Introduction: There is a debate that the volume and morphology of the prostate do not completely correlate with the micturition status. That is, Schafer nomogram, asessing lower urinary tract obstruction and the severity, may not be directly lead to good outcome of urination status after Holmium-Laser Enucleation of the Prostate (HoLEP). So, we re-assessed Schafer nomogram in HoLEP. And we created a benign prostatic hyperplasia model mouse, and evaluated how the increase in prostate volume affects inflammtion and function in prostate and bladder, and searched for new marker to evaluate bladder function.
Methods: We collected 320 patients who underwent HoLEP from April 2005 to March 2021 in Kobe university hospital. We retrospectively assess the relationship between Schafer nomogram and surgical outcome such as change of maximum flow rate (MFR, ml/s), average flow rate (AFR, ml/s) and residual urine volume (RUV, ml) from pre- to post-operation, and prostate volume (ml) and resected prostate weight (g). Next, we made a mouse prostatic hyperplasia model by testosterone propionate after castration, we evaluated to correlation between prostate volume, and the expressions of a1 -adrenoreceptor and TGF-ß in prostate glands and those of ß-3 receptor and Rho in bladder membrane.
Results: As to the HoLEP data, there was no significant difference of change of MFR (p=0.1044), AFR (p=0.2186) and RUV (p=0.5978) from pre- to post-HoLEP. However, there was significant difference of prostate volume and resected prostate weight among Schafer nomogram: prostate volume (p=0.009) and resected prostate weight (p=0.0007). In animal study, there was no difference in body weight among the individuals. The mean prostate weight was 75 ± 27 mg in the control group, 101.9 ± 1.7 mg in the castration group, and 130 ± 19 mg in the testosterone propionate group. There was no significant prostate volume difference between the castration group and the control group (p = 0.5) but was between the testosterone propionate group and the control group (p < 0.05). Immunostaining showed a significant correlation between prostate volumes, and a1-adrenoreceptor expression in prostate gland, and expressions of ß3 receptor and Rho in bladder
Conclusions: Our study demonstarted that he Schafer classification has not completely evaluated the degree of obstruction, so a new index for evaluating the degree of obstruction is required. And animal study showed that Rho expression in baldder membrane may reflects the degree of obstruction. Further evaluation needs to be performed for a definitive conclusion.
.jpg)
.jpg)