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Liu Z, Li YW, Wu WR, Lu Q. Long-term Clinical Efficacy and Safety Profile of Transurethral Resection of Prostate Versus Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia. Urology 2017; 103:198-203. [PMID: 28188760 DOI: 10.1016/j.urology.2017.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 01/20/2017] [Accepted: 02/01/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the differences on clinical efficacy, complications, and safety profile between transurethral resection of the prostate (TURP) and bipolar plasmakinetic resection of the prostate (PKRP) for benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Six hundred ninety patients of BPH were recruited from May 2008 to May 2011 and divided into TURP group and PKRP group. The International Prostate Symptom Score (IPSS), quality of life score (QoL), postvoid residual urine (PVR), maximum flow rate (Qmax), complications, International Index of Erectile Function-5 (IIEF-5) questionnaire, and retrograde ejaculation were used for evaluation of clinical efficacy and safety and sexual function between the 2 groups. RESULTS The intraoperative irrigation volume, postoperative irrigation volume, postoperative irrigation time, decrease in sodium, intraoperative blood loss, and duration of catheterization of the PKRP group were significantly lower than those of the TURP group (P <.05). For comparison of complications, the incidence rates of massive hemorrhage, blood transfusion, capsular perforation, prolonged hematuria, micturition frequency, micturition urgency, and micturition pain of the PKRP group were significantly less than those of the TURP group (P <.05). During the 5-year follow-up, the PKRP group showed better effect on IPSS, QoL, PVR, and Qmax compared with the TURP group (P <.05), but there were no significant differences on IIEF-5 and retrograde ejaculation (P > .05). CONCLUSION PKRP is just as efficacious as TURP and is associated with a lower rate of certain morbidities. Its lower complications and better safety profile make PKRP an attractive alternative for treatment of BPH.
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Affiliation(s)
- Zhe Liu
- Department of Urology, Hunan Provincial People's Hospital, Changsha, Hunan Province, China.
| | - Yuan Wei Li
- Department of Urology, Hunan Provincial People's Hospital, Changsha, Hunan Province, China
| | - Wan Rui Wu
- Department of Urology, Hunan Provincial People's Hospital, Changsha, Hunan Province, China
| | - Qiang Lu
- Department of Urology, Hunan Provincial People's Hospital, Changsha, Hunan Province, China
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152
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Dixon CM, Cedano ER, Pacik D, Vit V, Varga G, Wagrell L, Larson TR, Mynderse LA. Two-year results after convective radiofrequency water vapor thermal therapy of symptomatic benign prostatic hyperplasia. Res Rep Urol 2016; 8:207-216. [PMID: 27921028 PMCID: PMC5123707 DOI: 10.2147/rru.s119596] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to assess the effectiveness and safety of convective radiofrequency (RF) water vapor thermal therapy in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH); a pilot study design with 2-year follow-up evaluations. Patients and methods Men aged ≥45 years with an International Prostate Symptom Score ≥13, a maximum urinary flow rate (Qmax) ≤15 mL/s, and prostate volume 20–120 cc were enrolled in a prospective, open-label pilot study using convective RF water vapor energy with the Rezūm System. Patients were followed up for 2 years after transurethral thermal treatment at 3 international centers in the Dominican Republic, Czech Republic, and Sweden. The transurethral thermal therapy utilizes radiofrequency to generate wet thermal energy in the form of water vapor injected through a rigid endoscope into the lateral lobes and median lobe as needed. Urinary symptom relief, urinary flow, quality of life (QOL) impact, sexual function, and adverse events (AEs) were assessed at 1 week, 1, 3, 6, 12, and 24 months. Results LUTS, flow rate, and QOL showed significant improvements from baseline; prostate volumes were appreciably reduced. Sexual function was maintained and no de novo erectile dysfunction occurred. The responses evident as early as 1 month after treatment remained consistent and durable over the 24 months of study. Early AEs were typically transient and mild to moderate; most were related to endoscopic instrumentation. No procedure related to late AEs were seen. Conclusion The Rezūm System convective RF thermal therapy is a minimally invasive treatment for BPH/LUTS which can be performed in the office or as an outpatient procedure with minimal associated perioperative AEs. It has no discernable effect on sexual function and provides significant improvement of LUTS that remain durable at 2 years.
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Affiliation(s)
- Christopher M Dixon
- Department of Urology, Phelps Memorial Hospital, Sleepy Hollow, New York, NY, USA
| | - Edwin Rijo Cedano
- Department of Urology, Clinical Canela, La Romana, Dominican Republic
| | - Dalibor Pacik
- Department of Urology, Brno University Hospital, Brno, Czech Republic
| | - Vítězslav Vit
- Department of Urology, Brno University Hospital, Brno, Czech Republic
| | - Gabriel Varga
- Department of Urology, Brno University Hospital, Brno, Czech Republic
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Rukstalis D, Rashid P, Bogache WK, Tutrone RF, Barkin J, Chin PT, Woo HH, Cantwell AL, Cowan BE, Bolton DM. 24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham. BJU Int 2016; 118 Suppl 3:14-22. [DOI: 10.1111/bju.13666] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Prem Rashid
- Urology Centre; Port Macquarie NSW Australia
| | | | | | - Jack Barkin
- Toronto Urology Clinical Study Group; Toronto ON Canada
| | | | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; Wahroonga NSW Australia
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154
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Ertel P, Adalig B, Demircan I, Lartey B, Manyak MJ. Understanding patient and physician perceptions of benign prostatic hyperplasia in Asia Pacific, Latin America and the Commonwealth of Independent States: the Prostate Research on Behaviour and Education (PROBE) II survey. Int J Clin Pract 2016; 70:870-880. [PMID: 27774780 PMCID: PMC5129547 DOI: 10.1111/ijcp.12879] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/22/2016] [Indexed: 11/26/2022] Open
Abstract
AIM To assess attitudes and beliefs towards benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) and its treatment among patients and physicians in Latin America, Asia Pacific and the Commonwealth of Independent States (CIS). METHODS Cross-sectional, quantitative study conducted between December 2014 and September 2015. Separate questionnaires were administered to BPH/LUTS patients receiving drug treatment for their condition and to practising physicians who treat patients with BPH/LUTS. RESULTS In total, 1094 patients and 202 physicians completed a questionnaire. Most patients (61%) felt very/fairly well informed about BPH/LUTS, and 60% of physicians perceived patients to be very/somewhat informed. Overall, 70% of physicians felt that it would be valuable to raise awareness of BPH/LUTS and encourage men to consult a physician. The first symptoms most commonly noticed by patients were need to urinate more frequently, slower/weaker stream and nocturia. At first consultation, 71% of patients recalled providing a urine sample, 57% having a blood test for prostate-specific antigen and 56% a digital rectal examination being performed. Over two thirds of patients (69%) were satisfied with their current medication; highest satisfaction rates (among both patients and physicians) were reported for alpha blockers and 5ARIs, either as monotherapies or used in combination. Patients were prepared to wait longer for symptom relief in order to have a reduced risk of surgery. Most physicians (90%) thought that at least some patients believe BPH/LUTS to be a progressive condition. Most physicians thought that patients were very/fairly concerned about BPH surgery (92%) and acute urinary retention (72%); 52% of physicians thought treatment adherence was "extremely" important. CONCLUSIONS This study provides valuable insights into the attitudes and beliefs of patients and physicians in Asia Pacific, Latin America and CIS about BPH/LUTS and its management. It also highlights areas of discordance between patient/physician perceptions and beliefs about BPH/LUTS, and potential areas of focus to improve the experience of affected patients.
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155
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Use of Structural Equation Modeling to Demonstrate the Differential Impact of Storage and Voiding Lower Urinary Tract Symptoms on Symptom Bother and Quality of Life during Treatment for Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia. J Urol 2016; 196:824-30. [DOI: 10.1016/j.juro.2016.04.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/14/2022]
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Minutoli L, Rinaldi M, Marini H, Irrera N, Crea G, Lorenzini C, Puzzolo D, Valenti A, Pisani A, Adamo EB, Altavilla D, Squadrito F, Micali A. Apoptotic Pathways Linked to Endocrine System as Potential Therapeutic Targets for Benign Prostatic Hyperplasia. Int J Mol Sci 2016; 17:ijms17081311. [PMID: 27529214 PMCID: PMC5000708 DOI: 10.3390/ijms17081311] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 01/16/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a chronic condition common in older men that can result in bothersome lower urinary tract symptoms. The molecular mechanisms and networks underlying the development and the progression of the disease are still far from being fully understood. BPH results from smooth muscle cell and epithelial cell proliferation, primarily within the transition zone of the prostate. Apoptosis and inflammation play important roles in the control of cell growth and in the maintenance of tissue homeostasis. Disturbances in molecular mechanisms of apoptosis machinery have been linked to BPH. Increased levels of the glycoprotein Dickkopf-related protein 3 in BPH cause an inhibition of the apoptosis machinery through a reduction in B cell lymphoma (Bcl)-2 associated X protein (Bax) expression. Inhibitors of apoptosis proteins influence cell death by direct inhibition of caspases and modulation of the transcription factor nuclear factor-κB. Current pharmacotherapy targets either the static component of BPH, including finasteride and dutasteride, or the dynamic component of BPH, including α-adrenoceptor antagonists such as tamsulosin and alfuzosin. Both these classes of drugs significantly interfere with the apoptosis machinery. Furthermore, phytotherapic supplements and new drugs may also modulate several molecular steps of apoptosis.
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Affiliation(s)
- Letteria Minutoli
- Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Mariagrazia Rinaldi
- Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Herbert Marini
- Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Giovanni Crea
- Department of Human Pathology, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Cesare Lorenzini
- Department of Human Pathology, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Domenico Puzzolo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
| | - Andrea Valenti
- Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Antonina Pisani
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
| | - Elena B Adamo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
| | - Domenica Altavilla
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", 98125 Messina, Italy.
| | - Antonio Micali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
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157
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Wang XH, Wang X, Shi MJ, Li S, Liu T, Zhang XH. Systematic review and meta-analysis on phosphodiesterase 5 inhibitors and α-adrenoceptor antagonists used alone or combined for treatment of LUTS due to BPH. Asian J Androl 2016; 17:1022-32. [PMID: 25994648 PMCID: PMC4814957 DOI: 10.4103/1008-682x.154990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim of this systematic review is to determine the comparative effectiveness and safety of phosphodiesterase 5 inhibitors (PDE5-Is) and α-blockers used alone or combined for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). An electronic search of PubMed, Cochrane Library and Embase up to January 2014 was performed to identify randomized controlled trials comparing the efficacy and safety of PDE5-Is and α-blockers for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia, which assessed IPSS score, maximum flow rate, postvoided residual urine, quality of life and Erectile Function (IIEF) score as outcomes. Data were analyzed by fixed or random effect models using Cochrane Collaboration review manager software. A total of 12 studies were included. Our novel data demonstrated that there was a trend that α-blockers were more efficacious than PDE5-Is on decreasing IPSS score and increasing maximum flow rate. α-blockers were significantly more effective than PDE5-Is on reduction of postvoided residual urine with a mean difference of 3.67 (95% CI 1.56 to 5.77, P = 0.0006) and PDE5-Is showed greater effect than α-blockers on increasing IIEF score with a mean difference of 9.82 (95% CI 3.80 to 15.85, P = 0.001). In conclusion, our novel data demonstrated that PDE5-Is plus ABs ranked the highest on the improvement of LUTS/BPH. PDE5-Is monotherapy was also effective in this kind of disorder except less reduction of PVR than ABs. In addition, both combined- or mono-therapy were safe.
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Affiliation(s)
- Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | | | | | | | | | - Xin-Hua Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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158
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Roehrborn CG, Oyarzabal Perez I, Roos EPM, Calomfirescu N, Brotherton B, Palacios JM, Vasylyev A, Manyak MJ. Can we use baseline characteristics to assess which men with moderately symptomatic benign prostatic hyperplasia at risk of progression will benefit from treatment? A post hoc analysis of data from the 2-year CONDUCT study. World J Urol 2016; 35:421-427. [PMID: 27334136 PMCID: PMC5332489 DOI: 10.1007/s00345-016-1884-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/15/2016] [Indexed: 01/20/2023] Open
Abstract
Purpose To investigate (in a post hoc analysis of the 2-year CONDUCT study) the characteristics and clinical outcomes of men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression who benefitted from lifestyle changes alone. Methods Patients were given lifestyle advice and randomized to a fixed-dose combination (FDC) of dutasteride and tamsulosin or watchful waiting (WW) and followed for 24 months. Patients in the WW group were escalated to tamsulosin if any follow-up International Prostate Symptom Score (IPSS) was equal or greater than the baseline value. Improvements in symptoms (change in IPSS) and quality of life [measured by BPH Impact Index (BII) and question 8 of the IPSS (IPSS-Q8)] were analysed in the FDC group, men who initiated tamsulosin (WW-TAM) and men who received no medical intervention (WW-no treatment) and the impact of baseline variables on IPSS determined. Results The adjusted mean decrease in IPSS, BII and IPSS-Q8 at each post-baseline visit over 24 months appeared greater in the FDC (n = 369) and WW-no treatment groups (n = 144) than in the WW-TAM group (n = 229). IPSS improvements appeared similar in the FDC group and WW-no treatment subgroup, except in patients with the greatest degree of bother at baseline (BII 7–13). Conclusion BII at baseline may be a more relevant indicator than symptom severity as to whether a patient with moderate symptoms should receive medical therapy or not.
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Affiliation(s)
- Claus G Roehrborn
- Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, J8 142, Dallas, TX, 75390-9110, USA.
| | | | - Erik P M Roos
- Department of Urology, Antonius Hospital Sneek, Sneek, The Netherlands
| | | | - Betsy Brotherton
- GlaxoSmithKline, Research Triangle Park, NC, USA.,PAREXEL International, Durham, NC, USA
| | - Juan Manuel Palacios
- GlaxoSmithKline, Urology, Classic and Established Products, GlaxoSmithKline, Madrid, Spain
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159
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Shore ND. An Outcomes Review of Minimally Invasive Transurethral Convective Water Vapor Energy (WAVE) Therapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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160
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Positive Response to Thermobalancing Therapy Enabled by Therapeutic Device in Men with Non-Malignant Prostate Diseases: BPH and Chronic Prostatitis. Diseases 2016; 4:diseases4020018. [PMID: 28933398 PMCID: PMC5456275 DOI: 10.3390/diseases4020018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 12/18/2022] Open
Abstract
Background: The most common types of non-malignant prostate diseases are benign prostatic hyperplasia (BPH) and chronic prostatitis (CP). The aim of this study was to find out whether thermobalancing therapy with a physiotherapeutic device is effective for BPH and CP. Methods: During a 2.5-year period, 124 men with BPH over the age of 55 were investigated. Clinical parameters were tested twice: via the International Prostate Symptom Score (IPSS) and via ultrasound measurement of prostate volume (PV) and uroflowmetry maximum flow rate (Qmax), before and after six months of therapy. In 45 men with CP under the age of 55, the dynamics of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) were studied. Results: The results of the investigated index tests in men with BPH confirmed a decrease in IPSS (p < 0.001), a reduction in PV (p < 0.001), an increase in Qmax (p < 0.001), and an improvement of quality of life (QoL) (p < 0.001). NIH-CPSI scores in men with CP indicated positive dynamics. Conclusions: The observed positive changes in IPSS, PV, and Qmax in men with BPH and the improvement in NIH-CPSI-QoL in patients with CP after using a physiotherapeutic device for six months as mono-therapy, support the view that thermobalancing therapy with the device can be recommended for these patients. Furthermore, the therapeutic device is free of side effects.
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161
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Silva V, Grande AJ, Stanton KR, Peccin MS. Physical activity for lower urinary tract symptoms secondary to benign prostatic obstruction. Hippokratia 2016. [DOI: 10.1002/14651858.cd012044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Valter Silva
- Universidade Federal de São Paulo; Department of Human Movement Sciences; Santos Brazil
| | - Antonio Jose Grande
- Universidade do Extremo Sul Catarinense; Laboratory of Evidence-Based Practice; Av. Universitária, 1105 Predio S, LABEPI Criciuma Santa Catarina Brazil 88806-000
| | | | - Maria S Peccin
- Universidade Federal de São Paulo; Department of Human Movement Sciences; Santos Brazil
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162
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Mankowski C, Ikenwilo D, Heidenreich S, Ryan M, Nazir J, Newman C, Watson V. Men's preferences for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia: a discrete choice experiment. Patient Prefer Adherence 2016; 10:2407-2417. [PMID: 27920507 PMCID: PMC5125770 DOI: 10.2147/ppa.s112161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To explore and quantify men's preferences and willingness to pay (WTP) for attributes of medications for lower urinary tract symptoms associated with benign prostatic hyperplasia using a discrete choice experiment. SUBJECTS AND METHODS Men in the UK aged ≥45 years with moderate-to-severe lower urinary tract symptoms/benign prostatic hyperplasia (based on self-reported International Prostate Symptom Score ≥8) were recruited. An online discrete choice experiment survey was administered. Eligible men were asked to consider different medication scenarios and select their preferred medication according to seven attributes: daytime and nighttime (nocturia) urinary frequency, urinary urgency, sexual and nonsexual side effects, number of tablets/day, and cost/month. A mixed-logit model was used to estimate preferences and WTP for medication attributes. RESULTS In all, 247 men completed the survey. Men were willing to trade-off symptom improvements and treatment side effects. Men preferred medications that reduced urinary urgency and reduced day- and nighttime urinary frequency. Men preferred medications without side effects (base-case level), but did not care about the number of tablets per day. WTP for symptomatic improvement was £25.33/month for reduced urgency (urge incontinence to mild urgency), and £6.65/month and £1.39/month for each unit reduction in night- and daytime urination frequency, respectively. The sexual and nonsexual side effects reduced WTP by up to £30.07/month. There was significant heterogeneity in preferences for most attributes, except for reduced urinary urgency from urge incontinence to mild urgency and no fluid during ejaculation (dry orgasm). CONCLUSION To compensate for side effects, a medicine for lower urinary tract symptoms/benign prostatic hyperplasia must provide a combination of benefits, such as reduced urgency of urination plus reduced nighttime and/or reduced daytime urination.
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Affiliation(s)
- Colette Mankowski
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
- Correspondence: Colette Mankowski, Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, 2000 Hillswood Drive, Chertsey, Surrey KT16 0PS, UK, Tel +44 78 8194 0638, Email
| | - Divine Ikenwilo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jameel Nazir
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
| | - Cathy Newman
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Abstract
The use of testosterone to treat the symptoms of late-onset hypogonadal men has increased recently due to patient and physician awareness. However, concerns regarding the effect of testosterone on the prostate, in particular any possible effect on the risk of prostate cancer have prompted further research in this regard. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. The exact mechanism of this improvement is still debated but may have a close relationship to metabolic syndrome. For the clinician, the results of these studies are promising but do not constitute high levels of evidence. A thorough clinical examination (including history, examination and laboratory testing of testosterone) should be undertaken before considering the diagnosis of late-onset hypogonadism or instigating treatment for it. Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients.
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Affiliation(s)
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, USA
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164
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Jeong SM, Suh B, Jang SH, Jin HS, Kim N, Kwon H, Cho B, Park JH. Depression and Its Severity Are Strongly Associated with Both Storage and Voiding Lower Urinary Tract Symptoms Independently of Prostate Volume. J Korean Med Sci 2015; 30:1646-51. [PMID: 26539010 PMCID: PMC4630482 DOI: 10.3346/jkms.2015.30.11.1646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/04/2015] [Indexed: 11/20/2022] Open
Abstract
Depression is related to various functional medical conditions. Its association with lower urinary tract symptoms (LUTS) is also expected. We evaluated whether depression and its severity are associated with LUTS when LUTS risk factors including prostate volume (PV) are taken into account in a large population of Korean men. Study subjects included 10,275 men who underwent routine health check-ups at the Healthcare System Gangnam Center of Seoul National University Hospital. Depression was assessed using Beck Depression Inventory-II and LUTS using international prostate symptom score. PV was measured using transrectal ultrasonography by a radiologist. Effect sizes of depression severity on total, storage, and voiding symptoms were assessed. In multivariate logistic regression analysis, mild, moderate and severe depression were associated with total (adjusted odds ratio: aOR = 2.99, 3.86 and 8.99; all P < 0.001), voiding (aOR = 3.04, 3.28 and 5.58; all P < 0.001) and storage symptoms (aOR = 2.43, 3.43 and 2.89; all P < 0.05) showing dose response relationships (all P trend < 0.001). In a subgroup analysis for participants with PV data (n = 1,925), mild and moderate-severe depression were also associated with LUTS (aOR = 3.29, 2.84; P < 0.001 and 0.018, respectively). In conclusion, depression and its severity are strongly associated with total, voiding, and storage symptoms independently of PV state.
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Affiliation(s)
- Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Beomseok Suh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Hyun Jang
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho Seong Jin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nakhyun Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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165
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The prevalence of benign prostatic hyperplasia in mainland China: evidence from epidemiological surveys. Sci Rep 2015; 5:13546. [PMID: 26306721 PMCID: PMC4549711 DOI: 10.1038/srep13546] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/30/2015] [Indexed: 02/06/2023] Open
Abstract
The epidemiological characteristics of benign prostate hyperplasia (BPH) in mainland China are not completely understood. We performed this meta-analysis to assess the prevalence of BPH from 1989 through 2014. A total of 14 articles and 19 datasets were included. The pooled overall prevalence of BPH among men aged 40 years and older was 36.6% [95% CI, 32.3–44.8]. The occurrence rate of BPH in the age groups 40–49 years, 50–59 years, 60–69 years, 70–79 years and 80 years and older was 2.9%, 29.0%, 44.7%, 58.1% and 69.2%, respectively. The pooled occurrence rate of BPH was 41.5% [95% CI, 34.5–48.4] in urban areas and 38.6% [95% CI, 22.7–54.6] in rural areas; this difference in prevalence was not statistically significant [OR, 1.51; 95% CI, 0.97–2.36]. BPH is highly prevalent in mainland China, and its prevalence increased with age. The trend in the prevalence of BPH in mainland China was not steady; the prevalence map based on a geographic information system (GIS) showed an unequal geographic distribution. High-quality surveys on BPH with a larger sample size are needed throughout mainland China to confirm these findings.
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166
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Cost of illness of medically treated benign prostatic hyperplasia in Hungary. Int Urol Nephrol 2015; 47:1241-9. [PMID: 26093585 DOI: 10.1007/s11255-015-1028-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To perform a cost of illness study in lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH) in Hungary. METHODS A multicentre, cross-sectional survey was carried out in 2014. BPH patients who had never undergone prostate surgery were recruited to the study. EQ-5D and the International Prostate Symptom Score (IPSS) were used to evaluate health status and disease severity. All resource utilisations related to BPH in the past 12 months were recorded. Cost analysis was performed from societal perspective. RESULTS Overall, 246 patients were included with mean age of 70.6 (SD 8.1) years. Mean EQ-5D and IPSS were 0.85 (SD 0.19) and 12.8 (SD 6.3). Total annual per patient cost of BPH amounted to <euro>876 (SD <euro>1829). Distribution of the costs between direct medical, direct non-medical and indirect cost was 46, 31 and 23 %. High costs were related to informal care (<euro>243), medications (<euro>178) and private physician visits (<euro>132). Patients missed from work on average 14 h/year and 20 h/year due to absenteeism and presenteeism. Clinical severity expressed in IPSS score was found the strongest predictor of higher total costs (r = 0.429, p < 0.001). Mean costs of mild, moderate and severe patients were <euro>203, <euro>754 and <euro>2168, respectively. CONCLUSIONS To our knowledge, this is the first study in the literature that assessed indirect costs related to presenteeism in BPH. We found that costs of reduced productivity while working exceed costs of absence from work. As the retirement age is gradually increasing, the importance of presenteeism is getting more significant, especially in pursuit of sustainable employment.
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Gokkaya CS, Aktas BK, Ozden C, Bulut S, Karabakan M, Erkmen AE, Memis A. Flurbiprofen alone and in combination with alfuzosin for the management of lower urinary tract symptoms. Cent European J Urol 2015; 68:51-6. [PMID: 25918641 PMCID: PMC4408396 DOI: 10.5173/ceju.2015.01.500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/02/2015] [Accepted: 01/04/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We aimed to investigate the effectiveness and safety of flurbiprofen, a non-steroidal anti-inflammatory drug with dual cyclooxygenase inhibition, and α-blocker alfuzosin, both alone and in combination with each other for lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO). MATERIAL AND METHODS Ninety patients complaining of moderate-to-severe LUTS/BPO were randomly assigned into 3 groups (30 patients each) to receive alfuzosin XL 10 mg, or flurbiprofen SR 200 mg, or combination of alfuzosin XL 10 mg and flurbiprofen SR 200 mg, once daily for 4 weeks. Patients were evaluated using the international prostate symptom score (IPSS) (total and IPSSstorage, IPSSempty subscores), uroflow-metry (maximum (Qmax) and average (Qave) flow rates) and postvoid residual urine (PVR) both at baseline and following the drug therapy course. RESULTS There was no difference among the 3 groups regarding age and baseline values of prostate volume, IPSS, IPSSstorage, IPSSempty, Qmax, Qave and PVR (P >0.05). IPSS, IPSSstorage, IPSSempty, and PVR decreased significantly in all the 3 groups after drug therapies (P <0.01). However, Qmax and Qave significantly improved only in the combination group (P <0.01). CONCLUSIONS Addition of flurbiprofen increased the therapeutic effectiveness of alfuzosin by further improving symptoms in patients with LUTS/BPO. Combination therapy also improved urine flow compared to baseline. Monotherapy with flurbiprofen was not superior to alfuzosin.
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Affiliation(s)
- Cevdet Serkan Gokkaya
- Ankara Numune Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Binhan Kagan Aktas
- Ankara Numune Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Cuneyt Ozden
- Ankara Numune Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Suleyman Bulut
- Ankara Numune Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Mehmet Karabakan
- Ankara Numune Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Akif Ersoy Erkmen
- Ankara Numune Education and Research Hospital, Department of Urology, Ankara, Turkey
| | - Ali Memis
- Ankara Numune Education and Research Hospital, Department of Urology, Ankara, Turkey
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168
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Choi EPH, Chin WY, Lam CLK, Wan EYF. The responsiveness of the International Prostate Symptom Score, Incontinence Impact Questionnaire-7 and Depression, Anxiety and Stress Scale-21 in patients with lower urinary tract symptoms. J Adv Nurs 2015; 71:1857-70. [PMID: 25871549 DOI: 10.1111/jan.12662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 02/03/2023]
Abstract
AIMS To examine the responsiveness of a combined symptom severity and health-related quality of life measure, condition-specific health-related quality of life measure and mental health measure in patients with lower urinary tract symptoms. BACKGROUND To establish the responsiveness of measures that accurately capture the change in health status of patients is crucial before any longitudinal studies can be appropriately planned and evaluated. DESIGN Prospective longitudinal observational study. METHODS 402 patients were surveyed at baseline and 1-year using the International Prostate Symptom Score, the Incontinence Impact Questionnaire-7 and Depression, Anxiety and Stress Scales-21. The internal and external responsiveness were assessed. Surveys were conducted from March 2013-July 2014. RESULTS In participants with improvements, the internal responsiveness for detecting positive changes was satisfactory in males and females for all scales, expect for the Depression subscale. The health-related quality of life question of the International Prostate Symptom Score was more externally responsive than the Incontinence Impact Questionnaire-7. CONCLUSIONS The International Prostate Symptom Score and Anxiety and Stress subscales were more responsive in males than in females. The symptom questions of the International Prostate Symptom Score and Anxiety and Stress subscales were not externally responsive in females. The health-related quality of life question of the International Prostate Symptom Score outperformed the Incontinence Impact Questionnaire-7 in both males and females, in terms of external responsiveness.
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Affiliation(s)
- Edmond P H Choi
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Perera M, Roberts MJ, Doi SAR, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol 2014; 67:704-13. [PMID: 25466940 DOI: 10.1016/j.eururo.2014.10.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/21/2014] [Indexed: 01/30/2023]
Abstract
CONTEXT Treatment for lower urinary tract symptoms resulting from benign prostatic hyperplasia (BPH) is varied, and significant side effects, particularly concerning sexual function, affect uptake. The prostatic urethral lift (PUL) procedure is a recent addition to the armamentarium for BPH treatment, with independent reports suggesting improvement of symptoms, sexual function, and urinary flow. OBJECTIVE We undertook a systematic review and meta-analysis of reported symptomatic, functional, and sexual outcomes following the PUL procedure. EVIDENCE ACQUISITION We performed a critical review of Medline, Embase, ScienceDirect, Cochrane Library, and Web of Science databases in May 2014 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Quality assessment was performed using a modification of the Methodological Index for Non-Randomized Studies tool. All retrospective, prospective, and controlled trials were included for analysis. Symptom scores, sexual health scores, and functional outcomes were pooled and meta-analysed using quality and random-effects models. EVIDENCE SYNTHESIS Ten articles comprising six independent patient cohorts were included for analysis. Pooled estimates from between 452 and 680 patients suggested overall improvement following PUL, including symptoms (large gain; standardised mean gain range of 1.3-1.6, International Prostate Symptom Score difference of -7.2 to -8.7 points), maximum flow rate (3.8-4.0 ml/s), and quality of life (2.2-2.4 points). Sexual function was preserved with a small improvement estimated at 12 mo (standardised mean gain range of 0.3-0.4). Pooled estimates were mostly heterogeneous across study groups. CONCLUSIONS PUL is a well-tolerated, minimally invasive therapy for BPH that provides favourable symptom, sexual health, and functional outcomes during follow-up to 12 mo. Longer follow-up and larger randomised studies are required to further confirm these preliminary results. PATIENT SUMMARY We reviewed the early results of an innovative procedure directed towards the management of prostate enlargement. The results revealed a well-tolerated procedure that produces improvement in urinary symptoms and function while preserving sexual function.
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Affiliation(s)
- Marlon Perera
- Mackay Base Hospital, Mackay, Queensland, Australia; Urological Society of Australia and New Zealand, Edgecliff, New South Wales, Australia
| | - Matthew J Roberts
- Mackay Base Hospital, Mackay, Queensland, Australia; Urological Society of Australia and New Zealand, Edgecliff, New South Wales, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Suhail A R Doi
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia; Department of Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Damien Bolton
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Ludwig Institute for Cancer Research, Austin Hospital, Studley Road, Heidelberg, Victoria, Australia.
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The study about physical activity for subjects with prevention of benign prostate hyperplasia. Int Neurourol J 2014; 18:155-62. [PMID: 25279244 PMCID: PMC4180167 DOI: 10.5213/inj.2014.18.3.155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/31/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose The number of benign prostatic hyperplasia (BPH) subjects has been increasing worldwide, and many studies have been conducted to determine the treatment that can delay drug therapy or surgery. Subsequently, most of these studies involved physical activity (PA) and associated factors. Therefore, we aimed to determine factors associated with BPH prevalence based on a review of past and present studies and to investigate the effect of a healthy lifestyle as a protective factor of BPH occurrence. Methods We selected 582 subjects aged ≥40 years from an initial 779 subjects recruited from Gyeonggi, Yangpyeong, South Korea, during August 2009 to August 2011. Trained investigators surveyed International Prostate Symptom Score and demographic information, including PA and lifestyle questionnaire during face-to-face interviews; further, they performed digital rectal examination, rectal ultrasonography, and measured prostate-specific antigen levels. The statistical association between PA and BPH was analyzed by logistic regression analysis using multivariable regression models which use categorical variables by the Cochran-Mantel-Haenszel test and continuous variables by the general linear model. Results Seven statistically significant variables for PA were selected. Regular exercise, frequency of exercise, sedentary time, nonsedentary time, leisure time PA (metabolic equivalent, hr/wk) were not statistically associated with prostate volume but sedentary time (hr/day) was the only factor that showed a significant association in the multivariable model, including a linear effect relationship. Subjects with lower levels of sedentary time (4.5-7.0 hr/day) had a significantly lower risk of BPH (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.52-1.67) than those with a higher sedentary time (>7 hr/day) (OR, 1.72; 95% CI, 0.96-3.09) (P for trend=0.05). Conclusions Our study showed that reducing sedentary time could have a protective effect and reduce the prevalence of BPH. Further prospective studies with a larger sample size are needed to assess the impact of reducing sedentary time on BPH risk.
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