Can we predict the response to medical treatment in patients with symptomatic benign prostatic obstruction?

Semptomatik benign prostat obstrüksiyonu olan hastalarda medikal tedavinin başarısını önceden kestirmek mümkün müdür?

M. İlteriş TEKİN,A. Muhteşem AĞILDERE,Ç. Levent PEŞKİRCİOĞLU,Y. Cem AYGÜN,Ayhan DİRİM,Hakan ÖZKARDEŞ

Abstract

Can We Predict The Response To Medical Treatment In Patients With Symptomatic Benign Prostatic Obstruction? - Objective: To investigate the correlation of whole prostatic, fibromuscular and transitional zone volumes and their ratios to each other with treatment response to alpha adrenergic blockade. Patients and Methods: ^4 total of 20 patients seen between March 1997 and May 1998 with significant symptoms of infravesical obstruction and who could be evaluated by endorectal magnetic resonance imaging (erMRI) (Siemens, 1.0 tesla) were included into the study. All patients were put on alpha adrenergic blockade treatment following erMRI study, and recommended maximum doses of alpha adrenergic blockers were used in cases who remained unresponsive to the anticipated doses. Response to treatment was evaluated with monthly uroflowmetric examinations, determination of postvoiding residual urine volume and symptom scoring. Results: Twelve patients had satisfactory response to medical treatment but 8 patients remained unresponsive and underwent surgery. Significant correlations were found in neither responsive nor unresponsive group to medical treatment in terms of whole prostatic, fibromuscular and transitional zone volumes and their ratios to each other. A moderate correlation (r= 0.45, Pearson test) between whole prostate volume and response to alpha-adrenergic therapy and high correlation (r= 0.68) between transitional zone volume and response to treatment were present. Conclusion: Response to alpha adrenergic blockade treatment in benign prostatic obstruction cannot be predicted by using erMRI.

Özet

Semptomatik benign prostat obstruksiyonu bulunan hastalarda alfa adrenerjik blokor tedavisine cevabin'prostatikfibromuskulerve tranzisyonel zon hacimleri ve bunlarm birbirine ve turn prostat hacmine orani ile korelasyonunun incelenmesi. Hastalarve Yontem: Calismaya Mart 1997 ile Mayis 1998 arasinda belirgin infravezikal obstruksiyon semptomlan ileba§vuran ve endorektal manyetik rezonans goruntiileme (erMRG) (Siemens, 1.0 tesla) ile prostat degerlendirmesi yapr^bilen toplam 20 hasta alindi. Hastalann tumiinde erMRG gah§masi sonrasinda medikal tedavi baslandi, cevap alinmayan hastalarda kullanilan alfa adrenerjik blokor icin onerilen maksimum doza kadar gikildi. Medikal tedaviye cevap ayhk uroflovmetri, i§eme sonrasi reziduel idrar miktari tayini ve semptom skorlamasi ile degerlendirildi. Bulgular: Cahsmaya alman 20 hastadan 12'si medikal tedaviye yeterli yanit verdi, 8 hastada ise tedaviye yeterli yanit alinamadigi igin cerrahi girisim gerekti. Tedaviye yanit veren ve vermeyen hastalar arasinda turn prostat, fibromuskuler zon ve tranzisyonel zon hacimleri ile bunlarm birbirlerine oranlan arasinda anlamli ilinti saptanmadi. Bunun yaninda, turn prostat hacmi ile medikal tedaviye cevap arasinda orta derecede iliski (r= 0.45, Pearson testi), tranzisyonel zon hacmi ile tedaviye cevap arasinda iyi derecede bir iliski (r= 0.68) bulundu. Sonug: Benign prostatik obstrOksiyonda alfa adrenerjik blokor tedavisine cevabin onceden kestirilmesi erMRG incelemesi ile mumkun olmamistir.

Keywords: İlaç tedavisi,Adrenerjik alfa-antagonistleri,Tedavi sonucu,Manyetik rezonans görüntüleme,Prostat,Prostat hastalıkları,Prostat hiperplazisi