1
|
Madersbacher S, Oelke M. The Role of Bladder Outlet Obstruction in Male Non-neurogenic Lower Urinary Tract Symptoms-Any Additional News? Eur Urol 2024:S0302-2838(24)02404-7. [PMID: 38876914 DOI: 10.1016/j.eururo.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Stephan Madersbacher
- Department of Urology, Clinic Favoriten, Vienna, Austria; Sigmund Freud Private Medical University, Vienna, Austria.
| | | |
Collapse
|
2
|
Busetto GM, Lombardo R, De Nunzio C, Santoro G, Tocci E, Schiavone N, Tubaro A, Carrieri G, Kaplan SA, Herrmann TRW. Ejaculation sparing of classic and minimally invasive surgical treatments of LUTS/BPH. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00834-y. [PMID: 38615071 DOI: 10.1038/s41391-024-00834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The surgical landscape for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) has evolved with the introduction of Minimally Invasive Surgical Therapies (MISTs), recognizing the impact of sexual function on patients' well-being, and prioritizing ejaculation-sparing approaches. METHODS This systematic review explored ejaculation sparing after classic endoscopic procedures and MISTs (iTind, Rezūm, Urolift, Aquablation, and TPLA) and a literature search yielded 41 studies. RESULTS While all procedures demonstrated efficacy in improving LUTS/BPH symptoms (IPSS, QoL, Qmax), a subset of studies evaluated ejaculatory function. Positive outcomes were noted, challenging the historical association of BPH surgeries with ejaculatory dysfunction. Variations in study design, patient cohorts, and limited long-term data present challenges. Notably, the lack of baseline specificity, use of alpha-blockers, and non-specific sexual function assessments underscore potential biases. CONCLUSIONS Despite limitations, the review tentatively concluded that MISTs, including iTind, Rezūm, Urolift, Aquablation, and TPLA, appear comparable in sparing ejaculation. Long-term studies are essential to validate sustainability, and comparative research should assess trade-offs between MISTs and traditional surgeries. Incorporating patient-reported outcomes and quality of life assessments will enhance future investigations, refining MISTs as standard therapeutic options for LUTS/BPH.
Collapse
Affiliation(s)
- Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy.
| | | | | | | | - Edoardo Tocci
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Nicola Schiavone
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Andrea Tubaro
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Stellenbosch, South Africa
- Hannover Medical School, Hannover, Germany
| |
Collapse
|
3
|
Shin BNH, Qu L, Rhee H, Chung E. Systematic review and network meta-analysis of re-intervention rates of new surgical interventions for benign prostatic hyperplasia. BJU Int 2024. [PMID: 38600763 DOI: 10.1111/bju.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To assess the re-intervention rates of new surgical benign prostatic hyperplasia (BPH) interventions, as the clinical durability of new surgical interventions for BPH is not widely known. METHODS A critical review of new surgical BPH therapies namely 'UroLift®', 'Aquablation', 'Rezum', 'prostatic artery embolisation (PAE)' and 'temporary implantable nitinol device (iTIND)' was performed on PubMed, the Cochrane Library, and Embase databases between May 2010 and December 2022 according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. All relevant articles were reviewed, and the risk of bias was evaluated using the Cochrane risk assessment tool and Newcastle-Ottawa Scale. RESULTS Of the 32 studies included, there were 10 randomised controlled trials and 22 prospective observational cohorts. A total of 2400 participants were studied with a median patient age of 66 years, a median prostate volume of 51.9 mL, and a median International Prostate Symptom Score of 22. The lowest re-intervention rate at 12 months was for Aquablation at 0.01%, followed by Rezum at 0.02%, iTIND at 0.03%, and PAE at 0.05%. Network meta-analysis (NMA) showed that the best-ranked treatment at 12 months was transurethral resection of the prostate (TURP), followed by Aquablation, iTIND, Rezum, and UroLift. Re-intervention rates with these new BPH interventions are comparable, although some interventions reported better outcomes than TURP in the shorter term. CONCLUSIONS While this systematic review and NMA showed that the re-intervention rate with these new surgical BPH interventions appears to be comparable to TURP in the short term, further studies are required to directly compare these various BPH procedures.
Collapse
Affiliation(s)
- Brian Ng Hung Shin
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Liang Qu
- Department of Urology, Austin Health, Melbourne, Vic., Australia
| | - Handoo Rhee
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia
- AndroUrology Centre, Brisbane, Qld, Australia
| |
Collapse
|
4
|
Gravas S, Malde S, Cornu JN, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Alivizatos G, Bach T, Bachmann A, Descazeaud A, Desgrandchamps F, Drake M, Emberton M, Kyriazis I, Madersbacher S, Michel MC, N'Dow J, Perachino M, Plass K, Rioja Sanz C, Umbach R, de Wildt M, Oelke M, de la Rosette JJMCH. From BPH to male LUTS: a 20-year journey of the EAU guidelines. Prostate Cancer Prostatic Dis 2024; 27:48-53. [PMID: 37488274 DOI: 10.1038/s41391-023-00700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/07/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus.
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen-Hôpital Charles Nicolle, Rouen, France
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | | | - Thorsten Bach
- Department of Urology, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | | | | | | | - Marcus Drake
- Bristol Urological Institute, University of Bristol, Bristol, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, and University College London Hospitals NHS Foundation Trust, London, UK
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | | | - Martin C Michel
- Department of Pharmacology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - James N'Dow
- NHS Grampian, Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Massimo Perachino
- Center for Miniinvasive Techniques in Urology, Clinica S. Rita, Vercelli, Italy
| | - Karin Plass
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Roland Umbach
- Department of Urology, Klinikum Sindelfingen-Bӧblingen, Sindelfingen, Germany
| | | | - Matthias Oelke
- Department of Urology, St. Antonius-Hospital, Gronau, Germany
| | | |
Collapse
|
5
|
Daniels JP, Patel DN, Galvan GC, Friedrich NA, Das S, Akhavein A, Daskivich T, Josephson D, Desai P, De Nunzio C, Freedland SJ. Investigating trends in interest for benign prostatic hyperplasia surgery options using Google Trends. Prostate Cancer Prostatic Dis 2024; 27:150-152. [PMID: 37422525 PMCID: PMC10876473 DOI: 10.1038/s41391-023-00692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/07/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
Understanding patient interest among surgical options is challenging. We used Google Trends to analyze interest in benign prostatic hyperplasia (BPH) surgeries recommended for prostate volumes <80 cc. Google Trends was queried with five BPH surgeries. Final rank of search terms was TURP, UroLift, Rezum, Aquablation, and Greenlight. Google Trends can be an effective tool for evaluating public interest trends in BPH surgery.
Collapse
Affiliation(s)
| | | | | | | | - Sanjay Das
- University of California- Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Premal Desai
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Stephen J Freedland
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Durham VA Medical Center, Durham, NC, USA.
| |
Collapse
|
6
|
Nguyen DD, Li T, Ferreira R, Baker Berjaoui M, Nguyen ALV, Chughtai B, Zorn KC, Bhojani N, Elterman D. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis 2024; 27:22-28. [PMID: 37081044 DOI: 10.1038/s41391-023-00669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function. METHODS In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies. RESULTS Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function. CONCLUSIONS Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.
Collapse
Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tiange Li
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
7
|
Worthington J, Frost J, Sanderson E, Cochrane M, Wheeler J, Cotterill N, MacNeill SJ, Noble S, Avery M, Clarke S, Fader M, Hashim H, McGeagh L, Macaulay M, Rees J, Robles L, Taylor G, Taylor J, Thompson J, Lane JA, Ridd MJ, Drake MJ. Lower urinary tract symptoms in men: the TRIUMPH cluster RCT. Health Technol Assess 2024; 28:1-162. [PMID: 38512051 PMCID: PMC11017146 DOI: 10.3310/gvbc3182] [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] [Indexed: 03/22/2024] Open
Abstract
Background Conservative therapies are recommended as initial treatment for male lower urinary tract symptoms. However, there is a lack of evidence on effectiveness and uncertainty regarding approaches to delivery. Objective The objective was to determine whether or not a standardised and manualised care intervention delivered in primary care achieves superior symptomatic outcome for lower urinary tract symptoms to usual care. Design This was a two-arm cluster randomised controlled trial. Setting The trial was set in 30 NHS general practice sites in England. Participants Participants were adult men (aged ≥ 18 years) with bothersome lower urinary tract symptoms. Interventions Sites were randomised 1 : 1 to deliver the TReatIng Urinary symptoms in Men in Primary Health care using non-pharmacological and non-surgical interventions trial intervention or usual care to all participants. The TReatIng Urinary symptoms in Men in Primary Health care using non-pharmacological and non-surgical interventions intervention comprised a standardised advice booklet developed for the trial from the British Association of Urological Surgeons' patient information sheets, with patient and expert input. Patients were directed to relevant sections by general practice or research nurses/healthcare assistants following urinary symptom assessment, providing the manualised element. The healthcare professional provided follow-up contacts over 12 weeks to support adherence to the intervention. Main outcome measures The primary outcome was the validated patient-reported International Prostate Symptom Score 12 months post consent. Rather than the minimal clinically important difference of 3.0 points for overall International Prostate Symptom Score, the sample size aimed to detect a difference of 2.0 points, owing to the recognised clinical impact of individual symptoms. Results A total of 1077 men consented to the study: 524 in sites randomised to the intervention arm (n = 17) and 553 in sites randomised to the control arm (n = 13). A difference in mean International Prostate Symptom Score at 12 months was found (adjusted mean difference of -1.81 points, 95% confidence interval -2.66 to -0.95 points), with a lower score in the intervention arm, indicating less severe symptoms. Secondary outcomes of patient-reported urinary symptoms, quality of life specific to lower urinary tract symptoms and perception of lower urinary tract symptoms all showed evidence of a difference between the arms favouring the intervention. No difference was seen between the arms in the proportion of urology referrals or adverse events. In qualitative interviews, participants welcomed the intervention, describing positive effects on their symptoms, as well as on their understanding of conservative care and their attitude towards the experience of lower urinary tract symptoms. The interviews highlighted that structured, in-depth self-management is insufficiently embedded within general practitioner consultations. From an NHS perspective, mean costs and quality-adjusted life-years were similar between trial arms. The intervention arm had slightly lower mean costs (adjusted mean difference of -£29.99, 95% confidence interval -£109.84 to £22.63) than the usual-care arm, and a small gain in quality-adjusted life-years (adjusted mean difference of 0.001, 95% confidence interval -0.011 to 0.014). Conclusions The intervention showed a small, sustained benefit for men's lower urinary tract symptoms and quality of life across a range of outcome measures in a UK primary care setting. Qualitative data showed that men highly valued the intervention. Intervention costs were marginally lower than usual-care costs. Limitations of the study included that trial participants were unmasked, with limited diversity in ethnicity and deprivation level. Additional research is needed to assess the applicability of the intervention for a more ethnically diverse population.. Trial registration This trial is registered as ISRCTN11669964. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/90/03) and is published in full in Health Technology Assessment; Vol. 28, No. 13. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Jo Worthington
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Frost
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Sanderson
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Madeleine Cochrane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Stephanie J MacNeill
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Miriam Avery
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Samantha Clarke
- Clinical Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Lucy McGeagh
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Margaret Macaulay
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Luke Robles
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | - Jodi Taylor
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanne Thompson
- Clinical Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - J Athene Lane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew J Ridd
- Centre of Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
8
|
Porto JG, Titus R, Camargo F, Bhatia A, Ahie N, Blachman-Braun R, Malpani A, Lopategui DM, Herrmann TRW, Marcovich R, Shah HN. Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review. World J Urol 2024; 42:35. [PMID: 38217727 DOI: 10.1007/s00345-023-04747-8] [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: 09/28/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines. METHODS We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome. RESULTS Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System. CONCLUSION The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.
Collapse
Affiliation(s)
- Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Renil Titus
- Seth GS Medical College, KEM Hospital, Mumbai, India
| | - Feres Camargo
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ansh Bhatia
- Seth GS Medical College, KEM Hospital, Mumbai, India
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Nehizena Ahie
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ankur Malpani
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Diana M Lopategui
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Robert Marcovich
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL, USA.
| |
Collapse
|
9
|
Feiertag JH, Kane JA, Clark JY. Incidence of Surgical Reintervention for Benign Prostatic Hyperplasia Following Prostatic Urethral Lift, Transurethral Resection of the Prostate, and Photoselective Vaporization of the Prostate: A TriNetX Analysis. EUR UROL SUPPL 2024; 59:63-70. [PMID: 38298771 PMCID: PMC10829608 DOI: 10.1016/j.euros.2023.11.009] [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] [Accepted: 11/24/2023] [Indexed: 02/02/2024] Open
Abstract
Background Prostatic urethral lift, or UroLift, has gained popularity as a treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Surgical reintervention rates are a reliable indicator for treatment durability. Objective The objective of this study was to utilize TriNetX, a third-party database, to investigate the incidence of surgical reintervention following UroLift, transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) procedures for BPH from 2015 to 2018. Design setting and participants Male patients aged 18-100 yr diagnosed with BPH were identified in the TriNetX Diamond Network database between January 2015 and December 2018. Cohorts of individuals undergoing their first UroLift procedure were built using Current Procedural Terminology and International Classification of Diseases 10th Revision codes. TURP and PVP cohorts were built as comparison groups. The cohorts were then queried for subsequent BPH-related procedures. Outcome measurements and statistical analysis Reprocedure rates were assessed and descriptive statistics were used. Results and limitations The mean age at first-time UroLift was 70.1 ± 9.4 yr (n = 14 343). Cumulative reprocedure rates collected after first-time UroLift included 1 yr after UroLift (5.1%, n = 14 343) and 4 yr after UroLift (16.1%, n = 710), with an average annual increase of +3.6% per year following 1 yr after the procedure. Comparatively, TURP (n = 22 071) and PVP (n = 14 110) had 4-yr reprocedure rates of 7.5% and 7.8%, respectively, during the same timeframe. Limitations include a lack of clinical data and loss of follow-up data outside the Diamond Network. Conclusions The reprocedure rate of UroLift at 4 yr is double the rate of TURP and PVP. In appropriately selected patients, UroLift might be a suitable option for those who desire symptomatic relief from BPH with minimal erectile and ejaculatory side effects. However, the risk of secondary surgical intervention should be considered when considering BPH treatments. Patient summary We compared the reintervention rates of prostatic urethral lift (PUL), transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) using the TriNetX database, and have found that the highest reintervention rates were for PUL of 16% at 4 yr of follow-up, compared with about 8% for those who had TURP and PVP. Interestingly, the most common reintervention was the same operation at 1 yr. This has important implications when counseling patients about the durability of these various outlet procedures for BPH.
Collapse
Affiliation(s)
| | - Jennifer A. Kane
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph Y. Clark
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
10
|
Shin D, Yoon BI, Bang S, Bae WJ, Ha US, Kim S, Piao J, Kim JH, Koo GB, Jeon KH, Kim TH, Kim SW. Safety and Efficacy Assessment of Red Ginseng Oil (RXGIN) in Men with Lower Urinary Tract Symptoms in a Randomized, Double-Blind, Placebo-Controlled Trial. World J Mens Health 2024; 42:229-236. [PMID: 37652660 PMCID: PMC10782132 DOI: 10.5534/wjmh.230172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and safety of red ginseng oil (RXGIN) in men with lower urinary tract symptoms. MATERIALS AND METHODS Men aged between 40 and 75 years with a total International Prostate Symptom Score (IPSS) of 8 to 19 points were recruited from April 2020 to December 2020. Subjects were randomly assigned to either the RXGIN group or the control group in a 1:1 ratio and received either RXGIN or placebo daily for 12 weeks. For the primary outcome, changes in IPSS scores at 6 and 12 weeks from baseline were analyzed. The secondary outcomes were changes in International Index of Erectile Function (IIEF), maximum urinary flow rate, and post-void residual volume at weeks 6 and 12 compared to baseline. Urine analysis and blood tests were additionally performed for safety assessment. RESULTS A total of 88 subjects (RXGIN group, 46; control group, 42) completed the study. The total IPSS and IPSS subscores (residual urine sensation, frequency, intermittency, urgency, weak stream, straining, nocturia, and quality of life) were significantly improved in the RXGIN group compared to the control group at weeks 6 and 12. Total IIEF and sexual desire were significantly improved in the RXGIN group at week 6 and week 12, respectively, but there were no significant changes in the level of serum testosterone or dihydrotestosterone. The serum prostate-specific antigen showed significant decrease at weeks 12. No serious adverse events leading to discontinuation of the study drug were observed in the RXGIN group. CONCLUSIONS Red ginseng oil (RXGIN) appears to be safe and effective in improving lower urinary tract symptoms in men and may also improve some aspects of sexual function.
Collapse
Affiliation(s)
- Dongho Shin
- Department of Urology, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Byung Il Yoon
- Department of Urology, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Seokhwan Bang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soomin Kim
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Junjie Piao
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Jong Han Kim
- Laboratory of Efficacy Research, Korea Ginseng Corporation, Daejeon, Korea
| | - Gi-Bang Koo
- Laboratory of Efficacy Research, Korea Ginseng Corporation, Daejeon, Korea
| | - Kyung-Hwa Jeon
- College of Pharmacy, Ewha Womans University, Seoul, Korea
| | | | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
- Green Medicine Co., Ltd., Busan, Korea.
| |
Collapse
|
11
|
Shin D, Yoon BI, Kim S, Piao J, Jeon KH, Kwon Y, Park SH, Koo YT, Kim JS, Lee DS, Ha US, Kim SW, Jang H, Bae WJ. Cervi Parvum Cornu complex for men with lower urinary tract symptoms: a multicenter, randomized, double-blind, placebo-controlled trial. Prostate Int 2023; 11:222-227. [PMID: 38196553 PMCID: PMC10772165 DOI: 10.1016/j.prnil.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 01/11/2024] Open
Abstract
Background To evaluate the efficacy and safety of Cervi Parvum Cornu, Angelicae Gigantis Radix and Glycyrrhizae Radix complex (CAG) in men with moderate lower urinary tract symptoms (LUTS). Materials and methods From November 2020 to January 2022, participants with International Prostate Symptom Score (IPSS) of 12-19 in two centers were recruited and randomize into three groups: a CAG 500 mg/day group (CAG 500), a CAG 1000 mg/day group (CAG 1000), and a placebo group (PG). They were treated for 12 weeks. The primary endpoint was change of IPSS at the end of study from baseline. Secondary end points included change of prostate specific antigen (PSA), testosterone, dihydrotestosterone (DHT), maximum urinary flow rate (Q max), post-void residual volume (PVR), International Index of Erectile Function (IIEF), and drug safety. Results A total of 103 patients were able to finish the study according to the study protocol. Total IPSS and sub-scores (residual urine sensation, frequency, weak stream, hesistancy, nocturia, and quality of life) in CAG 500 and CAG 1000 were significantly improved at the 12th week compared to those of the PG. Changes of serum PSA, DHT, and testosterone levels at the 12th week from baseline did not show significant differences among the three groups. Q max and PVR changes did not show significant differences among the three groups either. Total IIEF and sub-scores (erectile function, orgasmic function, sexual desire, intercourse satisfaction) in CAG 1000 were significantly improved at 12th week compared to those in PG. No significant adverse events were found. Conclusions CAG is well tolerated in patients with moderate LUTS. Treatment with CAG for 12 weeks has a therapeutic effect on moderate LUTS.
Collapse
Affiliation(s)
- Dongho Shin
- Department of Urology, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Byung Il Yoon
- Department of Urology, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Soomin Kim
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - JunJie Piao
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Hwa Jeon
- College of Pharmacy, Ewha Womans University, Seoul, Korea
| | - Youngjoo Kwon
- College of Pharmacy, Ewha Womans University, Seoul, Korea
| | - Sang-Hyuck Park
- Institute of Cannabis Research, Colorado State University Pueblo, Pueblo, CO, USA
| | | | - Jin-Soo Kim
- Kwang Dong Pharmaceutical Co, Ltd., Seoul, Korea
| | - Dong Sup Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
- Green Medicine Co., Ltd, Pusan, Korea
| | - Hoon Jang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
12
|
Drake MJ, Worthington J, Frost J, Sanderson E, Cochrane M, Cotterill N, Fader M, McGeagh L, Hashim H, Macaulay M, Rees J, Robles LA, Taylor G, Taylor J, Ridd MJ, MacNeill SJ, Noble S, Lane JA. Treatment of lower urinary tract symptoms in men in primary care using a conservative intervention: cluster randomised controlled trial. BMJ 2023; 383:e075219. [PMID: 37967894 PMCID: PMC10646682 DOI: 10.1136/bmj-2023-075219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To determine whether a standardised and manualised care intervention in men in primary care could achieve superior improvement of lower urinary tract symptoms (LUTS) compared with usual care. DESIGN Cluster randomised controlled trial. SETTING 30 National Health Service general practice sites in England. PARTICIPANTS Sites were randomised 1:1 to the intervention and control arms. 1077 men (≥18 years) with bothersome LUTS recruited between June 2018 and August 2019: 524 were assigned to the intervention arm (n=17 sites) and 553 were assigned to the usual care arm (n=13 sites). INTERVENTION Standardised information booklet developed with patient and expert input, providing guidance on conservative and lifestyle interventions for LUTS in men. After assessment of urinary symptoms (manualised element), general practice nurses and healthcare assistants or research nurses directed participants to relevant sections of the manual and provided contact over 12 weeks to assist with adherence. MAIN OUTCOME MEASURES The primary outcome was patient reported International Prostate Symptom Score (IPSS) measured 12 months after participants had consented to take part in the study. The target reduction of 2.0 points on which the study was powered reflects the minimal clinically important difference where baseline IPSS is <20. Secondary outcomes were patient reported quality of life, urinary symptoms and perception of LUTS, hospital referrals, and adverse events. The primary intention-to-treat analysis included 887 participants (82% of those recruited) and used a mixed effects multilevel linear regression model adjusted for site level variables used in the randomisation and baseline scores. RESULTS Participants in the intervention arm had a lower mean IPSS at 12 months (adjusted mean difference -1.81 points, 95% confidence interval -2.66 to -0.95) indicating less severe urinary symptoms than those in the usual care arm. LUTS specific quality of life, incontinence, and perception of LUTS also improved more in the intervention arm than usual care arm at 12 months. The proportion of urology referrals (intervention 7.3%, usual care 7.9%) and adverse events (intervention seven events, usual care eight events) were comparable between the arms. CONCLUSIONS A standardised and manualised intervention in primary care showed a sustained reduction in LUTS in men at 12 months. The mean difference of -1.81 points (95% confidence interval -0.95 to -2.66) on the IPSS was less than the predefined target reduction of 2.0 points. TRIAL REGISTRATION ISRCTN Registry ISRCTN11669964.
Collapse
Affiliation(s)
- Marcus J Drake
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK
| | - Jo Worthington
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Frost
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Sanderson
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Madeleine Cochrane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Lucy McGeagh
- Oxford Institute Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Hashim Hashim
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Margaret Macaulay
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jonathan Rees
- Tyntesfield Medical Group, Brockway Medical Centre, Nailsea, Bristol, UK
| | - Luke A Robles
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, University Hospitals Bristol Education Centre, Bristol, UK
| | | | - Jodi Taylor
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew J Ridd
- Centre of Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephanie J MacNeill
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Athene Lane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
13
|
Lebdai S, Ben Boujema M, Benard A, Barry Delongchamps N, Benchikh A, Bruyere F, Della Negra E, Descazeaud A, Doizi S, Fourmarier M, Mallet R, Misrai V, Pelegrin T, Rouscoff Y, Ruffion A, Villers A, Saillour F, Robert G. Standardized technique for ejaculation preservation during prostatic endoscopic ablative surgery. World J Urol 2023; 41:3041-3049. [PMID: 37715788 DOI: 10.1007/s00345-023-04592-9] [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: 05/06/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE Ejaculatory dysfunction is the most common side effect of benign prostatic hyperplasia surgery. Modified techniques have emerged with the aim of preserving antegrade ejaculation without compromising obstruction relief. None are standardized or validated. The PARTURP study is a randomized study investigating partial versus complete prostate resection. We conducted an investigator consensus meeting to define the ideal surgical technique to achieve both correct obstruction relief with ejaculation preservation. METHODS An expert consensus meeting involving all investigators of the PARTURP study took place to define a common technique using the nominal group methodology. The objectives were to define the areas to be resected and the areas to be preserved; to define the criteria for proper obstruction relief; to define the criteria for proper ejaculation preservation. RESULTS All investigators (n = 15) attended the consensus meeting, and agreement between all the participants was obtained. The anatomical landmarks to be preserved are located around the verumontanum and along the posterior part of the prostatic urethra. These structures must be preserved up to 2 cm from the verumontanum. The participants agreed on the need to preserve the urethral mucosa in all the areas to be preserved and to reach the enucleation plane in the areas of resection. CONCLUSIONS Anatomical landmarks for ejaculation-sparing surgery have been defined by the investigators of the PARTURP randomized study. These landmarks will be used during the study, and the clinical outcomes of this ejaculation-sparing technique will be compared with complete resection with up to 3 years follow-up.
Collapse
Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
| | - Méric Ben Boujema
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Benard
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Amine Benchikh
- Urology Department, Clinique Des Franciscaines, Versailles, France
| | - Franck Bruyere
- Urology Department, University Hospital of Tours, Tours, France
| | | | | | - Steeve Doizi
- Urology Department, Hôpital Tenon, APHP, Paris, France
| | | | - Richard Mallet
- Urology Department, Hôpital Prive Francheville, Périgueux, France
| | | | | | - Yohan Rouscoff
- Urology Department, Polyclinique Saint Georges, Nice, France
| | - Alain Ruffion
- Urology Department, University Hospital of Lyon, Lyon, France
- EA 3738-CICLY EMR UCBL Lyon 1, Lyon, France
| | - Arnaud Villers
- Urology Department, University Hospital of Lille, Lille, France
| | - Florence Saillour
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Urology Department, University Hospital of Bordeaux, Bordeaux, France
| |
Collapse
|
14
|
Trujillo CG, Peña Rodríguez S, Diaz Ritter C. Re: Jean-Nicolas Cornu, Paul Zantek, Glyn Burtt, et al. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol. 2023;83:534-47. Eur Urol 2023; 84:e116. [PMID: 37271633 DOI: 10.1016/j.eururo.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Cesar Diaz Ritter
- Department of Urology, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| |
Collapse
|
15
|
Busetto GM, Checchia A, Recchia M, Tocci E, Falagario UG, Annunziata G, Annese P, d’Altilia N, Mancini V, Ferro M, Crocetto F, Tataru OS, Gianfrancesco LD, Porreca A, Giudice FD, Berardinis ED, Bettocchi C, Cormio L, Carrieri G. Minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS): promise or panacea? Asian J Androl 2023; 26:00129336-990000000-00138. [PMID: 37921510 PMCID: PMC10919430 DOI: 10.4103/aja202357] [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: 06/29/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
ABSTRACT The increasing importance of treatment of lower urinary tract symptoms (LUTS), while avoiding side effects and maintaining sexual function, has allowed for the development of minimally invasive surgical therapies (MISTs). Recently, the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia (BPH) to the management of nonneurogenic male LUTS. The aim of the present review was to evaluate the efficacy and safety of the most commonly used MISTs: ablative techniques such as aquablation, prostatic artery embolization, water vapor energy, and transperineal prostate laser ablation, and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device (iTIND). MISTs are becoming a new promise, even if clinical trials with longer follow-up are still lacking. Most of them are still under investigation and, to date, only a few options have been given as a recommendation for use. They cannot be considered as standard of care and are not suitable for all patients. Advantages and disadvantages should be underlined, without forgetting our objective: treatment of LUTS and re-treatment avoidance.
Collapse
Affiliation(s)
- Gian Maria Busetto
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Andrea Checchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Marco Recchia
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Edoardo Tocci
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | | | | | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Matteo Ferro
- Urology Unit, European Institute of Oncology (IEO) IRCCS, Milan 20141, Italy
| | | | - Octavian Sabin Tataru
- G. E. Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures 540142, Romania
| | - Luca Di Gianfrancesco
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35128, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Roma 00161, Italy
| | - Carlo Bettocchi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Luigi Cormio
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “L. Bonomo” Hospital, Andria 76123, Italy
| | - Giuseppe Carrieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| |
Collapse
|
16
|
Hughes T, Harper P, Somani BK. Treatment Algorithm for Management of Benign Prostatic Obstruction: An Overview of Current Techniques. Life (Basel) 2023; 13:2077. [PMID: 37895457 PMCID: PMC10608556 DOI: 10.3390/life13102077] [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: 09/24/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The management of benign prostatic obstruction (BPO) should involve a treatment algorithm that takes into account prostate size, and patient's symptoms and preference with the aim of helping with urinary symptoms and enhance quality of life. The diagnostic assessment for men with lower urinary tract symptoms (LUTS) should be comprehensive to help choose the best management strategy. Strategies from lifestyle modifications to medical treatment with alpha blockers and/or 5-alpha-reductase inhibitors to surgical procedures can all be used in the management algorithm. Surgical management ranges from transurethral resection of prostate (TURP) to minimally invasive surgical therapies (MIST) including laser therapies such as Holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), aquablation, Rezūm system, prostate artery embolisation (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (iTind) and Optilume BPH catheter system. BPO is a common urological condition that has a significant impact on quality of life and economic burden globally and is likely to become increasingly prevalent with an ageing population. Selecting the most appropriate treatment modality will depend on the individual patient preferences, availability of resources, cost, anatomical factors and the goals of treatment.
Collapse
Affiliation(s)
- Thomas Hughes
- Department of Urology, South Warwickshire University Hospital NHS Foundation Trust, Warwick CV34 5BW, UK;
| | - Philip Harper
- Department of Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| |
Collapse
|
17
|
Gacci M, Nunzio CD, Gravas S. Unveiling prostatic inflammation to optimize management of lower urinary tract symptoms: a discussion with experts. Biomark Med 2023; 17:739-745. [PMID: 37970796 DOI: 10.2217/bmm-2023-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Benign prostatic obstruction (BPO) and associated lower urinary tract symptoms (LUTS) are common conditions in men, which increase in frequency and severity with age, and have a significant impact on quality of life. Chronic prostatic inflammation is increasingly being recognized as a key component of BPO. This may lead to new targets for the management of BPO/LUTS. This podcast is based on presentations from a symposium titled 'Unveiling prostatic inflammation to optimize LUTS management' held at the European Association of Urology 2023 Congress. The presenters outline evidence of a role for prostatic inflammation in the development and progression of BPO/LUTS, approaches to the identification of biomarkers of inflammation, and the implications of prostatic inflammation for the optimal management of BPO/LUTS.
Collapse
Affiliation(s)
- Mauro Gacci
- Department of Minimally Invasive & Robotic Urologic Surgery & Kidney Transplantation, Careggi University Hospital, Florence, Italy
- Department of Experimental & Clinical Biomedical Science, University of Florence, Florence, Italy
| | - Cosimo De Nunzio
- Department of Molecular & Clinical Medicine, Faculty of Medicine & Psychology, Sapienza University of Rome, Rome, Italy
- Division of Urology, Sant'Andrea Hospital, Rome, Italy
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| |
Collapse
|
18
|
Tikkinen KAO, Guyatt GH. Evidence-based Urology: Introduction to Our Second Series of Articles. Eur Urol Focus 2023; 9:689-690. [PMID: 37945407 DOI: 10.1016/j.euf.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland.
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
19
|
Wheeler JR, Tikkinen KAO, Guyatt G, Malde S. How Can We Understand Patients' Values, Preferences, and Expectations in Urology? Eur Urol Focus 2023; 9:719-722. [PMID: 37863738 DOI: 10.1016/j.euf.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
Understanding patients' values and preferences is essential for patient-centred care. Qualitative research provides a broader understanding from a patient perspective at different time points across the patient's life. Quantitative methods quantify specific preferences and answer specific questions that have been informed by qualitative work.
Collapse
Affiliation(s)
- Jessica R Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| |
Collapse
|
20
|
Zhang Y, Hou S, Qi Z, Wu S, Zhu K, Wang W. Non-pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review. J Clin Nurs 2023; 32:6196-6211. [PMID: 37161602 DOI: 10.1111/jocn.16749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/10/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
AIMS To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. METHODS A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three-step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA-ScR Checklist was used to report. RESULTS A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence. CONCLUSION The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods. RELEVANCE TO CLINICAL PRACTICE Physicians and nurses need to be up to date on the latest evidence-based non-pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Sijia Hou
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Ziyi Qi
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Siyuan Wu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Keping Zhu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Wei Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| |
Collapse
|
21
|
Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Speakman MJ, Tikkinen KAO, Cornu JN. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2023; 84:207-222. [PMID: 37202311 DOI: 10.1016/j.eururo.2023.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. OBJECTIVE To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS. EVIDENCE ACQUISITION A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities. CONCLUSIONS The guidelines provide an evidence-based approach for the management of male LUTS. PATIENT SUMMARY A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
Collapse
Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece.
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| |
Collapse
|
22
|
Cornu JN, Zantek P, Burtt G, Martin C, Martin A, Springate C, Chughtai B. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol 2023; 83:534-547. [PMID: 36964042 DOI: 10.1016/j.eururo.2023.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
CONTEXT Minimally invasive surgical therapies for male lower urinary tract symptoms secondary to benign prostatic obstruction were developed to be safer and more tolerable than standard ablative techniques. These treatments have not been compared with each other in a randomised fashion, and for some treatments, there are no trials against a reference technique. OBJECTIVE To compare the efficacy, safety, and tolerability of water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device (iTIND), transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP). EVIDENCE ACQUISITION A systematic search of MEDLINE/PubMed, Embase, Cochrane Library, and grey literature for randomised controlled trials was performed. Trials meeting the selection criteria were assessed for the risk of bias using the Cochrane RoB2 tool. Treatments were compared, using a network meta-analysis, in terms of outcomes including symptom score, quality of life, maximum urinary flow rate, postvoid residual urine, International Index of Erectile Function (IIEF-5), and scales from the Male Sexual Health Questionnaire. EVIDENCE SYNTHESIS The search identified 63 trials. Symptoms and quality of life for PAE, PUL, and WVTT appeared similar to those for TURP, whereas TURP was found to have the most clinically significant improvement in flow rate. TUMT was less efficacious than TURP but provided similar results on quality of life. Comparisons of ejaculatory function favoured WVTT and PUL compared with TURP. The relative efficacy of iTIND was less clear because of the risk of bias in the respective trial. CONCLUSIONS PAE, PUL, and WVTT appear favourable from a risk-benefit perspective despite probably having less efficacy than TURP for objective outcomes. These findings warrant confirmation through long-term randomised controlled trials. PATIENT SUMMARY This paper has summarised the evidence from 63 clinical trials on minimally invasive surgical therapies for men with symptoms of an enlarged prostate, including water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device, and transurethral microwave thermotherapy (TUMT). Improvement in symptoms for each of PAE, PUL, TUMT, and WVTT in short-term follow-up was similar to that for the standard surgical treatment, although standard surgery appeared to provide the greatest increase in urine flow. Men who had WVTT or PUL were less likely to have problems with sexual function than those who had standard surgery.
Collapse
Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France.
| | | | | | | | | | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
23
|
Capdevila F, Insausti I, San Miguel R, Sanchez-Iriso E, Montesino M. Cost-Utility Analysis of Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03443-9. [PMID: 37142802 DOI: 10.1007/s00270-023-03443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To perform a post hoc cost-utility analysis of a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS We conducted a cost-utility analysis over a 5-year period to compare PAE versus TURP from a Spanish National Health System perspective. Data were collected from a randomized clinical trial performed at a single institution. Effectiveness was measured as quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER) was derived from the cost and QALY values associated with these treatments. Further sensitivity analysis was performed to account for the impact of reintervention on the cost-effectiveness of both procedures. RESULTS At the 1-year follow-up, PAE resulted in mean cost per patient of €2904.68 and outcome of 0.975 QALYs per treatment. In comparison, TURP had cost €3846.72 per patient and its outcome was 0.953 QALYs per treatment. At 5 years, the cost for PAE and TURP were €4117.13 and €4297.58, and the mean QALY outcome was 4.572 and 4.487, respectively. Analysis revealed an ICER of €2121.15 saved per QALY gained when comparing PAE to TURP at long-term follow-up. Reintervention rate for PAE and TURP was 12% and 0%, respectively. CONCLUSIONS Compared to TURP, in short term, PAE could be considered a cost-effective strategy within the Spanish healthcare system for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, in long term, the superiority is less apparent due to higher reintervention rates.
Collapse
Affiliation(s)
- Ferran Capdevila
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain.
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain.
| | - Iñigo Insausti
- Department of Radiology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Ramon San Miguel
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Eduardo Sanchez-Iriso
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Manuel Montesino
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Department of Urology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
| |
Collapse
|
24
|
Pratsinis M, Müllhaupt G, Güsewell S, Betschart P, Zumstein V, Engeler D, Schmid HP, Lamb AD, Abt D. Comparison of traditional outcome measures and self-assessed goal achievement in patients treated surgically for benign prostatic hyperplasia. World J Urol 2023; 41:1125-1131. [PMID: 36795145 DOI: 10.1007/s00345-023-04317-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/28/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE To determine self-assessed goal achievement (SAGA) outcomes in men treated surgically for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) and compare them to the traditional outcome measures. METHODS Single-center analysis of prospective database of men undergoing surgical treatment of LUTS/BPO at a single institution between July 2019 and March 2021. We assessed individual goals, traditional questionnaires, and functional outcomes prior to treatment, and at first follow-up after 6-12 weeks. We compared SAGA outcomes 'overall goal achievement' and 'satisfaction with treatment' to subjective and objective outcomes using Spearman's rank correlations (rho). RESULTS A total of sixty-eight patients completed the individual goal formulation prior to surgery. Preoperative goals varied between different treatments and individuals. IPSS correlated with 'overall goal achievement' (rho = - 0.78, p < 0.001) and 'satisfaction with treatment' (rho = - 0.59, p < 0.001). Similarly, the IPSS-QoL was correlated with overall goal achievement (rho = - 0.79, p < 0.001) and satisfaction with treatment (rho = - 0.65, p < 0.001). No correlation was seen between SAGA outcomes and functional outcomes Qmax and PVR. CONCLUSIONS SAGA represents a uniquely patient-specific outcome measure. Our study is, to our knowledge, the first to assess patient-specific goals prior to surgery and examine SAGA outcomes following treatment in men suffering from LUTS/BPO. The correlation of SAGA outcomes with IPSS and IPSS-QoL highlight the importance of this well-established questionnaire. Functional outcomes do not necessarily reflect patient's goals and may rather be considered physician-directed outcomes.
Collapse
Affiliation(s)
- Manolis Pratsinis
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland.
- Department of Urology, University of California, Davis, Sacramento, CA, USA.
| | - Gautier Müllhaupt
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel Engeler
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dominik Abt
- Department of Urology, Spitalzentrum Biel/Centre Hospitalier Bienne, Biel/Bienne, Switzerland
| |
Collapse
|
25
|
Franco JV, Tesolin P, Jung JH. Update on the management of benign prostatic hyperplasia and the role of minimally invasive procedures. Prostate Int 2023; 11:1-7. [PMID: 36910900 PMCID: PMC9995694 DOI: 10.1016/j.prnil.2023.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/24/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Lower urinary tract symptoms due to benign prostatic hyperplasia constitute a substantial burden, affecting the quality of life of those affected by this condition. While watchful waiting and medical management using a wide array of pharmaceuticals can be effective, surgery has been one of the most definite solutions for those highly affected by this condition. Transurethral resection of the prostate (TURP) is the gold standard surgical procedure, but other alternatives using laser (HoLEP and ThuLEP) and robotic water jets (Aquablation) are emerging treatments aimed at reducing postoperative morbidity. Minimally invasive procedures conducted in outpatient settings and under local anesthesia or sedation are increasingly being used, especially in those patients with high surgical risk due to comorbidities. These procedures include prostatic arterial embolization, water vapor thermal therapy (Rezum), prostatic urethral lift (Urolift), temporary implantable nitinol device (TIND/iTIND), and transurethral microwave thermotherapy (TUMT). The evidence supporting these treatments is growing, but some uncertainties remain as to what is the magnitude of their advantages and disadvantages compared to TURP. Innovations in the technologies involved in these new procedures may improve their profile for effectiveness and safety. Moreover, new devices are being investigated for marketing approval. Issues around costs and patients' preferences are also yet to be elucidated, thus their evolving role needs to be weighed against the aforementioned considerations.
Collapse
Affiliation(s)
- Juan V.A. Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Corresponding author. Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Pablo Tesolin
- Family and Community Division, Hospital Italiano de Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Korea
| |
Collapse
|
26
|
Tadrist A, Baboudjian M, Bah MB, Alegorides C, Bottet F, Arroua F, Eghazarian C, Fourmarier M. Water vapor thermal therapy for indwelling urinary catheter removal in frail patients. Int Urol Nephrol 2023; 55:249-253. [PMID: 36342555 DOI: 10.1007/s11255-022-03408-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To report the efficacy and safety of water vapor thermal therapy to achieve catheter removal in frail patients with refractory acute urinary retention. METHODS Data from consecutive frail patients with indwelling urinary catheter undergoing the Rezūm™ therapy (Boston Scientific Corporation, Marlborough, MA) at a single center between October 2017 and June 2021 were prospectively collected. The included patients were deemed unfit or at high risk of complications for conventional benign prostatic hyperplasia (BPH) surgery. Prostate volumes up to 120 mL were considered eligible. The primary endpoint was successful cessation of catheter dependency, assessed postoperatively and up to 1 year of follow-up. RESULTS A total of 24 men met our inclusion criteria. The median age, Charlson comorbidity index, and duration of preoperative catheterization were 77 years (IQR 67-86), 6 (IQR 3-7), and 113 days (IQR 87-159), respectively. Two cases (8.3%) of postoperative complications were recorded (Clavien II and Clavien IIIa). After a median postoperative catheterization time of 21 days (IQR 11-32), all patients regained spontaneous voiding. During follow-up, two patients died and a total of 22 patients completed the 1 year follow-up. All patients maintained spontaneous voiding without recurrence of urinary retention. No surgical retreatment was performed. In terms of pharmacological management, 22/24 patients (91.7%) had a BPH medication pre-Rezūm™; this decreased to 8/22 patients (36.3%) post-Rezūm™ (p < 0.001). CONCLUSIONS In this single-institution, prospective, and observational study, water vapor thermal therapy was found to be effective and safe in restoring successful spontaneous voiding in a cohort of elderly and frail patients.
Collapse
Affiliation(s)
- Abel Tadrist
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Michael Baboudjian
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France. .,Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France. .,Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Mamadou B Bah
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France.,Department of Urology, Hôpital National Ignace Deen, Conakry, Republic of Guinea
| | | | - Florie Bottet
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Frederic Arroua
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | | | - Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| |
Collapse
|
27
|
Post-voided residual urine ratio as a predictor of bladder outlet obstruction in men with lower urinary tract symptoms: development of a clinical nomogram. World J Urol 2023; 41:521-527. [PMID: 36527471 DOI: 10.1007/s00345-022-04259-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To confirm the correlation between post-void residual urine ratio (PVR-R) and BOO diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS) and to develop a clinical nomogram. METHODS A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment for BOO including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies, suprapubic ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BTW). PVR-R was defined as follows: PVR-R = (PVR/total Bladder Volume [BV]) × 100). Logistic regression analysis was used to investigate predictors of pathological bladder emptying (BOO) defined as Schafer > II. A nomogram to predict BOO based on the multivariable logistic regression model was then developed. RESULTS Overall 335 patients were enrolled. Overall, 131/335 (40%) presented BOO on PFS. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 2.21 per mm; 95% confidence interval [CI], 1.57-3.09; p = 0.001), PVR-R (OR: 1.02 per %; 95% CI, 1.01-1.03; p = 0.034) and prostate volume (OR: 0.97 per mL; 95% CI, 0.95-0.98; p = 0.001) were significant predictors for BOO. The model presented an accuracy of 0.82 and a clinical net benefit in the range of 10-90%. CONCLUSIONS The present study confirms the important role of PVR-ratio in the prediction of BOO. For the first time, we present a clinical nomogram including PVR-ratio for the prediction of BOO.
Collapse
|
28
|
Patients' Preferences and Expectations in Overactive Bladder: A Systematic Review. J Clin Med 2023; 12:jcm12020396. [PMID: 36675324 PMCID: PMC9864850 DOI: 10.3390/jcm12020396] [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: 11/07/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
The aim of our study is to review the current available knowledge regarding preferences and expectations of patients with overactive bladder (OAB). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines were followed for this manuscript's preparation. Three online databases were searched: PubMed/Medline, Embase, and Scopus, while a combination of the following keywords was used: detrusor overactivity, overactive bladder, urinary incontinence, perspectives, expectations, and preferences. Overall, 1349 studies were retrieved and screened while only 10 studies appeared to be relevant for the scope of this review. Most of the studies were related to preferences about OAB medications (i.e., antimuscarinics); four of them reported patients' inclinations to alternative treatments in the case of medication therapy failure (i.e., neuromodulation, Botox). No data were found about diagnosis or other aspects of disease management (i.e., surgery, follow-up). Based on these findings, from the patient's point of view, the ideal medication should be cheap, without risk of cognitive function impairment, and able to reduce daytime urinary frequency and incontinence episodes.
Collapse
|
29
|
Prostate Artery Embolization: Challenges, Tips, Tricks, and Perspectives. J Pers Med 2022; 13:jpm13010087. [PMID: 36675748 PMCID: PMC9865478 DOI: 10.3390/jpm13010087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Prostatic artery embolization (PAE) consists of blocking the arteries supplying the prostate to treat benign prostate hypertrophia (BPH). Its effectiveness on both urinary symptoms and flowmetric parameters has now been amply demonstrated by around a hundred studies, including several randomized trials. The main advantage of this procedure is the very low rate of urinary and sexual sequelae, including ejaculatory, with an excellent tolerance profile. The arterial anatomy is a key element for the realization of PAE. Its knowledge makes it possible to anticipate obstacles and prevent potential complications related to nontarget embolization. Nontarget embolization can occur with a small intraprostatic shunt or reflux and has no consequences except some local inflammation symptoms that resolve in a couple of days. Nevertheless, some situations with large arterial shunts arising from the prostatic artery must be recognized (accessory rectal, bladder, or pudendal branches), and must imperatively be protected before embolization, at the risk of exposing oneself to otherwise ischemic complications that are more severe, such as bladder necrosis and skin or mucosal necrosis. This article offers a step-by-step review of the various anatomical and technical key points to ensure technical and clinical success, while avoiding the occurrence of adverse events.
Collapse
|
30
|
De Nunzio C, Salonia A, Gacci M, Ficarra V. The Role of Combination Therapy with α-Blockers and Hexanic Extract of Serenoa repens in the Treatment of LUTS/BPH. J Clin Med 2022; 11:7169. [PMID: 36498751 PMCID: PMC9736252 DOI: 10.3390/jcm11237169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
The hexanic extract of Serenoa repens (HESr) has been in use for decades as an effective, safe and well-tolerated therapy for relieving bothersome lower urinary tract symptoms (LUTS) associated with benign prostate hyperplasia (BPH). This manuscript gives an overview of HESr as monotherapy for LUTS/BPH treatment and focuses on the currently available literature investigating the possible clinical benefits of HESr combination therapy with α-blockers. Combination therapy of HESr with α-blockers has been gaining significant interest in recent years, as an increasing body of evidence shows the beneficial pharmacological effects that HESr treatment can add to standard first-line treatment with α-blockers. By reducing persistent Prostatic Inflammatory Status (PIS), commonly present in LUTS/BPH patients, HESr complements the relaxation of prostate smooth muscle induced by α-blockers, thus providing additional symptom relief. Data suggest that patients harbouring PIS and having a specific clinical profile might especially benefit from the combination therapy. Future therapeutic efforts may take advantage of more personalised strategies for LUTS/BPH management.
Collapse
Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, 20132 Milan, Italy
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, 98122 Messina, Italy
| |
Collapse
|
31
|
Wang XY, Chai YM, Huang WH, Zhang Y. Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and meta-analysis. World J Clin Cases 2022; 10:11812-11826. [PMID: 36405270 PMCID: PMC9669846 DOI: 10.12998/wjcc.v10.i32.11812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Prostate artery embolization (PAE) is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Transurethral resection of the prostate (TURP) is the gold standard therapy for LUTS/BPH.
AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.
METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH. Sources included PubMed, Embase, Cochrane library databases, and Chinese databases before June 2022. A systematic review and meta-analysis were conducted. Outcome measurements were combined by calculating the mean difference with a 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.
RESULTS Eleven studies involving 1070 participants were included. Compared with the TURP group, the PAE group had a similar effect on the International Index of Erectile Function (IPSS) score, Peak urinary flow rate (Qmax), postvoid residual volume (PVR), Prostate volume (PV), prostatic specific antigen (PSA), The International Index of Erectile Function short form (IIEF-5) scores, and erectile dysfunction during 24 mo follow-up. Lower quality of life (QoL) score, lower rate of retrograde ejaculation and shorter hospital stay in the PAE group. There was no participant death in either group. A higher proportion of haematuria, urinary incontinence and urinary stricture was identified in the TURP group.
CONCLUSION PAE may be an appropriate option for elderly patients, patients who are not candidates for surgery, and patients who do not want to risk the potential adverse effects of TURP. Studies with large cases and long follow-up time are needed to validate results.
Collapse
Affiliation(s)
- Xiao-Yan Wang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yu-Meng Chai
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Wen-Hui Huang
- School of Information Science and Engineering, Shandong Normal University, Jinan 250014, Shandong Province, China
| | - Yong Zhang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| |
Collapse
|
32
|
Husted M, Gray D, Golding SE, Hindley R. Reaching a Tipping Point: A Qualitative Exploration of Quality of Life and Treatment Decision-Making in People Living With Benign Prostatic Hyperplasia. QUALITATIVE HEALTH RESEARCH 2022; 32:1979-1992. [PMID: 36154347 PMCID: PMC9629511 DOI: 10.1177/10497323221129262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Benign prostatic hyperplasia (BPH) is a common condition amongst older men and is associated with lower urinary tract symptoms and erectile dysfunction; these symptoms can be burdensome and negatively affect quality of life. Various surgical and pharmaceutical treatment options exist but there is a paucity of qualitative research exploring men's decision-making when seeking BPH treatment. This study qualitatively explored men's experience of living with BPH and seeking treatment for BPH. Twenty men (aged 52-75) were recruited from outpatient urology clinics at a hospital trust in Southern England. Data were collected using semi-structured interviews (via video or telephone call) and were audio-recorded; transcripts were analysed using thematic analysis. Four themes were generated: 'Impacts are about more than just physical symptoms', 'The path towards treatment', 'The process of information gathering' and 'Navigating hopes, fears and uncertainty'. Results indicate most men appear to seek treatment for BPH following a gradual, and sometimes lengthy, period of deterioration in symptoms; for some men, however, treatment seeking follows an acute episode of sudden or severe symptoms. The decision to proceed with surgical or minimally invasive treatment options appears to be dependent on men reaching a tipping point; they no longer perceive their symptoms as tolerable and feel their ability to cope with symptoms is reduced. Men each bring their own set of concerns and preferences about side effects and risk-benefit profiles of different treatments. Clinicians need to be sensitive to these individual differences and incorporate them into shared decision-making for choosing between treatment options for BPH.
Collapse
Affiliation(s)
- Margaret Husted
- Department of Psychology, University of Winchester, Winchester, UK
| | - Debra Gray
- Department of Psychology, University of Winchester, Winchester, UK
| | - Sarah E. Golding
- Department of Psychology, University of Winchester, Winchester, UK
| | - Richard Hindley
- Department of Psychology, University of Winchester, Winchester, UK
- Urology Department, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| |
Collapse
|
33
|
Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. THE PATIENT 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
Collapse
Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
34
|
Alcaraz A, Castro-Díaz D, Gacci M, Salonia A, Ficarra V, Carballido-Rodríguez J, Rodríguez-Antolín A, Medina-Polo J, Fernández-Gómez JM, Cózar-Olmo JM, Búcar-Terrades S, Pérez-León N, Brenes-Bermúdez FJ, Molero-García JM, Fernández-Pro-Ledesma A, Herdman M, Angulo JC, Manasanch J. Efficacy and Tolerability of 6-Month Treatment with Tamsulosin Plus the Hexanic Extract of Serenoa repens versus Tamsulosin Plus 5-Alpha-Reductase Inhibitors for Moderate-to-Severe LUTS-BPH Patients: Results of a Paired Matched Clinical Study. J Clin Med 2022; 11:jcm11133615. [PMID: 35806900 PMCID: PMC9267652 DOI: 10.3390/jcm11133615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this subset analysis was to evaluate and compare the efficacy and tolerability of two combination treatments for men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Data were from a real-world, open-label, prospective, and multicenter study performed in outpatient urology clinics. Men with moderate-to-severe LUTS/BPH received 6-month treatment with tamsulosin (TAM) in combination with either the hexanic extract of S. repens (HESr) or a 5-alpha-reductase inhibitor (5ARI). Changes in urinary symptoms and quality of life were measured using the IPSS and BII questionnaires, respectively. Treatment tolerability was assessed by recording adverse effects (AEs). Patients in the two study groups were matched using iterative and propensity score matching approaches. After iterative matching, data were available from 136 patients (n = 68 treated with TAM + 5ARI, n = 68 with TAM + HESr). After 6 months of treatment, mean (SD) IPSS total score improved by 7.7 (6.3) and 6.7 (5.0) points in the TAM + 5ARI and TAM + HESr groups, respectively (p = 0.272); mean BII total scores improved by 3.1 (2.9) and 2.9 (2.4) points (p = 0.751), respectively. AEs were reported by 26.5% and 10.3% of patients in the same groups, mostly affecting sexual function (p < 0.027). When used in a real-world setting to treat patients with moderate-severe LUTS/BPH, 6-month treatment with TAM + HESr was as effective as TAM + 5ARI, but with better tolerability.
Collapse
Affiliation(s)
- Antonio Alcaraz
- Urology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), 08036 Barcelona, Spain;
| | - David Castro-Díaz
- Urology Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Mauro Gacci
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy;
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi”, Urology Section, University of Messina, 98125 Messina, Italy;
| | | | - Alfredo Rodríguez-Antolín
- Urology Department, Research Institute i + 12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (A.R.-A.); (J.M.-P.)
| | - José Medina-Polo
- Urology Department, Research Institute i + 12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (A.R.-A.); (J.M.-P.)
- Urology Unit, HM Hospital, 28050 Madrid, Spain
- ROC Clinic, 28010 Madrid, Spain
| | | | - José M. Cózar-Olmo
- Urology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | | | | | | | | | | | - Michael Herdman
- Insight Consulting and Research, 08301 Mataró, Spain;
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Javier C. Angulo
- Clinical Department, Universidad Europea de Madrid, 28905 Getafe, Spain;
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain
| | | | | |
Collapse
|
35
|
Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
CONTEXT Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. OBJECTIVE To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. EVIDENCE ACQUISITION A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. EVIDENCE SYNTHESIS UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. CONCLUSIONS This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. PATIENT SUMMARY Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.
Collapse
Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| |
Collapse
|
36
|
Franco JVA, Jung JH, Liquitay CME, Dahm P. What is the role of minimally invasive surgical treatments for benign prostatic enlargement? BMJ 2022; 377:e069002. [PMID: 35613726 DOI: 10.1136/bmj-2021-069002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Juan Victor Ariel Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | | | - Philipp Dahm
- Minneapolis VAMC, Urology Section and Department of Urology, University of Minnesota, Minneapolis, USA
| |
Collapse
|
37
|
Vredeveld T, van Benten E, Beekmans REPM, Koops MP, Ket JCF, Mollema J, Ramaekers SPJ, Pool JJM, Coppieters MW, Pool-Goudzwaard AL. Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review. BMJ Open 2022; 12:e056234. [PMID: 35487713 PMCID: PMC9058800 DOI: 10.1136/bmjopen-2021-056234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). DESIGN Systematic review with best evidence synthesis. SETTING Primary care. PARTICIPANTS Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. REVIEW METHODS PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. RESULTS Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. CONCLUSION Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
Collapse
Affiliation(s)
- Tom Vredeveld
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Esther van Benten
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | | | - M Patrick Koops
- Physiotherapy Practice De Werfheegde, Haaksbergen, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jurgen Mollema
- Medical Library, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Stephan P J Ramaekers
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jan J M Pool
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | - Michel W Coppieters
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - Annelies L Pool-Goudzwaard
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
| |
Collapse
|
38
|
Castellani D, Di Rosa M, Saredi G, Pacchetti A, Banchero R, Ambrosini F, Meroni P, Guano G, Boltri M, Bucci S, Simonetti E, Maestroni U, Ferretti S, Terrone C, Dellabella M. Change in postoperative storage symptoms and de novo urge-incontinence after Thulium: YAG laser enucleation of the prostate: results from a prospective, multicenter study. J Endourol 2022; 36:1223-1230. [PMID: 35414264 DOI: 10.1089/end.2022.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the change of storage symptoms and their impact on quality of life in men undergoing Thulium: YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS BPH patients requiring surgery were prospectively evaluated (April 2019-October 2020). INCLUSION CRITERIA International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 ml/s, and urinary retention. EXCLUSION CRITERIA previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1,3,6 and 12 months after surgery. RESULTS 117 men were included. Mean age was 68.0±7.7 years. Mean prostate volume was 86.6±34 cc. Mean IPSS subscore was 8.7±3.1 and 11.7±4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1±16.8. Mean ICIQ-OABq was 80.3±30.6. Voiding IPSS decreased 72.8% at 1-month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1-month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge-incontinence was present in 26.5% of men at 1-month, 15.4% at 3-month and 4.3% at 6-month. 4(3.4%) patients complained of urge-incontinence 12 months after surgery. CONCLUSION Both storage and voiding LUTS significantly decreased after ThuLEP but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months.
Collapse
Affiliation(s)
- Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | | | - Giovanni Saredi
- Ospedale di Circolo e Fondazione Macchi, Urology, Varese, Italy;
| | - Andrea Pacchetti
- Ospedale di Circolo e Fondazione Macchi, Urology, via Tagliamento 14, Induno Olona, Italy, 21056;
| | | | | | - Paola Meroni
- Ospedale di Circolo e Fondazione Macchi, Urology, Varese, Italy;
| | - Giovanni Guano
- University of Genoa, 9302, Urology, Genova, Liguria, Italy;
| | - Matteo Boltri
- Hospital of Cattinara, 415994, Trieste, Friuli-Venezia Giulia, Italy;
| | | | - Elisa Simonetti
- Azienda Ospedaliero-Universitaria di Parma, 18630, Parma, Emilia-Romagna, Italy;
| | - Umberto Maestroni
- Hospital and University of Parma, Urology OU, Surgical Department, Parma, Italy;
| | - Stefania Ferretti
- Hospital and University of Parma, O.U. Urology, Via Gramsci, n° 14, Parma, Italy, 43100;
| | | | | |
Collapse
|
39
|
Miernik A, Roehrborn CG. Benign Prostatic Hyperplasia Treatment On Its Way to Precision Medicine: Dream or Reality? Eur Urol Focus 2022; 8:363-364. [PMID: 35400612 DOI: 10.1016/j.euf.2022.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Arkadiusz Miernik
- Department of Urology, University of Freiburg - Medical Centre, Faculty of Medicine, Freiburg, Germany.
| | - Claus G Roehrborn
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
40
|
Endoscopic Enucleation of the Prostate Is Better than Robot-assisted Simple Prostatectomy. Eur Urol Focus 2022; 8:365-367. [PMID: 35396196 DOI: 10.1016/j.euf.2022.03.020] [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: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
In 2022, endoscopic enucleation of the prostate (EEP) is the treatment of choice for benign prostatic obstruction (BPO) for glands >80 ml and is a valid alternative for patients with bleeding disorders. Unlike robot-assisted radical prostatectomy, EEP has no additional access-related trauma and can be performed using the same instruments as for bipolar enucleoresection. With favorable costs, EEP can serve as a global solution for BPO treatment.
Collapse
|
41
|
WATER vs WATER II 3-Year Update: Comparing Aquablation Therapy for Benign Prostatic Hyperplasia in 30-80 cc and 80-150 cc Prostates. Urology 2022; 165:268-274. [DOI: 10.1016/j.urology.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 11/18/2022]
|
42
|
Sokolakis I, Pyrgidis N, Russo GI, Sountoulides P, Hatzichristodoulou G. Preserving Ejaculation: A Guide Through the Landscape of Interventional and Surgical Options for Benign Prostatic Obstruction. Eur Urol Focus 2022; 8:380-383. [PMID: 35339416 DOI: 10.1016/j.euf.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Surgical treatment for benign prostatic obstruction in patients wishing to preserve normal ejaculation remains a urological challenge. Standard surgical techniques are associated with high rates of postoperative ejaculatory dysfunction. Research is now concentrating on ejaculation-preserving modifications of standard surgical techniques and on alternative minimally invasive interventional techniques. Ejaculation-preserving modifications seem to be superior to standard techniques for preservation of ejaculation with comparable efficacy in terms of improvement in lower urinary tract symptoms (LUTS). Among the alternative minimally invasive interventional techniques, prostatic artery embolization and prostatic urethral lift provide high success rates for patients wishing to preserve ejaculation but are inferior to standard surgical techniques regarding improvement in LUTS. High-quality studies focusing on ejaculatory function as the primary outcome are still lacking. PATIENT SUMMARY: Benign prostate enlargement can cause obstruction of the lower urinary tract. We reviewed the evidence for techniques that preserve ejaculatory function in treatment of this condition. These ejaculation-preserving treatment techniques may have lower efficacy in improving bothersome urinary symptoms.
Collapse
Affiliation(s)
- Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany.
| | - Nikolaos Pyrgidis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Petros Sountoulides
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
43
|
Baboudjian M, Peyronnet B, Boissier R, Robert G, Cornu JN, Misrai V, Pradere B. Best nonsurgical managements of acute urinary retention: what's new? Curr Opin Urol 2022; 32:124-130. [PMID: 34954701 DOI: 10.1097/mou.0000000000000969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). RECENT FINDINGS A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (-89.68 min, 95% confidence interval -160.55, -18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR. SUMMARY The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.
Collapse
Affiliation(s)
- Michael Baboudjian
- Department of Urology, La Conception Hospital
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille
| | | | | | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
44
|
Gravas S. Hot Topics in the Clinical Practice Guidelines for Treatment of Male Lower Urinary Tract Symptoms due to Benign Prostatic Obstruction. Eur Urol Focus 2022; 8:396-398. [PMID: 35337777 DOI: 10.1016/j.euf.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners in patient decisions about appropriate health care. Appropriate methodologies and rigorous strategies are required to achieve high-quality CPGs. However, several challenges may occur during the development of guidelines. This article highlights current hot topics related to the development of guidelines for the management of non-neurogenic male lower urinary tract symptoms (LUTS) including benign prostatic obstruction (BPO). Challenges include: (1) periodic updating of guidelines because of the rapid and continuous accumulation of new evidence and a range of emerging treatment options; (2) the requirements for inclusion of new interventions in guidelines; (3) inclusion of the values and preferences of patients with LUTS who have different needs and characteristics; and (4) a need to improve guideline implementation and adherence. Actions to overcome these challenges are also discussed. PATIENT SUMMARY: Guidelines are considered to improve the quality of clinical decisions by helping doctors and contributing to the consistency of care. The development and successful translation into clinical practice of guidelines on male lower urinary tract symptoms require management of several issues, including the identification and incorporation of patients' values and preferences.
Collapse
Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Cyprus.
| |
Collapse
|
45
|
Alcaraz A, Gacci M, Ficarra V, Medina-Polo J, Salonia A, Fernández-Gómez JM, Ciudin A, Castro-Díaz D, Rodríguez-Antolín A, Carballido-Rodríguez J, Cózar-Olmo JM, Búcar-Terrades S, Pérez-León N, Brenes-Bermúdez FJ, Molero-García JM, Ledesma AFP, Herdman M, Manasanch J, Angulo JC, Group OBOTQUALIPROSTS. Efficacy and Safety of the Hexanic Extract of Serenoa repens vs. Watchful Waiting in Men with Moderate to Severe LUTS-BPH: Results of a Paired Matched Clinical Study. J Clin Med 2022; 11:jcm11040967. [PMID: 35207238 PMCID: PMC8878824 DOI: 10.3390/jcm11040967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
We investigated changes in symptoms and quality of life (QoL) in men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) receiving the hexanic extract of Serenoa repens (HESr) and compared results with a matched group on watchful waiting (WW). Data was from a real-world, open-label, prospective, multicenter study. This sub-group analysis included patients with moderate-to-severe symptoms receiving either the HESr 320 mg/daily for six months (HESr) or who remained untreated for LUTS/BPH (WW). Changes in urinary symptoms and QoL were measured by IPSS and BII questionnaires. Two statistical approaches (iterative matching and propensity score pairing) were used to maximize between-group comparability at baseline. Tolerability was assessed in the HESr group. After iterative matching, data for analysis was available for 783 patients (102 WW, 681 HESr). IPSS scores improved by a mean (SD) of 3.8 (4.4) points in the HESr group and by 2.2 (4.5) points in the WW group (p = 0.002). Changes in BII score were 1.8 (2.4) points and 1.0 (2.2) points, respectively (p < 0.001). Three patients (0.9%) treated with the HESr reported mild adverse effects. Moderate-severe LUTS/BPH patients treated for six months with the HESr showed greater improvements in symptoms and QoL than matched patients on WW, with a very low rate of adverse effects.
Collapse
Affiliation(s)
- Antonio Alcaraz
- Urology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, 08036 Barcelona, Spain;
| | - Mauro Gacci
- Unit of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, 50134 Florence, Italy;
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology “Gaetano Barresi”, Urology Section, University of Messina, 98125 Messina, Italy;
| | - José Medina-Polo
- Urology Department, Research Institute Hospital 12 de Octubre (i+12), 28041 Madrid, Spain; (J.M.-P.); (A.R.-A.)
- Urology Unit, HM Hospital, 28050 Madrid, Spain
- ROC Clinic, 28010 Madrid, Spain
| | - Andrea Salonia
- Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy;
- Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | | | | | - David Castro-Díaz
- Urology Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Alfredo Rodríguez-Antolín
- Urology Department, Research Institute Hospital 12 de Octubre (i+12), 28041 Madrid, Spain; (J.M.-P.); (A.R.-A.)
| | | | - José M. Cózar-Olmo
- Urology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | | | | | | | | | | | - Michael Herdman
- Insight Consulting and Research, 08301 Mataró, Spain;
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | | | - Javier C. Angulo
- Clinical Department, Universidad Europea de Madrid, 28905 Getafe, Spain
- Urology Department, Hospital Universitario de Getafe, 28905 Getafe, Spain
- Correspondence: ; Tel.: +34-699-497-569
| | | |
Collapse
|
46
|
Nguyen DD, Trinh QD, Bhojani N. Combination of Tadalafil and Finasteride for the Treatment of Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia: Commercialization of the Prescribing Cascade. Eur Urol 2022; 81:323-324. [PMID: 35074250 DOI: 10.1016/j.eururo.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022]
Abstract
An oral capsule combining finasteride and tadalafil was recently approved in the USA for signs and symptoms of benign prostatic hyperplasia (BPH). The authors argue that this new formulation has a limited role in the management of BPH and represents an avoidable prescribing cascade and low-value care. There is an armamentarium of medical and surgical alternatives that should be considered instead of a tadalafil and finasteride combination therapy given the problem of increasing polypharmacy and considerations for value-based care.
Collapse
Affiliation(s)
- David-Dan Nguyen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.
| |
Collapse
|
47
|
Huffman PJ, Yin E, Cohen AJ. Evaluating Patient Preferences in Benign Prostatic Hyperplasia Treatment Using Conjoint Analysis. Urology 2022; 164:211-217. [PMID: 35063462 DOI: 10.1016/j.urology.2022.01.012] [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: 10/25/2021] [Revised: 12/17/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To quantify BPH patient preferences to promote guidelines-compliant, patient-centered care. Discordance between patient and urologist priorities for the treatment of benign prostatic hyperplasia (BPH) hinders patient-centered care. Physician assumptions regarding patient preferences lead to dissatisfied patients; a poor outcome in any quality of life surgery. American Urologic Association guidelines urge urologists to consider patient preferences when recommending a BPH treatment. METHODS In this cross-sectional, online survey study using researchmatch.org, participants were required to decide between theoretical BPH treatments in a balanced, choice-based conjoint analysis. The treatments had varying levels of four attributes: efficacy, recovery difficulty, risk of complications (Clavien-Dindo 2+), and risk of de novo ejaculatory dysfunction. Demographic information and International Prostate Symptom Score (IPSS) were collected and analyzed using comparative statistics. Each attribute was analyzed using a conditional logit model, and attribute importance (range in utility between attribute-levels) was calculated. RESULTS Out of 1235 recruited participants, 812 (66%) completed the study. Median IPSS and age was 6 (IQR 3-12) and 56 (IQR 38-67), respectively. Complication risk was the most important attribute, followed by efficacy, recovery difficulty, and risk of ejaculatory dysfunction. In a subgroup analysis of age quartiles, participants age <38 and >67 held efficacy (31%) and complication risk (47%) to the highest relative importance, respectively. CONCLUSIONS Males valued BPH treatments that minimize complication risks, while ejaculatory dysfunction was least impactful. Variation in results between age subgroups emphasizes the need for individualized care to maximize patient satisfaction.
Collapse
Affiliation(s)
- Phillip J Huffman
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Edward Yin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrew J Cohen
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| |
Collapse
|
48
|
Olaniyi P, Cotterill N, Drake MJ, Frost J, Lane JA, Ridd M, Robles L, Taylor G, Worthington J, Wheeler J. Qualitative Assessment of the Conservative Management of Nocturia with Standardised Written Materials for Lower Urinary Tract Symptoms in Men Treated in Primary Care. Eur Urol Focus 2022; 8:75-80. [PMID: 35034867 DOI: 10.1016/j.euf.2022.01.003] [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: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many men prefer conservative treatment of lower urinary tract symptoms (LUTS) but education and self-help guidance are limited in primary care. OBJECTIVE To report qualitative interview findings for men reporting nocturia in a primary care setting for LUTS. DESIGN, SETTING, AND PARTICIPANTS TRIUMPH (Treating Urinary Symptoms in Men in Primary Healthcare) is a multicentre cluster randomised trial of standardised manualised care (a booklet delivered by a health care professional) versus usual care for LUTS. The participants (524 in the intervention arm and 553 in the usual care arm) were men presenting for primary care for LUTS at 30 general practice (GP) sites in the UK. INTERVENTION Delivery of a LUTS self-management booklet by health care staff in comparison to usual care for men with LUTS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The qualitative component included 58 early-stage (0-3 mo after study enrolment) and 33 late-stage (3-9 mo later) interviews with participants to assess their experience of LUTS and conservative treatment in primary care. Purposive sampling was used to select participants for interview. RESULTS AND LIMITATIONS Nocturia is a common driver for seeking health care and is perceived by men as relatively acceptable to discuss. Information and self-help guidance were largely absent from descriptions of GP consultations, other than reducing evening caffeine and fluid intake. The TRIUMPH LUTS intervention booklet offers explanations and self-management guidance. Men with long-term disruptive symptoms, a perception that the booklet content was novel or worthwhile, and a belief that self-management might help, were more receptive to the intervention. In follow-up, improvements in nocturia were related to successful implementation of several aspects of the guidance. Most men were willing to complete a bladder diary, but some found it inconvenient, especially men in employment. The characteristics of the trial population mean that the findings may not apply to all men. CONCLUSIONS Reassuring men that nocturia is part of ageing without offering them information and support risks reinforcing the tendency to discount problematic LUTS. The trial booklet and the training of health care professionals support guidance on nocturia self-management, which is most effective for men receptive to this approach. However, the nature of the trial population means that the findings may not apply to all men. PATIENT SUMMARY Men are more comfortable in discussing waking at night to urinate than talking about other urinary symptoms with their GP. This problem should lead to a detailed discussion of all urinary symptoms rather than being thought of as a sign of ageing. An information booklet and nurse consultation helped many men to improve this symptom.
Collapse
Affiliation(s)
- Patrick Olaniyi
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jessica Frost
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke Robles
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gordon Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jo Worthington
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
49
|
Deyirmendjian C, Elterman D, Chughtai B, Zorn KC, Bhojani N. Surgical treatment options for benign prostatic obstruction: beyond prostate volume. Curr Opin Urol 2022; 32:102-108. [PMID: 34669611 DOI: 10.1097/mou.0000000000000937] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization. RECENT FINDINGS A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP. SUMMARY BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.
Collapse
Affiliation(s)
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
50
|
Drake MJ, Rees J, Henderson EJ. Nocturia Is an Orphan Symptom Seeking Caring Specialties Willing To Adopt. Eur Urol Focus 2022; 8:1-3. [DOI: 10.1016/j.euf.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
|