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Tarcan T, Hashim H, Malde S, Sinha S, Sahai A, Acar O, Selai C, Agro EF, Abrams P, Wein A. Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI-RS 2023. Neurourol Urodyn 2024; 43:1447-1457. [PMID: 38477358 DOI: 10.1002/nau.25435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
AIMS Lower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome. METHODS A think tank of ICI-RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS. RESULTS Our think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity. CONCLUSION Future research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust & King's College London, London, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Arun Sahai
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Omer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- College of Medicine, Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caroline Selai
- University College London - Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery/UCLH NHS Foundation Trust, London, UK
| | - Enrico Finazzi Agro
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Nasrallah OG, Herrera MT, Heidar NFA, Mahdi JH, Nasr RW. Impact of kidney disease on perioperative outcomes of endoscopic BPH surgery: a propensity score matched analysis from the NSQIP database. World J Urol 2024; 42:337. [PMID: 38762841 DOI: 10.1007/s00345-024-05039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION To assess the impact of kidney function in patients with BPH undergoing surgery prior to Transurethral resection of prostate (TURP), Laser enucleation of the prostate (LEP), and Laser Vaporization of the prostate (LVP) on operative and post-operative outcomes using the ACS-NSQIP database. METHODS The ACS-NSQIP database was reviewed for patients that underwent TURP, LEP and LVP for treatment of patients with BPH between the years of 2008 and 2021. Demographics, comorbidities, bleeding disorders, operative time, and surgical procedure performed were collected for comparison between Kidney function groups: G1, normal/high function; G2-G3, mild/moderate kidney disease; and G4-G5, severe kidney disease. The 30-day peri-operative complications were measured and a multivariate logistic regression analysis was performed while adjusting for all confounding variables. Propensity score matching was performed between the G1 and G4-G5 cohorts. RESULTS A total of 83,020 patients were included. On multivariable regression, in the G2-G3 cohort, patients were at significantly increased risk for renal complications with OR = 2.43[1.56-3.79]. After propensity score matching, the G4-G5 cohort showed increased odds of pneumonia OR = 4.02[1.343-12.056], renal complications with OR = 7.62[2.283-25.411], cardiac complications OR = 4.53[1.531-13.411], and sepsis/septic shock OR = 1.76[1.091-2.834]. They also had a higher need for blood transfusion OR = 3.58[2.242-5.714], and prolonged hospital stay with OR = 1.49[1.296-1.723]. CONCLUSION Pre-operative kidney disease may pose an increased risk of complications for patients undergoing endoscopic BPH surgery. The literature lacks information on the effect of pre-operative kidney disease on endoscopic BPH surgeries. Further studies are required to compare post-operative outcomes of LEP and LVP as compared to TURP across kidney function status.
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Affiliation(s)
- Oussama G Nasrallah
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya T Herrera
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nassib F Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana H Mahdi
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Rami W Nasr
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Maroof H, Paramore L, Ali A. Theories behind Bacillus Calmette-Guérin failure in high-risk non-muscle-invasive bladder cancer and update on current management. CANCER PATHOGENESIS AND THERAPY 2024; 2:74-80. [PMID: 38601486 PMCID: PMC11002745 DOI: 10.1016/j.cpt.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 04/12/2024]
Abstract
Bladder cancer encapsulates a wide spectrum of disease severities, with non-muscle invasive bladder cancer (NMIBC) representing an entirely different entity from muscle-invasive disease. Bacillus Calmette-Guérin (BCG) is one of the most successful intravesical treatment methods for patients diagnosed. However, a considerable proportion of patients fail to respond to BCG treatment. Given the propensity for recurrence in patients with high-risk bladder cancer, these patients present with surgical dilemmas. There is currently no gold standard for salvage treatment post-BCG failure or unified definition as to what that means. In this review, we discuss the mechanisms of action and pathophysiology of BCG, potential theories behind BCG failure, and the scope of novel treatments for this surgical conundrum.
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Affiliation(s)
- Hanna Maroof
- Department of Urology, Frimley Park Hospital, Portsmouth Rd, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Louise Paramore
- Department of Urology, Frimley Park Hospital, Portsmouth Rd, Frimley, Camberley GU16 7UJ, United Kingdom
| | - Ahmed Ali
- Department of Urology, Frimley Park Hospital, Portsmouth Rd, Frimley, Camberley GU16 7UJ, United Kingdom
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Müllhaupt G, Hechelhammer L, Graf N, Mordasini L, Schmid HP, Engeler DS, Abt D. Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Obstruction: 5-year Outcomes of a Randomised, Open-label, Noninferiority Trial. Eur Urol Focus 2024:S2405-4569(24)00045-2. [PMID: 38531756 DOI: 10.1016/j.euf.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostatic artery embolisation (PAE) and transurethral resection of the prostate (TURP) are two of the surgical options for treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). Our aim was to compare the efficacy and safety of PAE and TURP for LUTS/BPO treatment at long-term follow-up. METHODS We conducted a randomised, open-label, single-centre trial at a Swiss tertiary care centre. The main outcome was the change in International Prostate Symptom Score (IPSS) after PAE versus TURP. Secondary outcomes included patient-reported outcomes, functional measures, and adverse events assessed at baseline and at 3, 6, 12, 24, and 60 mo. Between-group differences in the change from baseline to 5 yr were tested using two-sided Mann-Whitney and t tests. KEY FINDINGS AND LIMITATIONS Of the 103 patients with refractory LUTS/BPO who were randomised between 2014 and 2017, 18/48 who underwent PAE and 38/51 who underwent TURP reached the 60-mo follow-up visit. The mean reduction in IPSS from baseline to 5 yr was -7.78 points after PAE and -11.57 points after TURP (difference 3.79 points, 95% confidence interval [CI] -0.66 to 8.24; p = 0.092). TURP was superior for most patient-reported secondary outcomes except for erectile function. At 5 yr, PAE was less effective than TURP regarding objective parameters, such as the improvement in maximum urinary flow rate (3.59 vs 9.30 ml/s, difference -5.71, 95% CI -10.72 to -0.70; p = 0. 027) and reduction in postvoid residual volume (27.81 vs 219.97 ml; difference 192.15, 95% CI 83.79-300.51; p = 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS The improvement in LUTS/BPO at 5 yr after PAE was inferior to that achieved with TURP. The limitations of PAE should be considered during patient selection and counselling. PATIENT SUMMARY In this study, we show the long-term results of prostate artery embolisation (PAE) in comparison to transurethral resection of the prostate (TURP) for the treatment of benign prostate enlargement causing urinary symptoms. PAE shows good long-term results in properly selected patients, although the improvements are less pronounced than with TURP. This trial is registered on ClinicalTrials.gov as NCT02054013.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spital Thun, Thun, Switzerland.
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Nicole Graf
- Biostatistics Department, Clinical Trials Unit, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Uroviva Practice Sursee, Uroviva Group, Sursee, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spitalzentrum Biel, Biel, Switzerland
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Cussenot O, Taille Y, Portal JJ, Cancel-Tassin G, Roupret M, de la Taille A, Ploussard G, Mathieu R, Hamdy FC, Vicaut E. A Comprehensive National Survey of Prostate-specific Antigen Testing and Prostate Cancer Management in France: Uncovering Regional and Temporal Disparities. Eur Urol Oncol 2024:S2588-9311(24)00053-1. [PMID: 38472031 DOI: 10.1016/j.euo.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
We report nationwide real-life practice in the management of prostate cancer (PC) in France in a population of 4936750 men. All prostate-specific antigen (PSA) blood tests performed between 2006 and 2018 were recorded in a National Health registry, which allowed to identify 692516 men diagnosed with PC and a control population consisting of 3899509 men without PC. PSA tests, age at diagnosis, treatments, and survival were analysed. Their management was analysed by age range and compared in the different French regions. Disparities were found in age at PSA testing and management approaches (surveillance, and local and systemic therapies). We found that 50% of men had received five PSA blood tests, but the first PSA test was taken late in life, with a peak in the decade between 65 and 75 yr of age. Adoption of monitoring was low (12%). Older men appeared to receive a late diagnosis with reduced chances of curative therapy and a subsequent increase in mortality, but cautious interpretation of our data is warranted in view of competing morbidities and other causes of death. The incidence of metastases at diagnosis, indicated by the use of systemic therapies, increased progressively from 2011 onwards. PATIENT SUMMARY: In this study, we report nationwide real-life practice in the management of prostate cancer (PC) in France in a population of 4936750 men, including 692516 patients with PC. We found that the first prostate-specific antigen test is taken too late in life, leading to a late diagnosis with reduced chances of curative therapy and a subsequent increase in mortality.
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Affiliation(s)
- Olivier Cussenot
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; CeRePP, Paris, France.
| | - Yoann Taille
- Clinical Research Unit, AP-HP. Nord - University Paris Cité, Paris, France
| | | | - Géraldine Cancel-Tassin
- CeRePP, Paris, France; GRC n°5 Predictive Onco-Urology, AP-HP, Sorbonne Université, Paris, France
| | - Morgan Roupret
- CeRePP, Paris, France; GRC n°5 Predictive Onco-Urology, AP-HP, Sorbonne Université, Paris, France
| | - Alexandre de la Taille
- Department of Urology, AP-HP, Hopitaux Universitaires Henri Mondor, University of Creteil, Créteil, France
| | | | | | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Eric Vicaut
- Clinical Research Unit, AP-HP. Nord - University Paris Cité, Paris, France
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Brument M, Kulawik J, Cornu JN. RE: Baunacke M, et al. Insufficient utilization of care in male incontinence surgery: health care reality in Germany from 2006 to 2020 and a systematic review of the international literature. World J Urol. 2023 Jul;41(7):1813-1819. World J Urol 2023; 42:5. [PMID: 38133661 DOI: 10.1007/s00345-023-04756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Mathilde Brument
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France
| | - Justine Kulawik
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France
| | - Jean-Nicolas Cornu
- Department of Urology, Charles-Nicolle Hospital, University of Rouen Normandy, 76000, Rouen, France.
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7
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Kaplan S, Kaufman RP, Mueller T, Elterman D, Chughtai B, Rukstalis D, Woo H, Roehrborn C. Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare claims and utilization study. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00741-8. [PMID: 37884615 DOI: 10.1038/s41391-023-00741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Up to 50% of men over 50 and 80% over 80 are affected by BPH. Shared decision-making regarding BPH treatment options can benefit from an improved understanding of relative risks and benefits for various treatments. METHODS Data for this longitudinal retrospective population-based cohort study were obtained from a random sample of US Medicare and commercial claims (IBM Watson MarketScan) and restricted to men undergoing BPH surgery (TURP, PVP, PUL, WVTT) from 2015 to 2021 across all sites of service. Retreatments included Holmium laser enucleation and index procedures. Main outcomes were rates of retreatment and procedural complications over 1 year, identified via CPT and ICD-9/10CM codes. Procedural complications that occurred at least 1 day post-index treatment were assessed, as were surgical retreatments with patients who had at least 1 and 5 year's-worth of data. Baseline phenotype characterization did not control for symptomatology and was limited to age, comorbidities, and BMI. Univariate cumulative incidence estimates, cumulative proportion and log-rank tests justified inclusion for covariate (e.g., age, comorbidities) adjustment in Cox proportional hazard models. RESULTS 43,147 men diagnosed with BPH underwent 22,629 TURP, 11,392 PVP, 7,529 PUL, and 1,597 WVTT. At 1-year post-index: PUL was associated with the lowest rate of complication (PUL 15%, TURP 17%; PVP 19%, ; WVTT 26%); retreatment rates were not different (TURP 5.3%, PVP 5.3%, PUL 5.9%, WVTT 6.2%). At 5 years post-index: retreatment was lowest for TURP (7.0%) and was not significantly different between PVP and PUL (8.9% and 11.6%, respectively). CONCLUSIONS Real-world patients diagnosed with BPH may be selected to undergo one of the various available therapies based on patient preference or baseline phenotype. These therapies, however, are associated with different risks for complications. The results of this study suggest that within one year of BPH surgery, one-in-twenty patients may require retreatment regardless of treatment choice, and for some technologies as many as one-in-four may require treatment for a complication.
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Affiliation(s)
| | | | | | | | | | | | - Henry Woo
- University of Sydney, Sydney, Australia
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8
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Rieken M, de Nunzio C, Cornu JN, Ramasamy R, Misrai V, Malde S, Oelke M, Gacci M, Madersbacher S. Medical Treatment Incidence and Persistence After Surgical Relief of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction: A Critical Analysis of the Literature. Eur Urol Focus 2023:S2405-4569(23)00193-1. [PMID: 37758614 DOI: 10.1016/j.euf.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT The incidence and risk factors for persisting pharmacotherapy following surgical treatment of benign prostatic obstruction (BPO) remain unclear. OBJECTIVE To evaluate the evidence on persisting pharmacotherapy of lower urinary tract symptoms (LUTS) following surgical treatment of BPO. EVIDENCE ACQUISITION A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PROSPERO ID CRD42022310598). PubMed and EMBASE databases were searched in February 2022, with an updated search in October 2022. Studies evaluating pharmacotherapy in men aged >18 yr following surgical treatment of BPO were included. EVIDENCE SYNTHESIS Overall, ten nonrandomized studies and one post hoc analysis of two randomized controlled trials were included. The incidence of persisting medical treatment or medical retreatment varied strongly between time points and investigated surgical techniques. Among the investigated techniques, most data were available for transurethral resection of the prostate (TURP). Persistence of pharmacotherapy after TURP at 6 mo ranged from 8.7% to 57% for the use of alpha-blockers. The use of 5-alpha reductase inhibitors after TURP ranged from 5.5% at 6 mo to 19% at 6-24 mo, whereas the use of antimuscarinics ranged from 3.4% to 28.1% at 6 mo. Data on initiation of pharmacotherapy after TURP also differed between study and type of medication. At 12 yr, the use of alpha-blockers after TURP ranged from 12% to 38%. The risk factors associated with medication after BPO surgery were age, history of diabetes mellitus, history of cerebrovascular accident, preoperative medication use, as well as surgical techniques other than laser enucleation of the prostate. CONCLUSIONS Pharmacotherapy for LUTS is common after BPO surgery. The outcomes following different surgical techniques are heterogeneous, with limited data from randomized controlled trials. Future studies on surgical treatment of BPO should include the use of LUTS-related pharmacotherapy after BPO surgery as a secondary endpoint. PATIENT SUMMARY In the present systematic review, we investigated the risk of ongoing or novel therapy with drugs following surgery for benign prostate enlargement. We found that a non-negligible proportion of men will need to take drug therapy after surgery. Certain risk factors can be identified, which are associated with a higher risk of drug therapy after surgery.
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Affiliation(s)
- Malte Rieken
- alta uro AG, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Cosimo de Nunzio
- U.O.C. di Urologia, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | | | | | | | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matthias Oelke
- Department of Urology, Prostate Center North-West, St. Antonius-Hospital, Gronau, Germany
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Baboudjian M, Cornu JN, Gondran-Tellier B, Fourmarier M, Robert G, Peyronnet B, Misrai V, Pradere B. Pharmacologic and Surgical Retreatment After Office-based Treatments for Benign Prostatic Hyperplasia: A Systematic Review. Eur Urol Focus 2023; 9:727-733. [PMID: 36906484 DOI: 10.1016/j.euf.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
CONTEXT Office-based treatments are increasingly offered as an optional step to replace medical treatment or delay surgery for male lower urinary tract symptoms (LUTS). Nevertheless, little is known regarding the risks of retreatment. OBJECTIVE To systematically evaluate the current evidence regarding retreatment rates after water vapor thermal therapy (WVTT), prostatic urethral lift (PUL), and temporarily implanted nitinol device (iTIND) procedures. EVIDENCE ACQUISITION A literature search was conducted up to June 2022 using the PubMed/Medline, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify eligible studies. The primary outcomes were the rates of pharmacologic and surgical retreatment during follow-up. EVIDENCE SYNTHESIS A total of 36 studies including 6380 patients met our inclusion criteria. Surgical and minimally invasive retreatment rates were generally well reported in the studies included and reached up to 5% after 3 yr of follow-up for iTIND, and up to 4% for WVTT and 13% for PUL after 5 yr of follow-up. The types and rates of pharmacologic retreatment are poorly reported in the literature, with the latter reaching up to 7% after 3 yr of follow-up for iTIND, and up to 11% after 5 yr of follow-up for WVTT and PUL. The main limitations of our review are the unclear to high risk of bias in most of the studies included and the lack of long-term (>5 yr) data on retreatment risks. CONCLUSIONS Our results highlight the low retreatment rates at mid-term follow-up after office-based treatments for LUTS, supporting the development of these strategies as an intermediate step between BPH medication and conventional surgery. Pending more robust data with longer follow-up, these results should be used to improve patient information and facilitate shared decision-making. PATIENT SUMMARY Our review highlights the low risk of mid-term retreatment after office-based treatments for benign enlargement of the prostate that is affecting urinary function. For well-selected patients, these results support the increasing use of office-based treatment as an intermediate option before conventional surgery.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, APHM, La Conception Hospital, Marseille, France; Department of Urology, APHM, North Academic Hospital, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | | | - Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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10
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Sapoval M, Thiounn N, Descazeaud A, Déan C, Ruffion A, Pagnoux G, Duarte RC, Robert G, Petitpierre F, Karsenty G, Vidal V, Murez T, Vernhet-Kovacsik H, de la Taille A, Kobeiter H, Mathieu R, Heautot JF, Droupy S, Frandon J, Barry Delongchamps N, Korb-Savoldelli V, Durand-Zaleski I, Pereira H, Chatellier G. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 31:100672. [PMID: 37415648 PMCID: PMC10320610 DOI: 10.1016/j.lanepe.2023.100672] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Abstract
Background Prostatic artery embolisation (PAE) is a minimally invasive treatment of symptomatic benign prostatic hyperplasia (BPH). Our aim was to compare patient's symptoms improvement after PAE and medical treatment. Methods A randomised, open-label, superiority trial was set in 10 French hospitals. Patients with bothersome lower urinary tract symptoms (LUTS) defined by International Prostatic Symptom Score (IPSS) > 11 and quality of life (QoL) > 3, and BPH ≥50 ml resistant to alpha-blocker monotherapy were randomly assigned (1:1) to PAE or Combined Therapy ([CT], oral dutasteride 0.5 mg/tamsulosin hydrochloride 0.4 mg per day). Randomisation was stratified by centre, IPSS and prostate volume with a minimisation procedure. The primary outcome was the 9-month IPSS change. Primary and safety analysis were done according to the intention-to-treat (ITT) principle among patients with an evaluable primary outcome. ClinicalTrials.gov Identifier: NCT02869971. Findings Ninety patients were randomised from September 2016 to February 2020, and 44 and 43 patients assessed for primary endpoint in PAE and CT groups, respectively. The 9-month change of IPSS was -10.0 (95% confidence interval [CI]: -11.8 to -8.3) and -5.7 (95% CI: -7.5 to -3.8) in the PAE and CT groups, respectively. This reduction was significantly greater in the PAE group than in the CT group (-4.4 [95% CI: -6.9 to -1.9], p = 0.0008). The IIEF-15 score change was 8.2 (95% CI: 2.9-13.5) and -2.8 (95% CI: -8.4 to 2.8) in the PAE and CT groups, respectively. No treatment-related AE or hospitalisation was noticed. After 9 months, 5 and 18 patients had invasive prostate re-treatment in the PAE and CT group, respectively. Interpretation In patients with BPH ≥50 ml and bothersome LUTS resistant to alpha-blocker monotherapy, PAE provides more urinary and sexual symptoms benefit than CT up to 24 months. Funding French Ministry of Health and a complementary grant from Merit Medical.
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Affiliation(s)
- Marc Sapoval
- Université de Paris Cité, PARCC - INSERM Unité-970, Paris, France
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Nicolas Thiounn
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Aurélien Descazeaud
- Centre Hospitalier Universitaire de Limoges, Department of Urology, Limoges, France
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
- Université Lyon 1, Faculté de médecine Lyon Sud, Equipe 2 - Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Lyon, France
| | - Gaële Pagnoux
- Department of Uroradiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology and Transplantation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Grégoire Robert
- Centre Hospitalier Universitaire de Bordeaux, Department of Urology, Université de Bordeaux, Bordeaux, France
| | - Francois Petitpierre
- Centre Hospitalier Universitaire de Bordeaux, Department of Diagnostic and Therapeutic Imaging, Bordeaux, France
| | - Gilles Karsenty
- Department of Urology and Renal Transplantation, Assistance publique-Hôpitaux de Marseille, Hôpital de la Conception, Aix-Marseille Université, Marseille, France
| | - Vincent Vidal
- Centre Hospitalier Universitaire de la Timone, Interventional Radiology Section, Department of Medical Imaging, Assistance publique-Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, LiiE, CERIMED, Marseille, France
| | - Thibaut Murez
- Centre Hospitalier Universitaire de Montpellier, Department of Urology and Renal Transplantation, Montpellier, France
| | - Hélène Vernhet-Kovacsik
- Centre Hospitalier Universitaire de Montpellier, Department of Diagnostic and Interventional Radiology, Hôpital Arnaud-de-Villeneuve, Montpellier, France
| | - Alexandre de la Taille
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Hicham Kobeiter
- Department of Diagnostic and Interventional Medical Imaging, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Université Paris Est, Créteil, France
| | - Romain Mathieu
- Centre Hospitalier Universitaire de Rennes, Department of Urology, Rennes, France
| | - Jean-Francois Heautot
- Centre Hospitalier Universitaire de Rennes, Vascular Medicine Unit, Department of Radiology, Hôpital Pontchaillou, Rennes, France
| | - Stéphane Droupy
- Centre Hospitalier Universitaire De Nîmes, Department of Urology and Andrology, Université de Montpellier, Nîmes, France
| | - Julien Frandon
- Centre Hospitalier Universitaire De Nîmes, Department of Medical Imaging, Université de Montpellier, Nîmes, France
- Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Nicolas Barry Delongchamps
- Université de Paris Cité, Inserm Unit U1151, Paris, France
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Virginie Korb-Savoldelli
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
- Department of Clinical Pharmacy, Université Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, France
| | - Isabelle Durand-Zaleski
- Université de Paris Cité, CRESS, INSERM UMR1153, INRA, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital de l'Hôtel Dieu, Université Paris Est Créteil, URCEco, Paris, France
| | - Helena Pereira
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, Paris, France
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Gilles Chatellier
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, Paris, France
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
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11
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de la Taille A, Chalret du Rieu Q, Dialla O, Bardin L. [Alpha-blockers or hexanic extract of Serenoa repens for 6 months: sub-analysis of the PERSAT study]. Prog Urol 2023; 33:66-72. [PMID: 36207246 DOI: 10.1016/j.purol.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this sub-analysis of the PERSAT study was to evaluate the efficacy of hexanic extract of S. Repens (HESr) and alpha-blockers (AB), at 6 months in patients with moderate to severe LUTS/BPH. METHODS The PERSAT observational study was conducted in France by general practitioners on patients with BPH with an IPSS≥12 score. The primary endpoint was the percentage of responders (decrease in total IPSS score ≥ 3) at 6 months. Improvement in quality of life (IPSS-QoL) as well as patient satisfaction were also measured. RESULTS Of the 759 patients in the study, 324 treated with HESr and 309 with AB were reviewed at 6 months, with no change in treatment during follow-up. Characteristics at inclusion were globally similar with a mean IPSS of 18.2±4.9. The response rates at 6 months (IPSS-total decrease ≥ 3) were 93.7% and 94.8% for patients treated with HESr and AB, with a mean decrease in IPSS score of 10.1±5.6 points, which reached 13.6 and 14.8 points respectively, in severe patients (IPSS>19), without major difference between groups. More than 95% of HESr or AB patients reported a significant overall improvement in their LUTS/BPH. The most frequently reported adverse events with AB were ejaculation disorders (4.9%) and hypotension (4.2%) and with HESr digestive disorders (1.5%). CONCLUSION This sub-analysis of the PERSAT cohort reported the clinical efficacy of HESr and AB as a first-line treatment in the management of moderate or severe LUTS/BPH patients. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Alexandre de la Taille
- Département de chirurgie urologique, CHU de Henri-Mondor, Assistance Publique Hôpitaux de Paris, 94010 Créteil, France.
| | - Quentin Chalret du Rieu
- Direction médicale pharmaceutical dermato, consumer care France, péraudel, 17, avenue Jean Moulin, 81100 Castres, France
| | - Olivia Dialla
- Direction RWE valorisation médicale et manifestations scientifiques, laboratoires Pierre Fabre, 33, avenue Emile Zola, 92012 Boulogne, France
| | - Laurent Bardin
- Direction médicale pharmaceutical dermato, consumer care France, péraudel, 17, avenue Jean Moulin, 81100 Castres, France
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12
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Mesnard B, Lecoq J, De Vergie S, Perrouin Verbe MA, Chelghaf I, Karam G, Rigaud J, Descazeaud A, Robert G, Branchereau J. [Prostatic hyperplasia: Evaluation of practices in general practice, dissemination, and impact of recommendations]. Prog Urol 2023; 33:58-65. [PMID: 35842333 DOI: 10.1016/j.purol.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION In 2015, the French Association of Urology, by the male lower urinary tract symptoms Committee, published a practices guideline for the management of prostatic hyperplasia in general practice. Five years after the publication of these recommendation, our objective is to assess their dissemination and their impact in general practice. MATERIAL A specially designed questionnaire was distributed online via the departmental councils of the order and to all regional unions of liberal doctors. The distribution to general practitioners was at the discretion of each organisation depending on local policies. RESULTS Two hundred and eighty responses were collected. Fifty-five percent of the population was female. 83 % of the general practitioners did not report having knowledge of the practice guideline. 77 % of doctors stated that they had not received training or information on prostatic hyperplasia in the past 5 years. Among the notable results, 51 % of general practitioners declared performing a digital rectal examination. 44 % prescribed an endorectal ultrasound. Only 7 % of doctors were aware of the existence of minimally invasive surgical techniques. CONCLUSION The practices guideline for the management of prostatic hyperplasia in general practice proposed in 2015 by the male lower urinary tract symptoms Committee seems to be little known by general practitioners. Dissemination of these recommendations solely through publication in Progrès en Urologie seems ill-suited to consideration by general practitioners, and it seems necessary to consider other modes of dissemination. LEVEL OF EVIDENCE 4, grade C.
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Affiliation(s)
- B Mesnard
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - J Lecoq
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - S De Vergie
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - M A Perrouin Verbe
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - I Chelghaf
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - G Karam
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - J Rigaud
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | - A Descazeaud
- Department of Urology, University Hospital of Limoges, Limoges, France
| | - G Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, University of Bordeaux, Bordeaux, France
| | - J Branchereau
- Department of Urology, Hôtel-Dieu Hospital, University of Nantes, Nantes, France.
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13
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Armando LG, Baroetto Parisi R, Remani E, Esiliato M, Rolando C, Vinciguerra V, Diarassouba A, Cena C, Miglio G. Persistence to Medications for Benign Prostatic Hyperplasia/Benign Prostatic Obstruction-Associated Lower Urinary Tract Symptoms in the ASL TO4 Regione Piemonte (Italy). Healthcare (Basel) 2022; 10:healthcare10122567. [PMID: 36554090 PMCID: PMC9778582 DOI: 10.3390/healthcare10122567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pharmacological treatment of benign prostatic hyperplasia (BPH)/benign prostatic obstruction (BPO)-associated lower urinary tract symptoms (LUTS) aims at improving patients' quality of life by managing urinary symptoms and preventing complications and disease progression. However, continuous use of drugs to treat BPH/BPO-associated LUTS decreases over time. The aim of this retrospective observational study was to describe use of α1-adrenoceptor antagonists (ABs) and steroid 5α-reductase inhibitors (5ARIs) by adult (age ≥ 40 years) men in the ASL TO4, a Local Health Authority in the northern area of the city of Turin (Italy). METHODS Persistence measures were adopted as a robust, informative, and feasible way to understand medication-taking behavior and to assess patient compliance. RESULTS A total of 4309 men (median age 71 years) were enrolled. Monotherapy was the treatment option prescribed to the largest part of the study population. However, ≥two drugs were prescribed to a substantial proportion of men (23%). Men prescribed alfuzosin or dutasteride had significantly greater persistence, which decreased over time. CONCLUSIONS Unmet needs and areas of intervention for healthcare systems aimed at improving the use of drugs for BHP/BPO-associated LUTS in the ASL TO4 Regione Piemonte were identified.
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Affiliation(s)
- Lucrezia Greta Armando
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Raffaella Baroetto Parisi
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Elisa Remani
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Mariangela Esiliato
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Cristina Rolando
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Valeria Vinciguerra
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Abdoulaye Diarassouba
- Struttura Complessa Farmacia Territoriale ASL TO4, Regione Piemonte, Via Po 11, 10034 Chivasso, Italy
| | - Clara Cena
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Gianluca Miglio
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
- Competence Centre for Scientific Computing, University of Turin, Corso Svizzera 185, 10149 Turin, Italy
- Correspondence: ; Tel.: +39-0116707150
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14
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Zhang J, Du Y, Zhang Y, Xu Y, Fan Y, Li Y. 1H-NMR Based Metabolomics Technology Identifies Potential Serum Biomarkers of Colorectal Cancer Lung Metastasis in a Mouse Model. Cancer Manag Res 2022; 14:1457-1469. [PMID: 35444465 PMCID: PMC9015044 DOI: 10.2147/cmar.s348981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Lung metastasis is a common metastasis site of colorectal cancer which largely reduces the quality of life and survival rates of patients. The discovery of potential novel diagnostic biomarkers is very meaningful for the early diagnosis of colorectal cancer with lung metastasis. Methods In the present study, the metabonomic profiling of serum samples of lung metastasis mice was analyzed by 1H-nuclear magnetic resonance (1H-NMR). Principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal partial least squares discriminant analysis (OPLS-DA) were used to elucidate the distinguishing metabolites between different groups, and all achieved excellent separations, which indicated that metastatic mice could be differentiated from control mice based on the metabolic profiles at serum levels. Furthermore, during lung metastasis of colorectal cancer, metabolic phenotypes changed significantly, and some of metabolites were identified. Results Among these metabolites, approximately 15 were closely associated with the lung metastasis process. Pathway enrichment analysis results showed deregulation of metabolic pathways participating in the process of lung metastasis, such as synthesis and degradation of ketone bodies pathway, amino acid metabolism pathway and pyruvate metabolism pathway. Conclusion The present study demonstrated the metabolic disturbances of serum samples of mice during the lung metastasis process of colorectal cancer and provides potential diagnostic biomarkers for the disease.
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Affiliation(s)
- Junfei Zhang
- Shanxi Provincial People’s Hospital Affiliated to Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Yuanxin Du
- Department of Pharmacology, Basic Medical Sciences Center, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Yongcai Zhang
- First Hospital of Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Yanan Xu
- Medical Imaging Department of Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Yanying Fan
- Department of Pharmacology, Basic Medical Sciences Center, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Yan Li
- Department of Pharmacology, Basic Medical Sciences Center, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
- Correspondence: Yan Li; Yanying Fan, Department of Pharmacology, Basic Medical Sciences Center, Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, 56#, Xin Jian South Road, Taiyuan, Shanxi Province, 030001, People’s Republic of China, Email ;
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15
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The UroLift implant: mechanism behind rapid and durable relief from prostatic obstruction. Prostate Cancer Prostatic Dis 2022; 25:79-85. [PMID: 34363010 PMCID: PMC9018420 DOI: 10.1038/s41391-021-00434-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/16/2021] [Accepted: 07/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is an affliction of the aging male population that contributes to bothersome and disruptive lower urinary tract symptoms (LUTS). The UroLift® implant has been developed as a mechanical means of widening the prostatic urethra and providing relief from lower urinary tract symptoms (LUTS) through a minimally invasive procedure. METHODS In the current study, we utilize histological results from canine tissue, resected tissue from human subjects treated with the UroLift System and post-market surveillance data collected by the manufacturer in order to elucidate the long-term biological mechanism of action of the UroLift implant. RESULTS The delivery of the implant causes tissue compression, likely resulting in focal ischemia that causes observed local atrophy and minimal-mild chronic inflammation that ultimately remodels tissue to produce a widened prostatic urethra. CONCLUSIONS These studies reveal the lack of impact the device has on systemic tissue, providing evidence that the UroLift System is benign and biocompatible, and offering histologic explanation for the clinically observed durability.
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Madersbacher S. Re: Medication Discontinuation Following Transurethral Prostatectomy: An Unrecognized Effectiveness Measure? Eur Urol 2021; 80:760. [PMID: 34474949 DOI: 10.1016/j.eururo.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Stephan Madersbacher
- Department of Urology, Clinic Favoriten, Sigmund Freud Private Medical University, Vienna, Austria.
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17
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Sabbagh P, Dupuis H, Cornu JN. State of the art on stress incontinence management after benign prostatic obstruction surgery. Curr Opin Urol 2021; 31:473-478. [PMID: 34397505 DOI: 10.1097/mou.0000000000000924] [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: 11/25/2022]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation. RECENT FINDINGS Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience. SUMMARY The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population.
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Affiliation(s)
- Paul Sabbagh
- From the Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
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18
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How I Handle Retreatment of LUTS Following a Failed MIST. Curr Urol Rep 2021; 22:40. [PMID: 34115242 DOI: 10.1007/s11934-021-01054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review retreatment management after failed minimally invasive treatment (MIST) of various technologies. RECENT FINDINGS A failed MIST can be defined by the return, persistence, or worsening of LUTS, as documented by symptom scores. Persistence, development, or recurrence of comorbidities such as recurrent urinary tract infection (UTI), retention, stones, hematuria, and incontinence can also signal a failed MIST. The common etiology for MIST failure is the preoperative consequence of long-term bladder outlet obstruction (BOO) on the bladder function. Close monitoring of therapies with antimuscarinics or beta-agonists can be empirically utilized if post-void bladder residual (PVR) is low. If there is a high PVR, urodynamic studies and cystoscopy can be used to determine overactive bladder (OAB), BOO, or necrosis. Depending on the timing of the observed BOO/OAB, subsequent retreatments involving transurethral debridement, medical and behavioral therapies, or repeat surgical debulking can be employed.
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Kim A, Hak AJ, Choi WS, Paick SH, Kim HG, Park H. Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study. Urology 2021; 154:300-307. [PMID: 33933503 DOI: 10.1016/j.urology.2021.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate and compare the postoperative efficacy and complications of the transurethral resection of prostate (TURP) and holmium laser enucleation (HoLEP) using the nationwide insurance database of Korea. METHODS We created a cohort of benign prostatic hyperplasia (BPH) patients treated with TURP and HoLEP between 2011 and 2017 from the nationwide database of reimbursement. We compared the postoperative effects between the two surgical groups. RESULTS We retrieved a total of 58,346 patients (TURP 38,308 and HoLEP 20,038 patients). The mean follow-up duration was 51.6 and 47.6 months, respectively. The rate of reoperation was significantly higher in the TURP group (4.50%) than in the HoLEP group (1.27%) (P < .01). The postoperative use of alpha-blockers and dutasteride/finasteride was significantly higher in the TURP group until 24 months postoperatively. The rate of the postoperative use of medications for symptoms of overactive bladder was lower in the TURP group than in the HoLEP group until 12 months postoperatively, but it did not differ after 12 months postoperatively. Overall, urethral surgeries were less frequently performed in the TURP group than in the HoLEP group (P < .05); however, more severe cases required surgeries under general anesthesia in the TURP group (P < .05). Postoperative surgery for stress incontinence was performed in 0.10% and 0.31% of patients after TURP and HoLEP, respectively (P < .01). CONCLUSION This study showed the superiority of HoLEP compared to TURP in terms of postoperative efficacy and its inferiority in terms of complications of stress incontinence in real life practice.
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Affiliation(s)
- Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - An-Jae Hak
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Suk Choi
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Hyun Paick
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyeong Gon Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - HyoungKeun Park
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
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20
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Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC. Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety. World J Urol 2021; 39:4389-4395. [PMID: 33837819 DOI: 10.1007/s00345-021-03688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.
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Affiliation(s)
- Kyle W Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
| | | | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Félix Couture
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Ahmed S Zakaria
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Hannes Cash
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,PROURO, Berlin, Germany.,Department of Urology, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees, France
| | - Dean Elterman
- Division of Urology, Department of Surgery, University. Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada.
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21
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Rabinowitz MJ, Alam R, Liu JL, Kohn TP, Bhanji Y, Peña VN, Herati AS. Prostatic Urethral Lift in Patients With Obstructive Median Lobes: A Single Surgeon Experience at an Academic Center. Urology 2021; 154:237-242. [PMID: 33493510 DOI: 10.1016/j.urology.2021.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the long-term efficacy of prostatic urethral lift (PUL) for treating men, with or without an obstructive median lobe (OML), who suffer from lower urinary tract symptoms attributed to benign prostatic hyperplasia. MATERIALS AND METHODS A retrospective review was performed on all consecutive PUL cases with or without OML from October 2017 to November 2019 by a single academic surgeon. Outcomes were measured using the International Prostate Symptoms Survey (IPSS) with quality of life (QoL) scores. Comparative testing and mixed-effects linear regression analysis were utilized with significance set at α = 0.05 and performed with Stata (College Station, TX). RESULTS A total of 110 PUL procedures were performed on 106 patients (4 repeat surgeries) with a median age of 66.5 (interquartile range: 60.4-73.7). Twenty-three patients (21.7%) had an OML. Following PUL, patients in both groups showed significant improvements in IPSS (P <.001) and QoL (P <.001) scores. When stratifying by OML and controlling for confounding, IPSS scores in both groups displayed statistically significant improvement at follow-up visits, with no statistically significant intergroup difference (P = .32). The same held true for QoL improvements, with no statistically significant difference between groups (P = .18). The presence of an OML resulted in minimal effects on perioperative outcomes and complications but required significantly more implants (P = .008). CONCLUSION PUL is a minimally invasive procedure effective at reducing lower urinary tract symptoms and improving the lives of men with benign prostatic hyperplasia without incurring risks of serious complications. These improvements were equivalent and upheld in patients who presented with OML.
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Affiliation(s)
- Matthew J Rabinowitz
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James L Liu
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taylor P Kohn
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yasin Bhanji
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vanessa N Peña
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amin S Herati
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
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22
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Klein C, Marquette T, Comat V, Alezra E, Capon G, Bladou F, Ferriere JM, Bensadoun H, Bernhard JC, Robert G. Evolution of Day-Case Holmium Laser Enucleation of the Prostate Success Rate Over Time. J Endourol 2021; 35:342-348. [PMID: 32935563 DOI: 10.1089/end.2020.0337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To describe the evolution of day-case success rate over the years and to identify predictive factors for prolonged hospitalization or readmissions. Methods: Retrospective review of all consecutive day-case holmium laser enucleation of the prostate (HoLEP) performed by a single surgeon between January 2013 and February 2019 using a prospective database. Day-case success was defined as discharge within less than 12 hours from admission without any readmission within 48 hours after discharge. Protocol for day-case treatment included systematic bladder catheter insertion with continuous irrigation for ∼2 hours and catheter removal on postoperative day 1. Patients were reached by phone on postoperative day 1 to ensure voiding. For the descriptive statistics, an analysis of variance was performed. Univariate and multivariate analyses were used to identify risk factors. Results: A total of 266 patients were retrieved and dispatched as follows: group 1 (n = 88) from January 2013 to July 2015, group 2 (n = 89) from August 2015 to June 2017, and group 3 (n = 89) from July 2017 to February 2019. The overall success rate was 80.5% (214/266) over the study period. It significantly improved over time from 70% in group 1 to 84% in group 2 and 87% in group 3 (p = 0.014). In the meantime, the operating time and the total energy delivered to the tissue decreased from 77 minutes in the first group to 60.4 minutes in the second group and 55.4 minutes in the third group (p < 0.001), and from 95.2 kJ in the first group to 84 kJ in the second group and 77.9 kJ in the third group (p = 0.041). On multivariate analysis, the only risk factor significantly associated with day-case failure was prostate volume greater than 90 cc (odds ratio = 2.041, p = 0.047). Conclusion: Day-case HoLEP is a reliable and safe procedure with a high success rate. The surgeon's experience seems to be crucial to improve perioperative outcomes, but prostate volume greater than 90 cc remains associated with higher failure rates.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Thibault Marquette
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Vincent Comat
- Department of Urology, Bayonne Hospital, Bayonne, France
| | - Eric Alezra
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Gregoire Capon
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Jean-Marie Ferriere
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Henri Bensadoun
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Jean-Christophe Bernhard
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
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23
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Phé V, Gamé X. [Male non-neurogenic overactive bladder]. Prog Urol 2020; 30:880-886. [PMID: 33220816 DOI: 10.1016/j.purol.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Male lower urinary tract symptoms (LUTS) and in particular overactive bladder (OAB) are a frequent reason for consultation in urology and have a significant functional impact in patients. OBJECTIVE To synthesize current knowledge on non-neurogenic OAB in male patients. METHOD A systematic literature review based on Pubmed, Embase, Google Scholar was conducted in June 2020. RESULTS The prevalence of OAB and benign prostatic hyperplasia increases with age. Symptoms of OAB, on the one hand, and symptoms of prostatic bladder outlet obstruction, on the other hand, can be concomitant and the causal link between the two types of symptoms is difficult to establish. In case of mixed symptoms, it is recommended to treat the most troublesome type of symptoms first and to inform the patient of the risks of failure or deterioration. Indeed, many patients remain symptomatic after prostate surgery and the predictive factors for failure remain to be defined. Thus, preoperative urodynamics is not routinely performed even in case of OAB. De novo detrusor overactivity after radical prostatectomy can reach 77% and persists in the majority of cases. The overall relative risk of storage symptoms after radiotherapy and brachytherapy is higher than that after prostatectomy. The etiology of OAB after prostate surgery is multifactorial. While drug treatments have proven to be effective, little data exists on second-line treatments for OAB after prostate surgery. CONCLUSION OAB in men is often linked to a prostatic bladder outlet obstruction. It is essential to inform patients about the possibility of persistence, deterioration, or occurrence of OAB after prostate surgery while the predictors of surgical failure are not clearly defined.
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Affiliation(s)
- V Phé
- Sorbonne université, hôpital Pitié-Salpêtrière, service d'urologie, assistance publique-hôpitaux de Paris, Paris, France.
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, université Paul-Sabatier, Toulouse, France
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24
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Alegorides C, Fourmarier M, Eghazarian C, Lebdai S, Chevrot A, Droupy S. Treatment of benign prostate hyperplasia using the Rezum® water vapor therapy system: Results at one year. Prog Urol 2020; 30:624-631. [DOI: 10.1016/j.purol.2020.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 11/16/2022]
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Ayele HT, Reynier P, Azoulay L, Platt RW, Cabaussel J, Benayoun S, Filion KB. Trends in the pharmacological treatment of benign prostatic hyperplasia in the UK from 1998 to 2016: a population-based cohort study. World J Urol 2020; 39:2019-2028. [PMID: 32909173 DOI: 10.1007/s00345-020-03429-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/30/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe trends in the pharmacological treatment of BPH in the United Kingdom (UK) from 1998 to 2016. METHODS We created a cohort of men with a diagnosis of BPH between 1998 and 2016 using the Clinical Practice Research Datalink. Using Poisson regression, we estimated annual prescription rates of 5αRIs, α-blockers, and combination therapy (5αRIs + α-blockers). Adherence was defined by a proportion of days covered > 80%. RESULTS Our cohort included 192,640 men with BPH who generated 1,176,264 person-years (PYs) of follow-up. The mean age was 68.0 (standard deviation: 10.7) years. The prescription rate of all BPH medications during the study period was 347.6 per 100 PYs (95% CI 347.2-347.9). α-Blockers had the highest prescription rate (222.9 per 100 PYs, 95% CI 222.7-223.2); prescription rates of 5αRIs and combination therapy were 69.1 per 100 PYs (95% CI 69.0-69.3) and 55.5 per 100 PYs (95% CI 55.4-55.7), respectively. The prescription rate for combination therapy was 19 times greater in 2013-2016 than in 1998-2000 (rate ratio: 19.2, 95% CI 18.6-19.7), while the prescription rates for 5αRIs and α-blockers each doubled during this period (rate ratio: 1.86, 95% CI 1.84-1.88 and rate ratio: 2.02, 95% CI 2.01-2.04, respectively). The proportion of patients who were adherent at 1 year to 5αRIs (32.3%), α-blockers (44.0%), and combination therapy (45.6%) was low. CONCLUSION The prescription rate of BPH medications increased substantially between 1998 and 2016 in the UK, with the greatest relative increase observed with combination therapy. Adherence to BPH medications was low in this population-based study.
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Affiliation(s)
- Henok Tadesse Ayele
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montréal, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada.,Department of Pediatrics, McGill University, Montréal, Canada
| | - Josselin Cabaussel
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
| | - Serge Benayoun
- Department of Surgery, Urology Unit, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada. .,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada. .,Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, 3755 Cote Ste Catherine, Suite H410.1, Montreal, QC, H3T 1E2, Canada.
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de la Taille A, Bardin L, Castagné C, Auges M, Capronnier O, Chalret du Rieu Q. [Alpha-blockers or phytotherapy as first-line treatment of LUTS/BPH in general medicine: The PERSAT non-interventional study]. Prog Urol 2020; 30:522-531. [PMID: 32753297 DOI: 10.1016/j.purol.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of the PERSAT study was to evaluate first-line treatment of BPH-associated LUTS in real-life conditions. METHODS This prospective observational study was conducted in France by general practitioners (GP) on patients with moderate to severe LUTS (IPSS ≥12). GPs freely decided to prescribe either an alpha-blocker (AB) or phytotherapeutic treatment (PT). The main criterion was the percentage of responding patients (decrease in total IPSS score ≥3) at 6 months. RESULTS Of the 849 patients included, 759 were analysed (381 treated with AB and 378 with PT); 718 were followed up at 6 months, 90% of which had no treatment modification. Their inclusion characteristics were similar between the AB and PT groups (mean IPSS: 18.6±4.5 and 17.8±4.1, respectively). Treatment response rates at 6 months were 94.2% [91.2%; 96.4%] in AB and 92.5% [89.2%; 95.1%] in PT. The IPSS decreased by 10.0±5.6 points, with no difference between groups. The proportion of patients bothered by their LUTS (IPSS-QoL ≥4) evolved from 88.5% to 6.5% at 6 months. The improvement of LUTS was perceived by more than 94% of patients (PGI-I) and doctors (CGI-I), 93% of patients were satisfied with the treatment at 6 months, regardless of the treatment initiated. The most reported adverse reactions were ejaculation disorder (3.9% for AB and 0.9% for PT). CONCLUSION PERSAT confirms in current practice the effectiveness of AB and PT treatments, recommended as first-line treatment in LUTS/BPH. LEVEL OF PROOF 3.
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Affiliation(s)
- A de la Taille
- Département de chirurgie urologique, CHU Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
| | - L Bardin
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
| | - C Castagné
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
| | - M Auges
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
| | | | - Q Chalret du Rieu
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
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27
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Cornu JN. Hyperplasie bénigne de la prostate et incontinence urinaire. Prog Urol 2020; 30:3S10-3S20. [DOI: 10.1016/s1166-7087(20)30194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Heidar NA, Labban M, Misrai V, Mailhac A, Tamim H, El-Hajj A. Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database. World J Urol 2020; 38:2891-2897. [PMID: 32036397 DOI: 10.1007/s00345-020-03100-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/19/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To compare the perioperative outcomes associated with laser enucleation of the prostate (LEP) and transurethral resection of the prostate (TURP) using a national database. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent TURP or LEP from 2008 to 2016. Baseline demographics, comorbidities, and predisposition to bleeding were compared between TURP and LEP. The 30-day perioperative outcomes including operative time, length of hospital stay (LOS), return to the operating room (OR), bleeding requiring transfusion, and organ system-specific complications were compared between the procedures. A multivariate logistic regression analysis was performed, adjusting for the type of surgery and other covariates. RESULTS The series included 37,577 TURP and 2869 LEP procedures. While TURP was associated with a shorter operative time (55.20 ± 37.80 min) than LEP (102.80 ± 62.30 min), the latter was associated with a shorter hospital stay (1.29 ± 2.73 days) than TURP (2.05 ± 5.20 days). Compared to TURP, LEP had 0.52 (0.47-0.58) times the odds of a LOS > 1 day and 0.67 (0.54-0.83) times the odds of developing urinary tract infections. Nevertheless, no difference was found for other postoperative complications, need for transfusion, and return to OR. CONCLUSION Real-life data from a large national database confirmed that LEP is a safe and reproducible procedure to treat benign prostatic obstruction. Compared to TURP, LEP was associated with a lower rate of infectious complications and a shorter LOS at the expense of an increased operative time.
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Affiliation(s)
- Nassib Abou Heidar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Muhieddine Labban
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Aurelie Mailhac
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon
| | - Hani Tamim
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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De Wachter S, Hervé F, Averbeck M. Can we predict the success of prostatic surgery for male lower urinary tract symptoms: ICI-RS 2018? Neurourol Urodyn 2019; 38 Suppl 5:S111-S118. [PMID: 31821634 DOI: 10.1002/nau.24036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/11/2019] [Indexed: 11/05/2022]
Abstract
AIMS Male lower urinary tract symptoms (LUTS) are common and bothersome symptoms in the aging population, of which the etiology is multifactorial. Prostatic surgery may be considered to alleviate some of these LUTS, especially in patients in which benign prostatic obstruction is believed to be the underlying cause. The aim of this paper is to discuss underlying pathophysiology, signs, and conditions that may lead to success or failure after prostatic surgery in male patients with LUTS. METHODS The paper is a report of presentations and subsequent discussions at the annual International Consultation on Incontinence Research Society, in June 2018 in Bristol. RESULTS AND CONCLUSIONS Unfavorable outcomes after prostatic surgery are reported in 25% to 30% of the patients. This may be due to persistent or de novo symptoms, related to the multifactorial origin of symptoms. Specific underlying conditions such as with detrusor overactivity, detrusor underactivity, and nocturnal polyuria are discussed in their relationship with prostatic surgery. Knowledge gaps are addressed and specific research questions proposed.
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Affiliation(s)
- Stefan De Wachter
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Francois Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Marcio Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
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Reitz A, Hüsch T, Haferkamp A. Persistent storage symptoms after TURP can be predicted with a nomogram derived from the ice water test. Neurourol Urodyn 2019; 38:1844-1851. [PMID: 31286547 DOI: 10.1002/nau.24068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/20/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE To predict the persistence of storage symptoms after transurethral resection of the prostate (TURP) using a nomogram derived from the ice water test (IWT). METHODS The IWTs of 73 men with lower urinary tract symptoms and prostatic bladder outlet obstruction were retrospectively analyzed. The strength of the detrusor contraction was approximated by using the detrusor gradient of Δpdet /Δt at maximum detrusor pressure and the area under the curve. The parameters were utilized in a nomogram, which facilitated a severity categorization from 1 to 10. Patients with a positive IWT in the categories 1 to 2 were assigned to group A, categories 3 to 4 to group B and categories 5 and higher to group C. After TURP, patients with persisting storage symptoms were offered a botulinum toxin injection. RESULTS There were 32 patients (44%) with negative and 41 patients (56%) with positive IWTs. Patients with negative IWTs were classified in category 1. Regarding patients with positive IWTs, 14 (34%) were correlated to group A, 14 (34%) to group B, and 13 (32%) to group C. The necessity of a subsequent botulinum toxin injection correlated significantly with a higher nomogram category (P < .001) as well as higher severity categorization (P < .001). In multivariate analysis, the nomogram category was an independent predictor for botulinum toxin injection (P = .002, OR, 6.9, CI, 2.0-23.9). CONCLUSION The quantification of the detrusor contraction during the IWT allowed stratification of patients in risk categories for persistent storage symptoms after TURP and the potential need for later botulinum toxin injections.
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Affiliation(s)
- André Reitz
- KontinenzZentrum Hirslanden, Zurich, Switzerland
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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Rossanese M, Crestani A, Inferrera A, Giannarini G, Bartoletti R, Tubaro A, Ficarra V. Medical treatment for benign prostatic hyperplasia: Where do we stand? Urologia 2019; 86:115-121. [DOI: 10.1177/0391560319859785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Male lower urinary tract symptoms are frequently due to benign prostatic enlargement. Medical therapy is strongly recommended in patients with moderate to severe symptoms. Lower urinary tract symptoms may require a different medical approach using drugs with different mechanisms of action. Alpha-1 blockers, muscarinic receptor antagonists and phosphodiesterase type 5 inhibitors are the most frequently used drugs. 5-Alpha reductase inhibitors are commonly prescribed to reduce prostate volume and to prevent benign prostatic hyperplasia progression. Currently, medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement can be tailored according to different symptom characteristics and severity, and to different patient comorbidities and preferences. For this reason, the decision-making process should be based on an accurate patient counselling with detailed clarification of potential benefits and, above all, potential side effects of different drugs. This non-systematic review of the literature presents an update of the current options for medical treatment of lower urinary tract symptoms suggestive of benign prostatic enlargement, helping urologists in the decision-making and counselling process.
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Affiliation(s)
- Marta Rossanese
- Urologic Section, Department of Human and Paediatric Pathology ‘Gaetano Barresi’, University of Messina, Messina, Italy
| | | | - Antonino Inferrera
- Urologic Section, Department of Human and Paediatric Pathology ‘Gaetano Barresi’, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital ‘Santa Maria della Misericordia’, Udine, Italy
| | - Riccardo Bartoletti
- Urologic Section, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, ‘La Sapienza’ University of Rome, Rome, Italy
| | - Vincenzo Ficarra
- Urologic Section, Department of Human and Paediatric Pathology ‘Gaetano Barresi’, University of Messina, Messina, Italy
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A Systematic Review and Meta-analysis of Efficacy and Safety Following Holmium Laser Enucleation of Prostate and Transurethral Resection of Prostate for Benign Prostatic Hyperplasia. Urology 2019; 131:14-20. [PMID: 31129190 DOI: 10.1016/j.urology.2019.03.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022]
Abstract
Transurethral resection of prostate (TURP) still remains the "gold standard" surgical treatment for benign prostatic hyperplasia (BPH). In recent years, holmium laser enucleation of prostate (HoLEP) gets more and more popularity in the world. Our objective is to compare the efficacy and safety of HoLEP and TURP for BPH. Eleven studies met our eligibility criteria including 1339 patients. The prostate sizes of the all included studies were smaller than 100 g. Overall, in patients with small to mid-sized prostates, HoLEP offers safer clinical outcomes with less blood drop and potentially better long-term relief of bladder outlet obstruction.
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Comparison of Outcomes Obtained After Regular Surgery Versus Live Operative Surgical Cases: Single-centre Experience with Green Laser Enucleation of the Prostate. Eur Urol Focus 2019; 5:518-524. [DOI: 10.1016/j.euf.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022]
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Speakman MJ, Cornu JN, Gacci M, Gratzke C, Mamoulakis C, Herrmann TR, Omar MI, Rieken M, Tikkinen KA, Gravas S. What Is the Required Certainty of Evidence for the Implementation of Novel Techniques for the Treatment of Benign Prostatic Obstruction? Eur Urol Focus 2019; 5:351-356. [DOI: 10.1016/j.euf.2019.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 11/27/2022]
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Lukacs B, Doizi S, Cornu JN. Voiding urethrocystoscopy: A new concept for benign prostatic obstruction characterization. Prog Urol 2019; 29:288-292. [PMID: 30962142 DOI: 10.1016/j.purol.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 07/08/2018] [Accepted: 10/31/2018] [Indexed: 12/01/2022]
Abstract
AIM To assess the feasibility of voiding urethrocystoscopy (VUC) in males and describe the characteristics of dynamic movements of the prostatic lobes during micturition. MATERIAL AND METHODS Patients scheduled for benign prostatic obstruction relief in a tertiary reference center were included in this prospective evaluation. During urethrocystoscopy with a small diameter flexible endoscope, the bladder was filled until desire to void. The patient was asked to void with endoscope in place facing the veru montanum. Movements of the prostatic lobes during micturition were characterized, video-recorded, and categorized based on the dynamics of the lateral lobes, the posterior lobe and the bladder neck. RESULTS In all, 192 evaluations were conducted. In 161 cases (84%), the patient was able to void. Among these patients, 126 cases were stated as "closed" (coalescent), without opening of the initial part of the urethra and the bladder neck. In 38 cases, there was no opening of the lateral lobes (type 1A), and in 47 cases a partial opening of the distal parts of the lateral lobes was seen (type 1B). In 31 cases, a fixed posterior bladder neck was seen (type 2A) and in 10 cases a mobile median lobe, with a rolling ball effect, was seen (type 2B). In 25 cases, the lumen was completely open and equivocal in 10 cases. CONCLUSIONS This study demonstrates the feasibility of VUC and describes for the first time the dynamics of prostatic lobes during micturition. This evaluation may lead to a new approach for understanding the mechanical aspects of benign prostatic obstruction. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- B Lukacs
- Department of urology, Tenon university hospital, Assistance publique-Hopitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
| | - S Doizi
- Department of urology, Tenon university hospital, Assistance publique-Hopitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - J-N Cornu
- Department of urology, Rouen university hospital, 1, rue de Germont, 76031 Rouen cedex, France
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Pigat N, Reyes-Gomez E, Boutillon F, Palea S, Barry Delongchamps N, Koch E, Goffin V. Combined Sabal and Urtica Extracts (WS ® 1541) Exert Anti-proliferative and Anti-inflammatory Effects in a Mouse Model of Benign Prostate Hyperplasia. Front Pharmacol 2019; 10:311. [PMID: 30984003 PMCID: PMC6450068 DOI: 10.3389/fphar.2019.00311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/14/2019] [Indexed: 12/19/2022] Open
Abstract
WS® 1541 is a phytopharmaceutical drug combination containing a lipophilic extract from fruits of Sabal serrulata (WS® 1473) and an aqueous ethanolic extract from roots of Urtica dioica (WS® 1031). It is approved in several countries worldwide for the treatment of lower urinary tract syndrome (LUTS) linked to benign prostate hyperplasia (BPH). Clinical studies have demonstrated the efficacy of this unique combination in the treatment of BPH-related LUTS. However, its mechanisms of action in vivo remain partly uncharacterized. The aim of this study was to take advantage of a validated mouse model of BPH to better characterize its growth-inhibitory and anti-inflammatory properties. We used the probasin–prolactin (Pb-PRL) transgenic mouse model in which prostate-specific overexpression of PRL results in several features of the human disease including tissue hypertrophy, epithelial hyperplasia, increased stromal cellularity, inflammation, and LUTS. Six-month-old heterozygous Pb-PRL male mice were randomly distributed to five groups (11–12 animals/group) orally treated for 28 consecutive days with WS® 1541 (300, 600, or 900 mg/kg/day), the 5α-reductase inhibitor finasteride used as reference (5 mg/kg/day) or vehicle (olive oil 5 ml/kg/day). Administration of WS® 1541 was well tolerated and caused a dose-dependent reduction of prostate weight (vs. vehicle) that was statistically significant at the two highest doses. This effect was accompanied by a reduction in prostate cell proliferation as assessed by lower Ki-67 expression (qPCR and immunohistochemistry). In contrast, finasteride had no or only a mild effect on these parameters. The growth-inhibitory activity of WS® 1541 was accompanied by a strong anti-inflammatory effect as evidenced by the reduced infiltration of cells expressing the leukocyte common antigen CD45. In sharp contrast, finasteride significantly increased the prostate inflammatory status according to this readout. Molecular profiling (qPCR) of 23 selected pro-inflammatory genes confirmed the strong anti-inflammatory potency of WS® 1541 compared to finasteride. Since treatment of WS® 1541 did not interfere with transgene expression and activity in the prostate of Pb-PRL mice, the effects observed in this study are entirely attributable to the intrinsic pharmacological action of the drug combination.
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Affiliation(s)
- Natascha Pigat
- PRL/GH Pathophysiology Laboratory, Institut Necker Enfants Malades, Unit 1151, Inserm, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Edouard Reyes-Gomez
- Unité d'Histologie et d'Anatomie Pathologique, Laboratoire d'Anatomo-Cytopathologie, Biopôle Alfort, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.,Inserm, U955 - IMRB, Ecole Nationale Vétérinaire d'Alfort, UPEC, Maisons-Alfort, France
| | - Florence Boutillon
- PRL/GH Pathophysiology Laboratory, Institut Necker Enfants Malades, Unit 1151, Inserm, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | | | - Nicolas Barry Delongchamps
- PRL/GH Pathophysiology Laboratory, Institut Necker Enfants Malades, Unit 1151, Inserm, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France.,Urology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Egon Koch
- Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Vincent Goffin
- PRL/GH Pathophysiology Laboratory, Institut Necker Enfants Malades, Unit 1151, Inserm, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
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Müllhaupt G, Hechelhammer L, Engeler DS, Güsewell S, Betschart P, Zumstein V, Kessler TM, Schmid HP, Mordasini L, Abt D. In-hospital cost analysis of prostatic artery embolization compared with transurethral resection of the prostate: post hoc analysis of a randomized controlled trial. BJU Int 2019; 123:1055-1060. [PMID: 30578705 PMCID: PMC6850481 DOI: 10.1111/bju.14660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To perform a post hoc analysis of in-hospital costs incurred in a randomized controlled trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS In-hospital costs arising from PAE and TURP were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs, including those arising from surgical and interventional procedures, consumables, personnel and accommodation, were analysed for all of the study participants and compared between PAE and TURP using descriptive analysis and two-sided t-tests, adjusted for unequal variance within groups (Welch t-test). RESULTS The mean total costs per patient (±sd) were higher for TURP, at €9137 ± 3301, than for PAE, at €8185 ± 1630. The mean difference of €952 was not statistically significant (P = 0.07). While the mean procedural costs were significantly higher for PAE (mean difference €623 [P = 0.009]), costs apart from the procedure were significantly lower for PAE, with a mean difference of €1627 (P < 0.001). Procedural costs of €1433 ± 552 for TURP were mainly incurred by anaesthesia, whereas €2590 ± 628 for medical supplies were the main cost factor for PAE. CONCLUSIONS Since in-hospital costs are similar but PAE and TURP have different efficacy and safety profiles, the patient's clinical condition and expectations - rather than finances - should be taken into account when deciding between PAE and TURP.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St. Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
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[Interest of a systematic assessment of the treatment of the lower urinary tract symptoms in the management of benign prostatic hypertrophy in general practice (1380 patients) - Study EVALURO]. Prog Urol 2019; 29:116-126. [PMID: 30665818 DOI: 10.1016/j.purol.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/22/2018] [Accepted: 12/01/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms. METHODS This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit. RESULTS Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly. CONCLUSION A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.
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Shore N, Tutrone R, Roehrborn CG. Efficacy and safety of fexapotide triflutate in outpatient medical treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia. Ther Adv Urol 2019; 11:1756287218820807. [PMID: 30719081 PMCID: PMC6348527 DOI: 10.1177/1756287218820807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/03/2018] [Indexed: 02/01/2023] Open
Abstract
Male lower urinary tract symptoms (LUTS) is an increasingly important problem for the majority of late middle aged and elderly men. Fexapotide triflutate (FT) is a first in-class compound given by local injection via the transrectal intraprostatic route under ultrasound guidance. Data from >1700 FT and control injections in prospective randomized blinded controlled multicenter trials are reviewed and discussed in relation to current developments in the field of treatments for LUTS associated with benign prostatic hyperplasia (BPH). Long-term studies of FT in the United States have shown statistically significant improvement in BPH symptoms and objective outcomes including significant reduction in both spontaneous acute urinary retention as well as the subsequent incidence of BPH surgery. FT has been shown to be well tolerated with an excellent safety profile, and is an efficacious clinic-based treatment for BPH involving an intraprostatic injection that requires only a few minutes to administer, with no catheter nor anesthesia requirements.
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Affiliation(s)
| | - Ronald Tutrone
- Chesapeake Urology Research Associates, Baltimore, MD, USA
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40
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Sountoulides P, Karatzas A, Gravas S. Current and emerging mechanical minimally invasive therapies for benign prostatic obstruction. Ther Adv Urol 2019; 11:1756287219828971. [PMID: 30792821 PMCID: PMC6376539 DOI: 10.1177/1756287219828971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022] Open
Abstract
Transurethral resection of the prostate (TURP) is considered the 'gold standard' for the surgical management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). However, during recent years TURP has been challenged by several minimally invasive therapies (MITs). The reasons for the development of these MITs are the need for anesthesia and the rather unchanged morbidity of TURP, including ejaculation disorders. Mechanical MITs may represent an attractive option for treating LUTS/BPO by using mechanical forces to maintain urethral patency without cutting, ablating, heating or removing prostatic tissue. The present paper provides an update on currently available mechanical devices for the treatment of LUTS/BPO including the prostatic urethral lift (PUL), the temporary implantable nitinol device, and new intraprostatic implants. It analyzes the evidence for their safety, tolerability, and efficacy in clinical practice and aims to define those subpopulations of patients who will benefit from these MITs. It is obvious that there is a wide variation in the degree of mature of the available mechanical MITs. Time and high-quality long-term studies will decide which of these therapies will be accepted by patients and urologists. At the moment, PUL is claiming its position in the armamentarium of BPO treatment.
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Affiliation(s)
- Petros Sountoulides
- Aristotle University of Thessaloniki, Department of Urology, Thessaloniki, Greece
| | - Anastasios Karatzas
- University of Thessaly, Faculty of Medicine, Department of Urology, Larissa, Greece
| | - Stavros Gravas
- University of Thessaly, Faculty of Medicine, Department of Urology, Feidiou 6-8, 41221, Larissa, Greece
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Abt D, Müllhaupt G, Mordasini L, Güsewell S, Markart S, Zumstein V, Kessler TM, Schmid HP, Engeler DS, Hechelhammer L. Outcome prediction of prostatic artery embolization: post hoc analysis of a randomized, open-label, non-inferiority trial. BJU Int 2018; 124:134-144. [PMID: 30499637 DOI: 10.1111/bju.14632] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify predictors for different treatment outcomes after prostatic artery embolization (PAE) in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. PATIENTS AND METHODS A post hoc analysis of data derived from the 48 patients undergoing PAE in a randomized, open-label, non-inferiority trial was performed. Relative changes in the International Prostate Symptoms Score (IPSS), absolute changes in maximum urinary flow rate (Qmax ), and relative changes in magnetic resonance imaging-assessed prostate volume from baseline to 12 weeks were defined as the outcomes measures of interest. Their association with various baseline characteristics and measures, technical details of PAE, and early postoperative measures were analysed using Spearman rank correlations and Wilcoxon rank-sum tests. The most promising predictors were further evaluated in receiver-operating characteristic (ROC) curve analyses. RESULTS Higher total prostate and central gland (i.e. central plus transitional zone) volumes were associated with more pronounced improvements in the IPSS (Spearman rank correlation [rs]: -0.35 and -0.34; P = 0.01 and P = 0.02, respectively) and the Qmax (rs: 0.31 and 0.39; P = 0.05 and P = 0.01, respectively). ROC curve analyses suggested that volumes of 39 and 38 mL for total prostate and central gland volume, respectively, would be the optimal thresholds with which to predict PAE success as measured by the IPSS. Other anatomical characteristics of the prostate, such as the central gland index, also showed an even more distinct correlation to the improvement in Qmax (rs: 0.46, P = 0.003). The relative changes in prostate volume were clearly dependent on the technical performance of PAE. Occurrence of postoperative pain and blood levels of prostate-specific antigen and C-reactive protein emerged as potential early-stage outcome predictors after PAE. CONCLUSION Baseline and peri-operative findings might help to guide patient selection and outcome prediction for PAE. Patients with larger prostates have a higher chance of success with PAE. Larger-scale clinical trials including a longer follow-up are warranted to further elucidate the most suitable patients for PAE.
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Affiliation(s)
- Dominik Abt
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
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Robert G, De La Taille A, Descazeaud A. Données épidémiologiques en rapport avec la prise en charge de l’HBP. Prog Urol 2018; 28:803-812. [DOI: 10.1016/j.purol.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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de la Taille A, Robert G, Descazeaud A. [Consequences of prostatic obstruction on bladder function, impact of removal, and management of recurrence after surgery]. Prog Urol 2018; 28:813-820. [PMID: 30262261 DOI: 10.1016/j.purol.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Our objective was to evaluate bladder outlet obstruction (BOO) consequences on the detrusor activity, to analyze the impact of medical and surgical treatments, and to study the reasons for recurrence of urinary symptoms after surgical treatment. METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications between 2000 and July 2018 with the keywords: BPH, bladder obstruction, bladder instability, surgery, and reoperation. A first research was crossed with the results of the reviews of literature already published and was enriched by the contributions of the various authors. A synthesis has been proposed. RESULTS The consequences of bladder outlet obstruction (BOO) on the detrusor may be detrusor overactivity (DOA) or detrusor hypocontractility. DOA is found in about 50% of patients at the time of their surgery and its evolution is most often favorable after surgical treatment (resolved or reduced in 2/3 of cases). Bladder hypocontractility is responsible for acute or chronic urinary retention. It can be the cause for poor postoperative micturition recovery requiring self-catheterization which the patient must have been informed before surgical treatment. Surgery reduces urinary symptoms with a low but significant surgical revision rate (10 to 30% depending on the surgical technique). The less efficient technique with regard to surgical revision rates are prostatic radiofrequency or cervico-prostatic incision, followed by laser vaporization techniques, TURP and adenomectomy (surgical or endoscopic). Adenomectomy is the surgical technique that has the lowest recurrence rate. The identified risk factors for surgical revision are the surgeon's experience, the power of the laser (in case of photovaporization), the surgical technique employed, the length of operative time, the low or excessive volume of the prostate, the significant pre-operative post-void residual volume, and the slight decrease of postoperative PSA level. Prior to any surgical revision for recurrence of urinary symptoms, the assessment should include the review of previous surgical report, the evaluation of the resected prostatic volume and the residual prostatic volume, the IPSS score, the calendar of micturition, the urethrocystoscopy and the urodynamic assessment. CONCLUSION BOO can lead to bladder dysfunction such as DOA or detrusor hypocontractility. Resolution of BOO by a suitable surgical treatment allows, in the majority of the cases, to resolve bladder dysfunctioning. In case of failure, the assessment must be complete to define the causes and to find the most suitable solution.
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Affiliation(s)
- A de la Taille
- Service de chirurgie urologique, CHU Henri-Mondor, AP-HP, 94000 Créteil, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, 30000 Bordeaux, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 87042 Limoges, France
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Roehrborn CG, Miner MM, Sadovsky R. Over-the-counter medication availability could augment self-management of male lower urinary tract symptoms. Postgrad Med 2018; 130:452-460. [PMID: 29932780 DOI: 10.1080/00325481.2018.1487238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this review, we focus on current trends in the management of male lower urinary tract symptoms (LUTS), defined here as LUTS, namely, storage, voiding, and post-micturition symptoms presumed secondary to benign prostatic hyperplasia (BPH), and discuss possible novel approaches toward better care. According to results of a PubMed database search covering the last 10 years and using keywords pertaining to male LUTS, this condition continues to be globally undiagnosed or diagnosed late, partly because of men's hesitation to seek help for perceived embarrassing problems or problems considered a normal part of aging. In addition, the prevalence of male LUTS is continually increasing because of a constantly aging population. Male LUTS can be bothersome and affect the quality of life (QoL) and sexual function. Additional effective alternatives for managing this condition need to be identified and incorporated into the current care model. Considering that most male LUTS such as frequency, hesitancy, urgency, and intermittency are easy to self-identify, a self-management approach toward male LUTS is proposed. Limited evidence supports the efficacy of phytotherapies and herbals as self-management options for male LUTS. However, introducing over-the-counter (OTC) medication with proven efficacy, accompanied by lifestyle and behavioral modifications, may be a promising approach that will encourage more men to treat their symptoms in a timely manner. Formal guidelines, along with appropriate education programs for patients and support from the healthcare community, will be needed to ensure that the promise of this approach is fully materialized.
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Affiliation(s)
- Claus G Roehrborn
- a Department of Urology , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Martin M Miner
- b Men's Health Center , Miriam Hospital , Providence , Rhode I , USA.,c Family Medicine and Urology , Warren Alpert School of Medicine, Brown University , Providence , RI , USA
| | - Richard Sadovsky
- d Department of Family Medicine , SUNY-Downstate Medical Center , Brooklyn , NY , USA
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45
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Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, Schmid HP, Engeler DS, Mordasini L. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 2018; 361:k2338. [PMID: 29921613 PMCID: PMC6006990 DOI: 10.1136/bmj.k2338] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare prostatic artery embolisation (PAE) with transurethral resection of the prostate (TURP) in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia in terms of patient reported and functional outcomes. DESIGN Randomised, open label, non-inferiority trial. SETTING Urology and radiology departments of a Swiss tertiary care centre. PARTICIPANTS 103 patients aged ≥40 years with refractory lower urinary tract symptoms secondary to benign prostatic hyperplasia were randomised between 11 February 2014 and 24 May 2017; 48 and 51 patients reached the primary endpoint 12 weeks after PAE and TURP, respectively. INTERVENTIONS PAE performed with 250-400 μm microspheres under local anaesthesia versus monopolar TURP performed under spinal or general anaesthesia. MAIN OUTCOMES AND MEASURES Primary outcome was change in international prostate symptoms score (IPSS) from baseline to 12 weeks after surgery; a difference of less than 3 points between treatments was defined as non-inferiority for PAE and tested with a one sided t test. Secondary outcomes included further questionnaires, functional measures, magnetic resonance imaging findings, and adverse events; changes from baseline to 12 weeks were compared between treatments with two sided tests for superiority. RESULTS Mean reduction in IPSS from baseline to 12 weeks was -9.23 points after PAE and -10.77 points after TURP. Although the difference was less than 3 points (1.54 points in favour of TURP (95% confidence interval -1.45 to 4.52)), non-inferiority of PAE could not be shown (P=0.17). None of the patient reported secondary outcomes differed significantly between treatments when tested for superiority; IPSS also did not differ significantly (P=0.31). At 12 weeks, PAE was less effective than TURP regarding changes in maximum rate of urinary flow (5.19 v 15.34 mL/s; difference 10.15 (95% confidence interval -14.67 to -5.63); P<0.001), postvoid residual urine (-86.36 v -199.98 mL; 113.62 (39.25 to 187.98); P=0.003), prostate volume (-12.17 v -30.27 mL; 18.11 (10.11 to 26.10); P<0.001), and desobstructive effectiveness according to pressure flow studies (56% v 93% shift towards less obstructive category; P=0.003). Fewer adverse events occurred after PAE than after TURP (36 v 70 events; P=0.003). CONCLUSIONS The improvement in lower urinary tract symptoms secondary to benign prostatic hyperplasia seen 12 weeks after PAE is close to that after TURP. PAE is associated with fewer complications than TURP but has disadvantages regarding functional outcomes, which should be considered when selecting patients. Further comparative study findings, including longer follow-up, should be evaluated before PAE can be considered as a routine treatment. TRIAL REGISTRATION Clinicaltrials.gov NCT02054013.
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Affiliation(s)
- Dominik Abt
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Gautier Müllhaupt
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St Gallen Cantonal Hospital, 9007 St Gallen, Switzerland
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Shore N, Tutrone R, Efros M, Bidair M, Wachs B, Kalota S, Freedman S, Bailen J, Levin R, Richardson S, Kaminetsky J, Snyder J, Shepard B, Goldberg K, Hay A, Gange S, Grunberger I. Fexapotide triflutate: results of long-term safety and efficacy trials of a novel injectable therapy for symptomatic prostate enlargement. World J Urol 2018; 36:801-809. [PMID: 29380128 PMCID: PMC5916987 DOI: 10.1007/s00345-018-2185-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/19/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE These studies were undertaken to determine if fexapotide triflutate 2.5 mg transrectal injectable (FT) has significant long-term (LT) safety and efficacy for the treatment of benign prostatic hyperplasia (BPH). METHODS Two placebo controlled double-blind randomized parallel group trials with 995 BPH patients at 72 sites treated 3:2 FT:placebo, with open-label FT crossover (CO) re-injection in 2 trials n = 344 and long-term follow-up (LF) 2-6.75 years (mean 3.58 years, median 3.67 years; FT re-injection CO mean 4.27 years, median 4.42 years) were evaluated. 12 months post-treatment patients elected no further treatment, approved oral medications, FT, or interventional treatment. Primary endpoint variable was change in Symptom Score (IPSS) at 12 months and at LF. CO primary co-endpoints were 3-year incidence of (1) surgery for BPH in FT treated CO patients versus patients crossed over to oral BPH medications and (2) surgery or acute urinary retention in FT-treated CO placebo patients versus placebo patients crossed over to oral BPH medications. 28 CO secondary endpoints assessed surgical and symptomatic outcomes in FT reinjected patients versus conventional BPH medication CO and control subgroups at 2 and 3 years. RESULTS FT injection had no significant safety differences from placebo. LF IPSS change from baseline was higher in FT treated patients compared to placebo (median FT group improvement - 5.2 versus placebo - 3.0, p < 0.0001). LF incidence of AUR (1.08% p = 0.0058) and prostate cancer (PCa) (1.1% p = 0.0116) were both reduced in FT treated patients. LF incidence of intervention for BPH was reduced in the FT group versus oral BPH medications (8.08% versus 27.85% at 3 years, p < 0.0001). LF incidence of intervention or AUR in placebo CO group with FT versus placebo CO group with oral medications was reduced (6.07% versus 33.3% at 3 years, p < 0.0001). 28/28 secondary efficacy endpoints were reached in LF CO re-injection studies. CONCLUSIONS FT 2.5 mg is a safe and effective transrectal injectable for LT treatment of BPH. FT treated patients also had reduced need for BPH intervention, and reduced incidence of PCa and AUR.
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Affiliation(s)
- Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA.
| | - Ronald Tutrone
- Chesapeake Urology Research Associates, Baltimore, MD, USA
| | | | | | - Barton Wachs
- Atlantic Urology Medical Group, Long Beach, CA, USA
| | - Susan Kalota
- Urological Associates of Southern Arizona, Tucson, AZ, USA
| | | | | | - Richard Levin
- Chesapeake Urology Research Associates, Towson, MD, USA
| | | | | | | | - Barry Shepard
- Urological Surgeons of Long Island, Garden City, NY, USA
| | | | - Alan Hay
- Willamette Urology, Salem, OR, USA
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Misraï V, Pasquie M, Bordier B, Elman B, Lhez JM, Guillotreau J, Zorn K. Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience. World J Urol 2018; 36:793-799. [PMID: 29368232 DOI: 10.1007/s00345-018-2192-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study sought to compare perioperative outcomes and morbidities for open simple prostatectomy (OSP) and endoscopic green laser enucleation of the prostate (GreenLEP). METHODS In a single department, all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and all consecutive patients undergoing GreenLEP between July 2013 and January 2017 were prospectively enrolled. Perioperative data, information regarding early postoperative complications for up to 6 months and outcomes were collected and retrospectively compared. RESULTS Overall, 204 patients were enrolled in each group. The baseline characteristics of patients in both groups were comparable. Intraoperative time was significantly longer for the OSP group than for the GreenLEP group (67 versus 60 min; p < 0.0001). The OSP group had significantly longer catheterisation (5 versus 2 days; p < 0.0001) and hospitalisation times (7 versus 2 days; p < 0.0001) than the GreenLEP group. The overall rate of complications was significantly higher after OSP than after GreenLEP (37.2 versus 20.6%; p = 0.0003); both Clavien-Dindo grade 3a complications (8.8 versus 0.98%) and Clavien-Dindo grade 3b complications (2.4 versus 3.4%) were observed. The transfusion rate was higher after OSP than after GreenLEP (8.3 versus 0.5%; p = 0.0001). The rehospitalisation rate was similar for both groups (7.8 versus 8.3%; p = 0.99). CONCLUSIONS The results of this single-centre cohort study confirm those of similar prior investigations addressing endoscopic enucleation of the prostate. Compared with OSP, GreenLEP may have a more desirable perioperative profile with lower morbidity. In contrast, GreenLEP and OSP were associated with similar 6-month rehospitalisation rates.
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Affiliation(s)
- Vincent Misraï
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France.
| | - Marie Pasquie
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Benoit Bordier
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Benjamin Elman
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Jean Michel Lhez
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | | | - Kevin Zorn
- CHUM Section of Urology, Department of Surgery, Université de Montréal, Montreal, QC, Canada
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Tuppin P, Leboucher C, Peyre-Lanquar G, Lamy PJ, Gabach P, Rébillard X. Analyse des prescriptions de PSA total et libre en France entre 2012 et 2014. Presse Med 2017; 46:e237-e247. [DOI: 10.1016/j.lpm.2017.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 11/21/2016] [Accepted: 04/10/2017] [Indexed: 11/29/2022] Open
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49
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Sokhal AK, Sankhwar S, Goel A, Singh K, Kumar M, Purkait B, Saini DK. A Prospective Study to Evaluate Sexual Dysfunction and Enlargement of Seminal Vesicles in Sexually Active Men Treated for Benign Prostatic Hyperplasia by Alpha-blockers. Urology 2017; 118:92-97. [PMID: 28860050 DOI: 10.1016/j.urology.2017.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/07/2017] [Accepted: 08/17/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate sexual dysfunction and enlargement of seminal vesicles in sexually active men who were treated by α1-blockers for benign prostatic hyperplasia and its possible clinical application. MATERIALS AND METHODS This is a prospective cohort study from January 2015 to December 2016. We enrolled sexually active men above the age of 40 years having moderate to severe lower urinary tract symptoms (LUTS). We excluded patients with a history of prostate surgery, suspicious digital rectal examination findings, a serum prostate-specific antigen of >4 ng/dL, and a history of medication with anticholinergic, cholinergic, and diuretic agents. Patients were divided into groups A, B, and C based on the prescription of silodosin 8 mg, tamsulosin 0.4 mg, or alfuzosin 10 mg orally once for LUTS and at 4 and 12 weeks. RESULTS The mean age was 54.8 years (41-68 years). Twelve weeks of treatment with silodosin, tamsulosin, and alfuzosin resulted in a significant improvement in the total International Prostate Symptom Score and the quality of life score (P <.001). The baseline erectile function scores were 26.4, 27.6, and 28.1, and the baseline overall satisfaction (OS) (International Index of Erectile Function [IIEF]-OS) scores were 7.1, 8.3, and 8.6 among groups A, B, and C, respectively. After 12 weeks of α1-blockers, the IIEF-erectile function scores were 24.0, 24.7, and 26.2, and the IIEF-OS scores were 6.4, 7.8, and 7.9. All 3 groups demonstrated a statistically significant enlargement of seminal vesicles after 12 weeks' treatment, most significant in group A patients (7.65-14.11 cc, P <.001). CONCLUSION Alpha-blockers as silodosin, tamsulosin, and alfuzosin are a safe and effective tool in benign prostatic hyperplasia for improving LUTS and the quality of life. Loss of seminal emission with alpha-blockers appears as the cause of seminal vesicle enlargement. The exact mechanism of these findings needs further clinical and experimental research.
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Affiliation(s)
- Ashok Kumar Sokhal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Satyanarayan Sankhwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kawaljit Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bimalesh Purkait
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Durgesh Kumar Saini
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Hennenberg M, Tamalunas A, Wang Y, Keller P, Schott M, Strittmatter F, Herlemann A, Yu Q, Rutz B, Ciotkowska A, Stief CG, Gratzke C. Inhibition of agonist-induced smooth muscle contraction by picotamide in the male human lower urinary tract outflow region. Eur J Pharmacol 2017; 803:39-47. [DOI: 10.1016/j.ejphar.2017.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 10/20/2022]
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