve muscle strength and power. The primary objective is to assess the effects of testosterone replacement vs. placebo therapy on the incidence of bone fractures in men 65 years of age and older. The secondary objectives include evaluations of (1) serum and urine markers of bone resorption and bone formation, (2) BMD of the total hip and lumbar spine, (3) incidence of clinical prostate cancer, (4) incidence of invasive therapy for benign prostatic hyperplasia (BPH), and (5) incidence of cardiovascular events (MI, sudden death, cerebrovascular accident, angioplasty or coronary bypass surgery or non-traumatic amputation). Phase(s): Phase IV

Clinical Trials 53

Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00032604

Benefits and Risks18 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·

A new treatment could be more effective than the current treatment for prostate enlargement. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.

·

If the treatment is effective, then it may improve health or prevent diseases or disorders.

·

Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.

·

People who take part in trials contribute to scientific discoveries that may help other people with prostate enlargement. In cases where certain conditions or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent

Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.

This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f2 91. 18


What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention.

How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent.

What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·

Information on all known risks and benefits of the treatments in the study.

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Know how the researchers plan to carry out the study, for how long, and where.

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Know what is expected of you.

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Know any costs involved for you or your insurance provider.

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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.

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Talk openly with doctors and ask any questions.

Clinical Trials 55

After you join a clinical trial, you have the right to: ·

Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.

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Receive any new information about the new treatment.

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Continue to ask questions and get answers.

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Maintain your privacy. Your name will not appear in any reports based on the study.

·

Know whether you participated in the treatment group or the control group (once the study has been completed). What about Costs?

In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·

What is the purpose of the clinical trial?

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What are the standard treatments for prostate enlargement? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?

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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?

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How long will the treatment last? How often will I have to come back for follow-up exams?

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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?


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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?

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How will my health be monitored?

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Where will I need to go for the clinical trial? How will I get there?

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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?

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Will I be able to see my own doctor? Who will be in charge of my care?

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Will taking part in the study affect my daily life? Do I have time to participate?

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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?

Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “prostate enlargement” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

Clinical Trials 57

·

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna

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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna

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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna

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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna

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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna

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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna


·

Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU]

59

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on prostate enlargement. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on prostate enlargement. In Part II, as in Part I, our objective is not to interpret the latest advances on prostate enlargement or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with prostate enlargement is suggested.

Studies 61

CHAPTER 4. STUDIES ON PROSTATE ENLARGEMENT Overview Every year, academic studies are published on prostate enlargement or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on prostate enlargement. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on prostate enlargement and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and prostate enlargement, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the


format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “prostate enlargement” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Diagnosis and Treatment of Benign Prostatic Hyperplasia Source: Hospital Medicine. 28(2): 117-118, 120-124. February 1992. Summary: This article discusses benign prostatic hyperplasia (BPH), enlargement of the prostate gland due to an increased number of stromal cells. Topics include its etiology, natural history, clinical manifestation, laboratory findings, cystourethroscopy, imaging modalities used in diagnosis, urodynamic evaluation, differential diagnosis, and surgical, pharmaceutical, and mechanical treatments for the condition. The authors also list the general indications for the relief of prostatic obstruction from BPH. 3 figures. 2 tables. 5 references.

·

Benign Prostatic Hyperplasia Source: Journal of Urological Nursing. 10(2): 1205-1226. April-May-June 1991. Summary: Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostate gland that develops in the aging male. The purpose of this article is to compare normal anatomy and physiology of the prostate compared to that of the hyperplastic prostate, and to review the diagnosis and treatment of BPH. The author notes that the standard, currently accepted treatment of symptomatic BPH is transurethral resection (TURP). Recent advances in medical management will result in increased use of pharmacological intervention and instrumentation as viable options. 6 figures. 3 tables. 13 references. (AA-M).

·

Benign Prostatic Hypertrophy: 'Cost-Benefits' of Surgery Greater Than That of Drug Therapy Source: Drugs and Therapy Perspectives. 10(11): 13-15. November 24, 1997. Contact: Available from Adis International, Ltd. Suite F-10, 940 Town Center Drive, Langhorne, PA 19047. (800) 876-7082 or (215) 741-5200. Fax (215) 741-5251.

Studies 63

Summary: Benign prostatic hypertrophy (BPH), defined as enlargement of the prostate with associated urinary symptoms, affects a large percentage of men over the age of 50 years. Treatment options include a wait and see approach with the introduction of surgery when symptoms become severe, or long term drug therapy, which is mainly indicated for men with moderate symptoms with the aim of circumventing the need for surgery. This article considers the cost benefits of surgery versus drug therapy for BPH. It is possible, and perhaps even likely, that efficient drug therapy itself will reduce the need for prostate surgery by lowering the general level of symptoms. Cost benefit considerations become unfavorable when they are applied to younger men with mild or no symptoms, and most men in this age group will probably object to taking drugs for years to prevent a benign condition such as BPH. Furthermore, cost benefit considerations are of questionable relevance in patients with severe symptoms, who are likely to require surgical management. Men with moderate symptoms of BPH are generally considered the best candidates for drug treatment. However, the distinction between mild and moderate symptoms is arbitrary, and there are wide differences in patient tolerance of symptoms. One possible benefit of closer long term followup of BPH as a result of drug treatment might be an increase in the early detection of prostate cancer. The author concludes that, until more potent drugs are introduced, transurethral resection and other alternative surgical treatments will continue to be the principal treatment modalities for symptomatic BPH. 9 references. ·

Operative Procedures for Benign Prostatic Hypertrophy Source: Nursing Times. 91(38): 34-35. September 20, 1995. Summary: This article examines the clinical management of an enlarged prostate. Topics include preoperative care; the operating procedure (prostatectomy); postoperative care and complications; the anatomy and physiology of the prostate and surrounding structures; signs and symptoms of benign prostatic enlargement; and pain control. The author concludes that, even though clinical trials comparing medical treatment and new surgical techniques flourish, open prostatectomy or transurethral resection (TURP) remain the treatments of choice. 1 figure. 10 references. (AA-M).

·

Balloon Dilation: A New Procedure to Treat Prostate Enlargement Source: Informer. p. 1-2. Summer 1990. Contact: Simon Foundation. P.O. Box 815, Wilmette, IL 60091. (800) 23SIMON.


Summary: As men age, it is normal for the prostate gland to enlarge. Unfortunately, in some cases this enlargement, known as benign prostatic hypertrophy (BPH), may cause urinary obstruction. This article discusses one of the nonsurgical treatment options now available, balloon dilation of the prostate. In this procedure, also known as transurethral dilation of the prostate (TUDP), a catheter with a deflated dilator balloon is inserted into the urethra and the balloon is properly positioned. After the positioning is carefully checked, the balloon is inflated against the prostate for approximately ten to twenty minutes, deflated, and removed. The inflated balloon, when pushed against the prostate gland, results in a widening of the urethra, thus allowing urine to flow more freely. The article goes on to discuss possible minor complications from the procedure; success rates; patient selection criteria for TUDP; insurance issues; and other newly developed therapies for BPH. One drawing illustrates the balloon dilation procedure.

Federally-Funded Research on Prostate Enlargement The U.S. Government supports a variety of research studies relating to prostate enlargement and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.19 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to prostate enlargement and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore prostate enlargement and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for prostate enlargement:

19 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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·

Project Title: Progression of BPH on Medical Therapy Principal Investigator & Institution: Kaplan, Steven A.; Urology; Columbia University Health Sciences Ogc New York, Ny 10032 Timing: Fiscal Year 2000; Project Start 7-APR-1995; Project End 1-MAR2002 Summary: Benign prostatic hyperplasia (BPH) is the most common affliction of men over the age of 50. Traditionally associated symptoms are felt to be secondary to bladder outlet obstruction, dynamic tone of the smooth muscle of the prostate or inherent bladder dysfunction. A host of alternative therapeutic options have been described in the literature over the past 5 years. However, these studies have focused on the relative efficacy and side effect profile of these therapies. There have been few long term studies of the natural history of BPH progression in those who are either treated or in those who are followed by watchful waiting. Moreover, the natural history of BPH in various age and ethnic groups have been poorly characterized. Finally, to date, there have been no long term studies of the association between bladder function, prostatic obstruction, prostate size, symptoms and therapy employed. This full scale, 7 year trial, will provide enormous insight into the progression of prostate enlargement and symptoms in both an untreated population and one treated with medication. This is of particular importance because efficacy of medical therapy can be truly determined only with an understanding of the untreated natural history of BPH. The effects of pharmacologic reduction in the size of the prostate utilizing the 5alpha reductase inhibitor, finasteride, and/or physiologic reduction of urethral outlet resistance using the alpha1 receptor antagonist, doxazosin, on symptoms, voiding parameters and reversibility of bladder dysfunction will be assessed. Four treatment groups will be studied, l) placebo, 2) 5 mg of finasteride (PROSCAR), 3) 8 mg of doxazosin (CARDURA) and, 4) 5 mg finasteride and 8 mg of doxazosin. Progression of disease will be measured by either a rise in baseline AUA Symptom Score of 4 points, development of urinary retention, incontinence or recurrent urinary tract infections or a rise in baseline serum creatinine of 50%. Through this full scale BPH trial, we hope to ascertain: A) the optimal temporal intervention in the treatment of BPH, B) whether reduction in the size of the prostate result in true regression of the disease process? C) a priori prostate tissue characteristics which predict severity of disease or preferential response to medical therapy, D) whether specific ethnic groups manifest various forms of BPH resulting in different rates of progression and differential response to therapy? and, E) whether concomitant prostate conditions such as cancer or prostatitis are effected by pharmacologic intervention for BPH?


Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Standardized and Improved Saw Palmetto Product Principal Investigator & Institution: Castor, Trevor P.; President & Chief Executive Officer; Aphios Corporation 3-E Gill St Woburn, Ma 01801 Timing: Fiscal Year 2000; Project Start 1-JUL-2000; Project End 1-DEC2000 Summary: We propose to develop an improved Saw Palmetto product which can be manufactured in standardized and reproducible manner, and in strict accordance with current Good Manufacturing Practices (cGMP) of the FDA. Saw palmetto, derived from a native American palm tree Serenoa repens, has been clinically proven to be as effective as conventional medications in providing symptomatic relief for benign prostatic hyperplasia (BPH), a type of non-malignant prostate enlargement that is common in older men. This condition typically causes frequent urination. The U.S. marketplace is estimated to be $1.3 billion annually. As the population ages, the marketplace is expected to expand. We propose to improve the quality and standardize the manufacturing of Saw Palmetto by utilizing supercritical fluids and nearcritical fluids w/wo polar cosolvents such as alcohols (SuperFluids(TM)). These fluids are gases such as carbon dioxide which when compressed, exhibit enhanced thermodynamic properties that can be "fine-tuned" for rapid and selective extraction of bioactive molecules. In Phase I, we plan to establish "best" conditions for the selective SuperFluids(TM) extraction and chromatographic purification of biologically active components. In Phase II, we plan to initiate pre-clinical studies, scale-up manufacturing, file an IND, and conduct clinical trials on the standardized Saw Palmetto product. Proposed Commercial Applications: This investigation should lead to the development of improved Saw palmetto product which can be manufactured to meet the cGMP requirements of the FDA's IND process. Thee is a rapid growth of interest in and use of more natural and alternative solutions such as Saw palmetto in the $1.3 billion marketplace for benign prostatic hyperplasia (BPH). Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

Studies 67

E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “prostate enlargement” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for prostate enlargement in the PubMed Central database: ·

Prostate enlargement in mice due to fetal exposure to low doses of estradiol or diethylstilbestrol and opposite effects at high doses by Frederick S. vom Saal, Barry G. Timms, Monica M. Montano, Paola Palanza, Kristina A. Thayer, Susan C. Nagel, Minati D. Dhar, V. K. Ganjam, Stefano Parmigiani, and Wade V. Welshons; 1997 March 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20042

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 23 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication. 20


To generate your own bibliography of studies dealing with prostate enlargement, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “prostate enlargement” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “prostate enlargement” (hyperlinks lead to article summaries): ·

Effect of Serenoa repens extract (Permixon) on estradiol/testosteroneinduced experimental prostate enlargement in the rat. Author(s): Paubert-Braquet M, Richardson FO, Servent-Saez N, Gordon WC, Monge MC, Bazan NG, Authie D, Braquet P. Source: Pharmacological Research : the Official Journal of the Italian Pharmacological Society. 1996 September-October; 34(3-4): 171-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9051712&dopt=Abstract

Vocabulary Builder Concomitant: Accompanying; accessory; joined with another. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]

Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]

Books 69

CHAPTER 5. BOOKS ON PROSTATE ENLARGEMENT Overview This chapter provides bibliographic book references relating to prostate enlargement. You have many options to locate books on prostate enlargement. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on prostate enlargement include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “prostate enlargement” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on prostate enlargement:


·

Live Now, Age Later: Proven Ways to Slow Down the Clock Source: New York, NY: Warner Books. 1999. 398 p. Contact: Available from Warner Books. 1271 Avenue of the Americas, New York, NY 10020. (800) 759-0190. E-mail: [email protected]. Website: www.twbookmark.com. Price: $7.99 plus shipping and handling. Summary: This book offers practical strategies and healthy living advice for people who want to slow down their own aging process. The book is written in casual language with an emphasis on explaining medical and health issues for the general public. Twenty chapters cover Alzheimer's disease, cancer, constipation, depression, hearing loss, heart attacks, erectile dysfunction (impotence), insomnia, libido, menopause, osteoarthritis, osteoporosis, prostate enlargement, aging skin, stroke, diminished taste and smell, tinnitus, tooth loss, and loss of vision (macular degeneration, cataracts, glaucoma). Each chapter reviews the topic in question, risk factors, the type of symptoms that can be expected, diagnostic tests that are used to confirm the problem, treatment options, and prognosis. A final section offers general health guidelines that focus on the importance of positive thinking and healthy lifestyle choices. A subject index concludes the book.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to prostate enlargement (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

Get It Out! Eliminating the Cause of Diverticulitis, Kidney Stones, Bladder Infections, Prostate Enlargement, Menopausal Discomfort, Cervical Dysplasia, PMS, and More by Sydney Ross Singer, Soma Grismaijer; ISBN: 1930858027; http://www.amazon.com/exec/obidos/ASIN/1930858027/icongroupin terna

·

Nettles: Both Potent Herb and Delectable Food, This Common 'Weed' Can Ease Allergies, Prostate Enlargement and More (Keats Good Herb Guide) by Janice J. Schofield (1998); ISBN: 087983840X;

Books 71

http://www.amazon.com/exec/obidos/ASIN/087983840X/icongroupi nterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “prostate enlargement” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:24 ·

Benign prostate diseases. Author: edited by W. Vahlensieck, G. Rutishauser; with the cooperation of R.U. Anderson ... [et al.]; Year: 1992; Stuttgart; Georg Thieme Verlag: New York; Thieme Medical Publishers, Inc., 1992; ISBN: 3137914019 (GTV: Stuttgart)

·

Biopsy pathology of the prostate. Author: David G. Bostwick and Paul A. Dundore; Year: 1997; London; New York: Chapman & Hall Medical, 1997; ISBN: 0412755106 http://www.amazon.com/exec/obidos/ASIN/0412755106/icongroupin terna

·

Clinical lectures on enlargement of the prostate; with a description of the author's operations of total enucleation of the organ. Author: Freyer, Peter Johnston, Sir, 1852-1921; Year: 1906; London, Baillière, Tindall & Cox, 1906

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Clinically organ-confined adenocarcinoma of the prostate: natural history, selection criteria for radical prostatectomy, and prognostic factors based on long-term follow-up. Author: Hans-Peter Schmid; Year: 1994; Darmstadt: Steinkopff, c1994; ISBN: 3798509980 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3798509980/icongroupin terna

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

24


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Cost effectiveness of prostate specific antigen and digital rectal examination in the detection of prostate cancer: final report. Author: by Kit N. Simpson, Ruth E. Brown; Year: 1993; Washington, DC: Battelle Medical Technology Assessment and Policy Research Center, [1993]

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Cost-effectiveness of prostate-specific antigen (PSA) screening. Author: ECRI; Year: 2001; Plymouth Meeting, PA: ECRI, c2001

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Enlargement of the prostate, its treatment and radical cure. Author: Moullin, Charles William Mansell, 1851-1940; Year: 9999; London, Lewis, 1894-

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Enlargement of the prostate; its history, anatomy, aetiology, pathology, clinical causes, symptoms, diagnosis, prognosis, treatment, technique of operations, and after-treatment, by John B. Deaver ... assisted by Astley Paston Cooper Ashhurst ... illustra. Author: Deaver, John Blair, 1855-1931; Year: 1905; Philadelphia, P. Blakiston's son & co., 1905

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Fifteen PSA assays. Author: M. Lee, P. White, A. M. Ward; Year: 1998; London: Department of Health, 1998; ISBN: 1858398444

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Guidelines for performance of the ultrasound examination of the prostate (and surrounding structures). Author: American Institute of Ultrasound in Medicine; Year: 1991; Laurel, MD: American Institute of Ultrasound in Medicine, c1991

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MDA evaluation of five free: total PSA assays. Author: D Patel, A Milford Ward, PA E White; Year: 2000; London: Medical Devices Agency, c2000; ISBN: 1841822191

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Neuroendocrine cells in the prostate. Author: guest editor, Abraham T.K. Cockett; Year: 1998; Danvers, MA: Wiley-Liss, c1998

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Pathology of the prostate. Author: [edited by] Christopher S. Foster, David G. Bostwick; Year: 1998; Philadelphia: Saunders, c1998; ISBN: 0721669514 http://www.amazon.com/exec/obidos/ASIN/0721669514/icongroupin terna

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Practical observations on the chronic enlargement of the prostate gland, in old people; with suggestions for the improved mode of treatment ... Author: Courtenay, Francis Burdett, 1811-1886; Year: 1839; London, 1839

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Primary reference preparations used to standardize calibration of immunochemical assays for serum prostate specific antigen (PSA); approved guideline. Author: R. M. Nakamura ... [et al.]; Year: 1997; Wayne, PA: NCCLS, 1997; ISBN: 156238323X http://www.amazon.com/exec/obidos/ASIN/156238323X/icongroupi nterna

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Prostaglandin content and metabolic activity of the human prostate. Author: D. Conte ... [et al.]; Year: 1979; 1979

Books 73

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Prostate cancer: biology, diagnosis, and management. Author: edited by Konstantinos N. Syrigos; Year: 2001; Oxford; New York: Oxford University Press, 2001; ISBN: 0192631853 (Hbk: alk. paper)

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Prostate enlargement: benign prostatic hyperplasia. ; Year: 1998; Bethesda, Md.: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health: National Kidney and Urologic Diseases Information Clearinghouse [distributor, 1998]

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Prostate enlargement: benign prostatic hyperplasia. Author: Downes, Nancy; Year: 1990; [Bethesda, Md.]: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, [1990]

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Prostate specific antigen in the early detection of prostate cancer. Author: C. J. Green ... [et al.]; Year: 1993; Vancouver, British Columbia, Canada: BCOHTA CHSPR, 1993

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Prostate specific antigen. Author: edited by Michael K. Brawer; Year: 2001; New York: Marcel Dekker, c2001; ISBN: 0824705556 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824705556/icongroupin terna

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Prostate-specific antigen and prostatic acid phosphatase: androgen and growth factor-regulated mRNAs and proteins in the human prostate. Author: Pirkko Henttu; Year: 1992; Oulu: Ouluensis Universitas, 1992; ISBN: 9514234286

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Prostatic obstruction: pathogenesis and treatment. Author: Christopher R. Chapple (ed.); Year: 1994; London; New York: Springer-Verlag, c1994; ISBN: 3540196811 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540196811/icongroupin terna

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PSA test in early detection of prostate cancer. Author: Health Services Utilization and Research Commission; Year: 1995; Saskatoon, SK: The Commission, [1995]

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Retropubic prostatectomy for benign enlargement of the prostate gland. Author: Beneventi, Francis Anthony, 1906-; Year: 1954; Springfield, Ill., Thomas [c1954]

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Role of alpha blockers in benign prostatic hyperplasia. Author: editors, Georg Bartsch, Roger S. Kirby, Herbert Lepor; Year: 1997; Montreal; Chicago: PharmaLibri, 1997; ISBN: 0919839401 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0919839401/icongroupin terna

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Self-injection of the bladder: in the treatment of the consequences of obstructive enlargement of the prostate, and the best means of accomplishing it: together with two cases illustrating another method


of removing foreign bodies from the urethra. ; Year: 1875; New York: D. Appleton & Co., 1875 ·

Techniques for ablation of benign and malignant prostate tissue. Author: [edited by] Joseph A. Smith, Jr., Douglas F. Milam; Year: 1996; New York: Igaku-Shoin, c1996; ISBN: 089640305X http://www.amazon.com/exec/obidos/ASIN/089640305X/icongroupi nterna

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Vasectomy and prostate cancer [microform]: a case-control study in a health maintenance organization. Author: K. Zhu; Year: 1994; Ann Arbor, Michigan, University Microfilms International, 1994

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Vasectomy in cryosurgery of the prostate. Author: W. Hiroto ... [et al.]; Year: 1980; 1980

Chapters on Prostate Enlargement Frequently, prostate enlargement will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with prostate enlargement, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and prostate enlargement using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “prostate enlargement” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on prostate enlargement: ·

Testosterone Effect: Hormone Replacement Therapy Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 64-66. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. Price: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This chapter, from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction, discusses hormone replacement therapy (namely, testosterone). Testosterone replacement is currently used today in both

Books 75

primary and secondary hypogonadism (decreased testicular production of testosterone). The current methods of androgen replacement available for human use include oral preparations, the long acting esters of testosterone, and the transdermal preparations. The author describes how each of these preparations is used, and then discusses how low serum testosterone contributes to erectile dysfunction. Testosterone therapy is contraindicated in men with prostate cancer. It is relatively contraindicated in older men with bladder neck obstruction from prostate enlargement. The author recommends that all men over the age of 50 receiving testosterone first have a prostate specific antigen (PSA) level measurement and a digital rectal exam. In addition, because oral testosterone preparations definitely increase the risk of liver problems, requiring close monitoring of liver function. The chapter is written in nontechnical language but includes enough medical information to be of use to medical professionals wishing to learn more about sexuality and sexual dysfunction. ·

Benign Prostate Problems Source: in Blaivas, J.G. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York, NY: Plenum Publishing Corporation. 1998. p. 157-176. Contact: Available from Kluwer Academic-Plenum Publishing Corporation. 233 Spring Street, New York, NY 10013-1578. (800) 221-9369 or (212) 620-8035. Fax (212) 647-1898. Website: www.plenum.com. Price: $26.95. ISBN: 0306458640. Summary: The prostate is a specialized gland that surrounds the male urethra near the opening to the bladder. It produces secretions that are mixed with sperm during ejaculation. This chapter on benign prostate problems is from a book for people who have urinary bladder and prostate problems: people who urinate too often, who plan their daily activities around the availability of a bathroom, men with prostate problems, women with incontinence, and people with bladder pain. The book is written in a clear, nontechnical, humorous style that makes the material more accessible to the lay reader. In middle age (beginning around age 40 years) the prostate gland increases in size; this condition is called benign prostatic hyperplasia (BPH). BPH is often associated with lower urinary tract symptoms (difficulty in urinating, for example) and it can cause bladder and kidney problems, but for most men it is more of a nuisance than a threat to their health. The other major cause of prostate enlargement is cancer of the prostate. The chapter describes lower urinary tract symptoms in men and how to know when they warrant a trip to the health care provider. Diagnostic tests utilized include the


patient history and examination, urinalysis, urine culture and sensitivities, cystoscopy, urodynamics, and prostate ultrasound. The author then discusses treatment options, including watchful waiting, medications, and surgical procedures: transurethral prostatectomy (TURP), transurethral incision of the prostate (TUIP), and open prostatectomy. Other treatment options include minimally invasive therapies such as hyperthermia, laser surgery, transurethral needle ablation (TUNA), high intensity focused ultrasound, and prostatic stents. The author reiterates that, in most patients, treatment is elective, but an accurate diagnosis is important to exclude more serious conditions such as bladder or prostate cancer. 4 figures. 1 table.

General Home References In addition to references for prostate enlargement, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna

Books 77

· The Merck Manual of Medical Information: Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna · Urodynamics Made Easy by Christopher R. Chapple, Scott A. MacDiarmid; Paperback -- 2nd edition (April 15, 2000), Churchill Livingstone; ISBN: 0443054630; http://www.amazon.com/exec/obidos/ASIN/0443054630/icongroupinterna

Vocabulary Builder Adenocarcinoma: organization. [NIH]

A malignant epithelial tumor with a glandular

Aetiology: Study of the causes of disease. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency or other output. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chronic: Persisting over a long period of time. [EU] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hypogonadism: A condition resulting from or characterized by abnormally


decreased functional activity of the gonads, with retardation of growth and sexual development. [EU] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Libido: Sexual desire. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH]

Multimedia 79

CHAPTER 6. MULTIMEDIA ON PROSTATE ENLARGEMENT Overview Information on prostate enlargement can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on prostate enlargement. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Video Recordings Most disorders do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on prostate enlargement is the Combined Health Information Database. You will need to limit your search to “video recording” and “prostate enlargement” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “prostate enlargement” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on prostate enlargement:


·

What You Really Need to Know About Enlarged Prostate Source: [Toronto, ON, Canada]: Videos for Patients. 1994. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. Suite 240, 2315 Whirlpool Street, Niagara Falls, NY 14305. Or P.O. Box 84548, 2336 Bloor Street West, Toronto, ON M6S 1TO, Canada. (800) 7574868 or (905) 602-1160. Fax (905) 602-8720. Price: $99.00 (Canadian); contact producer for current price in American dollars. Order Number VFP023. Summary: This videotape provides viewers with information about prostate enlargement. The videotape is introduced with a brief sketch featuring comedian John Cleese and Dr. Robert Buckman illustrating the difficulties sometimes experienced by patients during the traditional doctor's explanation. Dr. Buckman presents the medical facts using visual aids. Topics include why the prostate becomes enlarged, problems caused by an enlarged prostate, treatment options, including the details of various surgical options and nonsurgical hormone treatments, and the side effects and after-effects of the different types of treatment. (AA-M).

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Everything You Wanted to Know About the Prostate (But Were Afraid to Ask) Source: Madison, WI: University of Wisconsin Hospital and Clinics. 1993. Contact: Available from University of Wisconsin Hospital and Clinics, Department of Outreach Education. Picture of Health, 2870 University Avenue, Suite 206, Madison, WI 53705-3611. (800) 757-4354 or (608) 2636510. Fax (608) 265-5444. Price: $14.95 for VHS, $36.95 for broadcast master, plus $5.75 shipping and handling (as of 1995); discounts available for larger quantities. Item Number 112393A. Summary: In this patient education videotape program, two urologists discuss treatment for noncancerous prostate enlargement. Dr. Reginald Bruskewitz and Dr. Edward Messing provide readers with information about benign prostatic hyperplasia; diagnostic tests for prostate cancer; the symptoms of prostate enlargement; and treatment options. (AA-M).

Bibliography: Multimedia on Prostate Enlargement The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in prostate enlargement (or synonyms).

Multimedia 81

Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on prostate enlargement. For more information, follow the hyperlink indicated: ·

Anatomy and pathology of the prostate. Source: produced and distributed by Health Video Dynamics, Inc; Year: 1987; Format: Videorecording; Washington, D.C.: Health Video Dynamics, c1987

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Applications of prostate ultrasound in malignant and benign disease. Source: CME Conference Video, Inc.; produced and developed in cooperation with the Department of Continuing Education in Health Sciences, UCLA Extension; sponsored by the Div; Year: 1992; Format: Videorecording; [California]: Regents of the University of California, c1992

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BPH : a common denominator in aging men. Source: a presentation of Films for the Humanities & Sciences; Year: 2000; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2000

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Carcinoma of meibomian glands of right lower lid : duration 4 years, enlargement lately. Source: [production company unknown]; Wendell L. Hughes; Year: 1940; Format: Motion picture; [S.l.: s.n., 1940]

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Cardiac diagnosis: left ventricular enlargement. Source: Dept. of Continuing Medical Education, School of Medicine, State University of New York at Buffalo, in cooperation with the Lakes Area Regional Medical Program; Year: 1974; Format: Slide; [Buffalo]: Communications in Learning, 1974

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Interactive transrectal ultrasound guided transperineal prostate implantation. Source: from the Film Library and the Clinical Congress of ACS, Mount Sinai School of Medicine of the City University of New York, the Mount Sinai Hospital; Year: 1996; Format: Videorecording; [New York, N.Y.]: Video Services, Dept. of Medical Education, Mount Sinai School of Medicine, the Mount Sinai Medical Center, c1996

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Knowledge of pertinent ultrasound physics needed to do a proper prostate examination; Transrectal ultrasound of the normal prostate and pitfalls of normal with anatomical correlations. Source: produced and distributed by HealthVideo Dynamics, I; Year: 1987; Format: Videorecording; Washington, D.C.: Health Video Dynamics, c1987

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Konno-Rastan procedure for tunnel stenosis : enlargement of the left ventricular outflow tract and AVR. Source: a production of the BioCommunications Laboratory, Texas Heart Institute; Year: 1987; Format: Videorecording; [Houston, Tex.]: The Institute, c1987


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Living with prostate disease. Source: a presentation of Films for the Humanities & Sciences; Year: 1996; Format: Videorecording; Princeton, N.J: Films for the Humanities & Sciences, c1996

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Male genitalia, anus, rectum, and prostate. Source: [presented by] W.B. Saunders Company; Year: 1998; Format: Videorecording; [Philadelphia]: W.B. Saunders, c1998

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MR imaging of the prostate and bladder. Source: the Radiological Society of North America; Year: 1992; Format: Videorecording; [Oak Brook, Ill.]: RSNA, c1992

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Primary care : the prostate. Source: a co-production of the Regional Audio Visual Center and Physician Education & Development; Year: 1995; Format: Videorecording; [Oakland, Calif.]: Kaiser Foundation Health Plan, c1995

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Prostate cancer : screening and treatment. Source: a co-production of Multimedia Communications and Physician Education and Development; Year: 2000; Format: Videorecording; Oakland, CA: Kaiser Foundation Health Plan, c2000

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Prostate cancer and primary care : detection, diagnosis, and tracking treatment response. Source: Mitchell C. Benson; Year: 1998; Format: Videorecording; Clifton, N.J.: Network for Continuing Medical Education, c1998

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Prostate cancer screening. Source: edited by Ian M. Thompson, Martin I. Resnick, Eric A. Klein; Year: 2001; Totowa, N.J.: Humana Press, c2001

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Prostate cancer surgery. Source: a presentation of Films for the Humanities & Sciences; produced for the Learning Channel by Advanced Medical Education, Inc; Year: 1996; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1996

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Prostate cancer. Source: a presentation of Films for the Humanities & Sciences; ITV, Information Television Network; Year: 1998; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c1998

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Prostate cancer. Source: [presented by] the Medical University of South Carolina, College of Medicine and the Health Communications Network; produced by the Health Communications Network, Division of Television Services, Medical University of S; Year: 1994; Format: Videorecording; Charleston, S.C.: The University, c1994

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Prostate cancer. Source: Time Life Medical; produced in association with Sonalysts Studios; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996

Multimedia 83

·

Prostate disorders. Source: Time Life Medical; produced in association with Sonalysts Studios; Year: 1996; Format: Videorecording; New York, NY: Patient Education Media, c1996

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Prostatic enlargements (benign & malignant). Source: McMaster University Health Sciences; Year: 1973; Format: Slide; [Hamilton, Ont.: Health Sciences McMaster Univ.], 1973

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Transrectal ultrasonography and prostate cancer. Source: produced by Health Video Dynamics, Inc; Year: 1989; Format: Videorecording; Washington, D.C.: Health Video Dynamics, c1989

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Transurethral resection of the prostate. Source: [presented by] Informed Consent Incorporated; produced and distributed by Filmtec, Inc; Year: 1988; Format: Videorecording; Reston, VA: Filmtec, c1988

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Turtles, rabbits, and birds (TuRB) : an allegory for the management of prostate cancer. Source: Paul H. Lange; Year: 1995; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1995

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Ultrasonically guided prostate biopsy. Source: produced by Health Video Dynamics, Inc.; technical production by the Bowman Gray School of Medicine of Wake Forest University, Department of Audio-Visual Resources; Year: 1989; Format: Videorecording; Washington, D.C.: Health Video Dynamics, c1989

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Ultrasound of the prostate. Source: the Radiological Society of North America; Year: 1987; Format: Videorecording; Oak Brook, Ill.: The Society, c1987

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Urogenital tract : prostatic enlargement. Source: Trainex Corporation; Year: 1977; Format: Videorecording; Garden Grove, Calif.: Trainex, c1977

Vocabulary Builder Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ventricular: Pertaining to a ventricle. [EU]

Periodicals and News 85

CHAPTER 7. PERIODICALS AND NEWS ON PROSTATE ENLARGEMENT Overview Keeping up on the news relating to prostate enlargement can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on prostate enlargement. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover prostate enlargement beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on prostate enlargement is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.


PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “prostate enlargement” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·

Gyrus Group PLC Focuses on Prostate Cancer Surgery At American Urological Association Meeting Summary: Pittsburgh, May 23 /PRNewswire/ -- Men with asymptomatic benign prostatic hyperplasia (BPH), symptomatic BPH, and BPH with prostate cancer express different genes according to a study published by the University of Pittsburgh in the May 28 issue of the Proceedings of the National Academy of Sciences (PNAS). These findings are the first to investigate the molecular differences underlying BPH, commonly referred to as an enlarged prostate. "We have known that not all BPH is the same; patients experience different degrees of prostate enlargement and experience different symptoms, ranging from none to renal failure, but we didn't know why," said Robert Getzenberg, Ph.D., director of urological research and associate professor, department of urology, University of Pittsburgh School of Medicine and co-director of the prostate and urologic cancer program of the University of Pittsburgh Cancer Institute (UPCI). "In fact, we knew little about the causes of BPH, and prior to this study, we knew very little about the genetics of BPH. As a result, we were treating all patients in a similar manner, which proved to be very costly and, in many patients, ineffective. Now, we can look into targeting the different types of BPH and creating new therapies to alleviate the symptoms of the disease based upon their unique properties." Researchers identified a set of 511 genes that were differentially expressed in tissue samples taken from four groups of patients: normal (patients without BPH), BPH without symptoms, BPH with symptoms, and BPH with cancer. Principal component analysis (PCA) showed that each of the four groups were clearly distinguishable from one another. The prostates of the group of men with symptomatic BPH were most similar to the BPH areas of the individuals with prostate cancer. This relationship may indicate the presence of a potential link between BPH


and prostate cancer that has not been previously identified as well as support the concept of a genetic "field effect" in individuals with prostate cancer. "Studying patterns of gene expression is a powerful tool. Already it is providing important clues about the fundamental nature of disease which will allow us to more strategically target our therapies," said Joel B. Nelson, M.D., professor and chairman of the department of urology at the University of Pittsburgh School of Medicine and co-director of the Comprehensive Prostate and Urologic Cancer Program at UPCI. Further analysis showed that there were unique sets of genes that serve as a signature of each of the groups. Genes associated with cell proliferation were up regulated in the symptomatic BPH group. A series of genes including oncogenes were up regulated in the BPH cancer group. A cluster of genes with unknown function distinguished the asymptomatic BPH from the others. "One of the most striking of these discoveries is the strong correlation between inflammation and symptomatic BPH. With this information, we can now investigate new therapeutic approaches, such as using antiinflammatory agents to alleviate symptoms. This is a key finding because previously, we were using a few drugs that were effective only in a small population and now, we may be able to stratify our treatments and diagnostics to better treat patients," said Dr. Getzenberg. Subsets of genes including inflammatory mediators, cytokines and extracellular matrix associated molecules distinguished the symptomatic BPH and BPH with cancer from the normal and asymptomatic groups. The study also found that JM27, a gene up regulated in prostate cancer and specific to the prostate and female reproductive tissues, was up regulated in symptomatic BPH, suggesting that overexpression of JM27 may be involved in the progression of BPH, prostate cancer and tumors of the female reproductive tract. BPH is one of the most common diseases affecting men. More than half of all men over the age of 60, and 80 percent by age 80, will have enlarged prostates. Forty to 50 percent will develop symptoms of BPH, which include more frequent urination, urinary tract infections, the inability to completely empty the bladder, and, in severe cases, the eventual damage of the bladder and kidneys.


This study was completed as a collaborative effort between the University of Pittsburgh, GeneLogic Inc. of Gaithersburg, Md., and the Kagawa Medical University, Kagawa, Japan. Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to prostate enlargement. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “prostate enlargement” (or synonyms). The following was recently listed in this archive for prostate enlargement: ·

Two-drug combo works best for prostate enlargement Source: Reuters Health eLine Date: May 29, 2002 http://www.reuters.gov/archive/2002/05/29/eline/links/20020529elin 032.html

·

Surgery may improve sexual function in men with benign prostate enlargement Source: Reuters Medical News Date: May 07, 2002 http://www.reuters.gov/archive/2002/05/07/professional/links/20020 507clin019.html

·

PSA level predicts risk of urinary retention in benign prostatic hyperplasia Source: Reuters Medical News Date: March 11, 1999 http://www.reuters.gov/archive/1999/03/11/professional/links/19990 311clin009.html

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.


Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “prostate enlargement” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.

Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “prostate enlargement” (or synonyms). If you know the name of a company that is relevant to prostate enlargement, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “prostate enlargement” (or synonyms).

Newsletters on Prostate Enlargement Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “prostate


enlargement.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “prostate enlargement” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·

Benign Prostatic Hyperplasia: A New Look at an Old Problem Source: Focus on Geriatric Care and Rehabilitation. 7(3): 1-8. July/August, 1993. Summary: Benign prostatic hyperplasia (BPH) is the noncancerous enlargement of the prostate. This newsletter focuses on BPH, discusses its etiology and pathophysiology; screening and prevention; the clinical manifestations of BPH; the secondary effects of BPH; the diagnosis of BPH, including laboratory tests, radiographic tests and miscellaneous tests; the treatment of BPH, including medical management, surgical management, preprostatectomy education, transurethral resection of the prostate, suprapubic resection, retropubic resection, and the perineal approach; and postprostatectomy care in the extended care facility. A pull-out sheet summarizes recommended postprostatectomy education topics and their rationale. 4 figures. 4 tables.

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “prostate enlargement” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on prostate enlargement: ·

Nocturia: When Nature Calls at Night Source: Harvard Health Letter. 24(10): 6. August 1999.


Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. E-mail: [email protected]. Summary: This health newsletter article describes nocturia, the condition of frequent urination at night. Nocturia is often more of a bother than a major burden, but readers are cautioned that it can be a sign of early kidney, bladder, or prostate disease. Nocturia can also be a byproduct of heart failure and other conditions that cause edema (retention of fluid). Physicians usually treat nocturia by addressing the conditions that cause it. More men in their 40s and 50s are bothered by nocturia than women the same age, but the numbers start to even out with age. For men, nocturia is often associated with prostate problems. In this situation, the bladder can't completely empty because benign prostatic hyperplasia (BPH), the noncancerous enlargement of the prostate gland, compresses the urethra and slows or impedes the flow of urine. For women, childbirth and lower estrogen levels cause the muscles of the pelvic floor to weaken. Weaker pelvic floor muscles can mean less control and more interruptions at night to urinate. The article concludes by encouraging readers to seek treatment for nocturia, particularly that which interferes with adequate sleep, as there are a variety of approaches to the problem. 1 figure. ·

Incontinence: Ways to Help You Stay Dry Source: Mayo Clinic Health Letter. 16(1): 1-3. January 1998. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This patient education article from the Mayo Clinic newsletter reviews self care strategies for people with urinary incontinence (UI). The author emphasizes that most UI can be treated, with resulting cure or improvement. The author first outlines the urinary system and how the urinary sphincter and urethra work. The author then defines four types of UI: stress, urge, overflow, and mixed. A number of factors can lead to UI, including excess weight, frequent constipation, a chronic cough, or childbirth (all of which can stress and weaken the pelvic floor muscles). Other causes include urinary related infections, overactive bladder muscles, a malfunction of the urinary sphincter, and high fluid intake. In addition, diseases such as diabetes, stroke, and Parkinson's disease can damage the nerves that control the bladder. In men, UI can also stem from noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), prostate cancer, and prostate surgery. The author describes some of the treatments available, including behavior modification (bladder retraining), avoiding alcohol and caffeine, pelvic floor exercises,


medications, bulking agents (injected into the lining of the urethra), urethral plug, urethral patch, pessary, and surgery. The author concludes that most people treated for incontinence can see a significant reduction in urine leakage. One sidebar details how to perform Kegel exercises to strengthen pelvic floor muscles. 1 figure.

Academic Periodicals covering Prostate Enlargement Academic periodicals can be a highly technical yet valuable source of information on prostate enlargement. We have compiled the following list of periodicals known to publish articles relating to prostate enlargement and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on prostate enlargement published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on prostate enlargement: ·

Pharmacological Research: the Official Journal of the Italian Pharmacological Society. (Pharmacol Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ph armacological+Research+:+the+Official+Journal+of+the+Italian+Pharma cological+Society&dispmax=20&dispstart=0

Vocabulary Builder Asymptomatic: Showing or causing no symptoms. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or


cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Extracellular: Outside a cell or cells. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Nocturia: Excessive urination at night. [EU] Pessary: 1. an instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. a medicated vaginal suppository. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU]

Physician Guidelines and Databases 95

CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common disorders, the National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm


NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.25 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:26 ·

Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 26 See http://www.nlm.nih.gov/databases/databases.html. 25


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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

While all of the above references may be of interest to physicians who study and treat prostate enlargement, the following are particularly noteworthy.

The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and prostate enlargement using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “prostate enlargement” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with prostate enlargement. The following is a sample result:


·

Prostate Health: What Every Man Needs to Know Source: Zetland, New South Wales, Australia: Multicultural Health Communication Service. 1997. (web brochure). Contact: Available from Multicultural Health Communication Service. Royal South Sydney Community Health Complex, Joynton Avenue, Zetland, New South Wales, Australia 2107. (02) 9382 8111. E-mail: [email protected]. Website: mhcs.health.nsw.gov.au/. Item is available only through the website and can be found under Men's Health. Summary: This brochure, available online through the Multicultural Health Communication Service, is one in a series of health information publications available in languages other than English. The Service facilitates the communication of quality information about health issues and health services to people of non-English speaking backgrounds. This brochure describes the prostate gland, its function, and problems that can be encountered with prostatic enlargement. For some men, prostate enlargement, while normal and not an indication of cancer, can interfere with urination (because the enlarged prostate is pressing on the urethra). The brochure cautions that sometimes similar symptoms can be a sign of prostate cancer, so men should be encouraged to consult their health care providers. A final section briefly defines prostatitis. The brochure is not illustrated and written in straightforward, nontechnical language.

·

Prostate Disorders and Incontinence Source: Olivette, MO: Home Delivery Incontinent Supplies, Inc. 1995. 2 p. Contact: Available from Home Delivery Incontinent Supplies, Inc. 1215 Dielman Industrial Court, Olivette, MO 63132. (800) 269-4663. Price: Single copy free. Summary: This patient education brochure provides information on prostate disorders and urinary incontinence. Written in a question and answer format, the brochure covers the role of the prostate gland in the urinary process, the types of prostate disorders that can occur (prostatitis, benign prostate enlargement, and prostate cancer), the types of surgical procedures used in the treatment of prostate disorders, incontinence as a complication of prostate surgery, steps to improve bladder control following prostate surgery, and products available for managing incontinence.

·

Enlarged Prostate: Medication or Surgery Source: Hanover, MD: American Prostate Society. 1994. 4 p.


Contact: Available from American Prostate Society. 1340-F Charwood Road, Hanover, MD 21076-3169. (410) 859-3735. E-mail: [email protected]. Web site: http://www.ameripros.org. PRICE: Single copy free; bulk copies available. Summary: This brochure helps men with prostatic enlargement make the decision between medications or surgery for treatment. The brochure first describes the use of flutamide, finasteride (Proscar), and terazosin (Hytrin) and the drawbacks to each. The authors discuss two main objections to medication: cost factors and the lack of opportunity to detect prostatic cancer. The man's health, age, and degree of prostatic enlargement will affect the decision regarding treatment modality. Up to half of all men, properly evaluated for medication, could avoid surgery using Proscar or Hytrin under a physician's care. The remainder of the brochure outlines the steps taken prior to, during, and after surgery for prostatic enlargement. More than 400,000 men each year undergo surgery to correct prostate enlargement, at a cost of more than three billion dollars per year. The brochure lists the conditions that might require surgery (as opposed to watchful waiting): hesitating or difficult urination; incomplete voiding; recurring bladder infections; inability to control urination; and reduced kidney function. The brochure focuses on the transurethral resection of the prostate, or TURP, procedure. One series of diagrams illustrates how the enlarging prostate affects urination at different points in its enlargement. 5 references. (AA-M). ·

Prostate Problems: A Natural Consequence of Aging Source: San Clemente, CA: Advanced Surgical Intervention, Inc. 1990. 6 p.

Contact: Available from Advanced Surgical Intervention, Inc. 951 Calle Amanecer, San Clemente, CA 92672. (714) 361-0800. Price: Single copy free. Summary: This general health education brochure presents information on prostate problems. After a brief review of the normal anatomy and physiology of the prostate gland, the authors discuss non-cancerous prostate enlargement, surgical transurethral resection of the prostate (TURP), non-surgical transcystoscopic urethroplasty, prostate cancer, and the role of early detection in the successful treatment of prostate problems. The brochure includes a self-administered quiz to help the reader determine if he needs to see a physician about possible urinary obstruction problems caused by an enlarged prostate. ·

Important Things to Know About Prostate Health Source: Kalamazoo, MI: Hope Publications. 200x. 4 p.


Contact: Available from Hope Publications. 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851. (616) 343-0770. Website: hithope.com. Price: $1.45 for single copy; bulk copies available. Summary: This brochure familiarizes men with their prostate, prostate problems, and how to incorporate strategies into their health care that identify and manage prostate problems. The brochure emphasizes that increasing age is the major risk factor for both prostate enlargement and prostate cancer. However, prostate symptoms are not a necessary part of getting older; when the symptoms are properly diagnosed and treated, most can be relieved. The brochure begins with an overview of the anatomy of the prostate and its role in producing the fluid that transports sperm. The brochure then describes three prostate problems: prostatitis (inflammation of the prostate), benign prostatic hyperplasia (enlarged prostate), and prostate cancer. The brochure also outlines the common diagnostic tests for prostate problems, including the digital rectal exam (DRE), the PSA blood test, and biopsy. There are four options for men who are found to have prostate cancer: watchful waiting, surgery, radiation therapy, and hormone therapy and chemotherapy. One sidebar lists prostate symptoms to watch for, including weak or interrupted urine stream; inability to urinate; difficulty in starting or stopping urination; urgency (difficulty postponing urination); need to urinate frequently (especially at night); blood in the urine; painful or burning urination; continuing pain in the lower back; pelvis, or upper thighs; and a feeling that one still needs to urinate after just finishing. The brochure stresses that these symptoms are most likely due to prostate infection or enlargement, but they should be checked out by a health care provider. The brochure includes the toll free telephone lines of the American Cancer Society (800-ACS-2345) and the National Cancer Institute (8004CANCER). 1 figure. 1 table. ·

What Every Man Should Know About His Prostate Source: Chapel Hill, NC: Merck Information Center. 1992. 6 p. Contact: Available from Merck Information Center. 100 Europa Drive, Suite 290, Chapel Hill, NC 27514. (215) 661-3298 or (800) 635-4454 or 4452. Price: Single copy free. Summary: This health information booklet presents information about the prostate. The first part of the booklet explains the role of the prostate in the body and the prostate changes that tend to occur as a man ages. The second part takes a look at several prostate-related conditions and the steps that can be taken to catch prostate disease early. Three problems of the prostate are covered: prostate enlargement (benign prostatic hyperplasia), prostatitis, and prostate cancer. The inside front cover


includes a quiz about the prostate and the inside back cover offers a glossary of terms as well as the quiz answers. Simple line drawings illustrate the anatomy of the prostate and how a rectal exam is performed.

The NLM Gateway27 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.28 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.29 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “prostate enlargement” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category.

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 29 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 27 28


Results Summary Category Items Found Journal Articles 437 Books / Periodicals / Audio Visual 24 Consumer Health 37 Meeting Abstracts 2 Other Collections 0 Total 500

HSTAT30 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.31 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.32 Simply search by “prostate enlargement” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists33 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 32 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 33 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 30 31


may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.34 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.35 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

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MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.

·

Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 35 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 34


generally used by caregivers into terms from formal, controlled vocabularies; see http://www.lexical.com/Metaphrase.html.

The Genome Project and Prostate Enlargement With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to prostate enlargement. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.

Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).36 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “prostate enlargement” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for prostate enlargement: ·

Androgen Insensitivity Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?300068

Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

36


·

Androgen Receptor Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?313700

·

Aquaporin 3 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?600170

·

Fibulin 5; Fbln5 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?604580

·

Inhibin, Beta a Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?147290

·

Inhibin, Beta B Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?147390

·

Macrocephaly, Multiple Lipomas, and Hemangiomata Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?153480

·

Phosphatase and Tensin Homolog Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?601728

·

Pseudovaginal Perineoscrotal Hypospadias Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?264600

·

Spinal and Bulbar Muscular Atrophy, X-linked 1 Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?313200

Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s


disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html ·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

·

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

·

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein


·

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

·

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

·

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

·

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

·

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

·

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “prostate enlargement” (or synonyms) and click “Go.”

Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database37 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form.

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.

37


At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database38 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “prostate enlargement” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.

Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission.

38


Specialized References The following books are specialized references written for professionals interested in prostate enlargement (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Adult and Pediatric Urology (3-Volume Set) (Includes a Card to Return to Receive the Free CD-ROM) by Jay Y. Gillenwater, M.D. (Editor), et al; Hardcover - 2828 pages, 4th edition (January 15, 2002), Lippincott, Williams & Wilkins Publishers; ISBN: 0781732204; http://www.amazon.com/exec/obidos/ASIN/0781732204/icongroupinterna · Campbell’s Urology (4-Volume Set) by Meredith F. Campbell (Editor), et al; Hardcover, 8th edition (May 15, 2002), W B Saunders Co; ISBN: 0721690580; http://www.amazon.com/exec/obidos/ASIN/0721690580/icongroupinterna · Clinical Manual of Urology by Philip M. Hanno, M.D. (Editor), et al; Paperback - 924 pages, 3rd edition (May 2, 2001), McGraw-Hill Professional Publishing; ISBN: 0071362010; http://www.amazon.com/exec/obidos/ASIN/0071362010/icongroupinterna · Comprehensive Urology by George Weiss O’Reilly; Hardcover - 724 pages, 1st edition (January 15, 2001), Elsevier Science, Health Science Division; ISBN: 0723429499; http://www.amazon.com/exec/obidos/ASIN/0723429499/icongroupinterna · Manual of Urology: Diagnosis & Therapy by Mike B. Siroky (Editor), et al; Spiral-bound - 362 pages, 2nd spiral edition (October 15, 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 078171785X; http://www.amazon.com/exec/obidos/ASIN/078171785X/icongroupinterna · The Scientific Basis of Urology by A.R. Mundy (Editor), et al; 531 pages 1st edition (March 15, 1999), Isis Medical Media; ISBN: 1899066217; http://www.amazon.com/exec/obidos/ASIN/1899066217/icongroupinterna · Smith’s General Urology by Emil A. Tanagho (Editor), et al; Paperback 888 pages, 15th edition (January 21, 2000), McGraw-Hill Professional Publishing; ISBN: 0838586074; http://www.amazon.com/exec/obidos/ASIN/0838586074/icongroupinterna · Urology (House Officer Series) by Michael T. MacFarlane, M.D.; Paperback - 3rd edition (January 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0781731461; http://www.amazon.com/exec/obidos/ASIN/0781731461/icongroupinterna · Urology for Primary Care Physicians by Unyime O. Nseyo (Editor), et al; Hardcover - 399 pages, 1st edition (July 15, 1999), W B Saunders Co; ISBN:


0721671489; http://www.amazon.com/exec/obidos/ASIN/0721671489/icongroupinterna

Vocabulary Builder Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Flutamide: An antiandrogen with about the same potency as cyproterone in rodent and canine species. [NIH] Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Inhibin: Glyceroprotein hormone produced in the seminiferous tubules by the Sertoli cells in the male and by the granulosa cells in the female follicles. The hormone inhibits FSH and LH synthesis and secretion by the pituitary cells thereby affecting sexual maturation and fertility. [NIH] Lipoma: A benign tumor composed of fat cells. [NIH]

111

PART III. APPENDICES

ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with prostate enlargement and related conditions.

Researching Your Medications 113

APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with prostate enlargement. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for prostate enlargement. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of prostate enlargement. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.


Your Medications: The Basics39 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of prostate enlargement. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with prostate enlargement take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·

Ask about all parts of your treatment, including diet changes, exercise, and medicines.

·

Ask about the risks and benefits of each medicine or other treatment you might receive.

·

Ask how often you or your doctor will check for side effects from a given medication.

Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for prostate enlargement. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·

The name of the medicine and what it is supposed to do.

·

How and when to take the medicine, how much to take, and for how long.

·

What food, drinks, other medicines, or activities you should avoid while taking the medicine.

·

What side effects the medicine may have, and what to do if they occur.

39

This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.


·

If you can get a refill, and how often.

·

About any terms or directions you do not understand.

·

What to do if you miss a dose.

·

If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).

Do not forget to tell your doctor about all the medicines you are currently taking (not just those for prostate enlargement). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·

Name of medicine

·

Reason taken

·

Dosage

·

Time(s) of day

Also include any over-the-counter medicines, such as: ·

Laxatives

·

Diet pills

·

Vitamins

·

Cold medicine

·

Aspirin or other pain, headache, or fever medicine

·

Cough medicine

·

Allergy relief medicine

·

Antacids

·

Sleeping pills

·

Others (include names)


Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for prostate enlargement. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.40 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia. It is important to read the disclaimer by the United States Pharmacopoeia (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of prostate enlargement. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to prostate enlargement:

Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.

40


Doxazosin ·

Systemic - U.S. Brands: Cardura http://www.nlm.nih.gov/medlineplus/druginfo/doxazosinsyste mic202629.html

Finasteride ·

Systemic - U.S. Brands: Propecia; Proscar http://www.nlm.nih.gov/medlineplus/druginfo/finasteridesyste mic202649.html

Phenoxybenzamine ·

Systemic - U.S. Brands: Dibenzyline http://www.nlm.nih.gov/medlineplus/druginfo/phenoxybenza minesystemic202458.html

Prazosin ·

Systemic - U.S. Brands: Minipress http://www.nlm.nih.gov/medlineplus/druginfo/prazosinsystemi c202475.html

Tamsulosin ·

Systemic - U.S. Brands: Flomax http://www.nlm.nih.gov/medlineplus/druginfo/tamsulosinsyste mic203479.html

Terazosin ·

Systemic - U.S. Brands: Hytrin http://www.nlm.nih.gov/medlineplus/druginfo/terazosinsystem ic202546.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.


Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with prostate enlargement (including those with contraindications):41 ·

Amoxapine http://www.reutershealth.com/atoz/html/Amoxapine.htm

·

Atropine http://www.reutershealth.com/atoz/html/Atropine.htm

·

Benztropine Mesylate http://www.reutershealth.com/atoz/html/Benztropine_Mesylate.htm

·

Biperiden http://www.reutershealth.com/atoz/html/Biperiden.htm

·

Brompheniramine Maleate http://www.reutershealth.com/atoz/html/Brompheniramine_Maleate. htm

·

Chlorpheniramine Maleate http://www.reutershealth.com/atoz/html/Chlorpheniramine_Maleate. htm

·

Clemastine Fumarate http://www.reutershealth.com/atoz/html/Clemastine_Fumarate.htm

·

Cyproheptadine HCl http://www.reutershealth.com/atoz/html/Cyproheptadine_HCl.htm

·

Dicyclomine HCl http://www.reutershealth.com/atoz/html/Dicyclomine_HCl.htm

·

Dimenhydrinate http://www.reutershealth.com/atoz/html/Dimenhydrinate.htm

·

Diphenhydramine HCl http://www.reutershealth.com/atoz/html/Diphenhydramine_HCl.htm

·

Doxazosin Mesylate http://www.reutershealth.com/atoz/html/Doxazosin_Mesylate.htm

·

Finasteride http://www.reutershealth.com/atoz/html/Finasteride.htm

41

Adapted from A to Z Drug Facts by Facts and Comparisons.


·

Glycopyrrolate http://www.reutershealth.com/atoz/html/Glycopyrrolate.htm

·

Ipratropium Bromide http://www.reutershealth.com/atoz/html/Ipratropium_Bromide.htm

·

Ipratropium Bromide Albuterol Sulfate http://www.reutershealth.com/atoz/html/Ipratropium_Bromide_Albu terol_Sulfate.htm

·

Leuprolide Acetate http://www.reutershealth.com/atoz/html/Leuprolide_Acetate.htm

·

Meclizine http://www.reutershealth.com/atoz/html/Meclizine.htm

·

Orphenadrine Citrate http://www.reutershealth.com/atoz/html/Orphenadrine_Citrate.htm

·

Phenylephrine HCl http://www.reutershealth.com/atoz/html/Phenylephrine_HCl.htm

·

Phenylpropanolamine HCl http://www.reutershealth.com/atoz/html/Phenylpropanolamine_HCl. htm

·

Phenylpropanolamine HCl Guaifenesin http://www.reutershealth.com/atoz/html/Phenylpropanolamine_HCl_ Guaifenesin.htm

·

Procyclidine http://www.reutershealth.com/atoz/html/Procyclidine.htm

·

Promethazine HCl http://www.reutershealth.com/atoz/html/Promethazine_HCl.htm

·

Propantheline Bromide http://www.reutershealth.com/atoz/html/Propantheline_Bromide.htm

·

Protriptyline HCl http://www.reutershealth.com/atoz/html/Protriptyline_HCl.htm

·

Pseudoephedrine http://www.reutershealth.com/atoz/html/Pseudoephedrine.htm

·

Tamsulosin Hydrochloride http://www.reutershealth.com/atoz/html/Tamsulosin_Hydrochloride. htm

·

Terazosin http://www.reutershealth.com/atoz/html/Terazosin.htm


·

Testosterone http://www.reutershealth.com/atoz/html/Testosterone.htm

·

Trihexyphenidyl HCl http://www.reutershealth.com/atoz/html/Trihexyphenidyl_HCl.htm

·

Triprolidine HCl http://www.reutershealth.com/atoz/html/Triprolidine_HCl.htm Mosby’s GenRx

Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information in Mosby’s GenRx database can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.

Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.

Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.

Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with prostate enlargement--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with


drugs used to treat prostate enlargement or potentially create deleterious side effects in patients with prostate enlargement. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.

A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with prostate enlargement. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering


which medications are likely to improve the health of patients with prostate enlargement. The FDA warns patients to watch out for42: ·

Secret formulas (real scientists share what they know)

·

Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)

·

Quick, painless, or guaranteed cures

·

If it sounds too good to be true, it probably isn’t true.

If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna

·

The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna

·

Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna

·

Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000),

This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.

42


Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna ·

Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna

·

PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna

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Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna

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Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna

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Physician’s Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Biperiden: A muscarinic antagonist that has effects in both the central and peripheral nervous systems. It has been used in the treatment of arteriosclerotic, idiopathic, and postencephalitic parkinsonism. It has also been used to alleviate extrapyramidal symptoms induced by phenothiazine derivatives and reserpine. [NIH]


Dimenhydrinate: A drug combination that contains diphenhydramine and theophylline. It is used for treating vertigo, motion sickness, and nausea associated with pregnancy. It is not effective in the treatment of nausea associated with cancer chemotherapy. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Meclizine: A histamine H1 antagonist used in the treatment of motion sickness, vertigo, and nausea during pregnancy and radiation sickness. [NIH] Phenoxybenzamine: An alpha-adrenergic anatagonist with long duration of action. It has been used to treat hypertension and as a peripheral vasodilator. [NIH]

Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Procyclidine: A muscarinic antagonist that crosses the blood-brain barrier and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism. [NIH]

Researching Alternative Medicine 125

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to prostate enlargement. Finally, at the conclusion of this chapter, we will provide a list of readings on prostate enlargement from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.

What Is CAM?43 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 43

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.


treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?44 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are

44

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.


practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.


Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.

Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.

Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.


Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.

Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.45

45

Adapted from http://www.4woman.gov/faq/alternative.htm.


Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

Finding CAM References on Prostate Enlargement Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for prostate enlargement. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “prostate enlargement” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·

Effects of a Saw Palmetto Herbal Blend in Men With Symptomatic Benign Prostatic Hyperplasia Source: Journal of Urology. 163(5): 1451-1456. May 2000.


Summary: This journal article describes a randomized, placebo controlled trial of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia (BPH). Forty-four men with BPH, aged 45 to 80 years, were recruited from a general urology practice and enrolled in a 6month trial. At 6 months, 41 of the 43 men who completed the trial entered a long-term open label extension. Outcome measures included routine clinical parameters, blood chemistry studies, prostate volumetrics by magnetic resonance imaging, and prostate biopsy for zonal tissue morphometry and semi-quantitative histology studies. Clinical parameters improved in both the saw palmetto herbal blend and placebo groups, with a slight advantage in the saw palmetto group. Neither prostate specific antigen nor prostate volume changed from baseline. Prostate epithelial contraction was noted, especially in the transition zone, where percent epithelium decreased from 17.8 percent at baseline to 10.7 percent after 6 months of saw palmetto. Histological studies showed that the percent of atrophic glands increased from 25.2 percent to 40.9 percent after saw palmetto treatment. The mechanism of action appears to be nonhormonal, but it was not identified by tissue studies of apoptosis, cellular proliferation, angiogenesis, growth factors, or androgen receptor expression. No adverse effects of the saw palmetto herbal blend were observed. The article has 4 figures, 4 tables, and 23 references. ·

Benign Prostatic Hyperplasia Treated With Saw Palmetto: A Literature Search and an Experimental Case Study Source: Journal of the American Osteopathic Association. 100(2): 89-96. February 2000. Summary: This journal article describes a literature search and singlepatient clinical trial investigating the treatment of benign prostatic hyperplasia (BPH) with saw palmetto extract (SPE). The literature search began with MEDLINE and then expanded to alternative databases including AGRICOLA, EMBASE, IBIS, and Cochrane, plus a manual search of unindexed herbal journals. The expanded literature search revealed 58 clinical trials whereas MEDLINE yielded only 19 trials (33 percent of the total). The clinical trial was an experimental case study in which a 67 year old man with symptomatic BPH was administered 160 mg of a standardized SPE twice daily for 12 weeks in an unblinded fashion, followed by 12 weeks of double-blinded placebo, and then single-blinded administration of the standardized SPE for another 12 weeks. Outcome measures included the American Urological Association Symptom Index (AUASI), serum prostate specific antigen (PSA), and prostate volume. In the clinical trial, the AUASI score was 20 at baseline,


7 after unblinded SPE, 14 after placebo, and 11 after single-blinded SPE. PSA was 10.3 ng/ml at baseline and 10.7 ng/ml at trial end. Baseline prostatic volume was 92 ml and end volume was 75 ml. The authors conclude that MEDLINE alone may be inadequate for locating information about an herbal medicine. The experimental case study, similar to N=1 research, appears suitable for clinical evaluation of an herbal medicine by office-based clinicians. The article has 1 table and 132 references. ·

Combined Sabal and Urtica Extract Compared With Finasteride in Men With Benign Prostatic Hyperplasia: Analysis of Prostate Volume and Therapeutic Outcome Source: British Journal of Urology International. 86(4): 439-442. September 2000. Summary: This journal article examines the effect of prostate volume on treatment outcome in men with benign prostatic hyperplasia (BPH) receiving phytotherapy or finasteride. Data were obtained from a randomized, double-blind clinical trial involving 543 patients in the early stages of BPH. Participants received a fixed combination of saw palmetto and nettle root extracts (PRO 160/120) or finasteride. Patients included in the subgroup analyses (n=431) had valid ultrasonographic measurements and baseline prostate volumes of either up to 40 ml or greater than 40 ml. The safety analysis included all 516 men who entered the active treatment period. Mean maximum urinary flow increased after 24 weeks by 1.9 ml/s with PRO 160/120 and by 2.4 ml/s with finasteride; there was no significant difference between groups. The subgroups with prostates of 40 ml or less showed similar improvements, with mean values of 1.8 ml/s for PRO 160/120 and 2.7 ml/s for finasteride. Mean values for the subgroups with prostates greater than 40 ml were comparable at 2.3 and 2.2 ml/s, respectively. The International Prostate Symptom Score improved in both groups, with no significant difference between groups. The subgroup analysis showed slightly better results for voiding symptoms in the patients with larger prostates. The safety analysis revealed more adverse events in the finasteride group than the PRO 160/120 group. The results suggest that efficacy is equivalent in finasteride and PRO 160/120 and is unrelated to prostate volume. The article has 1 table and 14 references.

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Pygeum africanum for the Treatment of Patients With Benign Prostatic Hyperplasia: A Systematic Review and Quantitative Meta-Analysis Source: American Journal of Medicine. 109(8): 654-664. December 1, 2000.


Summary: This journal article presents a systematic review and quantitative meta-analysis of the therapeutic efficacy and tolerability of 'Pygeum africanum' in men with symptomatic benign prostatic hyperplasia (BPH). Randomized trials published from 1996 to 2000 in any language were included if participants had symptomatic BPH, the intervention was pygeum alone or with other phytotherapeutic agents, a control group received placebo or other pharmacologic therapies for BPH, and treatment duration was at least 30 days. A total of 18 randomized controlled trials involving 1,562 men met the inclusion criteria and were analyzed. Many of the trials did not report results in a manner that permitted meta-analysis. Only one study reported the method of treatment allocation concealment, although 17 were doubleblind. The mean study duration was 64 days. Compared with placebo in six studies, pygeum provided a moderately large improvement in the combined outcome of urologic symptoms and flow measures. Summary estimates of individual outcomes also were improved by pygeum. Nocturia was reduced by 19 percent and residual urine volume by 24 percent, and peak urine flow was increased by 23 percent. Adverse effects were mild and similar to those of placebo. The evidence suggests that 'P. africanum' can improve urologic symptoms and flow measures in men with BPH. The article has 5 figures, 2 tables, and 60 references. ·

Phytotherapy for Benign Prostatic Hyperplasia Source: Public Health Nutrition. 3(4A): 459-472. 2000. Summary: This journal article reviews the literature on the efficacy and safety of phytotherapies for benign prostatic hyperplasia (BPH). Studies were included if men had symptomatic BPH, the intervention was a phytotherapeutic preparation alone or combined, a control group received placebo or other pharmacologic therapy for BPH, and the treatment duration was at least 30 days. Forty-four studies of six phytotherapeutic agents met the inclusion criteria and were reviewed. 'Serenoa repens,' extracted from saw palmetto, is the most widely used phytotherapeutic agent for BPH. Eighteen trials involving 2,939 men were reviewed. Men taking 'Serenoa repens' reported greater improvement of urinary tract symptoms and flow measures compared with placebo. Improvement of BPH symptoms was comparable to that obtained with finasteride. 'Hypoxis rooperi' also was effective in improving symptom scores and flow measures compared with placebo. 'Secale cereale' (rye pulb) was found to modestly improve overall urological symptoms. 'Pygeum africanum' (African plum tree) may be a useful treatment option for BPH, but there was inadequate reporting of outcomes, which limits the ability to estimate efficacy and safety. Studies


involving 'Urtica dioica' (Stinging nettle root) and 'Curcubita pepo' (pumpkin seed) also are limited, although these agents may be effective when combined with other plant extracts such as 'Serenoa' and 'Pygeum.' Adverse events due to phytotherapies were generally reported to be infrequent and mild. The article has 5 figures, 5 tables, and 66 references. (AA-M). ·

Medical Management of Benign Prostatic Hyperplasia Source: Geriatric Nephrology and Urology. 9(1): 39-48. 1999. Summary: This journal article discusses the past, present, and future of the medical management of benign prostatic hyperplasia (BPH). Over the past decade, the management of BPH has evolved from a surgical emphasis to a medical emphasis. The treatment of clinical BPH aims to improve symptoms, relieve obstruction, improve bladder emptying, prevent urinary tract infection, and avoid renal insult. Alpha blockade treats the dynamic component of BPH symptoms, while 5-alphareductase inhibitors counteract the static component or mechanical enlargement. Medical therapies investigated for BPH include alphablockers, androgen suppression, aromatase inhibitors, and phytotherapy. Saw palmetto is the most popular phytotherapeutic agent used in the treatment of BPH. Other agents currently in use include African plum, beta-sitosterol, and pollen extract. While these plant extracts appear promising, few double-blind controlled trials have been conducted and existing studies have methodological limitations. The article has 1 figure, 1 table and 75 references.

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Phytotherapy for Treatment of Benign Prostatic Hyperplasia: Case Not Proven (editorial) Source: Urology. 53(3): 462-464. March 1999. Summary: This editorial discusses the role of phytotherapy in the treatment of benign prostatic hyperplasia. The author argues that the popularity of natural remedies among patients and many European physicians does not make them an automatic or acceptable treatment for lower urinary tract symptoms. In his opinion, the scientific case for their use remains unproved. First, the composition of the plant extracts varies across different products. Second, although a number of possible mechanisms of action have been proposed, none have been demonstrated with certainty. One of the most frequently claimed mechanisms is that of 5-alpha-reductase inhibition, but available evidence suggests that this is unlikely. Finally, scientific evidence of their efficacy is lacking. Most of the trials investigating the efficacy of plant extracts for lower urinary tract symptoms are either open studies, sometimes retrospective studies, or


poorly performed placebo-controlled studies. The article has 2 tables and 15 references. ·

Saw Palmetto Extract: Newest (and Oldest) Treatment Alternative for Men With Symptomatic Benign Prostatic Hyperplasia Source: Urology. 53(3): 457-461. March 1999. Summary: This journal article discusses the use of saw palmetto extract as an alternative treatment for men with symptomatic benign prostatic hyperplasia (BPH). In the authors' opinion, urologists should consider saw palmetto extract to be a reasonable first-line treatment option for BPH. These extracts appear to be safe, probably beneficial, and preferred by many BPH patients. In a European study involving 1,098 patients, the general safety profile of saw palmetto compared favorably with that of finasteride, with sexual side effects being less common with the herb than with the drug. The efficacy of saw palmetto has not been conclusively demonstrated. However, available evidence indicates that it is most likely of some clinical benefit. Two recent meta-analyses of the European literature reported a therapeutic advantage of saw palmetto compounds over placebo. The mechanism of action is not clear, but several studies suggest a possible interference with the action of androgen within the prostate. The article has 1 figure, 1 table, and 29 references.

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Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review Source: JAMA. Journal of the American Medical Association. 280(18): 1604-1609. November 11, 1998. Summary: This journal article reviews the research on the efficacy and safety of saw palmetto extract (Serenoa repens) in men with symptomatic benign prostatic hyperplasia (BPH). A comprehensive search of the literature identified 18 randomized controlled trials involving 2,393 men who met inclusion criteria. Studies were included if the participants had symptomatic BPH, the intervention was a preparation of Serenoa repens alone or in combination with other phytotherapeutic agents, a control group received a placebo or other pharmacological therapies for BPH, and the treatment duration was at least 30 days. Results from doctor and participant assessments showed that Serenoa repens was superior to a placebo and comparable with finasteride in improving urinary tract symptom scores, nocturia, peak and mean urine flow rates, and residual urine volume. Adverse effects due to Serenoa repens generally were mild and comparable with a placebo. Erectile dysfunction was more common with finasteride (4.9 percent) than with S repens (1.1 percent). The withdrawal rates in men receiving Serenoa repens, a placebo, and


finasteride were 9.1 percent, 7 percent, and 11.2 percent, respectively. The authors conclude that Serenoa repens appears to improve urologic symptoms and flow measures in men with BPH; its efficacy is similar to that of finasteride but with fewer adverse effects. The article has 4 figures and 51 references. ·

Multicentric, Placebo-Controlled, Double-Blind Clinical Trial of BetaSitosterol (Phytosterol) for the Treatment of Benign Prostatic Hyperplasia Source: British Journal of Urology. 80: 427-432. 1997. Summary: This journal article describes a multicenter, double-blind, placebo-controlled trial of Azuprostat, a beta-sitosterol, in patients with symptoms of bladder outflow obstruction associated with benign prostatic hyperplasia (BPH). A total of 177 BPH patients were recruited from 13 private urological centers in Germany. The patients were randomly assigned to receive 130 mg of beta-sitosterol daily or placebo for 6 months. The main outcome measure was the international prostate symptom score (IPSS). Secondary outcome measures were changes in quality of life, peak urinary flow rate, and post-void residual urinary volume. Eleven patients from each group withdrew from the study. No serious side effects were observed in the treatment group. There were significant improvements in all outcome measures with beta-sitosterol compared with placebo. The IPSS improved by 51 percent in the treatment group and 19 percent in the placebo group. The authors conclude that beta-sitosterol may be an effective option in the treatment of BPH. The article has 1 figure, 3 tables, and 32 references.

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Long-Term Drug Treatment of Benign Prostatic Hyperplasia - Results of Prospective 3-Year Multicenter Study Using Sabal Extract IDS 89 Source: Phytomedicine. 3(2): 105-111. 1996. Summary: This journal article describes a study of the long-term efficacy and tolerability of a saw palmetto extract in the treatment of benign prostatic hyperplasia (BPH). A total of 435 BPH patients, aged 41 to 89 years, were enrolled in 89 urology offices. After an initial washout period of 2 weeks, the patients received 160 mg b.i.d. Sabal extract IDS 89 for 3 years. Complete data for 36 months were obtained for 315 patients. The results suggest a marked improvement in BPH symptoms and urodynamic parameters, including a 50 percent reduction in residual urine and a 6.1 ml/sec increase in peak urinary flow, with IDS 89 therapy. Both physicians and patients rated efficacy as good or very good in more than 80 percent of the cases. The extract was well tolerated by 98 percent of the patients. The deterioration rate for the 3-year study was


significantly lower than that reported for untreated patients. Overall, the clinical status of BPH, and thus the quality of life, was markedly improved in four out of five patients receiving long-term treatment with IDS 89. The authors conclude that long-term therapy with a phytopharmaceutical preparation such as IDS 89 in general, helps treat BPH. The article has 3 figures, 5 tables, and 26 references. ·

Phytotherapy in Treatment of Benign Prostatic Hyperplasia: A Critical Review Source: Urology. 48(1): 12-20. 1996. Summary: This journal article reviews research on phytotherapeutic agents used for the treatment of benign prostatic hyperplasia (BPH). First, it discusses the types of phytotherapeutic agents used for BPH, possible mechanisms of action, and difficulties in evaluating such agents. Then, it reviews findings from basic and clinical research on saw palmetto berry (SPB) extracts, beta-sitosterols, cernilton, African plum, and Bazoton (an extract of 'Radix urticae'). Although SPB extract is the most extensively studied of the phytotherapeutic agents used for BPH, no well-defined mechanism of action has been proposed. Evidence for an antiandrogenic or antiestrogenic effect is conflicting, and there are no clinical data suggesting an effect on 5-alpha-reductase activity. Furthermore, clinical studies have had methodological problems that limit the value of their findings. In the authors' opinion, the most convincing evidence for the efficacy of phytotherapeutic agents for BPH comes from a recent study of Harzol, an agent that contains a variety of phytosterols, including sitosterol. However, a prior study showed no efficacy of beta-sitosterol-beta-D-glucoside. The authors conclude that standardization of compounds is necessary to accurately assess the effects of phytotherapeutic agents used for BPH. The article has 4 tables and 55 references. National Center for Complementary and Alternative Medicine

The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to prostate enlargement and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “prostate enlargement” (or synonyms) into the search box. Click “Go.” The following references provide information on particular


aspects of complementary and alternative medicine (CAM) that are related to prostate enlargement: ·

A zinc based self setting ceramic bone substitute for local delivery of testosterone. Author(s): Gordon E, Lasserre A, Stull P, Bajpai PK, England B. Source: Biomed Sci Instrum. 1997; 33: 131-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9731348&dopt=Abstract

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Angiotropic (intravascular) large cell lymphoma. A clinicopathologic study of seven cases with unique clinical presentations. Author(s): Stroup RM, Sheibani K, Moncada A, Purdy LJ, Battifora H. Source: Cancer. 1990 October 15; 66(8): 1781-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1698530&dopt=Abstract

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Development of a ceramic device for the continuous local delivery of steroids. Author(s): Zafirau W, Parker D, Billotte W, Bajpai PK. Source: Biomed Sci Instrum. 1996; 32: 63-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8672691&dopt=Abstract

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Effect of Serenoa repens extract (Permixon) on estradiol/testosteroneinduced experimental prostate enlargement in the rat. Author(s): Paubert-Braquet M, Richardson FO, Servent-Saez N, Gordon WC, Monge MC, Bazan NG, Authie D, Braquet P. Source: Pharmacological Research : the Official Journal of the Italian Pharmacological Society. 1996 September-October; 34(3-4): 171-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9051712&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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Chinese Medicine: http://www.newcenturynutrition.com/


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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Alternative/

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TPN.com: http://www.tnp.com/

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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WellNet: http://www.wellnet.ca/herbsa-c.htm

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to prostate enlargement; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

General Overview Prostate Enlargement Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html

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Herbs and Supplements Alanine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Alanine.htm Alanine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm


Alanine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Androstenedione Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Androstenedione.htm Beta-Sitosterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Beta-Sitosterol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Collinsonia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsa-c.htm Finasteride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Finasteride Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Finasteride Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Flaxseed Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html


GLA (Gamma-Linolenic Acid) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000111.html Glutamic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Glutamic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glutamic_Acid.htm Glutamic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Glycine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Glycine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glycine.htm Glycine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Nettle Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Nettle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html


Nettle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Nettle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000214.html Nettle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 48,00.html Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Pollen.htm Pollen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Pollen Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pumpkin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Pumpkin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pygeum Alternative names: African Prune; Pygeum africanum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Pygeum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm


Pygeum Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000224.html Pygeum Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pygeum africanum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Pygeum africanum Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Sabal serrulata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/SawPalmett och.html Saw Palmetto Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Saw Palmetto Alternative names: Serenoa repens, Sabal serrulata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/SawPalmett och.html Saw Palmetto Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Saw Palmetto Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html


Saw Palmetto Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000232.html Serenoa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Serenoa Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Serenoa repens Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Serenoa repens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/SawPalmett och.html Serenoa repens Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Sitosterol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Sitosterol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000234.html Urtica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Urtica Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html


Urtica dioica Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html ·

Related Conditions Benign Prostatic Hyperplasia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Benign Prostatic Hyperplasia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Benign Prostatic Hyperplasia Alternative names: Prostate Enlargement Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html BPH Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Varicose Veins Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000303.html Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Weight_Loss.htm

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at:


www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·

Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna

·

Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna

·

Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna

· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·

Herbs for the Urinary Tract: Herbal Relief for Kidney Stones, Bladder Infections and Other Problems of the Urinary Tract by Michael Moore; Paperback - 96 pages (June 1998), McGraw Hill - NTC; ISBN: 0879838159; http://www.amazon.com/exec/obidos/ASIN/0879838159/icongroupinterna

·

Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001), Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna

·

New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna

· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna


For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Intravascular: Within a vessel or vessels. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Sitosterols: A family of sterols commonly found in plants and plant oils. Alpha-, beta-, and gamma-isomers have been characterized. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]

Researching Nutrition 149

APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with prostate enlargement. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with prostate enlargement may be given different recommendations. Some recommendations may be directly related to prostate enlargement, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of prostate enlargement. We will then show you how to find studies dedicated specifically to nutrition and prostate enlargement.


Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·

Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.

·

Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.

·

Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.

·

Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.

Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·

Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.

·

Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.

·

Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from


nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·

Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains

·

Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.

·

Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.

·

Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.

·

Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.

·

Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.

·

Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.

·

Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.

It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·

Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.

·

Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.


·

Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.

·

Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.

·

Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.

·

Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.

·

Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.

·

Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.

·

Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.

The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:46 ·

DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.

·

DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.

46

Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.


·

RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”

·

RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?47

Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”48 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.49 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 48 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail: [email protected]. 49 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 47


overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail: [email protected]

Finding Studies on Prostate Enlargement The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.50 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

50


found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “prostate enlargement” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “prostate enlargement” (or a synonym): ·

Effect of Serenoa repens extract (Permixon) on estradiol/testosteroneinduced experimental prostate enlargement in the rat. Author(s): BIO-Inova EuroLab Research Labs, Plaisir, France. Source: Paubert Braquet, M Richardson, F O Servent Saez, N Gordon, W C Monge, M C Bazan, N G Authie, D Braquet, P Pharmacol-Res. 1996 Sep-October; 34(3-4): 171-9 1043-6618

·

Prostate enlargement in mice due to fetal exposure to low doses of estradiol or diethylstilbestrol and opposite effects at high doses. Author(s): Division of Biological Sciences, University of MissouriColumbia, 65211, USA. [email protected] Source: vom Saal, F S Timms, B G Montano, M M Palanza, P Thayer, K A Nagel, S C Dhar, M D Ganjam, V K Parmigiani, S Welshons, W V ProcNatl-Acad-Sci-U-S-A. 1997 March 4; 94(5): 2056-61 0027-8424

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

·

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

·

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov


·

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·


·

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.thedacare.org/healthnotes/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDÒHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to prostate enlargement; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:


·

Minerals Copper Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm

·

Food and Diet Beer Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Berries Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Diabetes Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Pumpkin seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Pumpkin seeds Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Rye Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm Rye Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Seeds Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/BPH.htm


Seeds Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Seeds Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000268.html Soy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Soy.htm Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Benign ProstaticHyperplasiacc.html

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]


Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]

Finding Medical Libraries 161

APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.51

51

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.


Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):52 ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

52

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.


·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

·

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

·

California: San José PlaneTree Health Library, http://planetreesanjose.org/

·

California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html

·

California: University of California, Davis. Health Sciences Libraries

·

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html

·

California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm

·

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

·

Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/


·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm

·

Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/

·

Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml


·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41


·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

·

Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

·

New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp


·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/

·

South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/

NIH Consensus Statement on Urinary Incontinence in Adults 169

APPENDIX E. NIH CONSENSUS STATEMENT ON URINARY INCONTINENCE IN ADULTS Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.53 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”54 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in October, 1988.55

53 This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 54 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 55 Urinary Incontinence in Adults. NIH Consens Statement Online 1988 Oct 3-5 [cited 2002 February 20];7(5):1-32. http://consensus.nih.gov/cons/071/071_statement.htm.


What Is Urinary Incontinence in Adults? Urinary incontinence, the involuntary loss of urine so severe as to have social and/or hygienic consequences, is a major clinical problem and a significant cause of disability and dependency. Urinary incontinence affects all age groups and is particularly common in the elderly. At least 10 million adult Americans suffer from urinary incontinence, including approximately 15 to 30 percent of community-dwelling older people and at least one-half of all nursing home residents. The monetary costs of managing urinary incontinence are conservatively estimated at $10.3 billion annually, and the psychosocial burden of urinary incontinence is great. Urinary incontinence is a symptom rather than a disease. It appears in a limited number of clinical patterns, each having several possible causes. In some cases, the disorder is transient, secondary to an easily reversed cause such as a medication or an acute illness like urinary tract infection. Many cases are chronic, however, lasting indefinitely unless properly diagnosed and treated. There is a persistent myth that urinary incontinence is a normal consequence of aging. While normal aging is not a cause of urinary incontinence, agerelated changes in lower urinary tract function predispose the older person to urinary incontinence in the face of additional anatomic or physiologic insults to the lower urinary tract or by systemic disturbances such as illnesses common in older people. Even frail nursing home residents or persons being cared for by family caregivers often have urinary incontinence that can be significantly improved or cured. Persons with urinary incontinence should be alerted to the importance of reporting their symptoms to a health care professional and of asserting their right to proper assessment, diagnosis, and treatment. The first steps to treatment are acknowledgment of the problem and appropriate assessment and diagnosis. Knowledge of the occurrence, causes, consequences, and treatment of the specific forms of urinary incontinence has increased. While new diagnostic tests have been developed, well-defined guidelines are needed for their application. Similarly, despite numerous new potential therapies, opinions differ widely concerning the best approach to many specific forms of the disorder. The most common treatments include pelvic muscle exercises and other behavioral treatments, local and systemic drug therapies, and a variety of surgical approaches.


The number of patients with urinary incontinence who are not successfully treated remains surprisingly high. This is due to several factors, including underreporting by patients; underrecognition as a significant clinical problem by health providers; lack of education of health providers regarding new research findings; inadequate staffing in the long-term care setting; and the persistent major gaps in our understanding of the natural history, pathophysiology, and most effective treatments of the common forms of urinary incontinence. The amount of basic research as well as research focusing on prevention is meager. To resolve issues regarding the incidence, causes, and consequences of urinary incontinence in adults, the National Institute on Aging and the Office of Medical Applications of Research of the National Institutes of Health, in conjunction with the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center for Nursing Research, the National Institute of Neurological and Communicative Disorders and Stroke, and the Veterans Administration, convened a Consensus Development Conference on Urinary Incontinence in Adults on October 3-5, 1988. After a day and a half of presentations by experts in the relevant fields involved with urinary incontinence, a consensus panel consisting of representatives from geriatrics, urology, gynecology, psychology, nursing, epidemiology, basic sciences, and the public considered the evidence and developed answers to the following central questions: ·

What is the prevalence and clinical, psychological, and social impact of urinary incontinence among persons living at home and in institutions?

·

What are the pathophysiological and functional factors leading to urinary incontinence?

·

What diagnostic information should be obtained in assessment of the incontinent patient? What criteria should be employed to determine which tests are indicated for a particular patient?

·

What are the efficacies and limitations of behavioral, pharmacological, surgical, and other treatments for urinary incontinence? What sequences and/or combination of these interventions are appropriate? What management techniques are appropriate when treatment is not effective or indicated?

·

What strategies are effective in improving public and professional knowledge about urinary incontinence?

·

What are the needs for future research related to urinary incontinence?


Occurrence and Risk of Urinary Incontinence Estimates of the occurrence of urinary incontinence depend on the nature of the study population and definition of the disorder. Prevalence rates range from 8 to 51 percent; an estimate of 15 to 30 percent for community-dwelling older persons seems reasonable, and of these, 20 to 25 percent may be classified as severe. Prevalence rates are twice as high in women as in men, and are higher in older than in younger adults. Though these community rates are alarmingly high, rates in nursing homes are even higher. Half or more of the 1.5 million Americans in nursing homes suffer from urinary incontinence. Little is known about the natural history of urinary incontinence, including age at onset, incidence rates, progression, and spontaneous remission. Limited data exist on associated morbidity and functional impairment. To date, most studies have been conducted in whites, and data are needed on the occurrence in nonwhite ethnic groups. Though urinary incontinence is a symptom of many conditions, defining risk factors would be extremely useful for identifying high-risk persons and remediable environmental causes. While age, gender, and parity are established risk factors, many other factors have been suggested but not rigorously proven. These include urinary infection, menopause, genitourinary surgery, lack of postpartum exercise, chronic illnesses, and various medications. Risk factor identification is essential for a concerted effort at prevention.

Clinical, Psychological, and Social Impact In the Community Because only about half of the people with incontinence in the community have consulted a doctor about the problem, the true extent and clinical impact of urinary incontinence is not known. Rashes, pressure sores, skin and urinary tract infections, and restriction of activity are some of the problems that could be prevented or treated if the underlying incontinence were brought to medical attention. Many people with incontinence turn prematurely to the use of absorbent materials without having their difficulty properly diagnosed and treated.


The psychosocial impact of incontinence in the community falls on individuals and their care providers. Studies of women show that the condition is associated with depressive symptoms and leads to embarrassment about appearance and odor, although such reactions may be related more to illness than to incontinence. Excursions outside the home, social interactions with friends and family, and sexual activity may be restricted or avoided entirely in the presence of incontinence. Spouses and other intimates also may share the burden of this condition. A highly conservative estimate of the direct costs of caring for persons with incontinence of all ages in the community is $7 billion annually in the United States. In Nursing Homes Many physicians fail to recognize the clinical impact of urinary incontinence in nursing homes, and very few nursing home residents with incontinence have had any type of diagnostic evaluation. In this setting, fecal incontinence, physical and mental impairment, pressure sores, and urinary tract infections are commonly associated with urinary incontinence, but cause-and-effect relationships are not clear. Many nursing home residents who are incontinent are managed with indwelling catheters, which carry an increased risk of significant urinary tract infection, and the use of such devices varies widely. The odor of urine that permeates many nursing homes can be repellent to residents, staff, and potential visitors. Managing those with incontinence presents a major problem to insufficient and often untrained staff. The annual direct cost of caring for incontinence among nursing home patients is approximately $3.3 billion.

Pathophysiological and Functional Factors Continence requires a compliant bladder and active sphincteric mechanisms, such that maximum urethral pressure always exceeds intravesical pressure. Normal voiding requires sustained and coordinated relaxation of the sphincters and contraction of the urinary bladder. These functions are regulated by the central nervous system through autonomic and somatic nerves. The system requires the integration of visceral and somatic muscle function and involves control by voluntary mechanisms originating in the cerebral cortex. These voluntary mechanisms are learned and culturally prescribed (i.e., toilet training).


Incontinence can be produced by any pathologic, anatomic, or physiologic factor that causes intravesical pressure to exceed maximum urethral pressure. Intravesical pressure can be raised by involuntary detrusor contractions (unstable bladder or detrusor hyperreflexia), by acute or chronic bladder overdistension (urinary retention with overflow), or by an increase in intra-abdominal pressure. Similarly, a decrease in urethral pressure may occur as a result of uninhibited sphincter relaxation (unstable urethra), loss of pelvic floor support (genuine stress incontinence), and urethral wall defects from trauma, surgery, or neurologic disease.

Subtypes of Urinary Incontinence The most commonly encountered clinical forms of urinary incontinence in adults are stress incontinence, urge incontinence, overflow incontinence, and a mixed form. In stress incontinence, dysfunction of the bladder outlet leads to leakage of urine as intra-abdominal pressure is raised above urethral resistance while coughing, bending, or lifting heavy objects. Volume of urine leakage is generally modest at each occurrence and, in uncomplicated cases, postvoid residual volume is low. Stress incontinence has many causes, including direct anatomic damage to the urethral sphincter (sphincteric incontinence), which may lead to severe, continuous leakage, and weakening of bladder neck supports, as is often associated with parity. Urge incontinence occurs when patients sense the urge to void (urgency) but are unable to inhibit leakage long enough to reach the toilet. In most, but not all, cases, uninhibited bladder contractions contribute to the incontinence. Urine loss is moderate in volume, occurs at several hour intervals, and postvoid residual volume is low at several hour intervals. Among the causes of urge incontinence are central nervous system lesions such as stroke or demyelinating disease, which impair inhibition of bladder contraction, and local irritating factors such as urinary infection or bladder tumors. In many cases of urge incontinence, no specific etiology can be identified despite detailed clinical and laboratory evaluation. An important variant of urge incontinence is reflex incontinence, in which urine is lost due to uninhibited bladder contractions in the absence of the symptoms of urgency. In addition, many persons suffer from very frequent symptoms of urgency and are only able to remain continent by conducting their activities in the proximity of restrooms. Overflow incontinence occurs when the bladder cannot empty normally and becomes overdistended, leading to frequent, sometimes nearly constant, urine loss. Causes include neurologic abnormalities that impair detrusor


contractile capacity, including spinal cord lesions, and any factor that obstructs outflow, including medications, tumors, benign strictures, and prostatic hypertrophy. Many cases of urinary incontinence fall into the mixed category, displaying some aspects of more than one of the major subtypes, both clinically and on extensive laboratory evaluation. The term “functional” incontinence is applied to those cases in which the function of the lower urinary tract is intact, but other factors such as immobility or severe cognitive impairment result in urinary incontinence. It should be clear that urinary incontinence can be caused by multiple and often interacting conditions. Of particular importance are the transient or reversible factors such as infection, delirium, and drugs. These causes, which may be common in the elderly patient, should be carefully considered in the pathophysiology of urinary incontinence. There are age-related changes in the lower urinary tract that increase its vulnerability to both chronic and transient factors. Increases in uninhibited contractions, nocturnal fluid excretion, and prostate size, accompanied by decreases in bladder capacity and flow rate, all lead to greater susceptibility to urinary incontinence in the face of stresses associated with disease, functional impairment, or environmental factors. In older persons, cognitive decline, musculoskeletal impairments, and restricted access to toilets may all convert the marginally continent system to incontinence.

Evaluation and Therapy Evaluation and therapy must be tailored to the individual, taking into account clinical, cognitive, functional, and residential status in addition to the potential for correcting the problem. Just as a child is not simply a young adult, octogenarians differ from persons in their forties. Patients with stress urinary incontinence are quite dissimilar from those with uninhibited contractions and unstable bladders. Proper diagnosis and active case finding are imperative.

History The evaluation of all patients with incontinence requires a thorough history, including medical, urologic, gynecologic, and neurologic assessment, with


particular attention to those factors that influence bladder function. The duration, frequency, volume, and type of incontinence should be described and validated by a voiding diary. Other important information includes associated illnesses, previous operations, and current medications.

Physical Examination Physical examination is required, with emphasis on mental status; mobility and dexterity; and neurologic, abdominal, rectal, and pelvic findings. A provoked full-bladder stress test is recommended. Since prostate enlargement is often asymmetric, the size of the prostate as estimated on rectal exam may be misleading when evaluating the possible contribution of prostatic hypertrophy to urinary obstruction. In addition to the history and physical examination, core measurements to be obtained in all patients are urinalysis, serum creatinine or blood urea nitrogen, and postvoid residual urine volume. Other tests such as urine culture, blood glucose, and urinary cytology may be useful. Based on the findings from the core evaluation, a decision for treatment or more definitive evaluation is made, taking into consideration the type and degree of incontinence.

Specialized Studies The tests currently available for specialized study include: ·

Cystometrogram--to be used as the basic study in cases requiring more than core evaluation, should be accompanied by measurement or estimation of abdominal pressure.

·

Electrophysiologic sphincter testing (EMG).

·

Ultrasound of the bladder or kidneys may detect residual urine or hydronephrosis.

·

Cystourethroscopy with or without cytology is indicated in patients with hematuria or the recent onset of urgency or urge incontinence who are at increased risk for carcinoma.

·

Uroflowmetry has wide application in the evaluation of obstructive disease in men but a limited role in the evaluation of women.


·

Videourodynamic evaluation requires special expertise. Its role is limited to the more elusive incontinence problems.

·

Urethral pressure profilometry is a controversial test. Its predictive value has been questioned, and it requires further validation before it can be recommended for widespread use.

These numerous noninvasive and invasive tests must be used selectively. Examples of patients rarely requiring further diagnostic testing after the core examination include the young woman with classic stress incontinence or the 80-year-old woman with a recent stroke and the new onset of urge incontinence. Patients with stress incontinence and a significant urge component or those in whom previous operations have failed may require combined cystography and fluoroscopy with a complete urodynamic evaluation. Some patients with urge or mixed incontinence, or those who are not helped by empiric therapy or operation, also will require more complete urodynamic testing. Some patients may not be candidates for sophisticated studies due to inability to cooperate or a poor prognosis for correction. Armed with this information, the investigating physician should be able to reach an accurate diagnosis leading to appropriate therapy.

General Principles of Treatment ·

All persons with incontinence should be considered for evaluation and treatment.

·

Treatment decisions should be based on a diagnosis made after a reasonable evaluation of anatomy and function of urine storage and emptying.

·

Treatment for incontinence is given to a specific individual, whose personality, environment, expectations, and clinical status are important determinants of treatment modalities to be used and the order of their application.

·

The patient requires sufficient information and explanation to be able to make a choice among therapeutic options.

·

Environmental constraints in the community or in an institution that may impede treatment are common, and strategies to circumvent impediments are a part of the therapy.

·

In particular, availability of adequate numbers of properly constructed public toilets is an important adjunct to incontinence management.


Pharmacologic Treatment Most drugs currently used in managing the varied causes of urinary incontinence have not been studied in well-designed clinical trials. Nevertheless, it has been suggested that many agents are beneficial, especially for urge incontinence due to uninhibited detrusor contractions. For these patients, drugs that increase bladder capacity can be helpful. One attendant risk is the precipitation of retention. Accordingly, outlet obstruction or a weak detrusor should be looked for as possible contraindications to these agents.

Bladder Relaxants These agents are generally used for urge incontinence.

Anticholinergics Anticholinergic agents inhibit detrusor contraction, and may produce increased bladder capacity and delay and reduction in amplitude of involuntary contractions. Propantheline is frequently effective, although high doses may produce unacceptable side effects such as dry mouth, dry eyes, constipation, confusion, or precipitation of glaucoma.

Direct Smooth Muscle Relaxants These antispasmodics work directly on bladder muscle, but they have a mild anticholinergic effect as well. A randomized, double-blind, placebocontrolled study has shown benefit with oxybutynin in patients with detrusor instability, some but not all of whom were incontinent. Favorable reports also exist about flavoxate and dicyclomine, the other two agents in this class.

Calcium Channel Blockers These agents, used clinically for cardiovascular indications, have a depressant effect on the bladder as well, but they have not been studied rigorously for the treatment of urge incontinence in comparison with other agents. In the patient being considered for treatment for heart disease, the


bladder effects of calcium antagonists must be kept in mind for both their potential benefit as well as risk of retention.

Imipramine This tricyclic antidepressant has anticholinergic and direct relaxant effects on the detrusor and an alpha adrenergic enhancing (contracting) effect on the bladder outlet, all of which enhance continence. Although imipramine is commonly used, potential side effects of postural hypotension and sedation as well as all peripheral anticholinergic effects make caution imperative when considering this agent in older persons.

Bladder Outlet Stimulants Alpha adrenergic agonists, used in treatment of stress incontinence, produce smooth muscle contraction at the bladder outlet and may improve continence. Pseudoephedrine and ephedrine both are active, but phenylpropanolamine has been used most often, and objective benefit by urodynamic study has been shown.

Estrogens Because urinary incontinence increases in women with increasing age, and because menopause results in estrogen deficiency, estrogen replacement has been thought to be helpful for urinary incontinence. Several studies have shown no improvement in stress incontinence, but women with postmenopausal urge incontinence, urgency, and frequency have shown improvement. Long-term use should be considered in view of other risks and benefits.

Surgery Surgery is particularly effective in treatment of pure stress incontinence associated with urethrocoele. A variety of surgical techniques for the transvaginal or transabdominal suspension of the bladder neck yield a success rate between 80 and 95 percent in appropriately selected patients with stress incontinence at 1-year followup. Long-term results require study. When incontinence in men is secondary to outflow obstruction and chronic


retention is secondary to prostatic enlargement, it is best treated with prostatectomy. In addition, there are several specialized and more extensive surgical procedures. When incontinence is due to intrinsic sphincter dysfunction, which may occur after the surgical trauma of radical prostatectomy or sphincter denervation, the compressive action of the sphincter is lost. An implantable prosthetic sphincter can restore this compression. Continence is restored in 70 to 90 percent of patients in various series. A complication rate greater than 20 percent includes erosion of the urethra, infection, and mechanical failure. Reoperations are frequently required. Urethral sling procedures pass a ribbon of fascia or artificial material beneath the urethra. The sling, fixed to the anterior body wall, serves to elevate and compress the urethra, restoring continence in 80 percent of patients. Bladder augmentation with isolated bowel segments will increase bladder capacity and vent excessive bladder pressure. This procedure is limited to certain specific bladder problems such as the contracted bladder of neurologic disease or tuberculosis. Bladder replacement with continent diversion can also be offered to the cystectomy patient. There are no simple procedures to control bladder instability or sensory urgency. When incontinence is due to a mixture of stress and urge, pharmacologic or behavioral treatment may be employed in conjunction with surgery, but results are not as good as when stress incontinence exists alone. Selection of patients for surgical procedures depends upon the diagnosis and upon the condition of the patient. The frailty of the patient, the condition of tissues, and the state of nutrition bear on the ability to heal. The severity of symptoms must be considered in relation to the risk the patients must undertake for their surgical correction. Finally, such factors as the durability of the treatment and the incidence of complications must also be considered in choosing a treatment option.

Behavioral Techniques Behavioral techniques increase the patient’s awareness of the lower urinary tract and environment and can enhance control of detrusor and pelvic muscular function. Such techniques are participatory, relatively noninvasive, and generally free of side effects, and they do not limit future options. They do require time, effort, and continued practice. Some patients become dry, while a larger number experience important reduction of wetness, and


others receive no benefit. Those who appear to benefit most are highly motivated individuals without cognitive deficits. Men and women with stress and urge incontinence have benefited, whereas patients with severe sphincter damage (such as in postradical prostatectomy with constant leakage) generally do not benefit. Behavioral techniques should be offered as a choice to patients who are motivated to put in the time and effort and wish to avoid a more invasive procedure. Commonly employed techniques include:

Pelvic Muscle Exercises Pelvic muscle exercises strengthen the voluntary periurethral and pelvic floor muscles, the contraction of which exerts a closing force on the urethra. These techniques have been emphasized for women with stress incontinence but appear to be useful in men as well. Benefit has been reported in 30 to 90 percent of women, but criteria for improvement differ among studies. Patients with mild symptoms may improve most. Continued exercise is required for continued benefit.

Biofeedback Biofeedback is a learning technique to exert better voluntary control over urine storage. Biofeedback uses visual or auditory instrumentation to give patients moment-to-moment information on how well they are controlling the sphincter, detrusor, and abdominal muscles. After such training, successful patients typically learn to perform the correct responses relatively automatically. Patients with urinary incontinence are trained to relax the detrusor and abdominal muscles and/or contract the sphincter, depending upon the form of incontinence. When used in patients with stress and/or urge incontinence, biofeedback has been shown to result in complete control of incontinence in approximately 20-25 percent of patients and to provide important improvement in another 30 percent. There are two caveats: the degree of improvement is variable, and long-term followup data are not available. It is important to recognize that biofeedback requires sophisticated equipment and training. The benefit of adding biofeedback to pelvic muscle exercise regimens has not been adequately evaluated.


Bladder Training Bladder training instructs patients to void at regular short intervals, usually hourly during the day, and then at progressively longer intervals of up to 3 hours over a training period of a few to a dozen weeks. Bladder training appears to be effective in reducing the frequency of stress and urge incontinence. Studies have indicated cure rates of 10-15 percent and improvement in the majority of patients.

Behavioral Techniques in the Nursing Home For institutionalized elderly, almost any consistent attention to the problem, including bladder training and frequent scheduled checks for dryness appears to reduce incontinence in at least some patients. Another technique applicable in the nursing home is prompted voiding, in which frequent (1 to 2 hourly) checks for dryness are made, reminding the patient to void and praising success.

Staging of Treatment As a general rule, the least invasive or dangerous procedures should be tried first. For many forms of incontinence, behavioral techniques meet this criterion. When behavioral techniques do not achieve the desired result, pharmacologic treatment can be initiated. Clear indications for surgical intervention must be respected, however, and surgical treatment should not be withheld inappropriately. Overflow incontinence due to prostatism and urge incontinence due to carcinoma of the bladder or prostate must be recognized and treated promptly. After having been informed of surgical and nonoperative options, the patient who is a surgical candidate and wants prompt treatment (e.g., as in the case of stress incontinence) should be operated on. In patients with mixed incontinence, a combination of surgery, behavioral techniques, and pharmacotherapy may be helpful.

Management Techniques For patients who have not been successfully treated, management plans must be developed to maximize their well-being. Even when permanent improvement is not expected, techniques such as frequent toileting and reminders may be useful in reducing the impact of the patient’s incontinence. Careful evaluation of the timing and pattern of incontinence


may suggest helpful changes such as bedtime fluid restriction, provision of easier access to toilet facilities, and temporary or permanent arrangements for protection of the patients, their clothing, and environment. Currently available modes of protection include absorbent pads or garments, indwelling catheters, and external collection devices such as condom catheters. Absorbent pads or garments provide comfort and convenience when used temporarily in conjunction with therapy; no method is entirely satisfactory for long-term use. For long-term use with incapacitated patients, absorbent materials are expensive, require personnel time, and can be associated with pressure sores when circumstances prevent meticulous attention to prompt changes. For men, external collection devices are less expensive and less timeconsuming for patient and caregiver, but they are associated with increased incidence of urinary tract infection and other complications. Practical external collection devices for women are not generally available. Indwelling urethral or suprapubic catheters may be necessary for selected patients, but almost invariably lead to bacteriuria within a few weeks and have been associated with sepsis.

Improving Public and Professional Knowledge There have been limited efforts to inform the public and professionals about urinary incontinence. The effectiveness of these strategies has not been evaluated. Incontinence education, therefore, must rely on methods that have been used in other areas of health education. Effective strategies to improve public and professional awareness need to be developed, implemented, and evaluated. Negative societal attitudes about urinary incontinence have been a barrier to increasing public and professional knowledge. The scientific study of incontinence and the dissemination of research findings will help professionals and laypersons realize that loss of continence need not be a condition that is inevitable or shameful.

Strategies for Improving Public Knowledge Providing accurate information on the management of incontinence to persons with this problem and their families is a challenging and important


task. Studies suggest that only half of the people with incontinence report their condition to a physician. Strategies that will reach the largest number of people will be effective in encouraging them to seek professional help. These include informative newspaper and magazine articles, radio and television programs, and special educational programs in senior centers. One innovative suggestion that deserves consideration is the mandatory labeling of all absorbent products, informing the public that persistent urinary incontinence should be evaluated and that effective treatments are available.

Strategies for Improving Professional Knowledge There is an urgent need to educate professionals and paraprofessionals about urinary incontinence. First and foremost, information on urinary incontinence should be included in the core curricula of undergraduate and graduate professional schools. Schools of nursing should consider the feasibility of educating specialists on incontinence care, who can serve as expert advisers to health care professionals. To increase practitioners’ knowledge of this important condition, continuing education courses focusing on the types of incontinence and appropriate diagnostic measures and treatment should be offered. Professionals most likely to provide care to people with incontinence should be encouraged to attend these courses. Education on the topic of urinary incontinence should also be a part of the training programs for paraprofessional students such as licensed vocational nurses, nurses aides, and auxiliary workers in the community. Because urinary incontinence is a problem of great magnitude in long-term care settings, special emphasis should be placed on educating nurses aides. Last, coordinated care for people with incontinence will be facilitated by encouraging alliances among all professionals responsible for caring for people with incontinence.


Need for Future Research Related to Urinary Incontinence The Consensus Development Conference on Urinary Incontinence in Adults has provided an overview of current knowledge on the etiology, pathophysiology, sequelae, and management of this prevalent clinical problem. Although information on incontinence is increasing, this field has long been neglected, and numerous gaps exist in our knowledge. While many controversies were addressed, numerous questions were identified that await answers and thus serve as the focus for future research directions. These issues will require the collaborative input of investigators from the spectrum of relevant disciplines and the rigorous application of appropriate research principles.

Directions for Future Research ·

Basic research on the mechanisms underlying the etiology, exacerbation, and response to treatment of specific forms of urinary incontinence and urgency.

·

Epidemiologic studies with emphasis on elucidation of risk factors for development of urinary incontinence, its occurrence in specific populations (particularly males and nonwhites), and the natural history of the various clinical and physiologic subtypes.

·

Studies of strategies to prevent urinary incontinence.

·

Randomized clinical trials, including longitudinal studies in wellspecified populations, of algorithms for the systematic assessment of patients with incontinence and of specific behavioral, pharmacologic, and surgical treatment, either alone or in combination.

·

Development of new therapies, including pharmacologic agents with greater specificity for the urinary tract and new behavioral and surgical strategies and other innovative techniques, including electrical stimulation.

Conclusions ·

Urinary incontinence is very common among older Americans and is epidemic in nursing homes.

·

Urinary incontinence costs Americans more than $10 billion each year.


·

Urinary incontinence is not part of normal aging, but age-related changes predispose to its occurrence.

·

Urinary incontinence leads to stigmatization and social isolation.

·

Of the 10 million Americans with urinary incontinence, more than half have had no evaluation or treatment.

·

Contrary to public opinion, most cases of urinary incontinence can be cured or improved.

·

Every person with urinary incontinence is entitled to evaluation and consideration for treatment.

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Most health care professionals ignore urinary incontinence and do not provide adequate diagnosis and treatment.

·

Inadequate nursing home staffing prohibits proper treatment and contributes to the neglect of nursing home residents.

·

Medical and nursing education neglect urinary incontinence. Curriculum development is urgent.

·

A major research initiative is required to improve assessment and treatment for Americans with urinary incontinence.

Vocabulary Builder Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antispasmodic: An agent that relieves spasm. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the


term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Criterion: A standard by which something may be judged. [EU] Cystectomy: Used for excision of the urinary bladder. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Flavoxate: A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist. [NIH] Fluoroscopy: screen. [NIH]

Production of an image when x-rays strike a fluorescent

Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperreflexia: Exaggeration of reflexes. [EU] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH]


Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]

Postmenopausal: Occurring after the menopause. [EU] Precipitation: The act or process of precipitating. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]

Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH]

Online Glossaries 189

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to prostate enlargement and keep them on file.


Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

Glossary 191

PROSTATE ENLARGEMENT GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Pertaining to the abdomen. [EU] Adenocarcinoma: organization. [NIH]

A malignant epithelial tumor with a glandular

Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Aetiology: Study of the causes of disease. [EU] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are


used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antispasmodic: An agent that relieves spasm. [EU] Anus: The distal or terminal orifice of the alimentary canal. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Showing or causing no symptoms. [EU] Atrial: Pertaining to an atrium. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Benign: Not malignant; not recurrent; favourable for recovery. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Biperiden: A muscarinic antagonist that has effects in both the central and peripheral nervous systems. It has been used in the treatment of

Glossary 193

arteriosclerotic, idiopathic, and postencephalitic parkinsonism. It has also been used to alleviate extrapyramidal symptoms induced by phenothiazine derivatives and reserpine. [NIH] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency or other output. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU]


Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Criterion: A standard by which something may be judged. [EU] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH] Cystectomy: Used for excision of the urinary bladder. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cystoscopy: Direct visual examination of the urinary tract with a cystoscope. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dilatation: The condition, as of an orifice or tubular structure, of being dilated or stretched beyond the normal dimensions. [EU] Dimenhydrinate: A drug combination that contains diphenhydramine and theophylline. It is used for treating vertigo, motion sickness, and nausea associated with pregnancy. It is not effective in the treatment of nausea associated with cancer chemotherapy. [NIH] Diverticulitis: Inflammation of a diverticulum, especially inflammation related to colonic diverticula, which may undergo perforation with abscess formation. Sometimes called left-sided or L-sides appendicitis. [EU] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Dysplasia: Abnormality of development; in pathology, alteration in size, shape, and organization of adult cells. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Ejaculation: A sudden act of expulsion, as of the semen. [EU]

Glossary 195

Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH]

Flavoxate: A drug that has been used in various urinary syndromes and as an antispasmodic. Its therapeutic usefulness and its mechanism of action are not clear. It may have local anesthetic activity and direct relaxing effects on smooth muscle as well as some activity as a muscarinic antagonist. [NIH] Fluoroscopy: screen. [NIH]

Production of an image when x-rays strike a fluorescent

Flutamide: An antiandrogen with about the same potency as cyproterone in rodent and canine species. [NIH] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU]


Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperplasia: The abnormal multiplication or increase in the number of normal cells in normal arrangement in a tissue. [EU] Hyperreflexia: Exaggeration of reflexes. [EU] Hyperthermia: Abnormally high body temperature, especially that induced for therapeutic purposes. [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypogonadism: A condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [EU] Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Hypotension: Abnormally low blood pressure; seen in shock but not necessarily indicative of it. [EU] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Incision: 1. cleft, cut, gash. 2. an act or action of incising. [EU]

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Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inhibin: Glyceroprotein hormone produced in the seminiferous tubules by the Sertoli cells in the male and by the granulosa cells in the female follicles. The hormone inhibits FSH and LH synthesis and secretion by the pituitary cells thereby affecting sexual maturation and fertility. [NIH] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Pertaining to the intestine. [EU] Intravascular: Within a vessel or vessels. [EU] Intravenous: Within a vein or veins. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Irrigation: Washing by a stream of water or other fluid. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Libido: Sexual desire. [EU] Lipoma: A benign tumor composed of fat cells. [NIH] Lobe: A more or less well-defined portion of any organ, especially of the brain, lungs, and glands. Lobes are demarcated by fissures, sulci, connective tissue, and by their shape. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lymphoma:

Any neoplastic disorder of the lymphoid tissue, the term


lymphoma often is used alone to denote malignant lymphoma. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Meclizine: A histamine H1 antagonist used in the treatment of motion sickness, vertigo, and nausea during pregnancy and radiation sickness. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nocturia: Excessive urination at night. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Orgasm: The apex and culmination of sexual excitement. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU]

Glossary 199

Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Penis: The male organ of copulation and of urinary excretion, comprising a root, body, and extremity, or glans penis. The root is attached to the descending portions of the pubic bone by the crura, the latter being the extremities of the corpora cavernosa, and beneath them the corpus spongiosum, through which the urethra passes. The glans is covered with mucous membrane and ensheathed by the prepuce, or foreskin. The penis is homologous with the clitoris in the female. [EU] Pessary: 1. an instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. a medicated vaginal suppository. [EU] Phenoxybenzamine: An alpha-adrenergic anatagonist with long duration of action. It has been used to treat hypertension and as a peripheral vasodilator. [NIH]

Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]

Postmenopausal: Occurring after the menopause. [EU] Postoperative: Occurring after a surgical operation. [EU] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Precipitation: The act or process of precipitating. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Procyclidine: A muscarinic antagonist that crosses the blood-brain barrier and is used in the treatment of drug-induced extrapyramidal disorders and in parkinsonism. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU]


Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatism: A symptom complex resulting from compression or obstruction of the urethra, due most commonly to hyperplasia of the prostate; symptoms include diminution in the calibre and force of the urinary stream, hesitancy in initiating voiding, inability to terminate micturition abruptly (with postvoiding dribbling), a sensation of incomplete bladder emptying, and, occasionally, urinary retention. [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]

Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Relaxant: 1. lessening or reducing tension. 2. an agent that lessens tension. [EU]

Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Resection: Excision of a portion or all of an organ or other structure. [EU] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Retrograde: 1. moving backward or against the usual direction of flow. 2. degenerating, deteriorating, or catabolic. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It

Glossary 201

occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sitosterols: A family of sterols commonly found in plants and plant oils. Alpha-, beta-, and gamma-isomers have been characterized. [NIH] Somatic: 1. pertaining to or characteristic of the soma or body. 2. pertaining to the body wall in contrast to the viscera. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU]


Sympathomimetic: 1. mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. an agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]

Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]

Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transurethral: Performed through the urethra. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor,

Glossary 203

screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Ventricular: Pertaining to a ventricle. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]

General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna

·

Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna

·

A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna

·

Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN:


0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna ·

Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna

·

Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618

·

Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna

·

Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna

·

Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna

·

Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna

Index 205

INDEX A Abdomen .......................................27, 191 Abdominal............................174, 176, 181 Adenocarcinoma....................................71 Adrenergic ......32, 34, 123, 124, 179, 191, 194, 199, 202 Adverse ...............................131, 132, 136 Aetiology................................................72 Albuterol ......................................123, 191 Algorithms............................................185 Anatomical.............................................81 Anesthesia.................................18, 19, 20 Angioplasty ............................................52 Antibiotic ........................................34, 201 Anticholinergic .............................178, 179 Antidepressant.....................179, 187, 196 Antigen ..........27, 72, 73, 75, 93, 131, 198 Antispasmodic .............124, 187, 195, 196 Anus ......................................................82 Asymptomatic ..................................86, 87 Atrophy ................................................106 Auditory ...............................................181 Autonomic............................................173 B Bacteria .....27, 31, 34, 150, 186, 192, 201 Bacteriuria .............................78, 183, 203 Biopsy..............................27, 83, 100, 131 Bulbar ..........................................110, 193 C Calibration .............................................72 Capsules..............................................153 Carbohydrate.......................................152 Cardiovascular...............................52, 178 Cataract .........................................77, 193 Catheter ...............................18, 21, 22, 64 Cerebral...............................................173 Chemotherapy .....................100, 124, 194 Cholesterol ....32, 147, 150, 152, 194, 201 Chronic ....72, 91, 170, 172, 174, 175, 179 Concomitant ..........................................65 Confusion ............................................178 Constipation.......................22, 70, 91, 178 Coronary................................................52 Cortex ....................................68, 173, 195 Criterion ...............................................182 Cryosurgery ...........................................74 Cystectomy..........................................180 Cystitis ...................................................25 Cystoscopy ............................................76 Cytokines ...............................................87

D Decongestant........................................ 14 Degenerative ........................ 78, 151, 198 Diarrhea .............................................. 150 Dilatation ................................. 29, 58, 191 Doxazosin ................................. 17, 52, 65 Dysplasia ............................................ 106 E Edema................................................... 91 Ejaculation ............ 20, 23, 24, 34, 75, 201 Empiric ................................................ 177 Endocrinology ............................. 187, 196 Epidemic ............................................. 185 Epithelium ........................................... 131 Erection................................................. 23 Estradiol .......................... 67, 68, 138, 155 Extracellular .......................................... 87 Extraction .............................................. 66 F Fatigue .................................................. 27 Finasteride .. 28, 52, 65, 99, 132, 133, 135 Flavoxate ............................................ 178 Flutamide .............................................. 99 G Genitourinary ...................................... 172 Gynecology ......................................... 171 H Hematology........................................... 10 Hematuria ........................................... 176 Hormones ...... 14, 68, 92, 147, 187, 194, 195, 200, 201 Hygienic .............................................. 170 Hyperreflexia....................................... 174 Hyperthermia ........................................ 76 Hypertrophy ...... 11, 63, 64, 78, 124, 175, 176, 198, 199 Hypogonadism ...................................... 75 Hypotension ........................................ 179 I Imipramine .......................................... 179 Implantation .......................................... 81 Impotence ..................... 16, 18, 19, 29, 70 Incision............ 19, 20, 22, 24, 33, 76, 197 Inflammation ............. 27, 77, 87, 100, 194 Insomnia ............................................... 70 Intermittent ............................................ 18 Interstitial............................................... 25 Intestinal.............................................. 150 Intravascular ....................................... 138 Intrinsic................................................ 180 Invasive. 18, 19, 28, 52, 76, 177, 181, 182


Irrigation.................................................21 L Libido .....................................................70 Lumbar ..................................................52 M Malignant ....32, 38, 39, 66, 74, 77, 81, 83, 147, 191, 192, 198 Menopause............70, 172, 179, 188, 199 Molecular ....10, 68, 86, 96, 103, 104, 188, 200, 202 N Neural ..................................................151 Niacin...................................................151 Nitrogen ...............................................176 Nocturia .........................................91, 135 O Oral ..............28, 33, 52, 75, 158, 193, 198 Orgasm ..................................................24 Osteoarthritis .........................................70 Osteoporosis .........................................70 Overdose .............................................151 P Parity ...........................................172, 174 Pelvic ......34, 91, 170, 174, 176, 180, 181, 200 Penis......16, 19, 21, 24, 33, 110, 196, 199 Pessary..................................................92 Physiologic ......58, 65, 68, 170, 174, 185, 200 Postmenopausal..................................179 Postoperative...................................28, 63 Postural ...............................................179 Potassium............................................152 Precipitation.........................................178 Preoperative ..........................................63 Prevalence.....................................28, 171 Prostatism......................................29, 182 Prostatitis .....................25, 27, 65, 98, 100 Proteins ....31, 73, 92, 150, 152, 188, 192, 194, 198 Psychology ..........................................171 Puberty ............................................12, 13 R Rectal .......15, 16, 24, 25, 27, 72, 75, 100, 101, 176 Relaxant ..............................................179 Remission............................................172 Reoperation .................................188, 200

Resection ................ 19, 62, 63, 83, 90, 99 Resorption............................................. 52 Retrograde ................................ 20, 23, 24 Riboflavin ............................................ 150 S Secretion................. 34, 78, 110, 197, 201 Selenium ............................................. 152 Semen................. 11, 24, 32, 34, 194, 200 Serum .... 32, 52, 58, 65, 72, 75, 131, 176, 194, 201 Sitosterols ........................................... 137 Somatic ............................................... 173 Spectrum....................................... 10, 185 Sphincter ...... 91, 93, 174, 176, 180, 181, 201 Stenosis ................................................ 81 Stents.................................................... 76 Steroid........................................... 68, 200 Sympathomimetic ................................. 14 Symptomatic .... 28, 35, 52, 62, 63, 66, 86, 87, 131, 133, 135, 202 Systemic ............................................. 170 T Testicular .............................................. 75 Thermoregulation................................ 150 Thyroxine ............................................ 152 Tinnitus ................................................. 70 Tolerance ................................ 63, 68, 202 Tomography.......................................... 27 Topical .................................... 27, 35, 202 Toxicology....................................... 10, 97 Transdermal.......................................... 75 Transurethral ... 18, 19, 20, 22, 23, 24, 62, 63, 64, 76, 90, 99 Tricyclic ............... 179, 186, 187, 192, 196 Tuberculosis........................................ 180 U Ultrasonography ................................... 83 Urinalysis ........................ 76, 78, 176, 202 Urodynamics ......................................... 76 Urology.............. 10, 86, 87, 131, 136, 171 V Vaginal .................................... 11, 93, 199 Ventricular............................................. 81 Visceral ............................................... 173 W Withdrawal .......................................... 135

Index 207


Index 209


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