Cyp17 Rs743572 Polymorphism In Benign Prostatic Hyperplasia
Weng and colleagues stated that many published studies have examined the association between CYP17 rs743572 polymorphism and BPH susceptibility but have yielded inconsistent results. These investigators carried out a meta-analysis using the multi-variate statistic method to address a more precise association. Case-control or cohort studies with adequate genotype distribution or minor allele frequency were identified by searching the PubMed, Embase, and Web of Science databases up to December, 2018 ORs and 95 % CIs were calculated to estimate the association between CYP17 rs743572 polymorphism and BPH susceptibility. Pooled MAFs of 13 studies were 37 % in Caucasians and 56 % in Orientals, respectively. Pooled results of 8 studies suggested that CYP17 rs743572 was not associated with the BPH susceptibility in the overall population . Sensitivity analysis showed the results were robust. Subgroup analysis based on ethnicity suggested that, in Orientals, A2 allele carriers had a 28 % lower risk of developing BPH compared with A1 allele carriers, and the risk of BPH is 47 % lower in A2/A2 genotype carriers compared with A1/A1 genotype carriers. No significant association was observed in Caucasians. The authors concluded that the findings of this study indicated a negative association between CYP17 and BPH in Orientals. However, due to limited sample size, the conclusion should be interpreted with caution and further studies with large sample size and high quality are needed.
Why Choose New York Urology Specialists For Treatment Of Enlarged Prostate Problems
- All treatment is performed by a board-certified urologist experienced in treating men with symptoms of frequent urination, urinary urgency, urinary incontinence, and bladder pain using medical therapy, minimally invasive therapies, lasers, and open surgery.
- We are one of the few practices in the region to offer a full range of options for treatment of urinary problems caused by an enlarged prostate in men.
- We offer treatment options for enlarged prostate, overactive bladder, UTI, and urinary incontinence in our office which avoids the risks, costs, and recovery from general anesthesia.
- Extensive experience: Thousands of men have been treated successfully using medical therapy, surgery, and minimally invasive procedures such as Urolift procedure, Rezum surgery, Botox for overactive bladder, Interstim for frequent urination and tibial neuromodulation.
- We offer diagnostic testing in our office, which avoids hospital costs.
- Confidential and Understanding Care. We understand that most of our patients desire privacy. We see patients with a variety of urological problems. Your reason for visiting us is entirely confidential.
- We are conveniently located within a 30-60 minute commute to men who are seeking BPH treatment in Manhattan, Brooklyn, Queens, Staten Island, Westchester, Long Island, Bronx, and New Jersey.
Transurethral Needle Ablation Of The Prostate
During a TransUrethral Needle Ablation of the prostate procedure, also referred to as TUNA, a specialized scope is inserted into the urethra, which allows the precise placement of two small needles into the prostate. The needles contain electrodes which are used to apply radiofrequency energy directly to the obstructing tissue. These unique needles have adjustable shields, which protect the urethra from thermal damage. This RF energy heats precise areas in the prostate to 70100°C, which ablates tissue and seals blood vessels.
Clinical studies show that TUNA reduces symptoms and causes fewer side effects than surgical treatment. Healthy prostate tissue and urethral tissue is unaffected by treatment, and clinical trials indicate that the procedure does not usually cause incontinence or impotence.
TUNA usually takes about 3060 minutes, depending on the size of the prostate, and is performed on an outpatient basis usually only requiring regional anesthesia. Depending on the size of the prostate, the procedure may be repeated in more than one area of the gland during the treatment session.
After treatment, approximately two percent of patients require catheterization for 13 days and antibiotics are prescribed for 35 days after removal of the catheter. Minimal discomfort can be treated using over-the-counter pain relievers.
Web Resources
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How Is Benign Prostatic Hyperplasia Diagnosed
Your doctor will look at your medical history and give you a complete physical examination.
Your doctor will perform a digital rectal examination by inserting a gloved, lubricated finger into your rectum to feel the prostate, estimate its size and detect any hard areas that could be cancer.
Several studies may be performed to help diagnose your condition:
- A survey to evaluate how severe your symptoms are.
- A flow study may be conducted to measure how slow the urinary stream is compared with normal urine flow.
- A study to detect how much urine is left in the bladder after you finish urinating.
- A cystoscopy to look into the bladder.
Who Is A Candidate For Rf Therapy
RF Therapy is an effective treatment for men suffering from BPH symptoms. Men of any age who are experiencing BPH symptoms may be a candidate for Prostiva® RF Therapy. Dr. Robert Pugach will conduct a medical examination and evaluate your BPH symptoms to determine if this minimally invasive therapy that is right for you. Dr. Pugach provides a customized treatment plan for each patient at our BPH Center of Excellence. The recommended plan is dependent upon your medical examination and the size and shape of your prostate.
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What Are The Risks Of Benign Prostatic Hyperplasia Surgery
Surgery for benign prostatic hyperplasia is common and generally very safe. However, there are risks with any surgery. After the procedure you might have the following issues:
- Frequent urination or difficulty urinating, painful urination.
- Blood in the urine and/or in semen.
- An inability to hold urine .
- Infection or symptoms resembling a urinary tract infection.
- Sexual dysfunction.
- Scar tissue.
In general, side effects from vapor ablation are milder than with other forms of surgery to correct BPH.
What To Expect During A Transurethral Needle Ablation
TUNA is typically performed in your doctors office under local anesthesia.
During the procedure, a cystoscopy with a needle connected to the end is inserted through the penis into the prostate. A cystoscope is a surgical instrument with a light on the end that allows the doctor to see the urethra. Low level radio waves are sent through the needles into various areas of the prostate gland to destroy excess cells.
Your doctor will determine how many needles need to be placed into the prostate and how long each one will be placed at each location based on the size and shape of the prostate. Typically, four to six needles are used and are held on each location for as long as three minutes.
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Rezum Vs Urolift: What Is More Effective
While no studies have been done to compare the effectiveness of Rezum and Urolift directly against each other, we can draw some conclusions based on the mechanism of action of each procedure, studies that have been published and clinical experience.
Most men experience improvement in urinary symptoms after Urolift surgery within 1-2 weeks. Improvement in symptoms after treatment with the REZUM procedure takes about 1 month as destroyed tissue needs to be resorbed by the body.
For men with pliable lateral lobe hypertrophy of the prostate, Urolift is very effective. For men with a component of the median lobe, REZUM surgery may be more effective as it is capable of destroying the median lobe.
Men whose obstruction by the lateral lobe of the prostate is predominantly at the bladder neck may be better off with REZUM as Urolift is not very effective at treating lateral lobe obstruction in proximity to the bladder neck.
Men with predominantly distal lateral lobe obstruction, may benefit more from the Urolift procedure as the placement of Urolift stents is very controlled and there is no concern about injury to the urethral sphincter with the Urolift procedure for BPH.
Did you know?Dr. Shteynshlyuger has performed over 500 surgeries and procedures for enlarged prostate, including Rezum, Urolift, prostate enucleation, laser ablation of the prostate, and TURP. He performs over 100 prostate procedures a year.
Further Considerations And Research
The Rezum system is an exciting and novel minimally invasive therapy for treatingBPH, which thus far has demonstrated strong evidence of clinical effectiveness witha potential wide scope of use with limited drawbacks. However, it is important toconsider limitations in the current literature when assessing this noveltreatment.
Previous trials have been supported or sponsored by NxThera which may represent a potential conflict of interest. So far outcomes up to 3yearshave been recorded, this is as part of a 5-year RCT currently ongoing. Long-termoutcomes are currently awaited so it is difficult to comment on the long-termefficacy of Rezum as a treatment for BPH and whether there will be continued successin relief of LUTS symptoms. A reduction in prostate volume was noted, although nological explanation on lack of substantial reduction in PVR was noted, which needsto be explored in the future studies.
Further evidence in a nontrial setting is needed in order to confirm theeffectiveness of Rezum in real-world applications and also to provide additionalsupport of findings published in a retrospective trial indicating the potential useof Rezum in patients with a large prostate burden and in urinary retention.
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Benefits Of Transurethral Needle Ablation
Advantages of TUNA over other treatments for BPH include:
- Lower risk of bleeding – Patients who are on blood-thinning medication may do better on this treatment because the risk of bleeding is less than with more invasive procedures.
- Shorter hospital stays – can be done on an outpatient basis
- Patients need less anesthesia
What Can I Expect After My Procedure
Given your prostate tissue will become swollen immediately after the procedure, you will need the catheter to stay for at least 3-14 days. You will then come to the clinic to have your catheter removed. Immediately after the catheter is removed, you might feel that your symptoms are worse than prior to your procedure. However, you will start noticing a gradual improvement of your symptoms after 2-3 weeks. This improvement will continue to progress up until 3 months after the procedure, when you will notice the maximal effect of the water vapor therapy. At that time, you will follow up with Dr. Arnold for a final evaluation.
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Patient Selection And Procedure Planning
As for all surgical procedures, patient selection is paramount. Not every patientwith BPH are candidates for Rezum therapy . However, in contrast with someother procedures, patients with median lobe obstruction are eligible to receiveRezum therapy. Critical factors that preclude patients from receiving Rezum therapyinclude previous surgical/radiation treatment involving the prostate, a history ofurinary retention and patients with a large prostate burden . Prior tosurgery, in order to determine areas of prostate enlargement, patients undergoflexible cystoscopy. It potentially also provides an opportunity to assess thepatients tolerance to rigid cystoscopy while awake. Obtaining an ultrasound scan toassess prostate volume is also useful.
Read Real Stories Of Men Who Underwent Treatment Of Enlarged Prostate At New York Urology Specialists
We offer treatment for prostate problems, including slow urine stream, frequent urination at night, difficulty emptying the bladder, and other problems to patients within driving distance to our offices as well as from other states and countries. Our patients come from New York, New Jersey, Pennsylvania, Connecticut, and over 70 countries worldwide.
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What Are The Symptoms Of An Enlarged Prostate
Some men with BPH experience a variety of urinary symptoms, which can range from mild and barely noticeable, to severe and life-altering. These symptoms include:
- Recurring, sudden need to urinate
- Increasing frequent urination, especially at night
- Weak or interrupted urine stream
- Difficulty starting urination
- Urine leakage
- Inability to completely empty the bladder
Caffeine, alcohol, spicy or acidic foods, certain cold and pain medications, and constipation can make symptoms worse. Left untreated, symptoms may worsen over time and can cause complications that may include inability to urinate , bladder or kidney damage, bladder stones, and urinary tract infections .
Men experiencing any of these urinary symptoms should have a thorough evaluation performed by a urologist as other conditions such as a UTI, prostatitis , prostate cancer, and diabetes can cause similar symptoms.
Enlarged Prostate
Greenlight Laser Therapy For Bph At Lowcountry Urology Clinics
The physicians of Lowcountry Urology Clinics of Charleston SC are skilled in performing GreenLight Laser Therapy for enlarged prostate . We invite referring physicians to consider us for their patients who may benefit from this procedure.
As a service to our referring physicians, Lowcountry Urology Clinics would like to present some basic information on GreenLight Laser Therapy that you may wish to share with your patients.
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What Is Rezm Water Vapor Therapy
Rezm Therapy treats the source of BPH your enlarged prostate. This short, in-office procedure uses the natural energy stored in a few drops of water to shrink the prostate so urine can flow freely. There are no incisions, no general anesthesia, and most patients return to regular activities within a few days.* And, it preserves sexual function.
Scheduling Appointments For Enlarged Prostate Treatment At New York Urology Specialists
We have excellent reviews from patients and their partners. Information for out-of-state and international patients. Find out our office hours or directions to our office.
We offer affordable appointment prices with or without insurance. We offer weekday, weekend, and evening office hours.
Dr. Alex Shteynshlyuger is a board-certified urologist and specialist in the treatment of urinary problems in men. He is one of the few urologists who offers a full range of treatment options for BPH . He specializes in all aspects of care for men with an enlarged prostate and urinary problems, including frequent urination at night, difficulty emptying the bladder, urinary urgency, and incontinence. He has successfully treated thousands of men with urinary problems, including urinary retention, painful urination, and frequent urination.
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What Are The Treatment Options For Enlarged Prostate
Treatment for enlarged prostate, or BPH, focuses on alleviating bothersome symptoms and will depend on the severity of your symptoms and how much they interfere with your lifestyle.
Men with minimal urinary issues may only need to make lifestyle changes those with more pronounced symptoms or complications from BPH may require medication or a minimally invasive surgical procedure to restore urinary function and quality of life.
Your provider can help you determine which treatment is more appropriate for you.
Avoid caffeine, acidic drinks such as colas, tomato and orange juices, and alcohol. Cold medications containing antihistamines or pseudoephedrine can cause urinary problems. Constipation can also make it more difficult to urinate.
Limit evening beverages and urinate when you first feel the urge.
Your doctor may prescribe one or a combination of medications that can help alleviate urinary symptoms caused by your enlarged prostate. Medications often have some side effects, so talk to your urologist about which medication is right for you.
Minimally Invasive
Specialized, minimally invasive procedures to treat enlarged prostate / BPH are excellent and effective alternatives to long-term medication therapy, often with quick results fewer side effects and improved quality of life. Your urologist will work with you to determine your best treatment option.
UroLift
Disadvantages:
- Temporary pelvic pain
Rezum
Advantages:
Disadvantages:
- N/A
Laser Vaporization of the Prostate
Why Should Steam Be The Preferred Treatment
In the Rezm Therapy procedure, steam delivers convective energy. RF energy is applied to water, and the water carries energy until it phase-shifts into steam. When the steam is delivered to the tissue, it condenses back into water delivering the stored energy convectively. This is an efficient and uniform way to transfer therapeutic energy inside the body because the vapor is convectively dispersed through the interstitial space in the prostate tissue, and the energy is delivered in a matter of seconds rather than minutes.2
Steam, which is delivered to the prostate at a temperature of about 103°C, does not penetrate tissue. Instead, steam travels through cell interstices until it meets a boundary, such as a cell membrane . On reaching the cell membrane, steam condenses to water releasing the stored energy, bringing the tissue temperature to 70°C-80°C, which leads to immediate cell death. Due to the convective nature of steam, the transfer of energy is uniform, which enhances the predictability of the procedure.8,9 Upon cell death, the bodys natural processes come into play. Inflammation occurs and the bodys inflammatory system sends out scavengers to the area of edema in the prostate.11 The body resorbs the necrotic tissue over time and the prostate volume is reduced.12 Rezm ablates tissue, like common surgical procedures, leading to a reduction in overall prostate size.
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How Is Prostiva Rf Therapy Performed
Patients are given a medication to help them relax, and local anesthesia is used so the patient remains comfortable throughout the treatment. Dr. Robert Pugach carefully passes a small tube with a telescope through the urethra to the prostate. RF energy is then precisely delivered directly into the prostate to reduce the excess prostate tissue that is squeezing the urethra.
Upon discharge from our office patients will have a catheter for a few days to allow the prostate to heal.Symptom improvement continues for up to 6 months after a Prostiva® RF Therapy treatment.
To schedule a consultation or receive more information about a minimally invasive BPH treatments, Call: 888-735-4336 or email us via our Contact Us Form.
Diagnosing An Enlarged Prostate
As with all incontinence conditions, a thorough diagnosis must be developed before action can be taken. You may have heard of some of these exams. And if you havent, now is a good time to familiarize yourself with them. Not only is knowledge power, but it also eliminates surprises.
Because those with BPH can experience symptoms from mild to severe, the treatment options featured here are organized from least invasive to more intense.
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