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Azhar RA, Elkoushy M, Subahi M, Faisal M, Bakhsh A, Sejiny M, Bagasi S, Tayeb W. Awareness and compliance of urologists in the Middle East with minimally invasive surgical devices for the management of benign prostate hyperplasia. Urol Ann 2024; 16:175-183. [PMID: 38818433 PMCID: PMC11135354 DOI: 10.4103/ua.ua_106_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/19/2024] [Indexed: 06/01/2024] Open
Abstract
Objectives The objective is to assess urologists' awareness of and compliance with available minimally invasive devices (MIDs) for the management of benign prostate hyperplasia (BPH). Methods An online Internet-based survey was sent to urologists through E-mail. Baseline characteristics included age, location and duration of practice, and number of prostatectomies performed in the previous 12 months. Awareness is based on the surgeons' opinions about their advantages and drawbacks. Results A total of 308 participants responded to the survey; 87.0% were most aware of Rezūm, followed by Urolift (59.1%), Aquablation (33.1%), and combined temporary implantable nitinol device (iTIND), and Zenflow (17%). In the past 12 months, 84.1% used MIDs in their practice. A total of 47.1% of respondents believe that these devices have comparable outcomes with the traditional interventions, 52.9% are unsure of their long-term benefits, and 71% feel that it is too early to judge. Forty-three percent believe that these devices are reserved only for high-risk patients, and 52% recommend that they should be available in their centers. Most respondents (90.9%) prefer Rezūm, Urolift (28.2%), and Aquablation (12.6%) because they are less invasive, less time-consuming, and have few complications. Interestingly, 59% recommend MIDs to their family members. Conclusions Most respondents are more aware of Rezūm, Urolift, and Aquablation than iTIND and Zenflow. In addition, most respondents agree that these MIDs and traditional prostate interventions have comparable outcomes despite the former lacking long-term outcome assessment. High cost and no long-term data may influence the widespread acceptance of these MIDs.
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Affiliation(s)
- Raed A. Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Elkoushy
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohnna Subahi
- Department of Urology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Mahmoud Faisal
- Department of Urology, King Abdullah Medical City, Makkah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Abdulaziz Bakhsh
- Department of Urology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Majed Sejiny
- Department of Urology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Salim Bagasi
- Department of Urology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Waseem Tayeb
- Department of Urology, King Abdullah Medical City, Makkah, Saudi Arabia
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Anezaki H, Endo F, Swan G, Takashima K, Rojanasarot S. Cost-effectiveness analysis of minimally invasive surgical treatments for benign prostatic hyperplasia: implications for Japan's public healthcare system. J Med Econ 2024; 27:554-565. [PMID: 38466193 DOI: 10.1080/13696998.2024.2327920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
AIMS Benign prostatic hyperplasia (BPH) represents a significant public health issue in Japan. This study evaluated the lifetime cost-effectiveness of water vapor energy therapy (WAVE) versus prostatic urethral lift (PUL) for men with moderate-to-severe BPH from a public healthcare payer's perspective in Japan. MATERIALS AND METHODS A decision analytic model compared WAVE to PUL among males in Japan. Clinical effectiveness and adverse event (AE) inputs were obtained from a systematic literature review. Resource utilization and cost inputs were derived from the Medical Data Vision database and medical service fee national data in Japan. Experts reviewed and validated model input parameters. One-way and probabilistic sensitivity analyses were conducted to determine how changes in the values of uncertain parameters affect the model results. RESULTS Throughout patients' lifetimes, WAVE was associated with higher quality-adjusted life years (0.920 vs. 0.911 year 1; 15.564 vs. 15.388 lifetime) and lower total costs (¥734,134 vs. ¥888,110 year 1; ¥961,595 vs. ¥1,429,458 lifetime) compared to PUL, indicating that WAVE is a more effective and less costly (i.e. dominant) treatment strategy across all time horizons. Lifetime cost-savings for the Japanese healthcare system per patient treated with WAVE instead of PUL were ¥467,863. The 32.7% cost difference between WAVE and PUL was predominantly driven by lower WAVE surgical retreatment rates (4.9% vs. 19.2% for WAVE vs PUL, respectively, at 5 years) and AE rates (hematuria 11.8% vs. 25.7%, dysuria 16.9% vs. 34.3%, pelvic pain 2.9% vs. 17.9%, and urinary incontinence 0.4% vs. 1.3% for WAVE vs PUL, respectively, at 3 months). Model findings were robust to changes in parameter input values. LIMITATIONS The model represents a simplification of complex factors involved in resource allocation decision-making. CONCLUSIONS Driven by lower retreatment and AE rates, WAVE was a cost-effective and cost-saving treatment for moderate-to-severe BPH in Japan compared to PUL, providing better outcomes at lower costs to the healthcare system.
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Affiliation(s)
- Hisataka Anezaki
- Field of Artificial Intelligence and Digital Health Science, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Georgia Swan
- Boston Scientific, Asia Pacific, Singapore, Singapore
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Leonardi R, Ambrosini F, Malinaric R, Cafarelli A, Calarco A, Colombo R, De Cobelli O, De Marco F, Ferrari G, Ludovico G, Pecoraro S, Tuzzolo D, Terrone C, Mantica G. New minimally invasive solutions for Benign Prostatic Obstruction (BPO) management: A position paper from the UrOP (Urologi Ospedalità Gestione Privata). Arch Ital Urol Androl 2023; 95:12003. [PMID: 38117214 DOI: 10.4081/aiua.2023.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. [...].
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Affiliation(s)
- Rosario Leonardi
- Urologi Ospedalità Gestione Privata (UrOP); Casa di Cura Musumeci GECAS, Gravina di Catania.
| | | | | | - Angelo Cafarelli
- Urologi Ospedalità Gestione Privata (UrOP); Urology Unit, Villa Igea, Ancona.
| | - Alessandro Calarco
- Urologi Ospedalità Gestione Privata (UrOP); Villa Pia Hospital, Via Folco Portinari 5, Rome.
| | - Renzo Colombo
- Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, Vita e Salute San Raffaele University, Milan.
| | - Ottavio De Cobelli
- Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, IEO European Institute of Oncology, IRCCS, Milan.
| | | | - Giovanni Ferrari
- Urologi Ospedalità Gestione Privata (UrOP); Hesperia Hospital, Modena.
| | - Giuseppe Ludovico
- Urologi Ospedalità Gestione Privata (UrOP); Ospedale Miulli, Acquaviva delle Fonti, Bari.
| | | | | | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
| | - Guglielmo Mantica
- Urologi Ospedalità Gestione Privata (UrOP); IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
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Khalil IA, Aldeeb M, Mohammed A, Awad K, Ibrahim T, Al-Zoubi RM, Aboumarzouk OM, Al-Rumaihi K. The role of Rezum in the management of refractory urinary retention due to benign prostate hyperplasia: A literature review. Arab J Urol 2023; 21:185-189. [PMID: 37521455 PMCID: PMC10373601 DOI: 10.1080/2090598x.2023.2178104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023] Open
Abstract
Background Benign prostatic hyperplasia is the most common cause of urinary retention in men (BPH). The gold standard surgical treatment is transurethral resection of the prostate (TURP). However, due to the morbidity and mortality associated with TURP, more minimally invasive treatments, such as vaporizing the prostate with the Rezum system, have been introduced. We investigated the efficacy of Rezum in the treatment of refractory urinary retention due to BPH in this review. Methodology and materials To conduct this review, the Cochrane methodology for systematic reviews was used. All studies that used Rezum to treat catheter-dependent patients with enlarged prostates were included. The literature search showed 111 studies, 84 of which were excluded due to non-relevance based on titles and 18 due to lack of relevance based on abstract review. Full manuscripts were reviewed in nine studies, three of which were excluded because they did not meet the inclusion criteria. Results This review included 301 patients in total. The rate of a successful trial of voiding post Rezum therapy was 85%. The complication rated between 3.8 and 4.3% all of which were mild and self-limited. As there was no major complication of Rezum (clavien dindo >2), the procedure-related morbidity is negligible. Conclusion In this review, Rezum was found to be an efficacious and safe alternative in the treatment of refractory retention with mild complications and minimal morbidity.
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Affiliation(s)
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mohammed
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Awad
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Tarek Ibrahim
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Veterinary and Life Science, The University of Medicine, University of Glasgow, Scotland, UK
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Zhang DP, Pan ZB, Zhang HT. Urinary and sexual function changes in benign prostatic hyperplasia patients before and after transurethral columnar balloon dilatation of the prostate. World J Clin Cases 2022; 10:6794-6802. [PMID: 36051138 PMCID: PMC9297432 DOI: 10.12998/wjcc.v10.i20.6794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/16/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transurethral columnar balloon dilatation of the prostate (TUCBDP) is a new surgical treatment, but its efficacy remains controversial because of limited clinical application.
AIM To investigate the clinical effect of TUCBDP for benign prostatic hyperplasia (BPH).
METHODS Overall, 140 patients with BPH who underwent surgical treatment were included in the study. A random number table was used to divide the participants into study and control groups (n = 70 per group). The study group underwent TUCBDP. The prostate resection surgical time, intraoperative blood loss, bladder irrigation time, catheter indwelling time, length of hospital stay, International Prostate Symptom Score (IPSS), maximum urine flow rate (Qmax), residual urine volume (RUV), changes in the International Erectile Function Score (IIEF-5) score, serum prostate-specific antigen (PSA), quality of life (QOL) score, and surgical complications were compared in both groups.
RESULTS The operation time, intraoperative blood loss volume, bladder flushing time, urinary catheter indwelling time, and length of hospital stay were significantly lower in the study group than in the control group (P < 0.05). There were no significant differences in the IPSS, Qmax, and RUV measurements between the study and control groups (P > 0.05). However, at 3 mo post-surgery, the IPSS and RUV measurements were both lower (P < 0.05) and Qmax values were higher (P < 0.05) compared to the pre-surgery results in both groups. The IIEF-5 scores before and 3 mo after surgery were not significantly different between the study and control groups (P > 0.05). At 1 mo after surgery, the IIEF-5 score was higher in the study group than in the control group (P < 0.05). The serum PSA levels and QOL scores before treatment and at 1 and 3 mo after treatment were not significantly different between the study and control groups (P > 0.05). However, lower serum PSA levels and QOL scores were observed after 1 and 3 mo of treatment compared to pre-treatment levels in the study group (P < 0.05). The surgical complication rate of the study group (4.29%) was lower than that of the control group (12.86%; P < 0.05).
CONCLUSION TUCBDP for BPH and transurethral resection of the prostate can achieve better results, but the former method is associated with less surgical trauma.
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Affiliation(s)
- Dong-Peng Zhang
- Department of Urology, Tianjin Hospital, Tianjin 300211, China
| | - Zheng-Bo Pan
- Department of Urology, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang Province, China
| | - Hai-Tao Zhang
- Department of Urology, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang Province, China
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The EXPANDER-1 trial: introduction of the novel Urocross™ Expander System for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Prostate Cancer Prostatic Dis 2022; 25:576-582. [PMID: 35641601 PMCID: PMC9385491 DOI: 10.1038/s41391-022-00548-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/22/2022] [Accepted: 04/13/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To demonstrate the safety and feasibility of the Urocross Expander System (formerly branded as XFLO Expander System), an implantable nitinol tissue expander to trea t patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Men of 50 years or older were eligible to participate in the international, prospective, three-arm, open-label EXPANDER-1 trial if they had a prostate volume between 30 and 80 cc, prostatic urethra length between 20 and 60/80 mm, international prostate symptom score (IPSS) > 13, peak urinary flow (Qmax) < 12 mL/s, post-void residual (PVR) urine volume < 250 mL and quality of life (QoL) score ≥ 3. Patients had pre-assigned implant indwell times (1, 6, and 12 months for Arm-1, Arm-2 and Arm-3 respectively) with follow-up through 6 months (Arm-1) and 3 years (Arm-2 and Arm-3) post-retrieval. RESULTS Outcome from treated subjects with their 6-month post-retrieval will be presented in this manuscript, as data collection from longer-term follow-up is ongoing. As of May 24, 2021, 39 and 22 men (mean age: 65), respectively, had implants successfully deployed and retrieved without any complications. No cases of implant encrustation were observed. Device- and procedure-related adverse events were predominantly mild to moderate in severity. Three SAEs were reported. Only one patient required catheterization post-implant for more than three days. Improvements in clinical parameters such as IPSS, QoL, PVR and Qmax as well as sexual function were observed. CONCLUSIONS Preliminary results demonstrate that the Urocross Expander System is a feasible and safe procedure for treating BPH/LUTS. A strong signal of efficacy justifies further evaluation of this PRostatic Urethral Expansion (PURE) procedure. Negative features of earlier generations of prostatic implants such as biocompatibility, migrations and encrustation have possibly been overcome.
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Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis. J Vasc Interv Radiol 2021; 33:359-367.e8. [PMID: 34968671 DOI: 10.1016/j.jvir.2021.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. RESULTS No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. CONCLUSION Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.
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Lucas MI, Diaz P, Escobedo FJ, Limbrick BJ, Scotland KB. Online engagement with surgical treatments for benign prostatic hyperplasia: Are Minimally Invasive Surgical Therapies outpacing the gold standard? J Endourol 2021; 36:554-561. [PMID: 34779667 DOI: 10.1089/end.2021.0741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients suffering from progressive symptoms of benign prostatic hyperplasia (BPH) increasingly turn to the internet for information on invasive and minimally invasive surgical therapies (MIST). This study aimed to identify online articles accessed by patients seeking guidance on said options and to evaluate the quality and readability of their content. METHODS Social media analytics tool Buzzumo was used to identify the most shared articles on Facebook, Twitter, Reddit, and Pinterest related to BPH surgical treatments from 2016 to 2021. The content quality was graded using the DISCERN tool; a questionnaire that assesses the quality of written information on treatment choices for a health problem. An online Automatic Readability Checker was used to evaluate the readability of the written transcripts. Google Trends data was used to evaluate search term popularity for BPH procedures from 2016 to 2021. Google trends data and DISCERN ratings were analyzed with ANOVA and paired t-test, respectively. RESULTS Thirty-nine percent of identified articles were rated as low quality, 39% as moderate quality, and 22% as high quality using the DISCERN tool, with no significant difference among reviewer ratings (p = 0.0561). The median reading level of all articles was 12th grade. Google Trends data illustrated a rising popularity of MIST such as Rezūm and Urolift, exceeding interest in more invasive procedures like Holmium laser enucleation of the prostate (HoLEP) and laser surgery. Transurethral resection of the prostate (TURP) remained popular with no significant difference between MIST and TURP on Google Trends (p = 3.46). CONCLUSIONS The most accessed articles on BPH treatments have important shortcomings including risks of treatment and other available options for treatment. Article transcripts exceed the reading level of the average adult patient. TURP has remained a popular procedure online, but there is a notable rising interest in MIST, especially Urolift.
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Affiliation(s)
- Mayra I Lucas
- University of California Los Angeles David Geffen School of Medicine, 12222, 10833 Le Conte Ave, Los Angeles, California, United States, 90095;
| | - Parris Diaz
- Charles Drew University of Medicine and Science, 5140, Los Angeles, California, United States;
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Miernik A, Fritzsche J, Libutzki B, Malka V, Kilemnik I, Mohebbi D, May M, Gratzke C, Suarez-Ibarrola R. Real-world data and treatment patterns of patients with lower urinary tract symptoms due to benign prostatic hyperplasia in Germany: an observational study using health insurance claims data. World J Urol 2021; 39:4381-4388. [PMID: 34292368 DOI: 10.1007/s00345-021-03787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Benign prostatic hyperplasia (BPH) is associated with lower urinary tract symptoms (LUTS), representing one of the most common urological conditions. However, insights into the actual healthcare of this patient cohort in Germany are scarce. We aimed to retrospectively analyse management patterns of patients with LUTS in Germany using health insurance claims databases. METHODS A retrospective, longitudinal cohort analysis was conducted obtaining claims data from the German InGef health insurance database containing approximately five million member-records from over 60 nationwide statutory health insurances. First, a cross-sectional prevalence analysis was performed on all individuals with a diagnosis on LUTS (ICD-10 GM N40) in 2018. Second, a longitudinal analysis of individuals with either a newly started BPH medication or initial BPH surgery who were indexed in 2014 and followed-up for 4 years. RESULTS In 2018, 132,386 (6.7%) prevalent BPH patients were identified from 1,979,916 continuously insured males. A potential overcoding bias could not be assessed which may influence the outpatient sector estimation. 10,361 (0.7%) patients were identified with incident BPH medication and 1768 (0.1%) patients with incident BPH surgery out of 1,575,604 males (2013-2018). Alpha-blockers were the drug of choice (95.6%) in the first year. Half of patients received specific BPH medications four years after index, while almost 98% of initial BPH surgeries were performed within the inpatient setting. TURP was the most frequent surgical intervention (76%). CONCLUSIONS A widespread diffusion of alternative individualized minimally invasive approaches in the outpatient sector might address pharmacotherapy discontinuation and patient-access barriers to other treatments.
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Affiliation(s)
- Arkadiusz Miernik
- Faculty of Medicine, Department of Urology, Medical Centre - University of Freiburg, Freiburg, Germany
| | | | - Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Düsseldorf, Germany.
| | | | | | - Damon Mohebbi
- HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Düsseldorf, Germany
| | - Melanie May
- HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Düsseldorf, Germany
| | - Christian Gratzke
- Faculty of Medicine, Department of Urology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Faculty of Medicine, Department of Urology, Medical Centre - University of Freiburg, Freiburg, Germany
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Weiss JK, Santucci NM, Sajadi KP, Chouhan JD. Post-Surgical Complications After Bladder Outlet Reducing Surgery: An Analysis of The FDA Manufacturer and User Facility Device Experience (MAUDE) Database. Urology 2021; 156:211-215. [PMID: 33971189 DOI: 10.1016/j.urology.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/05/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine voluntary reports in the Food & Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, categorize complications and assign device-related causality with transurethral resection of the prostate (TURP), prostatic urethral lift (PUL), and transurethral water vapor therapy (TWVT). METHODS A review was performed using the terms "Urolift," "Rezum," and "transurethral resection of the prostate" between 01/01/2015 and 12/31/2019. Duplicate and incomplete reports were excluded. The Gupta system was used to report complications and device related causality.1 Pearson's Chi-square analysis was performed to compare minor (Level 1) versus major (Levels 2-4) complications. RESULTS A total of 548 events were examined. After removal of duplicates (n = 60), irrelevant reports (n=65), and incomplete information (n = 14), we included 409 events (74.6%). Of the 409 events, 214 were for TURP, 112 for TWVT, and 83 for PUL. In aggregate, 39.4% of events were minor/Level 1 (n=161/409). The proportion of subjects with Level 2-4 complications versus Level 1 complications was significantly higher for PUL than TURP or TWVT [X2 (2, N = 408) = 41.4023, P < .00001]. Device causality was attributable to device malfunction in 60.4% of cases (n=247/409). CONCLUSION Device malfunction was noted in all groups and 39.4% of these were minor (Level 1). However, the majority of PUL reports noted a Level 3 or 4 complication (50.6%, 42/83), primarily bleeding related. Previous studies have not revealed significant risk of bleeding and suggests a discrepancy between study data and real-world experience that may alter patient counseling practices.
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Affiliation(s)
- Jason K Weiss
- School of Medicine, Oregon Health & Science University
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Bhat SA, Rather SA, Islam N. An overview of benign prostatic hyperplasia and its appreciation in Greco-Arab (Unani) system of medicine. Asian J Urol 2021; 9:109-118. [PMID: 35509487 PMCID: PMC9051355 DOI: 10.1016/j.ajur.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/30/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
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Al Khayal AM, Balaraj FK, Alferayan TA, Alrabeeah KA, Abumelha SM. Current surgical procedures for benign prostatic hyperplasia and impression of new surgical modalities. Urol Ann 2021; 13:95-100. [PMID: 34194132 PMCID: PMC8210715 DOI: 10.4103/ua.ua_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Surgery is considered the most effective treatment for Benign prostatic hyperplasia (BPH) and Transurethral resection of prostat (TURP) is considered the gold standard. The goal of this study is to assess the surgical interventions used in Saudi Arabia, the difference in surgical procedures done depending on age and years of experience and the participant's impression on the new modalities in the management of BPH. Methodology: An online survey using Google Forms was sent to the participants. The data were collected during Saudi Urological Association Annual Meeting February 2019. Additional data were gathered 2 months later. The study was closed in May 2019. No incentives were provided to participants. Results: A total of 65 (54.1% response rate) urologist participated in the survey, of whom 41.5% of respondents were aged <40 years, while 40% of them aged between 40 and 60 years. Forty-seven (72.3%) out of 65 were consultants. The essential investigations used by most participants prior to surgical interventions are prostate specific antigen, urine culture, urinalysis, and abdominal ultrasound. The most used surgical interventions are unipolar transurethral resection (TURP), Bipolar TURP, and open prostatectomy. About 50% of respondents preferred open prostatectomy for prostate size above 100 g. In general, 40%–50% of participants believe that urethral lift, Rezum, Aquablation, prostate artery embolization, and robotic simple prostatectomy are useful options. Conclusion: TURP continues to be the main intervention for prostate sizes <100 g. Open prostatectomy is widely used intervention for prostate sizes more than 100 g. New modalities gained little acceptance among urologist practicing in Saudi Arabia. Hands on workshops may help in educating urologists and introduce these new modalities for the future use.
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Affiliation(s)
- Abdullah M Al Khayal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
| | - Faisal K Balaraj
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
| | - Turki A Alferayan
- Department of Urology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid A Alrabeeah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
| | - Saad M Abumelha
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
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13
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Abstract
Interventional therapies (IT) are increasingly popular treatment options for benign prostatic hyperplasia (BPH). IT aim to reduce morbidity and side effects related to invasive surgical procedures. To date, IT are considered experimental, though they are evolving rapidly and starting to challenge established surgical strategies. With gradually increasing evidence for the benefits of IT in BPH, several techniques are moving out of the realm of research and into everyday clinical practice. As such, IT provides encouraging mid-term functional outcomes with improved health-related quality of life (QoL), particularly in terms of better preservation of ejaculation. The distinct role IT could play as a bridge between exhausted drug-based treatment options and surgery is yet to be defined. Further studies are required before IT can be recommended as alternatives to invasive therapies. Systematic trials are needed to identify subgroups of patients who can benefit particularly from IT in comparison to other treatments, to identify features of the prostate particularly suited to a specific IT, and to analyze the durability of success for each technique.
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14
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Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terrens W, Kohan A, Gonzalez RR, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu LM, Alshak MN, Kaminetzky J. The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial. Urology 2020; 153:270-276. [PMID: 33373708 DOI: 10.1016/j.urology.2020.12.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report the results of a multicenter, randomized, controlled trial with a temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Hadera, Israel) compared to sham for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS Men 50 years or older were randomized 2:1 between iTind and sham procedure arms. A self-expanding, temporary nitinol device was placed for 5-7 days and an 18F Foley catheter was inserted and removed for the iTind and sham group, respectively. Patients were assessed at baseline, 1.5, 3, and 12 months postoperatively using the IPSS, peak urinary flow rate, residual urine, quality of life, and the International Index of Erectile Function. Unblinding occurred at 3 months. RESULTS A total of 175 men (mean age 61.1 ± 6.5) participated (118 iTind vs 57 sham). A total of 78.6% of patients in the iTind arm showed a reduction of ≥3 points in IPSS, vs 60% of patients in the control arm at 3 months. At 12 months, the iTind group reported a 9.25 decrease in IPSS (P< .0001), a 3.52ml/s increase in peak urinary flow rate (P < .0001) and a 1.9-point reduction in quality of life (P < .0001). Adverse events were typically mild and transient, most Clavien-Dindo grade I or II, in 38.1% of patients in the iTind arm and 17.5% in the control arm. No de novo ejaculatory or erectile dysfunction occurred. CONCLUSION Treatment with the second-generation iTind provided rapid and sustained improvement in lower urinary tract symptoms for the study period while preserving sexual function.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, NY-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Neal Shore
- Carolina Urology Research Center, Myrtle Beach, SC
| | | | | | | | | | | | - Alfred Kohan
- Integrated Medical Professionals, Long Island, NY
| | | | | | | | | | | | - Le Mai Tu
- Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
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15
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Stoddard MD, Cho A, Te AE, Chughtai B. A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE). Curr Urol Rep 2020; 21:64. [PMID: 33230722 DOI: 10.1007/s11934-020-01016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Surgical intervention for benign prostatic enlargement (BPE) is typically reserved for those who fail medical therapy (i.e., α-blocker or 5-α reductase inhibitor treatment). We conducted a systematic review to determine whether timing of surgical intervention for BPE affects patient outcomes. RECENT FINDINGS The studies we reviewed suggested that patients who undergo surgical intervention for BPE after failing medical therapy may have worse outcomes. Increased age, worsened bladder function, and worse overall health may contribute to worsened outcomes. To date, there are few high-quality studies on the timing of surgical intervention for BPE in the literature. Further prospective trials are needed to determine ideal timing for intervention.
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Affiliation(s)
| | - Ahra Cho
- Weill Cornell Medicine, New York, NY, 10065, USA
| | - Alexis E Te
- Weill Cornell Medicine, New York, NY, 10065, USA
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16
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Srinivasan A, Wang R. An Update on Minimally Invasive Surgery for Benign Prostatic Hyperplasia: Techniques, Risks, and Efficacy. World J Mens Health 2020; 38:402-411. [PMID: 31496146 PMCID: PMC7502324 DOI: 10.5534/wjmh.190076] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 02/02/2023] Open
Abstract
Benign prostatic hyperplasia (BPH), a common cause of lower urinary tract symptoms in the elderly male population, has conventionally treated by transurethral resection of the prostate (TURP). During recent years, newer minimally invasive therapies (MITs) have entered the playing field and challenged TURP with their convenience, lack of sexual side effects, and overall safety. The present paper provides an update on the more heavily studied and most recent MITs, analyzing their mechanism of action, tolerability, and efficacy in clinical practice. Particularly, robust clinical data have propelled UroLift and Rezuum to the forefront in the armamentarium of minimally invasive BPH treatment. Newer mechanical therapies such as the temporary implantable nitinol device, ClearRing, ZenFlow Spring, and Butterfly are appealing options as they forego cutting, ablation, heating, or removing prostatic tissue. It is obvious that there is wide variation in the degree of clinical readiness of each modality and only time and long-term, multicenter studies will decide which of these therapies are accepted by the patient and urologist.
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Affiliation(s)
- Aditya Srinivasan
- Department of Urology, McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Run Wang
- Department of Urology, McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, TX, USA.
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17
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Kabeshova A, Yu Y, Lukacs B, Bacry E, Gaïffas S. ZiMM: A deep learning model for long term and blurry relapses with non-clinical claims data. J Biomed Inform 2020; 110:103531. [PMID: 32818667 DOI: 10.1016/j.jbi.2020.103531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/25/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
This paper considers the problems of modeling and predicting a long-term and "blurry" relapse that occurs after a medical act, such as a surgery. We do not consider a short-term complication related to the act itself, but a long-term relapse that clinicians cannot explain easily, since it depends on unknown sets or sequences of past events that occurred before the act. The relapse is observed only indirectly, in a "blurry" fashion, through longitudinal prescriptions of drugs over a long period of time after the medical act. We introduce a new model, called ZiMM (Zero-inflated Mixture of Multinomial distributions) in order to capture long-term and blurry relapses. On top of it, we build an end-to-end deep-learning architecture called ZiMM Encoder-Decoder (ZiMM ED) that can learn from the complex, irregular, highly heterogeneous and sparse patterns of health events that are observed through a claims-only database. ZiMM ED is applied on a "non-clinical" claims database, that contains only timestamped reimbursement codes for drug purchases, medical procedures and hospital diagnoses, the only available clinical feature being the age of the patient. This setting is more challenging than a setting where bedside clinical signals are available. Our motivation for using such a non-clinical claims database is its exhaustivity population-wise, compared to clinical electronic health records coming from a single or a small set of hospitals. Indeed, we consider a dataset containing the claims of almost all French citizens who had surgery for prostatic problems, with a history between 1.5 and 5 years. We consider a long-term (18 months) relapse (urination problems still occur despite surgery), which is blurry since it is observed only through the reimbursement of a specific set of drugs for urination problems. Our experiments show that ZiMM ED improves several baselines, including non-deep learning and deep-learning approaches, and that it allows working on such a dataset with minimal preprocessing work.
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Affiliation(s)
| | | | | | | | - Stéphane Gaïffas
- LPSM, Université de Paris, France; DMA, Ecole normale supérieure, Paris, France.
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18
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Ullah R, Wazir J, Hossain MA, Diallo MT, Khan FU, Ihsan AU, Zhou X. A glimpse into the efficacy of alternative therapies in the management of benign prostatic hyperplasia. Wien Klin Wochenschr 2020; 133:153-162. [PMID: 32533441 DOI: 10.1007/s00508-020-01692-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
Benign prostatic hyperplasia (BPH) is a common disease that can cause uncomfortable lower urinary tract symptoms. The occurrence of symptomatic BPH develops after the age of 40 years and increases gradually with age to reach more than 50% at the age of 60 years and severely disturbs the quality of life of the patients. Alpha-blockers and 5‑alpha reductase inhibitors are first-line agents used for the treatment of BPH. Due to the adverse effects of these conventional therapies, many patients turn to phytotherapy and other alternative therapies. This review covers alternative therapies, i.e., phytotherapy (cernilton, eviprostat, quercetin, saw palmetto and pumpkin seed) and physical therapy (acupuncture, aquablation, pulsed electromagnetic field, prostate urethral lift, radial extracorporeal shock wave therapy, thermobalancing therapy, and transurethral needle ablation) commonly used in the management of BPH.
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Affiliation(s)
- Rahat Ullah
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Junaid Wazir
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Md Amir Hossain
- Center for New Drug Safety Evaluation and Research, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Maladho Tanta Diallo
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Farhan Ullah Khan
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Awais Ullah Ihsan
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China
| | - Xiaohui Zhou
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, 211198, Nanjing, Jiangsu, China.
- Department of Surgery, Nanjing Shuiximen Hospital, 211198, Nanjing, Jiangsu, China.
- Zhongda Hospital, Affiliated with Southeast University, 211198, Nanjing, Jiangsu, China.
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19
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García-Cruz E, Otero JR, Ineva PA, Pérez LMM, Elías LP, Asensio AA. Robot-assisted aquablation for resection of benign prostatic hyperplasia: A series of cases. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2020. [DOI: 10.25083/2559.5555/5.1/18.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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20
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Kailavasan M, Berridge C, Athanasiadis G, Gkentzis A, Rai B, Jain S, Biyani CS, Nabi G. Design, implementation, and evaluation of a novel curriculum to teach transurethral resection of the prostate (TURP): a 3-year experience of urology simulation bootcamp course. World J Urol 2020; 38:2899-2906. [PMID: 32040716 DOI: 10.1007/s00345-020-03104-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/22/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To present the three-year experience of the multi-component TURP module at Urology Simulation Bootcamp Course (USBC) and demonstrate trainee's competence progression and satisfaction. METHODS During the USBC, a 4-h TURP module was developed and consisted of (a) familiarisation and assembly of resectoscope instrument, (b) didactic lecture on TURP operative techniques and postoperative complications, (c) learning hands-on resection on validated simulators [Samed, GmBH, Dresden, Germany; TURP Mentor™, Simbionix, Israel], and (d) practicing clot evacuation using the Ellik bladder Evacuator. Trainee's level of instrument knowledge, operative competence, and confidence were assessed pre- and post-course. Trainee's feedback was also collected. RESULTS One hundred thirty trainees participated in the USBC between 2016 and 2018. Eighty-seven percent of trainees scored themselves as 1-3 (low confidence in resection) on a 5-point Likert scale. Trainees significantly improved in their ability to perform resectoscope assembly for resection, coagulation and incision by 33.6% (p < 0.001), 28.1% (p < 0.001) and 34.0% (p < 0.001), respectively. There was a significant improvement in scores in itemised technical skill on the TURP simulator following completion of the TURP module (Mean difference = 3.4 points, 95% CI 2-4, p < 0.001). Ninety-one percent of trainees agreed that the TURP module was useful for their development in urological training. CONCLUSION Our results demonstrated that it is feasible to develop and implement a focussed module for teaching TURP with significant improvement in learning. Trainee feedback suggests that they were highly satisfied with the teaching provided and models used. This style of training can be implemented for other common surgical procedures.
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Affiliation(s)
| | | | | | | | | | - Sunjay Jain
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - Chandra S Biyani
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK.
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21
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Maron SZ, Sher A, Kim J, Lookstein RA, Rastinehad AR, Fischman A. Effect of Median Lobe Enlargement on Early Prostatic Artery Embolization Outcomes. J Vasc Interv Radiol 2020; 31:370-377. [PMID: 31956004 DOI: 10.1016/j.jvir.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate outcomes after prostatic artery embolization (PAE) in patients with severe intravesical prostatic protrusion (IPP). MATERIALS AND METHODS This was a retrospective, single health system, 2-hospital study from April 2015 to December 2018 of 54 patients who underwent elective PAE procedures (age mean 67.5 years; standard deviation [SD] 8.5). The cohort had a mean ellipsoid prostate volume of 100.1 cm3 (SD 56.7), a mean baseline International Prostate Symptom Score (IPSS) of 18.7 (SD 8.2), a mean baseline quality of life (QOL) score of 4.1 (SD 1.4), and a median follow-up of 38 days (range 10-656 days). Outcomes including IPSS and QOL score reduction (where a lower QOL score indicates an improvement in QOL), and clinical success were compared between severe (≥10 mm) and nonsevere (<10 mm) IPP patients. A linear regression model was used to examine the impact of IPP on these outcomes. RESULTS No significant differences in patient characteristics were found between nonsevere (n = 17) and severe (n = 37) IPP patients. Both cohorts showed IPSS reduction (nonsevere 6.0, P = .0397; severe 8.2, P < .0001) and QOL score reduction (nonsevere 1.0, P = .102; severe 2.0, P < .0001). No significant differences in IPSS or QOL score reduction were found between the cohorts (P = .431 and P = .127). Linear regression found that baseline IPP was not a significant contributor to the outcomes (IPSS: R2 = .5, P < .0001; IPP: P = .702; QOL: R2 = .5, P = .0003; IPP: P = .108). CONCLUSIONS There were no significant differences in early outcomes in PAE between patients with severe and nonsevere IPP.
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Affiliation(s)
- Samuel Z Maron
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029. https://twitter.com/MaronSamuel
| | - Alex Sher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Jeremy Kim
- Charlotte Radiology, Charlotte, North Carolina
| | - Robert A Lookstein
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Ardeshir R Rastinehad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Aaron Fischman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029.
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22
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El-Dakhakhny AS, Gharib T, Issam A, El-Karamany TM. Transperineal intraprostatic injection of botulinum neurotoxin A vs transurethral resection of prostate for management of lower urinary tract symptoms secondary to benign prostate hyperplasia: A prospective randomised study. Arab J Urol 2019; 17:270-278. [PMID: 31723444 PMCID: PMC6830273 DOI: 10.1080/2090598x.2019.1662214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
Objectives: To evaluate transperineal intraprostatic injection of botulinum neurotoxin A (BoNT-A) in patients with lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH) who failed to respond to 6-month medical treatment compared with transurethral resection of the prostate (TURP). Patients and methods: In all, 92 men were divided into TURP and BoNT-A groups after being evaluated using the International Prostate Symptom Score (IPSS) and five-item version of the International Index of Erectile Function, estimation of serum total prostate-specific antigen (tPSA), ultrasonographic estimation of prostatic volume (PV), and uroflowmetry determination of voiding volume (VV), maximum urinary flow rate (Qmax) and post-void residual urine volume (PVR). BoNT-A (200 U diluted in 3 mL saline) was injected, using a 22-G spinal needle under transrectal ultrasonography guidance, with 1-mL in each lobe. Patients were assessed 3-monthly for 12 months. Results: The IPSS significantly decreased in all patients with a non-significant difference between the groups. The mean VV and Qmax increased, whilst PVR, PV and serum tPSA significantly decreased. Patients who showed deterioration at 12 months were re-evaluated and underwent TURP. BoNT-A injection significantly maintained erectile function compared with TURP. Conclusion: Intraprostatic BoNT-A injection reduced PV with subsequent increases in VV and Qmax, and decreases in PVR and serum tPSA level. Intraprostatic BoNT-A injection allowed surgery sparing in >70% and preserved erectile function in 91.3% of patients. Abbreviations: BoNT-A: botulinum neurotoxin A; HRQOL: health-related quality of life; IIEF-5: five-item version of the International Index of Erectile Function; PV: prostatic volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; tPSA: total PSA; VV: voided volume
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Affiliation(s)
- Amr S El-Dakhakhny
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Tarek Gharib
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Issam
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
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23
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Zhao H, Kim HH. The Complex Relationship Between Lower Urinary Tract Symptoms and Sexual Health. Curr Urol Rep 2019; 20:58. [DOI: 10.1007/s11934-019-0930-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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24
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DeWitt-Foy ME, Gill BC, Ulchaker JC. Cost Comparison of Benign Prostatic Hyperplasia Treatment Options. Curr Urol Rep 2019; 20:45. [PMID: 31218458 DOI: 10.1007/s11934-019-0907-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW To provide an economic context within which to consider treatment options for benign prostatic hyperplasia (BPH). To this end, this review provides a comparison of the costs of combination medical therapy, operative treatment, and office-based therapies for BPH from a payer perspective. RECENT FINDINGS Analysis of Medicare charges from the authors' institution, as well as local retail costs of medication, demonstrated a wide range in costs of commonly used BPH treatments. In this study, interventions for BPH reached cost equivalence with combination medical therapy within 6 months to 8 years. A myriad of options for managing men with symptomatic BPH exist. It is prudent not only to consider surgeon preference and patient-specific factors when selecting a treatment but also to understand the economic impact different BPH therapies confer.
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Affiliation(s)
- Molly E DeWitt-Foy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1 9500 Euclid Avenue, Cleveland, OH, 44195, USA. .,Lerner College of Medicine, Education Institute, Cleveland Clinic, Mail Stop NA21 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Bradley C Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1 9500 Euclid Avenue, Cleveland, OH, 44195, USA.,Lerner College of Medicine, Education Institute, Cleveland Clinic, Mail Stop NA21 9500 Euclid Avenue, Cleveland, OH, 44195, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James C Ulchaker
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1 9500 Euclid Avenue, Cleveland, OH, 44195, USA.,Lerner College of Medicine, Education Institute, Cleveland Clinic, Mail Stop NA21 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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25
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Karkhanei B, Musavi-Bahar SH, Bayat M, Kaseb K, Rezaee H, Moradi A, Moradi M. Safety and efficacy of intraoperative administration of intravenous tranexamic acid in transurethral resection of prostate: A double-blind, randomised, placebo-controlled trial. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819855887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of this article is to evaluate and compare the effect of intravenous tranexamic acid (TXA) with placebo on haemorrhage and quality of vision during and post-transurethral resection of the prostate (TURP). Methods: For nine months (September 2016 until June 2017), a randomised clinical trial was conducted with 70 patients, age 50–80 years, who were included in the study according to inclusion criteria (patients who required surgical intervention because of benign prostatic hyperplasia, prostate weight (<100 cc), American Society of Anesthesiologists score ⩽II, etc.) and enrolled randomly one to one in two study groups, and who underwent TURP in Shahid Beheshti Hospital of Hamadan University of Medical Sciences by a single surgeon. Interventions: The study group participants received 500 mg TXA in 500 ml ringer serum (concentration of 1 mg/ml, infusion rate 100 mg/min, maximum dose of 15 mg/kg), whereas the control group received only ringer serum during surgery. The results were then compared for the variables operation time, amount of haematocrit (HCT)-haemoglobin (Hb) reduction following surgery and surgeon satisfaction. Results: Both groups had no difference in age, weight and prostate weight. Surgeon satisfaction was evaluated at the end of the operation. The frequency of high satisfaction in case and control groups was 74.3% and 8.65%, whereas low satisfaction was 0% and 42.69%, respectively ( p < 0.05). The mean time of operation was 53.57±16.43 vs 120.71±47.76 minutes in the case and control group, respectively ( p < 0.05). The mean HCT-Hb decrease ( p = 0.00) and the amount of infused volume before and after the operation ( p = 0.03) between both groups were significantly different. None of the patients experienced TXA side effects. Conclusions: Intravenous TXA can prevent haemorrhage and higher Hb and HCT reduction following TURP, shortening the operation time and improving surgeon vision during TURP. Level of evidence: 1b
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Affiliation(s)
- Behrooz Karkhanei
- Anesthesiology, Hamadan University of Medical Sciences, Islamic Republic of Iran
| | | | - Masume Bayat
- Hamadan University of Medical Sciences, Islamic Republic of Iran
| | - Kaveh Kaseb
- Urology, Kermanshah University of Medical Sciences, Islamic Republic of Iran
| | - Haress Rezaee
- Urology, Kermanshah University of Medical Sciences, Islamic Republic of Iran
| | - Abbas Moradi
- Epidemiology, Hamadan University of Medical Sciences, Islamic Republic of Iran
| | - Mahmoudreza Moradi
- Pediatric Urology, Kermanshah University of Medical Sciences, Islamic Republic of Iran
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26
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Guelce D, Kini M, Thomas D, Chughtai B. BPH-Related Voiding Dysfunction—i-Tind. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Guelce D, Thomas D, Elterman D, Chughtai B. Recent advances in managing benign prostatic hyperplasia: The Rezūm System. F1000Res 2019; 7. [PMID: 30631433 PMCID: PMC6290970 DOI: 10.12688/f1000research.15851.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/20/2022] Open
Abstract
Benign Prostatic Hyperplasia is a common condition that affects 50% of men in their 50
th decade. There have been many advances in the treatment of this condition, which aim to improve the patient’s quality of life. A new treatment that shows promising results is the Rezūm System, a water vapor therapy for BPH. We present the most current literature on this therapy.
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Affiliation(s)
| | | | - Dean Elterman
- Urology, University of Toronto, Toronto, Ontario, M5T2S8, Canada
| | - Bilal Chughtai
- Urology, Weill Cornell Medical Center, New York, NY, 10065, USA
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28
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The Aquabeam System: a Review. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Taktak S, Jones P, Haq A, Rai BP, Somani BK. Aquablation: a novel and minimally invasive surgery for benign prostate enlargement. Ther Adv Urol 2018; 10:183-188. [PMID: 29899759 DOI: 10.1177/1756287218760518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/29/2018] [Indexed: 11/17/2022] Open
Abstract
Aquablation is a minimally invasive surgical technology for benign prostate enlargement, which uses high-pressure saline to remove parenchymal tissue through a heat-free mechanism of hydrodissection. Early results show this to be a promising surgical strategy with a strong morbidity profile and reduced resection time. This review serves to provide an overview of the technique and evaluate its safety and efficacy.
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Affiliation(s)
| | - Patrick Jones
- University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, SO16 6YD, UK
| | - Ahsanul Haq
- Royal Preston Hospital, Preston, Lancashire, UK
| | | | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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30
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Foo KT. Current consensus and controversies on male LUTS/BPH (part two). Asian J Urol 2018; 5:8-9. [PMID: 29379728 PMCID: PMC5780284 DOI: 10.1016/j.ajur.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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