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Licari LC, Bologna E, Manfredi C, Franco A, Ditonno F, DE Nunzio C, Franco G, Cindolo L, Leonardo C, Adelstein SA, Fiori C, Cherullo EE, Olweny EO, Autorino R. Postoperative urinary incontinence following BPH surgery: insights from a comprehensive national database analysis. Minerva Urol Nephrol 2024; 76:618-624. [PMID: 39320252 DOI: 10.23736/s2724-6051.24.05802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
BACKGROUND Postoperative urinary incontinence (UI) is a feared complication of BPH surgery. Our study aims to investigate the incidence of UI among patients undergoing different procedures for BPH. METHODS A retrospective analysis was conducted using a large national database, containing patient records between 2011 and 2022. The most employed surgical procedures for BPH were considered, including TURP, Transurethral Incision of the Prostate (TUIP), Holmium/Thulium Laser Enucleation of the Prostate (HoLEP/ThuLEP), Open Simple Prostatectomy (OSP), minimally invasive simple prostatectomy (Lap/Rob SP), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Robotic Waterjet Treatment (RWT - Aquablation®), Water Vapor Thermal Therapy (WVTT - Rezum®) and Prostatic Artery Embolization (PAE). Rates of any type of UI, including stress UI (SUI), urge UI (UUI) and mixed UI (MUI) were assessed. Multivariate regression analysis was used to identify predictors of "persistent" postoperative UI, defined as the presence of an active UI diagnosis at 12 months post-surgery. RESULTS Among 274,808 patients who underwent BPH surgery, 11,017 (4.01%) experienced persistent UI. UUI rates varied between 0.62% (PAE) and 2.71% (PVP), SUI ranged from 0.04% (PAE) and 2.75% (Lap/Rob SP), while MUI between 0.11% (PAE) and 1.17% (HoLEP/ThuLEP). On multivariable analysis, HoLEP/ThuLEP (OR 1.612; 95% CI: 1.508-1.721; P<0.001), PVP (OR 1.164; 95% CI:1.122-1.208; P<0.001), Open SP (OR 1.424; 95% CI:1.241- 1.624; P<0.001), and Lap/Rob SP (OR 1.667; 95% CI:1.119-2.384; P<0.01) showed significant higher likelihood of UI compared to TURP. PUL (OR 0.604; 95% CI:0.566-0.644; P<0.001), WVTT (OR 0.661; 95% CI:0.579-0.752; P<0.001), RWT (OR 0.434; 95% CI:0.216-0.767; P<0.01), and PAE (OR 0.178; 95% CI:0.111-0.269; P<0.001) were associated with lower likelihood of UI. CONCLUSIONS UI remains a concerning complication following BPH surgery, but it is an uncommon event affecting <5% of patients. Some differences in UI rates and risk might exist among various BPH procedures. These findings underscore the need for thorough patient selection and counseling.
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Affiliation(s)
- Leslie C Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giorgio Franco
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy
| | | | | | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
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Castellani D, Rubilotta E, Fabiani A, Maggi M, Wroclawski M, Teoh JYC, Pirola GM, Gubbioti M, Pavia MP, Gomez Sancha F, Galosi AB, Gauhar V. Correlation between transurethral interventions and their influence on type and duration of postoperative urinary incontinence: results from a systematic review and meta-analysis of comparative studies. J Endourol 2022; 36:1331-1347. [PMID: 35587146 DOI: 10.1089/end.2022.0222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective To perform a systematic review to assess the incidence of transient (<6-month) and persistent (>6-month) stress (SUI), urge (UUI), and mixed urinary incontinence (MUI) after transurethral surgeries for benign prostatic hyperplasia (BPH). Materials and Methods A systematic literature search was performed using Embase, PubMed, and Web of Science. We included studies comparing monopolar(M)/bipolar(B) TURP vs ablation vs enucleation procedures. Incidence of incontinence was assessed using Cochran-Mantel-Haenszel Method and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Statistical significance was set at p <0.05 Evidence synthesis 28 studies were included. Incidence of transient SUI was 4.6%, 6.0%, 3.0%, 2.4% after ablation, enucleation, M-TURP, and B-TURP, respectively. Incidence of persistent SUI was 1.1% after ablation, 1.7%, after enucleation and M-TURP, 1.0% after B-TURP. Incidence of transient UUI was 2.0%, 7.3%, 4.4%, 2.8% after ablation, enucleation, M-TURP, and B-TURP, respectively. Incidence of persistent UUI was 2.2% after M-TURP. The incidence of transient MUI was 5.1%, 0.8%, 5.4%, 0.9% after ablation, enucleation, M-TURP, and B-TURP, respectively. Incidence of persistent MUI was 3.1% after ablation, and 4.8% after M-TURP. Incidence of transient and persistent SUI and UUI did not differ after TURP vs enucleation. Incidence of transient (OR 3.32, 95% CI 0.41-26.65, p=0.26) and persistent SUI (OR 4.79, 95%CI 0.52-43.89,p=0.17) was not significantly higher after ablation. Incidence of transient UUI was not significantly higher after ablation (OR 2.62, 95%CI 0.04-166.01,p=0.65), whilst persistent UUI did not differ. Incidence of transient MUI was significantly higher after enucleation (OR 3.26, 95%CI 1.51-7.05,p=0.003). Incidence of transient and persistent MUI did not differ after TURP vs ablation. Conclusions Ablation, enucleation, and TURP have an impact on all forms of incontinence but this is transient in most cases with no difference between the groups, except for MUI which was higher after enucleation vs M-TURP.
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Affiliation(s)
- Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | - Emanuele Rubilotta
- Azienda Ospedaliera Universitaria Integrata Verona, 9286, Urology, Verona, Veneto, Italy;
| | - Andrea Fabiani
- ASUR Area Vasta 3 Macerata, 125697, Macerata, Marche, Italy;
| | - Martina Maggi
- Sapienza University of Rome, 9311, Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Viale del Policlinico 155, Roma, Lazio, Italy, 00161;
| | - Marcelo Wroclawski
- Hospital Israelita Albert Einstein, Urology, Sao Paulo, Sao Paulo, Brazil;
| | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | | | | | - Maria Pia Pavia
- ASUR Area Vasta 4 Fermo, 165362, Dept of Urology, Porto San Giorgio, Italy;
| | - Fernando Gomez Sancha
- Clinica Cemtro, Av. ventisquero de la condesa 42, Madrid, Spain, Urology, Ventisquero de la Condesa 42, Madrid, Madrid, Spain, 28034;
| | - Andrea Benedetto Galosi
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, 18494, Urology, Via Conca, Ancona, Marche, Italy, I-60100.,Polytechnic University of Marche, 9294, Ancona, Italy, 60121;
| | - Vineet Gauhar
- Ng Teng Fong General Hospital, 242949, Urology, Singapore, Singapore;
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Meta-analysis of prognostic factors related to early urinary incontinence following new transurethral procedures dominated by laser therapy for benign prostatic hyperplasia. Lasers Med Sci 2022; 37:2937-2946. [DOI: 10.1007/s10103-022-03563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
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Bae J, Kang HW, Lee HW, Lee KS, Cho MC. Predictors of de novo urge urinary incontinence after photoselective vaporization of the prostate. World J Urol 2015; 34:413-8. [DOI: 10.1007/s00345-015-1635-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/02/2015] [Indexed: 12/01/2022] Open
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Wang CC, Liao CH, Kuo HC. Clinical guidelines for male lower urinary tract symptoms associated with non-neurogenic overactive bladder. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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HIRAYAMA F, LEE AH. Dietary Nutrients and Urinary Incontinence in Japanese Adults. Low Urin Tract Symptoms 2013; 5:28-38. [DOI: 10.1111/j.1757-5672.2012.00162.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cho MC, Park JH, Jeong MS, Yi JS, Ku JH, Oh SJ, Kim SW, Paick JS. Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn 2011; 30:1343-1349. [PMID: 21538499 DOI: 10.1002/nau.21050] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 11/15/2010] [Indexed: 09/20/2023]
Abstract
AIMS To investigate the incidence of de novo urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia and to determine predictors of postoperative de novo UI. METHODS A total of 204 men who underwent HoLEP and in whom 12-month follow-up data on UI were available were included in this study. The efficacy of HoLEP was assessed at 1-, 3-, 6-, and 12-month postoperatively using the International Prostate Symptom Score (IPSS) and with uroflowmetry. The presence or absence of UI was recorded at each follow-up visit. All definitions of UI corresponded to recommendations of the International Continence Society. RESULTS The mean preoperative total prostate and transition zone volumes were 53.3 (range 20-162) g and 27.2 (range 4-107) g, respectively. The mean enucleated weight was 23.0 (range 3.0-82.3) g. The IPSS and uroflowmetry showed that all micturition parameters improved significantly starting at 1-month postoperatively. After HoLEP, 29 patients (16.2%) had de novo UI, most of which resolved within 1-6 months; 11 had stress UI, 12 had urgency UI, and the remaining 6 had mixed UI. On logistic regression analysis, bladder mucosal injury during morcellation and maximum urethral closure pressure on baseline urodynamics were the independent predictors of de novo UI after surgery. CONCLUSIONS Our data suggest that HoLEP is effective in improving micturition, but de novo postoperative UI occurred in some patients although usually transient. Surgeons should be careful to not injure the bladder mucosa during morcellation.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, College of Medicine, Dongguk University, Gyeonggi, Korea
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Hrisanfow E, Hägglund D. The prevalence of urinary incontinence among women and men with chronic obstructive pulmonary disease in Sweden. J Clin Nurs 2011; 20:1895-905. [DOI: 10.1111/j.1365-2702.2010.03660.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
OBJECTIVES To investigate the association between alcohol consumption and urinary incontinence among Japanese men. METHODS Seven hundred men aged 40-75 years were recruited from the community in middle and southern Japan. A validated food frequency questionnaire was administered face-to-face to obtain information on dietary intake and habitual alcohol consumption. Urinary incontinence status was ascertained using the International Consultation on Incontinence Questionnaire-Short Form. RESULTS Among the 683 eligible male participants, 49 men (7.2%) experienced urine leakage for the past 2.6 years (standard deviation [SD] 1.9). Their prevalence of alcohol drinking (beer, sake, shochu, wine, whisky) was lower than others without the condition, even though the daily mean ethanol intakes were similar between the two groups, 31.8 g (SD 45.4) and 31.3 g (SD 41.9), respectively. Relative to non-drinkers, the adjusted odds of urinary incontinence were 0.43 (95% CI 0.19 to 0.96) for low ethanol intake, and up to 32 g per day and 0.53 (95% CI 0.22 to 1.28) for drinking, at most, one can (350 mL) of beer daily. However, higher levels of alcohol consumption had no significant benefit in reducing the incontinence risk. CONCLUSION The findings suggested an inverse association between urinary incontinence and low alcohol consumption particularly beer in middle-aged and older Japanese men.
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Affiliation(s)
- Andy H Lee
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, WA, Australia
| | - Fumi Hirayama
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, WA, Australia
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Li J, Motsko SP, Goehring EL, Tave A, Pezzullo JC, Jones JK. Prevalence of pediatric dyslipidemia: comparison of a population-based claims database to national surveys. Pharmacoepidemiol Drug Saf 2011; 19:1031-40. [PMID: 20602343 DOI: 10.1002/pds.1982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the prevalence of pediatric dyslipidemia in a large US medical insurance claims database and to compare the resulting estimate to the prevalence from the National Health and Nutrition Examination Survey (NHANES). PATIENTS AND METHODS Children 10-18 years old who had laboratory-defined dyslipidemia were identified from the Integrated Healthcare Information Services (IHCIS) database 2003-2006. For comparison purposes, the corresponding prevalence among the US children of same age was estimated from the NHANES 1999-2004 data. RESULTS Among the 273 064 children with at least one laboratory lipid value in the IHCIS database, 22.9% (n = 62 451) had laboratory-defined dyslipidemia. This prevalence was the same as the NHANES estimate (23.9%, 95%CI: 21.6-26.3). Elevated triglyceride (TG) was the most common type of dyslipidemia, detected among 13.2% of the IHCIS children and 14.2% of the US children, followed by elevated total cholesterol (TC), 7.7 and 9.6%, respectively. Among IHCIS dyslipidemic children, older teenage boys had higher rates than younger boys for high-density lipoprotein cholesterol (HDL-C) abnormality, but lower rates for elevated TC and low-density lipoprotein cholesterol (LDL-C). These age-related trends were also seen among NHANES dyslipidemic children. CONCLUSIONS Analyses of a population-based claims database revealed the same prevalence of pediatric dyslipidemia as that among the US children assessed in the NHANES data. Among dyslipidemic children in the claims database, the occurrence of specific dyslipidemias appeared to vary by age and gender, a trend that was also seen among the dyslipidemic children in the US.
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Affiliation(s)
- Jie Li
- Department of Research, The Degge Group, Ltd, Arlington, VA 22209, USA.
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Opportunity to optimize management of benign prostatic hyperplasia. Geriatr Nurs 2010; 31:441-5. [PMID: 21056517 DOI: 10.1016/j.gerinurse.2010.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Five-alpha reductase inhibitor may be underused and their value underappreciated in nursing home residents with enlarged prostates due to BPH. Initiation of a 5-alpha reductase inhibitor with an alpha-1 selective blocker may reduce the occurrence of acute urinary retention, decrease the risk of developing incontinence, and avoid or significantly delay the need for surgical intervention in this highly vulnerable male population.
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Li J, Motsko SP, Goehring EL, Vendiola R, Maneno M, Jones JK. Longitudinal study on pediatric dyslipidemia in population-based claims database. Pharmacoepidemiol Drug Saf 2010; 19:90-8. [PMID: 20035528 DOI: 10.1002/pds.1877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE To examine the rate of lipid testing among children from a large US medical insurance claims database, describe the characteristics of pediatric dyslipidemia, and assess the sensitivity of the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identifying dyslipidemic children. METHODS This retrospective cohort study used the claims data from the Integrated Healthcare Information Services (IHCIS), for the years 2003-2006. Two study cohorts consisted of children with laboratory-defined and diagnosis/treatment-defined dyslipidemia, respectively. They were compared to age- and gender-matched children without dyslipidemia, with respect to co-morbidities during the 6-month prior to and 12-month after the first dyslipidemic laboratory value or diagnosis/treatment. RESULTS Seven per cent of the children who had laboratory values available in the database had a cholesterol test during the study period. Only 15% of laboratory-defined children (n = 23,475) had a dyslipidemia diagnosis. Cholesterol-modifying medications were rarely prescribed. Substantially more laboratory-defined children than their comparators were obese (8 times), had diabetes mellitus (10 times), or had hypertension (5 times). These co-morbidities were even higher among diagnosis/treatment-defined children. CONCLUSIONS The rate of lipid testing among children was low. The ICD-9-CM diagnostic codes showed low sensitivity against laboratory definitions. Though only a small proportion of dyslipidemic children were diagnosed or treated with a medication, co-morbidities associated with dyslipidemia were common.
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HIRAYAMA F, LEE AH, BINNS CW, NISHIMURA K, TANIGUCHI H. Association of impaired respiratory function with urinary incontinence. Respirology 2009; 14:753-6. [DOI: 10.1111/j.1440-1843.2009.01538.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hirayama F, Lee AH, Binns CW, Taniguchi H, Nishimura K, Kato K. Urinary incontinence in men with chronic obstructive pulmonary disease. Int J Urol 2008; 15:751-3. [DOI: 10.1111/j.1442-2042.2008.02093.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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