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Galey L, Olanrewaju A, Nabi H, Paquette JS, Pouliot F, Audet-Walsh É. PSA, an outdated biomarker for prostate cancer: In search of a more specific biomarker, citrate takes the spotlight. J Steroid Biochem Mol Biol 2024; 243:106588. [PMID: 39025336 DOI: 10.1016/j.jsbmb.2024.106588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
The prevailing biomarker employed for prostate cancer (PCa) screening and diagnosis is the prostate-specific antigen (PSA). Despite excellent sensitivity, PSA lacks specificity, leading to false positives, unnecessary biopsies and overdiagnosis. Consequently, PSA is increasingly less used by clinicians, thus underscoring the imperative for the identification of new biomarkers. An emerging biomarker in this context is citrate, a molecule secreted by the normal prostate, which has been shown to be inversely correlated with PCa. Here, we discuss about PSA and its usage for PCa diagnosis, its lack of specificity, and the various conditions that can affect its levels. We then provide our vision about what we think would be a valuable addition to our PCa diagnosis toolkit, citrate. We describe the unique citrate metabolic program in the prostate and how this profile is reprogrammed during carcinogenesis. Finally, we summarize the evidence that supports the usage of citrate as a biomarker for PCa diagnosis, as it can be measured in various patient samples and be analyzed by several methods. The unique relationship between citrate and PCa, combined with the stability of citrate levels in other prostate-related conditions and the simplicity of its detection, further accentuates its potential as a biomarker.
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Affiliation(s)
- Lucas Galey
- Endocrinology - Nephrology Research Axis, Centre de recherche du CHU de Québec - Université Laval, Québec City, Canada; Department of Molecular Medicine, Faculty of Medicine, Université Laval, Québec City, Canada; Centre de recherche sur le cancer de l'Université Laval, Québec City, Canada
| | - Ayokunle Olanrewaju
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hermann Nabi
- Centre de recherche sur le cancer de l'Université Laval, Québec City, Canada
| | - Jean-Sébastien Paquette
- Laboratoire de recherche et d'innovation en médecine de première ligne (ARIMED), Groupe de médecine de famille universitaire de Saint-Charles-Borromée, CISSS Lanaudière, Saint-Charles-Borromée, QC, Canada; VITAM Research Centre for Sustainable Health, Québec, QC, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Frédéric Pouliot
- Centre de recherche sur le cancer de l'Université Laval, Québec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada; Department of surgery, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Étienne Audet-Walsh
- Endocrinology - Nephrology Research Axis, Centre de recherche du CHU de Québec - Université Laval, Québec City, Canada; Department of Molecular Medicine, Faculty of Medicine, Université Laval, Québec City, Canada; Centre de recherche sur le cancer de l'Université Laval, Québec City, Canada.
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Nanjundaswamy R, B NJ, Vijayakumar V, Jois SN, Nagendra Prasad K. Effectiveness of Pranic Healing as complementary therapy on lower urinary tract symptoms and sleep: Single-blind randomized trial. Complement Ther Med 2024; 84:103067. [PMID: 39033882 DOI: 10.1016/j.ctim.2024.103067] [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: 04/24/2024] [Revised: 06/14/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Benign Prostatic Hyperplasia (BPH) commonly affects older men, leading to lower urinary tract symptoms (LUTS) that affect sleep and quality of life. This study evaluates the effect of Pranic Healing (PH) as a complementary therapy for bothersome LUTS by normalising biofield energy centres called Chakras. METHODOLOGY A single blind trial involving 76 men with LUTS was conducted, randomised into Medication-only (MED) and Medication-plus-Pranic Healing (MEDPH) groups. The MEDPH received PH sessions twice weekly for 5 weeks. RESULTS The study compared MED (n = 30) and MEDPH (n = 36) participants, finding significant improvements in IPSS scores (p ≤ .001) in both groups. The MEDPH group showed a greater reduction in incomplete bladder emptying and intermittency. The post void residual volume increased significantly in the MED group (Wilcoxon Z = -2.335, p = .02), while the MEDPH group reduced non-significantly. Sleep quality index improved significantly (McNemar=.013) in the MEDPH group, while the MED group showed no significant change. Subjective sleep quality, duration, and latency improved significantly in the MEDPH group. Healers reported improved energy balance in chakras of MEDPH group. Perceived energy by healers in lower chakra relates to urinary parameters. CONCLUSION PH could alleviate LUTS, enhancing quality of life due to urination, and improved sleep, among moderate BPH patients. TRIAL REGISTRATION This study has been registered under the Clinical Trial Registry of India. (CTRI No: CTRI/2023/01/049004).
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Affiliation(s)
- Roopa Nanjundaswamy
- World Pranic Healing Foundation, India, Research Centre, CH 44, First Floor, 4th Main, 1st Cross Rd, Saraswathipuram, Mysuru, Karnataka 570009, India.
| | - Narendra J B
- Department of Urology, Mysore Medical College and Research Centre, Mysore, India.
| | - Vinu Vijayakumar
- World Pranic Healing Foundation, India, Research Centre, CH 44, First Floor, 4th Main, 1st Cross Rd, Saraswathipuram, Mysuru, Karnataka 570009, India.
| | - Srikanth N Jois
- World Pranic Healing Foundation, India, Research Centre, CH 44, First Floor, 4th Main, 1st Cross Rd, Saraswathipuram, Mysuru, Karnataka 570009, India.
| | - K Nagendra Prasad
- World Pranic Healing Foundation, India, Research Centre, CH 44, First Floor, 4th Main, 1st Cross Rd, Saraswathipuram, Mysuru, Karnataka 570009, India.
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Li EV, Lee MS, Guo J, Dean N, Kumar S, Mi X, Zhou R, Neill C, Yang X, Ross AE, Krambeck AE. Modern predictors and management of incidental prostate cancer at holmium enucleation of prostate. Prostate 2024. [PMID: 39154284 DOI: 10.1002/pros.24781] [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: 04/17/2024] [Revised: 07/15/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND To evaluate contemporary preoperative risk factors and subsequent postoperative management of incidental prostate cancer (iPCa) and incidental clinically significant prostate cancer (icsPCa, Grade Group [GG] ≥ 2 PCa). METHODS A retrospective cohort of 811 men undergoing Holmium enucleation of the prostate (HoLEP) (January 2021-July 2022) were identified. Advanced preoperative testing was defined as prostate health index (PHI), prostate MRI, and/or negative preoperative biopsy. Descriptive statistics (Whitney-Mann U test, Chi-squared test) and multivariable logistic regression were performed. RESULTS iPCa and icsPCa detection rates were 12.8% (104/811) and 4.4% (36/811), respectively. Advanced preoperative testing (406/811, 50%) was associated with younger age and higher (prostate specific antigen) PSA, prostate volume, and PSA density. On multivariable analysis, PHI ≥ 55 was associated with iPCa (OR 6.91, 95% CI 1.85-26.3, p = 0.004), and % free PSA (%fPSA) was associated with icsPCa (OR 0.83, 95% CI 0.67, 0.94, p = 0.01). GG1 disease comprised the majority of iPCa (65%, 68/104) with median 1% involvement. iPCa patients were followed with active surveillance (median follow up 9.3 months), with higher risk patients receiving prostate MRI and confirmatory biopsy. Three patients proceeded to radical prostatectomy or radiation. CONCLUSIONS In the era of MRI and advanced biomarkers, the majority of iPCa following HoLEP is low volume GG1 suitable for active surveillance. A tentative follow-up strategy is proposed. Patients with PHI ≥ 55 or low %fPSA, even with negative prostate MRI, can consider preoperative prostate biopsy before HoLEP.
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Affiliation(s)
- Eric V Li
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Matthew S Lee
- Department of Urology, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jenny Guo
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Nicholas Dean
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Sai Kumar
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Xinlei Mi
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Ruoji Zhou
- Feinberg School of Medicine, Department of Pathology, Northwestern University, Chicago, Illinois, USA
| | - Clayton Neill
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Ximing Yang
- Feinberg School of Medicine, Department of Pathology, Northwestern University, Chicago, Illinois, USA
| | - Ashley E Ross
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Amy E Krambeck
- Feinberg School of Medicine, Department of Urology, Northwestern University, Chicago, Illinois, USA
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Brown N, Kiosoglous A, Castree S, Firouzmand S, McBean R, Walker DG, Wallace S, Kua B, Gianduzzo T, Esler RC, Campbell P, Schoeman J, Yaxley J. The 'Prostate Embolisation AS first-line therapY compAred to meDication in treatment naïVe men with prostAte eNlargement, a randomised ControllEd trial' (P-EASY ADVANCE): a randomised controlled trial of prostate embolisation vs medication for BPH. BJU Int 2024. [PMID: 39139009 DOI: 10.1111/bju.16479] [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: 08/15/2024]
Abstract
OBJECTIVE To compare prostate artery embolisation (PAE) to the combination of tamsulosin and dutasteride therapy as a potential first-line therapy for obstructive benign prostatic hyperplasia (BPH) in treatment-naïve patients in the 'Prostate Embolisation AS first-line therapY compAred to meDication in treatment naïVe men with prostAte eNlargement, a randomised ControllEd trial' (P-EASY ADVANCE). PATIENTS AND METHODS A total of 39 men with enlarged prostates, moderate-severe lower urinary tract symptoms (LUTS) and obstructed/equivocal urodynamic studies (UDS), and who had no prior treatment for BPH, were randomised to receive either combined medical therapy with tamsulosin and dutasteride (medication) or PAE. Follow-up UDS, International Prostate Symptom Score (IPSS), uroflowmetry and ultrasound were performed at short- to medium-term intervals following interventions and compared to baseline. RESULTS The medication and PAE treatment groups had similar baseline characteristics, including prostate volumes (87.8 and 85.4 mL respectively), maximum urinary flow rate (Qmax; 6.5 and 6.6 mL/s, respectively), IPSS (19.5 and 21, respectively) and obstructed UDS (79% and 74%, respectively). Both interventions improved voiding and bladder outflow obstruction from baseline, with more patients unobstructed after PAE (63%) compared to medication (28%) (P = 0.03). PAE patients had significantly greater reductions in prostate size (P < 0.001), incomplete emptying (P = 0.002), total IPSS (P = 0.032), Qmax (P = 0.006) and quality of life (P = 0.001). Altered ejaculation, erectile dysfunction and nausea were more common in the medication group. CONCLUSION Prostate artery embolisation was more effective than combined medical therapy at reducing urinary obstruction, decreasing prostate volume and improving LUTS in patients with BPH who had not previously been treated. This is the first randomised control study to compare PAE and combined medical therapy in exclusively treatment-naïve patients and raises the potential of PAE as an alternative early treatment option for BPH. Further randomised comparative trials are planned to further validate the role of PAE in mitigating obstructive BPH.
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Affiliation(s)
- Nicholas Brown
- The University of Queensland, Brisbane, Queensland, Australia
- I-MED Radiology, Brisbane, Queensland, Australia
| | - Anthony Kiosoglous
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | | | | | | | | | - Sean Wallace
- I-MED Radiology, Brisbane, Queensland, Australia
| | - Boon Kua
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Troy Gianduzzo
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Rachel C Esler
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Peter Campbell
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Joseph Schoeman
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - John Yaxley
- The University of Queensland, Brisbane, Queensland, Australia
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
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Tsai K, Xu P, Guo J, Dean N, Khondakar N, Michael J, Neill C, Krambeck A. Do Prostate Imaging-Reporting and Data System (PIRADS) lesions predict holmium laser enucleation of prostate outcomes? Prostate 2024. [PMID: 39045792 DOI: 10.1002/pros.24771] [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: 02/14/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION AND OBJECTIVES Prostate magnetic resonance imaging (MRI) is used for prostate cancer (PCa) screening and risk stratification and is helpful for surgical planning for patients undergoing holmium laser enucleation of the prostate (HoLEP). There are few studies investigating the correlation between MRI Prostate Imaging-Reporting and Data System (PIRADS) lesion characteristics and HoLEP pathology and outcomes. METHODS We performed retrospective review of patients who underwent HoLEP between January 2021 and August 2023 by a single surgeon. Preoperative, intraoperative, and postoperative characteristics and outcomes were analyzed for all patients who had a documented preoperative prostate MRI. RESULTS There were 334 patients without a pre-existing diagnosis of PCa and with a preoperative prostate MRI, of which 140 (42%) had at least one PIRADS lesion. There was a total of 203 PIRADS lesions: 91 (45%) in the peripheral zone (PZ), 106 (52%) in the transition zone (TZ), and 6 (2%) not specified. Incidental PCa was noted in 44 (13%) patients at time of HoLEP. Presence or location of lesion was not significantly associated with rate or grade of incidental PCa on pathology. Greater number of lesions and lesion size correlated with longer procedure times. Lesion number, size, or grade were not found to correlate with cancer grade or rate of cancer. CONCLUSIONS Grade, presence, location, size, and number of PIRADS lesions on preoperative prostate MRI for patients with an appropriate prior PCa workup were not significantly associated with incidental PCa or higher PCa grade on HoLEP pathology.
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Affiliation(s)
- Kyle Tsai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Perry Xu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jenny Guo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicholas Dean
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Nabila Khondakar
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jamie Michael
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clayton Neill
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Infante Hernández S, Gómez Rivas J, Moreno Sierra J. Benign prostatic hyperplasia. Med Clin (Barc) 2024:S0025-7753(24)00307-5. [PMID: 39013719 DOI: 10.1016/j.medcli.2024.04.014] [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: 10/09/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 07/18/2024]
Abstract
Benign prostatic hyperplasia (BPH) is a histopathologic definition associated with enlargement of the prostate gland that causes obstruction of the lower urinary tract and manifests clinically with characteristic symptoms that are what bring patients for consultation. Urinary tract symptoms are common, especially in an increasingly aging population. Diagnosis and the decision on when and how to treat depend on the patient's quality of life and objective clinical parameters. An individualized, risk-based approach is necessary to guide conservative, pharmacologic, or surgical treatment.
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Affiliation(s)
| | - Juan Gómez Rivas
- Servicio de Urología, Hospital Clínico San Carlos, Madrid, España; Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, Sección de Urología, Madrid, España
| | - Jesús Moreno Sierra
- Servicio de Urología, Hospital Clínico San Carlos, Madrid, España; Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, Sección de Urología, Madrid, España
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Chung EH, Kim JW, Kim JH, Jeong JS, Lim JH, Boo SY, Ko JW, Kim TW. Ageratum conyzoides Extract Ameliorates Testosterone-Induced Benign Prostatic Hyperplasia via Inhibiting Proliferation, Inflammation of Prostates, and Induction of Apoptosis in Rats. Nutrients 2024; 16:2267. [PMID: 39064710 PMCID: PMC11280401 DOI: 10.3390/nu16142267] [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: 06/27/2024] [Revised: 07/12/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Ageratum conyzoides, an annual herbaceous plant that inhabits tropical and subtropical regions, has been traditionally used in Asia, Africa, and South America for phytotherapy to treat infectious and inflammatory conditions. However, the pharmacological effects of standardized ethanolic extract of Ageratum conyzoides (ACE) on benign prostatic hyperplasia (BPH) remain unexplored. The objective of this research is to examine the potential physiological impacts of ACE, a traditionally utilized remedy for inflammatory ailments, in a rat model with BPH induced by testosterone propionate (TP). Rats were subcutaneously administered TP (3 mg/kg) to induce BPH and concurrently orally administered ACE (20, 50, and 100 mg/kg) daily for 42 days. ACE markedly improved BPH characteristics, including prostate weight, prostate index, and epithelial thickness, while also suppressing androgens and related hormones. The findings were supported by a decrease in androgen receptor and downstream signals associated with BPH in the prostate tissues of the ACE groups. Furthermore, increased apoptotic signals were observed in the prostate tissue of the ACE groups, along with heightened detection of the apoptotic nucleus compared to the BPH alone group. These changes seen in the group that received finasteride were similar to those observed in this group. These findings suggest that ACE shows promise as an alternative phytotherapeutic agent for treating BPH.
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Affiliation(s)
- Eun-Hye Chung
- BK21 FOUR Program, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Daejeon 34131, Republic of Korea; (E.-H.C.); (J.-W.K.); (J.-H.K.); (J.-S.J.); (S.-Y.B.)
| | - Jeong-Won Kim
- BK21 FOUR Program, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Daejeon 34131, Republic of Korea; (E.-H.C.); (J.-W.K.); (J.-H.K.); (J.-S.J.); (S.-Y.B.)
| | - Jin-Hwa Kim
- BK21 FOUR Program, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Daejeon 34131, Republic of Korea; (E.-H.C.); (J.-W.K.); (J.-H.K.); (J.-S.J.); (S.-Y.B.)
| | - Ji-Soo Jeong
- BK21 FOUR Program, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Daejeon 34131, Republic of Korea; (E.-H.C.); (J.-W.K.); (J.-H.K.); (J.-S.J.); (S.-Y.B.)
| | | | - So-Young Boo
- BK21 FOUR Program, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Daejeon 34131, Republic of Korea; (E.-H.C.); (J.-W.K.); (J.-H.K.); (J.-S.J.); (S.-Y.B.)
| | - Je-Won Ko
- BK21 FOUR Program, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Daejeon 34131, Republic of Korea; (E.-H.C.); (J.-W.K.); (J.-H.K.); (J.-S.J.); (S.-Y.B.)
| | - Tae-Won Kim
- BK21 FOUR Program, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Daejeon 34131, Republic of Korea; (E.-H.C.); (J.-W.K.); (J.-H.K.); (J.-S.J.); (S.-Y.B.)
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Lopategui DM, Shah HN, Herrmann TRW. Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function. Curr Opin Urol 2024; 34:286-293. [PMID: 38595170 DOI: 10.1097/mou.0000000000001178] [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: 04/11/2024]
Abstract
PURPOSE OF REVIEW Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. RECENT FINDINGS Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. SUMMARY Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.
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Affiliation(s)
- Diana M Lopategui
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hemendra N Shah
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Stellenbosch, South Africa
- Hannover Medical School, Hannover, Germany
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Watanabe K, Otsuka A, Kitagawa Y, Sano A, Sato R, Matsushita Y, Watanabe H, Tamura K, Motoyama D, Ito T, Takada S, Miyake H. Preoperative factors predicting poor therapeutic efficacy of holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia. Low Urin Tract Symptoms 2024; 16:e12530. [PMID: 39011581 DOI: 10.1111/luts.12530] [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: 01/20/2024] [Revised: 06/27/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES We assessed preoperative factors predicting the poor therapeutic efficacy of holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) patients. METHODS The present study included 159 patients who underwent HoLEP between August 2015 and June 2021 at our institution. Overall therapeutic efficacy was divided into good and poor therapeutic efficacies according to changes in the international prostate symptom score (IPSS), IPSS quality of life (IPSS-QOL), and the maximum urinary flow rate. Patients were divided into good and poor therapeutic efficacy groups based on findings obtained 3 months after HoLEP, and comparative assessments were performed between the two groups. RESULTS The therapeutic efficacy of HoLEP was poor in 53 (33.3%) out of 159 patients. Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group. A multivariable analysis of several factors identified the preoperative presence of OAB and short IPP as independent risk factors for the poor therapeutic efficacy of HoLEP. When treatment efficacy was divided according to risk factors, poor therapeutic efficacy was observed in only 14% of patients with prolonged IPP and the absence of OAB. CONCLUSIONS The therapeutic efficacy of HoLEP may be poor in patients with OAB and short IPP, resulting in the significant deterioration of lower urinary tract symptoms. Accordingly, it is important to consider the presence or absence of OAB and IPP measurements when selecting indications for HoLEP.
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Affiliation(s)
- Kyohei Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichi Kitagawa
- Department of Urology, JA Shizuoka Kohseiren Enshu Hospital, Hamamatsu, Japan
| | - Asuka Sano
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryo Sato
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Developed Studies for Advanced Robotic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Sanki Takada
- Department of Urology, JA Shinshiro Municipal Hospital, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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10
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Bhatia A, Porto JG, Titus RS, Ila V, Shah K, Malpani A, Lopategui DM, Marcovich R, Herrmann TRW, Shah HN. A systematic review and network meta-analysis comparing Rezūm with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate. BJUI COMPASS 2024; 5:621-635. [PMID: 39022654 PMCID: PMC11250421 DOI: 10.1002/bco2.361] [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: 02/02/2024] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives We aim to compare efficacy and safety of water vapour therapy (Rezūm), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms. Materials PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included. Results At 12 months, Rezūm showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score - Rezūm versus TUMT: 1.33 points (95% CI: -1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezūm versus TUNA: 0.07 points (95% CI: -3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rezūm versus TUMT: 1.05 mL/s (95% CI: -4.88 to 2.82) favouring Rezūm (QoE: Low) and Rezūm versus TUNA: 0.37 mL/s (95% CI: -4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rezūm was similar, or inferior to other techniques at 12 months - Rezūm versus TUMT: 11.20 mL (95% CI: -32.40 to 10.30) favouring TUMT (QoE: Low) and Rezūm versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezūm also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years - TUMT versus Rezūm RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezūm showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezūm had a higher rate of serious adverse events (Clavien-Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezūm with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezūm with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low). Conclusions Moderate to weak evidence suggests that Rezūm is not superior to TUNA and TUMT in all domains studied.
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Affiliation(s)
- Ansh Bhatia
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
- Seth GS Medical College and KEM HospitalMumbaiIndia
| | - Joao G. Porto
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Vishal Ila
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Khushi Shah
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Ankur Malpani
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Diana M. Lopategui
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Robert Marcovich
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Hemendra N. Shah
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
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11
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Bibok A, Kis B, Parikh N. Prostate Artery Embolization with 4D-CT. Semin Intervent Radiol 2024; 41:302-308. [PMID: 39165653 PMCID: PMC11333114 DOI: 10.1055/s-0044-1788622] [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: 08/22/2024]
Abstract
Prostate artery embolization (PAE) is a technically challenging angiographic therapy that has been shown to have excellent clinical outcomes for men with benign prostatic hyperplasia and lower urinary tract symptoms. Although clinical outcomes have been well documented, several questions remain regarding various technical details of the procedure. This article is a brief review of indications and technical parameters of PAE as well as commonly debated topics throughout the literature. Finally, the article serves to report tips and tricks from a high-volume center.
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Affiliation(s)
- Andras Bibok
- Department of Interventional Radiology, Semmelweis University, Budapest, Hungary
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Bela Kis
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Nainesh Parikh
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, Tampa, Florida
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12
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Li Marzi V, Musco S, Lombardo R, Cicione A, Gemma L, Morselli S, Gallo ML, Serni S, Campi R, De Nunzio C. Prevalence of lower urinary tract symptoms in taxi drivers: a cross-sectional web-based survey. Prostate Cancer Prostatic Dis 2024; 27:283-287. [PMID: 38160226 DOI: 10.1038/s41391-023-00777-w] [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: 06/07/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Aim of the study was to evaluate the prevalence of LUTS in taxi drivers. METHODS Between February 24th 2021 and March 26th 2021 a web based survey was administered to Taxi drivers in the city of Florence. Taxi drivers were evaluated with baseline characteristics such as: age, BMI, smoking, career length, comorbidities, and treatment. LUTS were evaluated using the international prostate symptom score (IPSS) and the overactive bladder (OAB) score. As well sexual function was evaluated using the international index erectile function (IIEF) and female sexual function index (FSFI) questionnaires. Risk factors for LUTS were evaluated using regression analysis. RESULTS The overall response rate was 64.6% (537/830 taxi drivers filled the questionnaires). Among them, 449 (83.6%) were men and 88 (16.4%) females. Overall, median IPSS was 5 (2/9) and median OAB score was 10 (7/14). On multivariate binary regression analysis age > 50 (OR:1.60; p < 0,05), Smoking (OR:1.57; p < 0,05), chronic treatment (OR:1.57; p < 0,05), recurrent cystitis (OR: 2.66; p < 0,05) and chronic pelvic pain (OR:4.94; p < 0,05) were independent risk factors for moderate/severe LUTS. On multivariate binary logistic regression analysis, risk factors for erectile dysfunction were age older than 50 years (OR = 3.64; p < 0.05) and urinary incontinence (OR = 5.53; p = 0.005). CONCLUSIONS According to our web-based survey, Taxi drivers in the metropolitan city of Florence had non-negligible symptomatic LUTS and even sexual dysfunction. Our data suggest as LUTS are particular influenced by several life-style and behavioural factors as type and duration of work.
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Affiliation(s)
- Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Stefania Musco
- Unit of Neuro-Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Lombardo
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Antonio Cicione
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simone Morselli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Lucia Gallo
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
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13
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Hegazy M, Sheir KZ, Gaballah MA, Elshal AM. A randomized controlled trial evaluating low-intensity shockwave therapy for treatment of persistent storage symptoms following transurethral surgery for benign prostatic obstruction. Prostate Cancer Prostatic Dis 2024; 27:305-311. [PMID: 38553627 PMCID: PMC11096095 DOI: 10.1038/s41391-024-00820-4] [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: 11/29/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Low-intensity shockwave therapy (Li-SWT) can improve bladder function through enhancement of angiogenesis and nerve regeneration and suppression of inflammation and overactivity. In this trial, we aimed to evaluate the efficacy of Li-SWT on persistent storage symptoms after transurethral surgery (TUS) for benign prostatic obstruction (BPO). METHODS Between July 2020 and July 2022, 137 patients with persistent storage symptoms; urgency episodes/24 h ≥ 1 and daytime frequency ≥8, for at least three months after TUS for BPO were randomly allocated to Li-SWT versus sham versus solifenacin 10 mg/day in 3:1:1 ratio. The primary end point was the percent reduction from baseline in overactive bladder symptom score (OABSS) at 3-month follow-up. The changes in 3-day voiding diary parameters, quality of life (QoL) score, peak flow rate and residual urine at 3 and 6-month follow-up were compared. Treatment-related adverse effects were also evaluated. RESULTS Baseline data were comparable between groups. The percent reduction from baseline in OABSS at 3-month follow-up was significantly higher in Li-SWT compared to sham (-55% versus -11%), and it was comparable between Li-SWT and solifenacin-10 (-55% versus -60%). Li-SWT achieved significant improvement like solifenacin-10 in 3-day voiding diary parameters and QoL score at 3-month follow-up. This improvement remained comparable between Li-SWT and solifenacin-10 at 6-month follow-up. No adverse effects related to Li-SWT were noted apart from tolerable pain during the procedure. Solifenacin-10 was associated with bothersome adverse effects in 73% of the patients with 11.5% discontinuation rate. CONCLUSIONS Li-SWT ameliorates persistent storage symptoms and promotes QoL after TUS for BPO, with comparable efficacy and better tolerance compared to solifenacin.
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Affiliation(s)
- Mohammed Hegazy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Khaled Z Sheir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Ahmed M Elshal
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Bou Kheir G, Verbakel I, Vande Walle J, Wyndaele M, Sinha S, Arlandis S, Raes A, Abrams P, Wein A, Hervé F, Everaert K. Exploring lifelong overactive bladder: Transitions, evidence, and clinical implications; A modified Delphi process. Neurourol Urodyn 2024; 43:1040-1057. [PMID: 38289322 DOI: 10.1002/nau.25307] [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: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) is a prevalent urological condition characterized by urinary urgency, with or without urgency urinary incontinence, accompanied by increased daytime frequency and nocturia. However, the current definition of OAB lacks a specified time frame, hindering our understanding of the temporal aspects and transitions that occur within the OAB spectrum. METHODS A modified Delphi study was conducted in three rounds, involving a panel of international experts in functional urology, urogynaecology, geriatrics, transitional medicine, and pediatric urology. The study took place between February 2023 and June 2023 and employed two sequential rounds of online surveys, followed by a final hybrid group discussion session in June 2023. RESULTS The Delphi process resulted in a consensus definition of lifelong OAB as a persistent and continuous condition that may manifest differently from birth and evolve over time, with varying levels of clinical perception. The course of its progression is influenced by transition periods and modifying factors, mainly anatomical, hormonal, and psychosocial/stressors. Three main transition periods were identified: achievement of daytime continence, adulthood to elderly, and transition to frail elderly. The panel also considered the therapeutic and diagnostic implications of lifelong OAB, as well as future research prospects in terms of importance and feasibility. CONCLUSIONS Future longitudinal research is needed to develop this concept and further identify transitions and temporal dynamics.
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Affiliation(s)
- George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Paediatric Nephrology and Rheumatology, ERknet Center, Ghent University Hospital, Ghent, Belgium
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Ann Raes
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Alan Wein
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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Malshy K, Balen A, Golijanin B, Jentzsch M, Greenberg R, Kazal F, Glebocki R, Danaher K, Spence R, Hyams E, Golijanin D, Pareek G, Eaton S. Optimising postoperative care: Same-day discharge after transurethral resection of the prostate. J Perioper Pract 2024:17504589241251697. [PMID: 38785312 DOI: 10.1177/17504589241251697] [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: 05/25/2024]
Abstract
INTRODUCTION This study aims to assess the feasibility and safety of same-day discharge after transurethral resection of the prostate. MATERIALS AND METHODS Five years of records were retrospectively analysed. Length of stay categorised patients into Groups 1 (same-day discharge) and 2 (standard-length discharge). Logistic regression analysis was performed, controlling for clinicodemographic factors. Student's t-test compared continuous bladder irrigation and catheter dwell times. RESULTS A total of 459 patients were identified between 2016 and 2021, 280 in Group 1 and 179 in Group 2, with median ages of 71.0 (interquartile range 36-92) and 72.0 (interquartile range 47-101) years (p = 0.067), respectively. Same-day discharge rates notably increased post-2018 (p = 0.025). Median prostate tissue resected in Group 2 was 7.1g (3.4-12.4g) and in Group 1 was 4.9g (2.4-10.2g; p = 0.034). While continuous bladder irrigation >1 hour was significantly lower in Group 1 than Group 2 (96.8% versus 27.4%; p = 0.0001), catheter dwell times were comparable (70.1 and 70.8 hours, respectively). Control-adjusted results showed a 40% reduction in emergency department representation odds for Group 1 compared with Group 2 (odds ratio = 0.60; 95% confidence interval = 0.37-0.99; p = 0.04). Length of stay was not significantly associated with hospital readmissions (p = 0.11). Continuous bladder irrigation for <1 hour in Group 1 was associated with a reduced emergency department representation (odds ratio = 0.43; 95% confidence interval = 0.197-0.980) but not readmission (odds ratio = 0.413; 95% confidence interval = 0.166-1.104). CONCLUSIONS Same-day discharge post-transurethral resection of the prostate may be a viable and safe option for carefully selected patients.
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Affiliation(s)
- Kamil Malshy
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alejandra Balen
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Borivoj Golijanin
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Rachel Greenberg
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Frances Kazal
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Katherine Danaher
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ryland Spence
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Elias Hyams
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Dragan Golijanin
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Gyan Pareek
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Samuel Eaton
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
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16
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Demour SA, Al-Zubi MT, Ababneh M, Al-Rawashdah SF, Ahmad M. A randomized clinical trial: timing of indwelling urethral catheter removal following transurethral resection of prostate. Future Sci OA 2024; 10:FSO927. [PMID: 38827798 PMCID: PMC11140637 DOI: 10.2144/fsoa-2023-0195] [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: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 06/05/2024] Open
Abstract
Aim: We aimed to evaluate early versus delayed removal of the indwelling urethral catheter (IUC) following transurethral resection of prostate (TURP). Methods: In this clinical trial conducted between July 2016 and June 2020, 90 patients underwent TURP were randomized equally into: group A, early IUC removal (24 h), and group B, delayed IUC removal (72 h). Results: The mean length of hospital stay was longer among the patients in group B. There were no significant differences in recatheterization, secondary bleeding, or UTI between groups A and B. The mean VAS score and CRBD were higher in group B. Conclusion: Early IUC removal following TURP is safe approach with favorable clinical outcomes. Clinical Trial Registration: NCT04363970 (clinicaltrials.gov).
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Affiliation(s)
- Saddam Al Demour
- Department of Special Surgery, Division of Urology, School of Medicine, The University of Jordan, Amman, 11942, Jordan
- Dr Sulaiman Al Habib Medical Group, Riyadh, 12214, Kingdome of Saudi Arabia
| | - Mohammad T Al-Zubi
- Department of Urology, School of Medicine, Yarmouk University, Irbid, 21110, Jordan
| | - Mera Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Samer F Al-Rawashdah
- Department of Special Surgery, Urology Unit, School of Medicine, Mutah University, Karak, 61710, Jordan
| | - Muayyad Ahmad
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, 11942, Jordan
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17
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Rostambeigi N, Crawford D, Golzarian J. Benefits and advances of Cone Beam CT use in prostatic artery embolization: review of the literature and pictorial essay. CVIR Endovasc 2024; 7:46. [PMID: 38744805 PMCID: PMC11093965 DOI: 10.1186/s42155-024-00459-1] [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: 03/25/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024] Open
Abstract
Prostatic artery embolization (PAE) has proven to be an efficacious treatment for urinary symptoms of benign prostatic hyperplasia. PAE is performed in a complex and challenging anatomical field which may pose difficulties from procedural standpoint. Cone beam computed tomography (CBCT) has been proposed as an invaluable tool during the PAE procedure. A review of different techniques and advancements, as well as demonstration of CBCT benefits via a pictorial overview of the salient examples is lacking. The techniques of CBCT are discussed herein and the virtual injection technology as an advancement in CBCT is discussed. To show the merits of CBCT in PAE, a pictorial overview of various clinical scenarios is presented where CBCT can be crucial in decision making. These scenarios are aimed at showing different benefits including identification of the origin of the prostatic artery and avoiding non-target embolization. Other benefits may include ensuring complete embolization of entire prostate gland as angiographic appearance alone can be inconclusive if it mimics a severely thickened bladder wall or ensuring adequate embolization of the median lobe to provide relief from "ball-valve" effect. Further examples include verification of embolization of the entire prostate when rare variants or multiple (> 2) arterial feeders are present.
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Affiliation(s)
- Nassir Rostambeigi
- Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis, USA, 510 South Kingshighway Blvd, MO, 63110.
| | - Daniel Crawford
- Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis, USA, 510 South Kingshighway Blvd, MO, 63110
| | - Jafar Golzarian
- Vascular and Interventional Radiology, North Star Vascular & Interventional / University of Minnesota, Golden Valley, USA
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Ganesan V, Agarwal D. Medical Advancements in Benign Prostatic Hyperplasia Treatments. Curr Urol Rep 2024; 25:93-98. [PMID: 38448685 DOI: 10.1007/s11934-024-01199-4] [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] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE OF REVIEW This review aims to identify and summarize the current literature on the most recent therapeutic agents and combination strategies for the medical management of lower urinary tract symptoms resulting from benign prostatic hyperplasia. RECENT FINDINGS The latest advancements in BPH therapy have been in combination strategies. Alpha blockers continue to be the mainstay of treatment, but research is exploring the synergistic benefits of combining them with 5-alpha reductase inhibitors (5-ARIs), phosphodiesterase-5 (PDE5) inhibitors, and beta-3 agonists. The alpha-blocker + 5-ARI combination remains ideal for enlarged, significantly reducing clinical progression risk compared to monotherapy. Alpha-blocker + PDE5 inhibitor combinations appear safe and potentially beneficial for men with concomitant erectile dysfunction; sildenafil might hold an edge over tadalafil based on limited data. Beta-3 agonists show synergistic effects with alpha blockers for residual storage symptoms, offering similar efficacy to anticholinergics but with a better side effect profile.
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Affiliation(s)
| | - Deepak Agarwal
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.
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Ini’ C, Vasile T, Foti PV, Timpanaro C, Castiglione DG, Libra F, Falsaperla D, Tiralongo F, Giurazza F, Mosconi C, David E, Palmucci S, Lavalle S, Venturini M, Basile A. Prostate Artery Embolization as Minimally Invasive Treatment for Benign Prostatic Hyperplasia: An Updated Systematic Review. J Clin Med 2024; 13:2530. [PMID: 38731058 PMCID: PMC11085005 DOI: 10.3390/jcm13092530] [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: 03/10/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Benign prostatic hyperplasia (BPH) has a significant impact on the quality of life of symptomatic patients. In patients manifesting lower urinary tract symptoms (LUTS), prostatic arterial embolization (PAE) has become a topic of interest in recent years. The purpose of this systematic review is to analyze and review techniques and clinical outcomes of patients who underwent endovascular treatment of BPH, with a special focus on the comparison of surgical and endovascular procedures. Methods: Through the major scientific databases, 1225 articles were selected from the initial research utilizing specific keywords and medical subject headings. Based on the inclusion and exclusion criteria established for selecting relevant studies for our purposes, the systematic analysis of the literature was conducted on a total of seven articles. Results: We collected data on 718 male patients (408 patients underwent PAE and 310 received TURP). The technical success rate varied from 86% to 100% for TAE and was 100% for TURP. During a 12-month follow-up period, both PAE and TURP were comparable on the reduction in IPSS and QoL questionnaire, while TURP showed significant improvements in Qmax and in the reduction in prostate volume. Length and cost of hospitalization were lower for PAE. Complication and adverse events rates were higher in the TURP group rather than in the PAE group (60.6% vs. 35.5%). Conclusions: Prostatic artery embolization represents an emerging minimally invasive procedure for BPH. According to previously released clinical studies, quality-of-life and urological symptom scores of the PAE group were comparable to those of the TURP group. Our research strengthens the evidence supporting the effectiveness and safety of PAE as a therapy for LUTS related to BPH.
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Affiliation(s)
- Corrado Ini’
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Tiziana Vasile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
- NANOMED-Research Centre for Nanomedicine and Pharmaceutical Nanotechnology, University of Catania, 95125 Catania, Italy
- Centro di Ricerca Multidisciplinare “Chirurgia delle Sindromi Malformative Complesse della Transizione e dell’Età Adulta” (ChiSMaCoTA), Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
| | - Concetta Timpanaro
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Davide Giuseppe Castiglione
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Federica Libra
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Daniele Falsaperla
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Francesco Tiralongo
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy;
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Salvatore Lavalle
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Enna “Kore” Cittadella Universitaria, 94100 Enna, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
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20
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Xie Z, Liu X, Hu Z, Dong C. Longitudinal association between the dynamic nature of depression with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). BMC Public Health 2024; 24:1121. [PMID: 38654263 DOI: 10.1186/s12889-024-18618-3] [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: 08/11/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Depression is associated with an increased risk of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Whether the dynamic nature of depression affects the incidence of LUTS/BPH remains unknown. A four-year cohort study based on the China Health and Retirement Longitudinal Study (CHARLS) was conducted to assess their association. METHODS This study included 3433 Chinese men from the CHARLS 2011, representative of > 95 million individuals. All eligible individuals underwent three assessments of LUTS/BPH and depression in 2011, 2013 and 2015. The dynamic nature of depression was classified as acute depression with remission, acute depression with recurrence, or chronic major depression. Weighted, generalized additive analyses with three binomial models were used to investigate the relationship between LUTS/BPH and the dynamic nature of depression. RESULTS During the four-year follow-up, 11.5% (95% confidence interval [95% CI] = 9.5-13.3%) of Chinese men were diagnosed with newly incident LUTS/BPH. Meanwhile, there were 60.6% (95% CI = 58.5-62.7%) of the individuals without depression and 8.9% (95% CI = 7.9-10%) of the individuals with chronic major depression. A total of 25.1% (95% CI = 23.4-26.9%) and 5.4% (95% CI = 4.6-6.3%) of the individuals were categorized as acute depression with remission and recurrence. After weighted, adjusted all included confounding risk factors, chronic major depression (RR = 1.63, 95% CI = 1.14-2.33, P < 0.01) but not acute depression with remission (RR = 1.2, 95% CI = 0.92-1.56, P = 0.18) and recurrence (RR = 1.32, 95% CI = 0.82-2.10, P = 0.26) significantly increased the incidence of LUTS/BPH compared with no depression. The subgroup analysis showed that the above relationships appeared to be evident among Chinese men < 60 years. CONCLUSIONS Our results suggest that the dynamic nature of depression has a different effect on the incidence of LUTS/BPH. The monitoring and treatment of depression are important in preventing LUTS/BPH.
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Affiliation(s)
- Zonglan Xie
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China
| | - Xuebin Liu
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China
| | - Zhigang Hu
- Department of Evidence Based Medicine Center, The First College of Clinical Medicine Science, China Three Gorges University, 443003, Yichang, China
| | - Chuanjiang Dong
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China.
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21
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Lee SM, Lee SM, Song J. Effects of Taraxaci Herba (Dandelion) on Testosterone Propionate-Induced Benign Prostatic Hyperplasia in Rats. Nutrients 2024; 16:1189. [PMID: 38674879 PMCID: PMC11054461 DOI: 10.3390/nu16081189] [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: 03/24/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Benign prostatic hyperplasia (BPH) is the non-malignant enlargement of the prostate, associated with lower urinary tract symptoms (LUTSs). Taraxaci Herba (TH), commonly known as dandelion, has traditionally been utilized in East Asia to treat symptoms related to LUTSs. Based on this traditional use, our study aimed to explore the inhibitory effects of TH on BPH progression using a testosterone propionate-induced rat model. To induce BPH, male Sprague Dawley rats were castrated and injected subcutaneously with testosterone propionate (3 mg/kg/day) for 28 days. Concurrently, TH extract was administered orally at doses of 100 and 300 mg/kg/day throughout the four-week period of testosterone propionate injections. The TH extract significantly reduced both the absolute and relative weights of the prostate, along with histopathological changes in the gland. Moreover, it lowered serum levels of testosterone and dihydrotestosterone and reduced the expression of the androgen receptor in the prostate. Additionally, the TH extract modulated the protein expressions of Bax and Bcl-2, which are key regulators of apoptosis in prostate cells. Collectively, our findings suggest that TH inhibits BPH development partially by modulating androgen signaling and inducing apoptosis within the prostate.
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Affiliation(s)
| | | | - Jungbin Song
- Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
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22
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Alharbi M, Alshamsan B, Almansour M, Alharbi A, Algaadi A, Abdelhafez MF. Early experience of " En bloc" holmium laser enucleation of the prostate in Saudi Arabia. Urol Ann 2024; 16:150-154. [PMID: 38818436 PMCID: PMC11135345 DOI: 10.4103/ua.ua_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/04/2023] [Indexed: 06/01/2024] Open
Abstract
Purpose Holmium laser enucleation of the prostate (HoLEP) showed higher efficacy than transurethral resection for treating benign prostatic hyperplasia (BPH). The present study aims to report the outcome of BPH treatment by HoLEP in a tertiary center. Patients and Methods An observational prospectively collected data for consecutive symptomatic BPH patients undergoing HoLEP between January 2020 and December 2021. Demographic and perioperative data were collected with the International Prostate Symptom Score (IPSS), quality of life, peak flow rate (Qmax), residual urine postvoid residual (PVR), and prostate-specific antigen (PSA) changes, in addition to perioperative and late adverse events. Results One hundred patients were included with a median age of 73 years (range 65-80). The IPSS improved by 80% postoperatively (25 vs. 5, P < 0.001). Similarly, Qmax significantly improved. Seven patients were found to have incidental prostate cancer. No patient needed a perioperative blood transfusion. Compared to its preoperative values, follow-up PSA has been reduced by 75% (P < 0.001). Urethral stricture and bladder neck contracture were noted in < 2% of the patients. Conclusions HoLEP is feasible for all prostate sizes and a safe and effective treatment for BPH patients; our results are consistent with the reported data in the literature regarding functional outcomes, complication rates, and urinary incontinence rates.
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Affiliation(s)
- Mohannad Alharbi
- Department of Surgery, College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Bader Alshamsan
- Department of Medicine, College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Mohammed Almansour
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Abdullah Alharbi
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Adel Algaadi
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Mohamed F. Abdelhafez
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
- Urology and Nephrology Center, Assiut University Hospital, Assiut, Egypt
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23
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Warli SM, Ikram MF, Sarumpaet RG, Tala ZZ, Putrantyo II. The efficacy and safety of prostatic urethral lift as a minimally invasive therapeutic modality to treat lower urinary tract symptoms while maintaining sexual function in patients with benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. Arch Ital Urol Androl 2024; 96:12066. [PMID: 38451253 DOI: 10.4081/aiua.2024.12066] [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: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is prevalent among elderly men, necessitating focused attention. The Prostatic Urethral Lift (PUL) procedure, a minimally invasive intervention, has emerged as a promising option for BPH management. It has shown remarkable results in ameliorating lower urinary tract symptoms (LUTS), enhancing quality of life, and preserving sexual function. This study aims to evaluate the effectiveness and safety of PUL in BPH patients. METHODS Key databases (MEDLINE, Cochrane CENTRAL, ScienceDirect, EBSCO, Google Scholar) were systematically searched using pertinent terms related to PUL and BPH. Following the PRISMA checklist, we considered only randomized controlled trials (RCTs) from 2013 to 2023. The assessment focused on LUTS, quality of life, sexual function, and adverse events within three months. Follow-up post-treatment mean values compared with controls (Sham) and the improvement from baseline to post-treatment follow-up duration were considered. Statistical analysis and risk of bias evaluation were conducted using Review Manager 5.4.1, presenting results as difference of mean values (MD) and risk ratios (RR). RESULTS A meta-analysis with a Random Effects Model of 7 RCTs involving 378 confirmed BPH patients demonstrated significant improvements in the PUL arm including International Prostate Symptom Score (IPSS) (MD 5.51, p<0.0001), maximum urinary flow rate (Qmax) (MD 2.13, p=0.0001), BPH Impact Index (BPHII) (MD 2.14, p=0.0001), and IPSS-QoL (MD 1.50, p<0.0001), without significant increase of adverse events (RR 1.51; p=0.50). Positive outcomes were observed in sexual function variables and post-void residual measurements when post-treatment values were compared to baseline. CONCLUSIONS PUL holds advantages over control interventions, providing encouraging prospects for BPH management. This study underscores the need for further exploration of PUL's efficacy and safety in BPH patients.
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Affiliation(s)
- Syah Mirsya Warli
- Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan; Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan.
| | | | | | | | - Ignatius Ivan Putrantyo
- Department of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan.
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Devulapalli KK. Interventional radiologists and OBLs: An excellent match. Tech Vasc Interv Radiol 2024; 27:100952. [PMID: 39025608 DOI: 10.1016/j.tvir.2024.100952] [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: 07/20/2024]
Abstract
While office-based laboratories (OBLs) have been increasing in popularity, only a small proportion of the current interventional radiology (IR) workforce works in an OBL. With the relative lack of an IR presence in OBLs compared to other endovascular specialists, combined with the growth of the OBL space, the presence of IR within OBLs will likely increase in the coming years. This article addresses the value interventional radiologists (IRs) can bring to the OBL, with primary impacts being the ability to impact a larger proportion of the population than is traditionally cared for in most hospital settings, the ability to positively influence multidisciplinary care teams and the financial leverage inherent in procedural diversification not readily afforded by other specialists working in the OBL space. IR-specific pitfalls in the OBL space are also addressed, including difficulties in obtaining patient referrals, investor relationships, and group practice arrangements. Despite potential challenges, IRs have a lot to offer within the OBL space, and conversely, the OBL space provides a mechanism for IRs to increase their reach and improve career longevity.
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25
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Herschorn S, Tarcan T, Jiang YH, Chung E, Abdul Hadi F, Steup A, Sumarsono B. Safety and efficacy of an α 1 -blocker plus mirabegron compared with an α 1 -blocker plus antimuscarinic in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia and overactive bladder: A systematic review and network meta-analysis. Neurourol Urodyn 2024; 43:604-619. [PMID: 38291827 DOI: 10.1002/nau.25399] [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: 07/06/2023] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
AIM Antimuscarinics and the β3-adrenoreceptor agonist, mirabegron, are commonly used for treating patients with overactive bladder (OAB) and α1 -adrenoreceptor antagonists (α1 -blockers) are the main pharmacological agents used for treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). As these conditions commonly occur together, the aim of this systematic review was to identify publications that compared the use of an α1 -blocker plus mirabegron with an α1 -blocker plus antimuscarinic in men with LUTS secondary to BPH and OAB. A meta-analysis was subsequently conducted to explore the safety and efficacy of these combinations. METHODS Included records had to be from a parallel-group, randomized clinical trial that was ≥8 weeks in duration. Participants were male with LUTS secondary to BPH and OAB. The indirect analyses that were identified compared an α1 -blocker plus OAB agent with an α1 -blocker plus placebo. The PubMed/Medical Literature Analysis and Retrieval System Online, the Excerpta Medica Database, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry were searched for relevant records up until March 5, 2020. Safety outcomes included incidences of overall treatment-emergent adverse events (TEAEs) and urinary retention, postvoid residual volume, and maximum urinary flow (Qmax ). Primary efficacy outcomes were micturitions/day, incontinence episodes/day, and urgency episodes/day, and secondary outcomes were Overactive Bladder Symptom Score and International Prostate Symptom Score. A Bayesian network meta-analysis approach was used for the meta-analysis. RESULTS Out of a total of 1039 records identified, 24 were eligible for inclusion in the meta-analysis. There were no statistically significant differences between the α1 -blocker plus mirabegron and α1 -blocker plus antimuscarinic groups in terms of the comparisons identified for all the safety and efficacy analyses conducted. Numerically superior results were frequently observed for the α1 -blocker plus mirabegron group compared with the α1 -blocker plus antimuscarinic group for the safety parameters, including TEAEs, urinary retention, and Qmax . For some of the efficacy parameters, most notably micturitions/day, numerically superior results were noted for the α1 -blocker plus antimuscarinic group. Inconsistency in reporting and study variability were noted in the included records, which hindered data interpretation. CONCLUSION This systematic review and meta-analysis showed that an α1 -blocker plus mirabegron and an α1 -blocker plus antimuscarinic have similar safety and efficacy profiles in male patients with LUTS secondary to BPH and OAB. Patients may, therefore, benefit from the use of either combination within the clinical setting.
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Affiliation(s)
- Sender Herschorn
- Department of Surgery/Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tufan Tarcan
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
- Department of Urology, School of Medicine, Koç University, Istanbul, Turkey
| | - Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Achim Steup
- Astellas Pharma Global Development Inc., Northbrook, Illinois, USA
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Liedtke V, Stöckle M, Junker K, Roggenbuck D. Benign prostatic hyperplasia - A novel autoimmune disease with a potential therapy consequence? Autoimmun Rev 2024; 23:103511. [PMID: 38168573 DOI: 10.1016/j.autrev.2023.103511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
Benign prostatic hyperplasia (BPH) is considered as an age-related disease of men with an unknown etiopathophysiology. Chronic inflammation has been proposed as one of the major pathophysiological mechanisms. There is growing evidence for the involvement of autoimmune responses in an inflammatory setting in the prostate. Patients with autoimmune diseases show a significantly elevated prevalence of BPH. Conventional therapy options for BPH are limited, rendering surgery the ultimate alternative. However, immunosuppression via tumor necrosis factor alpha blocker appears to reduce symptoms in patients with BPH and concurrent autoimmune disease due to the reduction of epithelial hyperplasia and macrophage-induced inflammation. New diagnostic options using HEp-2 cells with overexpression of LEDGF/p75 or mitochondrial DNA as autoimmune targets could be used to identify BPH patients with autoimmune responses. Given the presumed involvement of autoimmune responses in BPH and the efficacy of immunosuppression in reducing BPH symptoms, BPH or subvariants of BPH may be candidates for a new autoimmune disease in males.
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Affiliation(s)
- Victoria Liedtke
- Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, 01968 Senftenberg, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, 66424 Homburg, Germany
| | - Kerstin Junker
- Department of Urology and Pediatric Urology, Saarland University, 66424 Homburg, Germany
| | - Dirk Roggenbuck
- Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, 01968 Senftenberg, Germany; Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus-Senftenberg, 01968 Senftenberg, Germany.
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27
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Long Depaquit T, Baboudjian M, Chiron P, Corral R, Anastay V, Bastide C, Toledano H. Modified holmium laser enucleation for benign prostatic obstruction to preserve sexual and ejaculatory function. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102581. [PMID: 38717462 DOI: 10.1016/j.fjurol.2024.102581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION To report ejaculatory and urinary results in patients who underwent holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe (MLHoLEP). METHODS Patients with lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) who underwent MLHoLEP to preserve ejaculatory function in a single center were retrospectively identified. Urinary function was assessed using International Prostate Score Symptom (IPSS), IPSS-Quality of Life index (IPSS-QoL), peak urinary flow (Qmax) and postvoid residual (PVR). Erectile function was assessed using International Index of Erectile Function (IIEF-5). In patients with preoperative antegrade ejaculation, retrograde ejaculation was routinely screened at each follow-up visit. Sexual and urinary functions at 3 and 12 months were compared with baseline values. RESULTS A total of 55 patients met our inclusion criteria. A significant improvement in the IPSS, IPSS-QoL, PVR and Qmax was found at 3 and 12 months, compared with baseline (all P<0.05). Eight patients (14.5%) required surgical reintervention due to persistant LUTS/BPO. No significant changes in the erectile function were found at 3 (P=0.3) and 12 months (P>0.9). In patients with preoperative antegrade ejaculation (n=32), only four cases of de novo retrograde ejaculation were recorded postoperatively. CONCLUSION MLHoLEP represents a new alternative for men with LUTS/BPO who wish to preserve their ejaculatory function. Patients should be aware that improvement in urinary function may be inferior to the traditional technique, with a higher reintervention rate due to persistent LUTS. LEVEL OF EVIDENCE Grade 4.
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Affiliation(s)
- Thibaut Long Depaquit
- Department of Urology, HIA Sainte-Anne, Toulon, France; Department of Urology, North Hospital, AP-HM, Marseille, France.
| | | | - Paul Chiron
- Department of Urology, HIA Begin, Saint-Mandé, France
| | - Renaud Corral
- Department of Urology, North Hospital, AP-HM, Marseille, France
| | - Vassili Anastay
- Department of Urology, North Hospital, AP-HM, Marseille, France
| | - Cyrille Bastide
- Department of Urology, North Hospital, AP-HM, Marseille, France
| | - Harry Toledano
- Department of Urology, North Hospital, AP-HM, Marseille, France; Department of Urology, Martigues Hospital, Martigues, France
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Chan K, Keane A, Pradhan S, King T, Moroco A, Goyal N, Choi KY. Postoperative Urinary Complications in Head and Neck Free Flap Reconstructive Surgery. Ann Otol Rhinol Laryngol 2024; 133:284-291. [PMID: 37902061 PMCID: PMC10865755 DOI: 10.1177/00034894231208256] [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: 10/31/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the postoperative urinary complications and the optimal timing of foley catheter removal in patients who underwent free flap reconstructive surgery for head and neck pathology. METHODS A retrospective case-control study of head and neck patients who underwent free flap reconstructive surgery at a single institution between January 2009 and December 2021 was conducted. Patient risk factors for postoperative urinary retention (POUR) were analyzed. Fisher Exact and Wilcoxon Rank Sum tests were used to evaluate rates of foley replacement, straight catheterization, and catheter-associated urinary tract infection (CAUTI) and associated risk factors. RESULTS Two hundred and eleven patients were included in this study. Older age, lower BMI, lower intraoperative fluid volumes, and need for straight catheterization were statistically significant for POUR requiring foley replacement. Shorter total (P = .04) and postoperative (P = .01) foley duration showed statistical significance for POUR requiring straight catheterization. About 60% of patients who had straight catheterization required a foley replacement (P < .001). Only one patient (0.5%) developed a urinary tract infection (UTI). CONCLUSION Foley catheter duration impacts the risk of POUR requiring straight catheterization and subsequently, foley replacement. Optimal timing for foley catheter removal in the postoperative period remains to be elucidated. Removal of catheters between 21 and 48 hours after surgery may decrease the risk of POUR without increasing the rate of CAUTI in patients with head and neck pathology undergoing free flap reconstructive surgery.
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Affiliation(s)
- Kimberly Chan
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Allison Keane
- Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Tonya King
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Annie Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Neerav Goyal
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Karen Y. Choi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Zhou H, Xu M, Pan Y, Wang S, Xu Z, Liu L, Liu X. The association between several serum micronutrients and benign prostatic hyperplasia: Results from NHANES 2003-2006. Prostate 2024; 84:212-220. [PMID: 37899678 DOI: 10.1002/pros.24641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a common condition that affects the quality of life of older men. Specific micronutrients, including retinol, retinyl esters, carotenoids, vitamin E, and vitamin C, have antioxidant and anti-inflammatory properties. However, the correlation between serum concentrations of these micronutrients and BPH is unclear. METHODS We used data from the National Health and Nutrition Examination Survey (NHANES), which included 2067 representative US men. BPH was assessed using the self-reported questionnaire. This association was explored by adjusting for confounders using multivariate logistic regression. RESULTS After fully adjusting for confounders, for every 0.01 μmol/L increase in serum retinyl esters, the risk of BPH increased by 2% (OR = 1.02; 95% CI: 1.01-1.03; p = 0.006). Based on the Bonferroni-corrected p-value, we found this correlation to be significant. One μmol/L increase in total carotenoids was associated with a 22% increase in BPH risk (OR = 1.22; 95% CI: 1.03-1.46; p = 0.025). By analyzing the correlation between different types of carotenoids and BPH, we also found that β-carotenoids (OR = 1.43; 95% CI: 1.03-1.99; p = 0.036) was also positively correlated with BPH. The subgroup analysis revealed a positive correlation between serum vitamin E (OR = 1.02; 95% CI: 1.00-1.04; p = 0.018) and BPH in men under 60 years of age. Serum retinyl ester (OR = 1.02; 95% CI: 1.01-1.04; p = 0.008) and carotenoid (OR = 1.52; 95% CI: 1.22-1.87; p < 0.001) concentrations were positively correlated with BPH in men over 60 years of age. CONCLUSION Our study suggests that excessive serum retinyl esters, total carotenoids, and especially β-carotenoids are potential risk factors for BPH, and this association should be further investigated.
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Affiliation(s)
- Hang Zhou
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingming Xu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Pan
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shangren Wang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhunan Xu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Aizezi X, Feng L, Wang Z, Ma Y, Li J, Keremu A, Rouzi M, Dilixiati A, Wang B, Shi H, Huang J. Comparison of the efficacy of HoLEP and TURP in the treatment of elderly benign prostatic hyperplasia patients: a retrospective study. Aktuelle Urol 2024. [PMID: 38262432 DOI: 10.1055/a-2210-5913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To prove that holmium laser prostatectomy (HoLEP) is safe and effective in the treatment of benign prostatic hyperplasia (BPH), and is superior to transurethral prostatectomy (TURP) for elderly patients. METHODS We retrospectively studied 565 HoLEP patients and 76 TURP elderly patients. HoLEP patients were first divided into three groups according to their age(Under 65 years old group, 65-79 years old group and over 80 years old group), and their preoperative, intraoperative, and postoperative characteristics were then compared. Secondly, the same characteristics of HoLEP and TURP patients over 80 years were compared. Chi-square test, one-way ANOVA and Fisher's exact test were used in this study. RESULTS Firstly, we compared HoLEP patients in different age groups and found that there was statistically significant difference in diabetes, CCVD and bladder stones, among the three groups (P<0.05).Secondlye, we compared HoLEP and TURP treatments in elderly patients (≥80 years old). The patients with HoLEP had a higher share of diabetes, CCVD and anticoagulation (P<0.05). Moreover, compared with TURP patients, HoLEP patients had shorter enucleation duration, more enucleate prostate weight, fewer hemoglobin diminutions, shorter bladder irrigation time, shorter catheter-indwelling period, and shorter hospital period (P<0.05). Although there was no difference in IPSS, Qmax and QOL between the two groups before operation (P>0.05), the difference was statistically significant, 6 months after the operation (P<0.05). CONCLUSION HoLEP is safe and effective for BPH patients, and is superior to transurethral TURP for elderly patients.
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Affiliation(s)
- Xierzhati Aizezi
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Liancheng Feng
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Zheng Wang
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Yuan Ma
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Jifu Li
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Abuduweili Keremu
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Maihemujiang Rouzi
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Ailiyaer Dilixiati
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Beiping Wang
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Hanzhen Shi
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Jinxing Huang
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
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Lee YW, Kim BS, Chung J. Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2024; 103:41-48. [PMID: 34281423 DOI: 10.1177/01455613211033112] [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: 11/16/2022] Open
Abstract
OBJECTIVES Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. METHODS A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. RESULTS Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR (P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. CONCLUSIONS General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient's urological history and urinary conditions appear to affect the occurrence of POUR.
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Affiliation(s)
- Yong Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Veterans Health Service Daejeon Hospital, Daejeon, Republic of Korea
| | - Bum Sik Kim
- Department of Urology, Veterans Health Service Daejeon Hospital, Daejeon, Republic of Korea
| | - Jihyun Chung
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Wang X, Liu P, Zhao S, Wang F, Li X, Wang L, Yan Y, Zou GA, Xu G. Dynamic simulation and analysis of the influence of urethral morphological changes on urodynamics after benign prostatic hyperplasia surgery: A computational fluid dynamics study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107915. [PMID: 37995487 DOI: 10.1016/j.cmpb.2023.107915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Computational fluid dynamics (CFD) technology has been widely used in medicine to simulate and analyse urine flow characteristics in urology. In previous studies, researchers have modelled the analysis with a simple circular urethra, ignoring the effect of the patient's true urethral morphology on the urinary flow rate. Moreover, the studies tended to be steady-state simulations rather than dynamic simulations. Therefore, this study is established a relatively realistic model of the posterior urethra based on MRI data combined with the urodynamic data of patients and analysed the urodynamic characteristics of the posterior urethra model after benign prostatic hyperplasia (BPH) surgery using a CFD dynamic simulation. METHODS Based on clinical MRI data, a three-dimensional real urethral model was established for two patients with BPH after surgery. The boundary conditions were set according to the patients' real urodynamic data, and a Reynolds averaged Navier‒Stokes model was used for transient simulations. The dynamic simulation depicted the entire urination process, and the urine flow characteristics were studied under real urethral morphology after surgery. RESULTS 1. By comparing the three-dimensional trajectory of urine and the vortex identification cloud map based on the Q criterion, we intuitively observed the distribution of the vortex in the model, and a 'gourd-shaped' urethra was more likely to generate a vortex than a 'funnel-shaped' urethra. 2. After surgery for BPH, the changes in the posterior urethral pressure were mainly concentrated in the urethral membrane, and the velocity increased while the pressure decreased. The curve of the posterior urethral pressure changes during urination was simulated and calculated. The posterior urethral pressure gradients of the two patients were 6.6 cmH2O and 5.26 cmH2O. CONCLUSIONS The complete urinary discharge process can be dynamically simulated using CFD techniques. By comparing the simulation results, the posterior urethral morphology can have an important impact on the urinary flow characteristics. Determining the location of vortex generation can lay a foundation for personalized surgical plans for patients in the future. Furthermore, numerical simulations can provide a new method for the study of non-invasive posterior urethral pressure gradients.
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Affiliation(s)
- Xihao Wang
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Pengyue Liu
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Sen Zhao
- Department of Medical Imageology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Fei Wang
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Xiaodong Li
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Lianqu Wang
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Yongjun Yan
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Guang-An Zou
- School of Mathematics and Statistics Henan University, Kaifeng, China
| | - Guoliang Xu
- Department of Urology, The First Affiliated Hospital of Henan University, Kaifeng, China.
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Patel VS, Beamer MR, H Sanford T, V Wiener S. Laser enucleation of the prostate (LEP) vs. simple prostatectomy: an analysis of hospital charges and comparison of practice trends. Int Urol Nephrol 2023; 55:3051-3056. [PMID: 37584861 DOI: 10.1007/s11255-023-03742-7] [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: 06/26/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Laser enucleation of the prostate (LEP) and simple prostatectomy (SP) are surgical treatment options for large gland Benign Prostatic Hyperplasia. While multiple studies compare clinical outcomes of these procedures, there are limited data available comparing hospital charges in the United States. Here, we present current practice trends and a hospital charge analysis on a national level using an annual insurance claims data repository. METHODS The Healthcare Cost and Utilization Project National Inpatient Sample and Nationwide Ambulatory Surgery Sample databases for 2018 were queried. CPT and ICD-10PCS codes identified patients undergoing LEP or SP, who were then compared for practice setting, total hospital charges, and payor. Laser type for LEP and surgical approach for SP could not be differentiated. RESULTS The median hospital charge of 5782 LEPs and 973 SPs is $26,689 and $51,250 (p < 0.001), respectively. LEP independently predicts a decreased hospital charge of $16,464 (p < 0.001) per case. Medicare is the primary payor for both procedures. More LEP procedures are completed in the outpatient setting (87.8%) vs. SPs (5.7%, p < 0.001). Median length of stay is longer for SP (LEP: 0, IQR: 0; SP: 3, IQR: 2-4; p < 0.001). In the Western region, LEP is least commonly performed (184, p < 0.001), most expensive ($43,960; p < 0.001), and has longer length of stay (2, p < 0.001). CONCLUSIONS LEP should be considered a cost-effective alternative to SP. Regions of the U.S. that perform more LEPs have shorter length of stay and lower hospital charges associated with the procedure.
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Affiliation(s)
- Valmic S Patel
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, USA
| | - Matthew R Beamer
- Department of Urology, SUNY Upstate Medical University, Syracuse, USA
| | | | - Scott V Wiener
- Department of Urology, SUNY Upstate Medical University, Syracuse, USA.
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Ornaghi PI, Porreca A, Sandri M, Sciarra A, Falsaperla M, Ludovico GM, Cerruto MA, Antonelli A. Features of patients referring to the outpatient office due to benign prostatic hyperplasia: analysis of a national prospective cohort of 5815 cases. Prostate Cancer Prostatic Dis 2023; 26:730-735. [PMID: 35869394 DOI: 10.1038/s41391-022-00575-w] [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: 03/13/2022] [Revised: 06/10/2022] [Accepted: 07/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evidence on clinical presentation of benign prostatic hyperplasia (BPH) is scarce, and studies involving outpatients are lacking. We aimed to provide an insight into the contemporary Italian scenario of BPH-affected outpatients using symptom scores (International Prostate Symptom Score [IPSS], BPH Impact Index [BII]), and to compare characteristics of patients with known BPH and those first-diagnosed at the visit. METHODS "IMPROVING THE PATH" project working group designed a questionary prospectively administered to BPH-affected outpatients by urologists. A cross-sectional study was performed. Data were adjusted for patient age as a potential confounding factor. RESULTS Of 5815 patients enrolled, BPH was already diagnosed in 4144 (71.3%), and not in 1671 (28.7%). Patients with known BPH, compared to newly diagnosed, were older (median 68 versus [vs] 55), had more frequent smoking (smoker 27.2 vs 22.6%, and ex-smoker 16.4 vs 12.5%) and drinking habits (55.4 vs 45.1%), were more frequently affected by hypertension (60.0 vs 42.4%), obesity (15.3 vs 9.6%), diabetes (17.9 vs 12.5%), and cardiovascular diseases (14.2 vs 9.5%), p < 0.001. At IPSS, moderate and severe symptoms correlated with already known BPH (56.1 vs 47.3% and 24.8 vs 7.8%), whereas newly diagnosed patients showed milder symptoms (44.9 vs 19.1%), all p < 0.001. At BII, concern for one's health and time lost due to urinary problems were higher in patients with known BPH (p < 0.001). For these patients, the urologist changes at least one of the ongoing medications in 63.5%. For patients newly diagnosed, supplements/phytotherapeutics, alpha-blockers, and 5-alfa reductase inhibitors were prescribed in 54.6%, 21.6%, and 7.1%, respectively. CONCLUSIONS Despite medical treatment, natural history of BPH leads to a progressive deterioration of symptoms. This may reflect the difference between newly diagnosed patients and those with known BPH in lifestyle and associated comorbidities. A healthy lifestyle and treatments including local anti-inflammatory agents may delay worsening of symptoms and improve quality of life.
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Affiliation(s)
- Paola Irene Ornaghi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy
| | - Angelo Porreca
- Department of Urology, Polyclinic of Abano Terme, Piazza Cristoforo Colombo, 1, 35031, Abano Terme, PD, Italy
| | - Marco Sandri
- Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Via S. Faustino 74/B, 25122, Brescia, BS, Italy
| | - Alessandro Sciarra
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Viale Regina Elena, 328, 00161, Roma, RM, Italy
| | - Mario Falsaperla
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, piazza Santa Maria di Gesù, 5, 95124, Catania, CT, Italy
| | - Giuseppe Mario Ludovico
- Department of Urology, Regional General Hospital Francesco Miulli, Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021, Acquaviva delle Fonti, BA, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani, 1, 37126, Verona, VR, Italy.
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Devulapalli KK, Julien WH. The Future of Interventional Radiology: Point-Why Interventional Radiology Must Become a Stand-Alone Specialty. AJR Am J Roentgenol 2023; 221:732-733. [PMID: 37436034 DOI: 10.2214/ajr.23.29815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
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Abdel-Fattah MM, Abo-El Fetoh ME, Afify H, Ramadan LAA, Mohamed WR. Probenecid ameliorates testosterone-induced benign prostatic hyperplasia: Implications of PGE-2 on ADAM-17/EGFR/ERK1/2 signaling cascade. J Biochem Mol Toxicol 2023; 37:e23450. [PMID: 37352135 DOI: 10.1002/jbt.23450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023]
Abstract
Benign prostatic hyperplasia (BPH) is one of the most prevalent clinical disorders in the elderly. Probenecid (Prob) is a well-known FDA-approved therapy for gout owing to its uricosuric effect. The present study evaluated the use of Prob for BPH as a COX-2 inhibitor. Prob (100 and 200 mg/kg) was intraperitoneally injected into male Wistar rats daily for 3 weeks. In the second week, testosterone (3 mg/kg) was subcutaneously injected to induce BPH. Compared with BPH-induced rats, Prob treatment reduced prostate weight and index and improved histopathological architecture. The protease activity of ADAM-17/TACE and its ligands (TGF-α and TNF-α) were regulated by prob, which in turn abolished EGFR phosphorylation, and several inflammatory mediators (COX-2, PGE2, NF-κB (p65), and IL-6) were suppressed. By reducing the nuclear import of extracellular regulated kinase protein 1/2 (ERK1/2), Prob helped re-establish the usual equilibrium between antiapoptotic proteins like Bcl-2 and cyclin D1 and proapoptotic proteins like Bax. All of these data point to Prob as a promising treatment for BPH because of its ability to inhibit COX-2-syntheiszed PGE2 and control the ADAM-17/TGF-α-induced EGFR/ERK1/2 signaling cascade. These findings might help to repurpose Prob for the treatment of BPH.
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Affiliation(s)
- Maha M Abdel-Fattah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohammed E Abo-El Fetoh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Egyptian-Russian University, Cairo, Egypt
| | - Hassan Afify
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Egyptian-Russian University, Cairo, Egypt
| | - Laila A A Ramadan
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Egyptian-Russian University, Cairo, Egypt
| | - Wafaa R Mohamed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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Baran C. The effect of acute urinary retention on the results of transurethral resection of the prostate. Urologia 2023; 90:642-646. [PMID: 37491943 DOI: 10.1177/03915603231189627] [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: 07/27/2023]
Abstract
INTRODUCTION Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. METHODS Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. RESULTS There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. DISCUSSION Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.
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Affiliation(s)
- Caner Baran
- Çukurova State Hospital, Department of Urology, Adana, Turkey
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Kaneta K, Tanaka A, Nakai M, Sumita Y, Kaneko H, Noguchi M, Node K. Prevalence and temporal trends of prostate diseases among inpatients with cardiovascular disease: a nationwide real-world database survey in Japan. Front Cardiovasc Med 2023; 10:1236144. [PMID: 37928758 PMCID: PMC10620699 DOI: 10.3389/fcvm.2023.1236144] [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: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Benign prostate hyperplasia (BPH) and prostate cancer (PCa) are major prostate diseases that potentially share cardiometabolic risk factors and an elevated risk for cardiovascular disease (CVD). However, the prevalence of prostate diseases among patients with established CVD remains unclear. Materials and methods This nationwide retrospective study assessed the prevalence and temporal trend of prostate diseases (i.e., BPH or PCa) among patients hospitalized for CVDs in Japan. We used a claims database (the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination), which included data on 6,078,487 male patients recorded from 1,058 hospitals between April 2012 and March 2020. We conducted the Cochran-Armitage trend test and calculated the adjusted odds ratio (aOR) with 95% confidence intervals (CIs). Results The prevalence of prostate diseases over the entire study period was 5.7% (BPH, 4.4%; PCa, 1.6%). When dividing the overall cohort into age categories (<65, 65-74, and ≥75 years old), the prevalence was 1.1%, 4.7%, and 9.9%, respectively (P for trend <0.05). In addition, the annual prevalence showed a modest increasing trend over time. Patients admitted for heart failure (HF) were significantly associated with a higher incidence of coexisting prostate diseases than those admitted for non-HF causes [aOR 1.02 (95% CI, 1.01-1.03)] or acute coronary syndrome [aOR 1.19 (95% CI, 1.17-1.22)]. Conclusions The nationwide real-world database revealed that the prevalence of prostate diseases is increasing among patients hospitalized for CVD, particularly HF. Attention to detailed causality and continued surveillance are needed to further clarify the clinical characteristics of prostate diseases among patients with CVD.
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Affiliation(s)
- Kohei Kaneta
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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Su YT, Chen HL, Teoh JYC, Chan VWS, Wu WJ, Lee HY. Comparison of add-on medications for persistent storage symptoms after α-blocker treatment in BPH patients - a network meta-analysis. BMC Urol 2023; 23:154. [PMID: 37789333 PMCID: PMC10546657 DOI: 10.1186/s12894-023-01327-1] [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: 04/21/2023] [Accepted: 09/17/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Patients with benign prostatic hyperplasia (BPH) receive α-blockers as first-line therapy to treat lower urinary tract symptoms; however, some individuals still experience residual storage symptoms. Antimuscarinics, β3-agonists, and desmopressin are effective add-on medications. Nevertheless, there is currently no evidence for the appropriate choice of the first add-on medication. This systematic review aimed to investigate the clinical benefits of antimuscarinics, β3-agonists, and desmopressin, in addition to α-blockers, for persistent storage symptoms in BPH patients. METHODS A comprehensive literature search of randomized controlled trials (RCTs) comparing the efficacy of different add-on medications in BPH patients with persistent storage symptoms despite α-blocker treatment was conducted. Clinical outcomes included the International Prostate Symptom Score (IPSS), IPSS storage subscore, nocturia, micturition, and urgency. A network meta-analysis was performed to estimate the effect size. Surface under cumulative ranking curves (SUCRAs) were used to rank the included treatments for each outcome. RESULTS A total of 15 RCTs were identified. Add-on imidafenacin and mirabegron resulted in significant improvement in all outcomes assessed. Other add-on medications such as desmopressin, tolterodine, solifenacin, fesoterodine, and propiverine showed positive benefits for most, but not all, outcomes. Based on the SUCRA rankings, add-on desmopressin was the best-ranked treatment for IPSS and nocturia, and add-on imidafenacin was the best for the IPSS storage subscore and micturition. CONCLUSIONS BPH patients presenting with persistent storage symptoms despite α-blocker administration are recommended to include additional treatment. Desmopressin and imidafenacin may be considered high-priority add-on treatments because of their superior efficacy compared with other medications.
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Affiliation(s)
- Yi-Ting Su
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsiao-Ling Chen
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Vinson Wai-Shun Chan
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan.
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan.
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Parrott D, Suh EH, Khalighinejad P, Jordan VC, Arreola I, Lo ST, Sherry AD. Investigations into the Signaling Pathways Involving Glucose-Stimulated Zinc Secretion (GSZS) from Prostate Epithelial Cells In Vitro and In Vivo. Mol Imaging Biol 2023; 25:935-943. [PMID: 37097498 DOI: 10.1007/s11307-023-01821-w] [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: 01/12/2023] [Revised: 03/18/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Recently, we reported that exposure of prostate cells in vitro or the in vivo prostate to high glucose results in release of Zn2+ ions, a process now referred to as glucose-stimulated zinc secretion (GSZS). To our knowledge, the metabolic event(s) that trigger GSZS remain largely unknown. Here, we explore several signaling pathways both in vitro using a prostate epithelial cell line and in vivo from the rat prostate. METHODS PNT1A cells grown to confluence were washed and tagged with ZIMIR to monitor zinc secretion by optical methods. The expression levels of GLUT1, GLUT4, and Akt in cells cultured in either zinc-rich or zinc-poor media and after exposure to high versus low glucose were determined. Zinc secretion from the rat prostate in vivo as detected by MRI was compared in control animals after injection of glucose, deoxyglucose, or pyruvate to initiate zinc secretion and in animals pre-treated with WZB-117 (a GLUT1 inhibitor) or S961 (a peripheral insulin receptor inhibitor). RESULTS PNT1A cells exposed to high levels of glucose secrete zinc whereas cells exposed to an equivalent amount of deoxyglucose or pyruvate do not. Expression of Akt was dramatically altered by zinc supplementation of the culture media but not after exposure to glucose while GLUT1 and GLUT4 levels were less affected. Rats pre-treated with WZB-117 prior to imaging showed a reduction in GSZS from the prostate compared to controls whereas rats pre-treated with S961 showed no difference. Interestingly, in comparison to PNT1A cells, pyruvate and deoxyglucose also stimulate zinc secretion in vivo likely through indirect mechanisms. CONCLUSIONS GSZS requires metabolism of glucose both in vitro (PNT1A cells) and in vivo (rat prostate). Pyruvate also stimulates zinc secretion in vivo but likely via an indirect pathway involving rapid production of glucose via gluconeogenesis. These combined results support the conclusion that glycolytic flux is required to trigger GSZS in vivo.
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Affiliation(s)
- Daniel Parrott
- Advanced Imaging Research Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, NE 4.210, Dallas, TX, 775390-8568, USA
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 7575390-8896, USA
| | - Eul Hyun Suh
- Advanced Imaging Research Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, NE 4.210, Dallas, TX, 775390-8568, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX, 76107-2699, USA
| | - Pooyan Khalighinejad
- Advanced Imaging Research Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, NE 4.210, Dallas, TX, 775390-8568, USA
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 7575390-8896, USA
| | - Veronica Clavijo Jordan
- Advanced Imaging Research Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, NE 4.210, Dallas, TX, 775390-8568, USA
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 7575390-8896, USA
- Athinoula A. Martinos Center for Biomedical Imaging, The Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivan Arreola
- Advanced Imaging Research Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, NE 4.210, Dallas, TX, 775390-8568, USA
- Departments of Cell Biology and Biochemistry, UT Southwestern Medical Center, Dallas, TX, 75390-9039, USA
| | - Su-Tang Lo
- Advanced Imaging Research Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, NE 4.210, Dallas, TX, 775390-8568, USA
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 7575390-8896, USA
| | - A Dean Sherry
- Advanced Imaging Research Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, NE 4.210, Dallas, TX, 775390-8568, USA.
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, 7575390-8896, USA.
- Department of Chemistry & Biochemistry, University of Texas at Dallas, Richardson, TX, 7575083-3021, USA.
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Diosdado-Figueiredo M. [Lower urinary tract symptoms in patients with arterial hypertension. Cardiovascular risk and impact on their quality of life]. HIPERTENSION Y RIESGO VASCULAR 2023; 40:205-214. [PMID: 37980226 DOI: 10.1016/j.hipert.2023.05.008] [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: 11/29/2022] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 11/20/2023]
Abstract
OBJETIVES To determine the prevalence of erectile lower urinary tract symptoms in hypertensive patients, cardiovascular risk and the impact on quality of life. MATERIAL AND METHODS Setting: Health Center (Vilagarcia, Pontevedra). PERIOD April 2015-June 2017. INCLUSION CRITERIA Hypertensive patient with informed consent. MEASUREMENTS sociodemographic variables, toxic habits, comorbidity, blood pressure, cardiovascular risk, analytical and examination parameters. Questionaries: International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF-15) and quality of life in arterial hypertension (MINICHAL). SAMPLE SIZE n=262 (± 6% accuracy, 95% confidence). STATISTICAL ANALYSIS Bivariate and multivariate statistical analysis. Informed consent and ethics committee approval were obtained (2024/237) RESULTS: The mean age was 65.84 (12.70), and mean hypertension duration of 13.25 (9.84) years. 76.7% reported lower tract urinary symptoms, 91.6% being mild. The bivariate analysis showed an association with the variables: age, educational level, profession, work activity, tobacco, benign prostatic hypertrophy, years of diagnosis, concomitant medication, Framingham-Wilson score, electrocardiogram, glycated hemoglobin, glomerular filtration (Crockroft-Gault), LDL-cholesterol, somatic manifestations (MINICHAL), erectile dysfunction. The multivariate analysis showed increased risk with:abdominal obesity, pathological electrocardiogram, high risk of Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents and decreased with not smoking and use diuretics. CONCLUSIONS Three quarters of hypertensive men presented lower urinary tract symptoms, increasing the risk of cardiovascular disease early according to the Framingham-Wilson score. Other predictive factors were: abdominal obesity, tobacco, pathological electrocardiogram, high Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents.
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Jung HC, Kim YU. Fournier's gangrene after insertion of thermo-expandable prostatic stent for benign prostatic hyperplasia: A case report. World J Clin Cases 2023; 11:6498-6504. [PMID: 37900218 PMCID: PMC10601010 DOI: 10.12998/wjcc.v11.i27.6498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Thermo-expandable urethral stent (Memokath 028) implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction. Following prostatic urethral stent implantation, minor complications such as urinary tract infection, irritative symptoms, gross hematuria, and urethral pain have been observed; however, there are no reports of life-threatening events. Herein, we report a critical case of Fournier's gangrene that occurred 7 years after prostatic stenting. CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia (volume, 126 ccs; as measured by transrectal ultrasound) had undergone insertion of a thermo-expandable urethral stent (Memokath 028) as he was unfit for surgery under general anesthesia. However, the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent (Memokath 028). We had planned to remove the Memokath 028; however, the patient was lost to follow-up. The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area. In digital rectal examination, tenderness and heat of prostate was identified. Also, the black skin color change with foul-smelling from right scrotum to right inguinal area was identified. In computed tomography finding, subcutaneous emphysema was identified to same area. He was diagnosed with Fournier's gangrene based on the physical examination and computed tomography findings. In emergency room, Fournier's gangrene severity index value is seven points. Therefore, he underwent emergent extended surgical debridement and removal of the Memokath 028. Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed. However, the patient died 14 days after surgery due to multiorgan failure. CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients, its rapid removal may help prevent severe complications.
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Affiliation(s)
- Hee Chang Jung
- Department of Urology, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Yeong Uk Kim
- Department of Urology, Yeungnam University College of Medicine, Daegu 42415, South Korea
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Felice MD, Kim K, Janakiraman S, Pahouja G, Adams W, Fruth E, Farooq A, McVary KT. Risk factors for a failed trial without catheter following convective water vapor thermal therapy (CWVTT-Rezum). Low Urin Tract Symptoms 2023; 15:158-164. [PMID: 37232068 DOI: 10.1111/luts.12483] [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: 11/28/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Convective water vapor thermal therapy (CWVTT-Rezum) is a minimally invasive surgical therapy that is being increasingly utilized for bladder outlet obstruction. Most patients leave the site of care with a Foley catheter in place for a mean reported duration of 3-4 days. A minority of men will fail their trial without catheter (TWOC). We aim to identify the frequency of TWOC failure following CWVTT and its associated risk factors. METHODS Patients who underwent CWVTT at a single institution from October 2018 to May 2021 were retrospectively identified and pertinent data extracted. The primary endpoint was TWOC failure. Descriptive statistics were performed, and rate of TWOC failure was determined. Potential risk factors for failed TWOC were assessed through univariate and multivariate logistic regression. RESULTS A total of 119 patients were analyzed. Seventeen percent (20/119) had a failed TWOC on their first attempt. Of those, 60% (12/20) failed in a delayed fashion. In patients who failed, the median number of total TWOC attempts required for success was two (interquartile range [IQR] = 2-3). All patients eventually had a successful TWOC. The median preoperative postvoid residual for successful and failed TWOC was 56 mL (IQR = 15-125) and 87 mL (IQR = 25-367), respectively. Preoperative elevated postvoid residual (unadjusted odds ratio [OR] 1.02, 95% CI: 1.01-1.04; adjusted OR 1.02, 95% CI: 1.01-1.04) was associated with TWOC failure. CONCLUSIONS Seventeen percent of patients failed their initial TWOC after CWVTT. Elevated postvoid residual was associated with TWOC failure.
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Affiliation(s)
- Michael D Felice
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Kaylin Kim
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Sarang Janakiraman
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Gaurav Pahouja
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - William Adams
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Erin Fruth
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ahmer Farooq
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
- Center for Male Health, Loyola University Medical Center, Maywood, Illinois, USA
| | - Kevin T McVary
- Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
- Center for Male Health, Loyola University Medical Center, Maywood, Illinois, USA
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Pichardo M, Rijo E, Espino G, Lay RR, Estrella R, Gonzalez C, Fernandez M, Soriano D, Peralta IM, Kaplan SA. Durable benefit after treatment of obstructive benign prostatic hyperplasia with a novel drug-device combination product: 2-year outcomes from the EVEREST-I study. World J Urol 2023; 41:2209-2215. [PMID: 37354260 DOI: 10.1007/s00345-023-04473-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of the Optilume BPH Catheter System for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS This open-label, single-arm study enrolled eighty subjects with LUTS secondary to BPH who were treated with the Optilume BPH Catheter System. Symptoms were recorded utilizing the International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia Impact Index (BPH-II). Functional improvement was measured utilizing peak urinary flow rate (Qmax) and post-void residual urine volume (PVR). Adverse events were systematically captured and reported at each follow-up visit. RESULTS Subjects treated with the Optilume BPH Catheter System experienced a significant improvement in LUTS from baseline through 2 years of follow-up, as measured by IPSS (22.3 vs 8.2, p < 0.001) and BPH-II (6.9 vs 2.3, p < 0.001). Functional improvement was also significant, with Qmax improving from an average of 10.9 mL/s at baseline to 17.2 mL/s at the 2-year follow-up and PVR improving from 63.1 to 45.0 mL. Treatment-related adverse events were typically minor, with none occurring between 1- and 2-year post-treatment. CONCLUSIONS The Optilume BPH Catheter System is a unique minimally invasive surgical therapy that combines mechanical and pharmaceutical aspects for the treatment of BPH. The functional and symptomatic improvements seen after treatment are significant and have been sustained through 2 years in this early feasibility study. REGISTRATION NCT03423979, registered February 6, 2018.
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Affiliation(s)
| | - Edwin Rijo
- Centro Médico Dr. Canela SRL, La Romana, Dominican Republic
| | | | | | - Rafael Estrella
- Clínica Unión Medica, Santiago de los Caballeros, Dominican Republic
| | | | | | | | | | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, 625 Madison Avenue, 2nd Floor, New York, NY, 10065, USA.
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Lopes MHBDM, D'Ancona CAL, Moretti TBC, Higa R, Victal ML, Camisão AR, Braga DA, Reis LO. Validation of Visual Prostate Symptom Score (VPSS) in Brazilian Sample Population. J Wound Ostomy Continence Nurs 2023; 50:326-330. [PMID: 37467413 DOI: 10.1097/won.0000000000000996] [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: 07/21/2023]
Abstract
PURPOSE The aim of the study was to evaluate the reliability and validity of the Visual Prostate Symptom Score (VPSS), its correlation with the International Prostate Symptom Score (IPSS), and the time required and need for help when completing the instrument. We also aimed to identify variables associated with difficulty completing these instruments. DESIGN Longitudinal, prospective correlational study. SUBJECTS AND SETTING The target population was Brazilian men from different cities within the state of São Paulo with lower urinary tract symptoms followed in urological consultation at a university hospital during October 2017. The sample comprised 59 patients with a mean age of 66.53 years. METHODS Reliability of the VPSS was evaluated using a test-retest approach and its convergent validity with the IPSS. Cronbach α coefficient was also calculated. Both questionnaires were self-administered and, in case of difficulty of comprehension, assistance was provided. RESULTS Mean completion time of the IPSS was 6.56 minutes and for VPSS was 5.02 minutes. The variables skin color and educational level were associated with the difficulty in completing the IPSS and for comprehending meaning of the VPSS pictograms. Internal consistency evaluated using Cronbach α coefficient was 0.74 for IPSS and 0.15 for VPSS, respectively. Test-retest reliability testing revealed that both instruments had a high intraclass correlation index (>0.75). There was a significant correlation between the health-related quality of life (QoL) scores of the 2 instruments (0.71, P = .0001) and between the total score of each instrument with its corresponding QoL score. CONCLUSION Although time for response of the VPSS was shorter and it demonstrated good test-retest reliability, it more frequently required help to answer. The VPSS showed low internal consistency and low correlation with the IPSS (except for the QoL item).
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Affiliation(s)
- Maria Helena Baena de Moraes Lopes
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
| | - Carlos Arturo Levi D'Ancona
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
| | - Tomás Bernardo Costa Moretti
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
| | - Rosangela Higa
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
| | - Marcella Lima Victal
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
| | - Agnês Raquel Camisão
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
| | - Daniel A Braga
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
| | - Leonardo Oliveira Reis
- Maria Helena Baena de Moraes Lopes, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Carlos Arturo Levi D'Ancona, PhD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Tomás Bernardo Costa Moretti, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Rosangela Higa, PhD, University of Campinas (Center for Integral Attention to Women's Health-CAISM), Campinas, São Paulo, Brazil
- Marcella Lima Victal, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Agnês Raquel Camisão, PhD, School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
- Daniel A. Braga, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
- Leonardo Oliveira Reis, MD, Department of Urology, University of Campinas, Campinas, São Paulo, Brazil
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Black M, Slade A, Caras RJ, DeLeon GA, Large T, Shelton TM, Tong Y, Rivera M. Evaluation of Renal Function Recovery After Holmium Laser Enucleation of the Prostate in Patients with Chronic Kidney Disease. J Endourol 2023; 37:817-822. [PMID: 37212242 DOI: 10.1089/end.2023.0062] [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: 05/23/2023] Open
Abstract
Introduction: Holmium laser enucleation of the prostate (HoLEP) has become a new surgical gold standard treatment for benign prostatic hyperplasia (BPH). It is known that untreated BPH can lead to bladder outlet obstruction (BOO). A positive correlation exists between BOO and chronic kidney disease (CKD), but stability or recovery of renal function after HoLEP remains unknown. We sought to describe changes in renal function after HoLEP in men with CKD. Methods: A retrospective study was conducted of patients who underwent HoLEP with glomerular filtration rates (GFRs) <60, CKD stages III to V. Pre- and postoperative GFRs were selected within 3 months before the operation and within 1 year postoperatively. The presence of an indwelling catheter, preoperative hydronephrosis, history of kidney stones, and prostate size were also reviewed. Data were analyzed in accordance with preoperative CKD stage. Results: Of the reviewed patients, 138 met inclusion criteria with CKD stages III to V. Each CKD group was without significant postoperative complications. There was a significant increase between pre- and postoperative GFR for patients in CKD stages III (n = 116) and IV (n = 17) (p < 0.0001 and p = 0.010, respectively). The mean increase between pre- and postoperative GFR for the CKD stages III and IV patients were 6.4 and 6.49, respectively. There was no correlation between presence of preoperative hydronephrosis, history of kidney stones, catheter dependency, nor prostate size on change in postoperative GFR (p > 0.05). Conclusion: These findings suggest that patients in CKD stages III or IV undergoing HoLEP experience an increase in GFR. It is noteworthy that there appears to be no decline in renal function postoperatively in any group. HoLEP represents an excellent surgical option for patients with preoperative CKD and may prevent further renal decline.
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Affiliation(s)
- Morgan Black
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Austen Slade
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ronald Joseph Caras
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Genaro A DeLeon
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas M Shelton
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Franco JV, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database Syst Rev 2023; 6:CD001423. [PMID: 37345871 PMCID: PMC10286776 DOI: 10.1002/14651858.cd001423.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate, which can lead to obstructive and irritative lower urinary tract symptoms (LUTS). The pharmacologic use of plants and herbs (phytotherapy) for the treatment of LUTS associated with BPH is common. The extract of the berry of the American saw palmetto or dwarf palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several phytotherapeutic agents available for the treatment of BPH. OBJECTIVES To assess the effects of Serenoa repens in the treatment of men with LUTS consistent with BPH. SEARCH METHODS We performed a comprehensive search of multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 16 September 2022, with no restrictions on language or publication status. SELECTION CRITERIA We included randomized controlled trials of participants with BPH who were treated with Serenoa repens or placebo/no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias assessment and GRADE assessment of the certainty of the evidence. We considered review outcomes measured up to 12 months after randomization as short term, and beyond 12 months as long term. Our main outcomes included urologic symptom scores, quality of life, and adverse events. MAIN RESULTS For this update, we narrowed the review question to only comparisons with placebo. We included 27 studies (of which 9 were new) involving a total of 4656 participants, 19 studies comparing Serenoa repens with placebo, and 8 studies comparing Serenoa repens in combination with other phytotherapeutic agents versus placebo. Most studies included men aged > 50 (mean age range 52 to 68) with moderate urologic symptoms (International Prostate Symptom Score [IPSS] range 8 to 19). Ten studies were funded by the pharmaceutical industry; two studies were funded by government agencies; and the remaining studies did not specify funding sources. Serenoa repens versus placebo or no intervention Results for this comparison are based on predefined sensitivity analyses limited to studies at low risk of bias. Serenoa repens results in little to no difference in urologic symptoms at short-term follow-up (3 to 6 months; IPSS score range 0 to 35, higher scores indicate worse symptoms; mean difference (MD) -0.90, 95% confidence interval (CI) -1.74 to -0.07; I2 = 68%; 9 studies, 1681 participants; high-certainty evidence). Serenoa repens results in little to no difference in the quality of life at short-term follow-up (3 to 6 months; IPSS quality of life domain range 0 to 6, higher scores indicate worse quality of life; MD -0.20, 95% CI -0.40 to -0.00; I2 = 39%; 5 studies, 1001 participants; high-certainty evidence). Serenoa repens probably results in little to no difference in adverse events (1 to 17 months; risk ratio (RR) 1.01, 95% CI 0.77 to 1.31; I2 = 18%; 12 studies, 2399 participants; moderate-certainty evidence). Based on 164 cases per 1000 men in the placebo group, this corresponds to 2 more (38 fewer to 51 more) per 1000 men in the Serenoa repens group. Serenoa repens results in little to no difference in urologic symptoms at long-term follow-up (12 to 17 months, IPSS score, MD 0.07, 95% CI -0.75 to 0.88; I2 = 34%; 3 studies, 898 participants; high-certainty evidence). Serenoa repens results in little to no difference in quality of life at long-term follow-up (12 to 17 months, IPSS quality of life, MD -0.11, 95% CI -0.41 to 0.19; I2 = 65%; 3 studies, 882 participants; high-certainty evidence). There were no data on long-term adverse events for this comparison. Serenoa repens in combination with other phytotherapy versus placebo or no intervention Different phytotherapeutic agents that include Serenoa repens may result in little to no difference in urologic symptoms compared to placebo at short-term follow-up (12 to 24 weeks, IPSS score, MD -2.41, 95% CI -4.54 to -0.29; I2 = 67%; 4 studies, 460 participants; low-certainty evidence). We are very uncertain about the effects of these agents on quality of life (very low-certainty evidence). These agents may result in little to no difference in the occurrence of adverse events; however, the CIs included substantial benefits and harms (12 to 48 weeks, RR 0.91, 95% CI 0.58 to 1.41; I2 = 0%; 4 studies, 481 participants; low-certainty evidence). Based on 132 cases per 1000 men in the placebo group, this corresponds to 12 fewer (55 fewer to 54 more) per 1000 men in the combined phytotherapeutic agents with Serenoa repens group. AUTHORS' CONCLUSIONS Serenoa repens alone provides little to no benefits for men with lower urinary tract symptoms due to benign prostatic enlargement. There is more uncertainty about the role of Serenoa repens in combination with other phytotherapeutic agents.
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Affiliation(s)
- Juan Va Franco
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Leonel Trivisonno
- Department of Health Science, Universidad Nacional de La Matanza, San Justo, Argentina
| | - Nadia J Sgarbossa
- Department of Health Science, Universidad Nacional de La Matanza, San Justo, Argentina
| | - Gustavo Ariel Alvez
- Medical School, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Cecilia Fieiras
- Medical School, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
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Kanai A, Andersson KE, Birder L, Fry C. Soluble Guanylate Cyclase Activators to Treat Benign Prostatic Hyperplasia and associated LUTS. CONTINENCE (AMSTERDAM, NETHERLANDS) 2023; 6:100699. [PMID: 37389026 PMCID: PMC10310070 DOI: 10.1016/j.cont.2023.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
This review summarises the presentations during a workshop session entitled "The Use of Soluble Guanylate Cyclase Activators to Treat Benign Prostatic Hyperplasia, Obstruction and Fibrosis - Mechanistic Concepts and Clinical Implications" at the International Continence Society (ICS) 2021 Melbourne Virtual meeting. Benign prostatic hyperplasia (BPH) is a highly prevalent condition that can result in bladder outflow obstruction (BOO) and development of lower urinary tract symptoms (LUTS), and by 80 years of age is present in about 75% of men. Current pharmacological therapies include α-adrenoceptor antagonists, 5α-reductase inhibitors, and the phosphodiesterase type 5 (PDE5) inhibitor, tadalafil. The efficacy of tadalafil suggests a role for nitric oxide (NO•) through activation of soluble guanylate cyclase (sGC) and production of cyclic guanosine 3'5'-monophosphate (cGMP), a cyclic nucleotide that relaxes smooth muscle, reduces neurotransmitter release and also acts as an antifibrotic agent. Patient refractoriness to tadalafil may be, for example, due to sGC inactivation due to oxidative stress. The workshop discussed the superiority of cinaciguat, an sGC activator that functions even when the enzyme is oxidised, over PDE5 inhibitors, and potentially its use in combination with agents that reduce formation of reactive oxygen species.
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Affiliation(s)
- A.J. Kanai
- University of Pittsburgh, Department of Medicine, Renal-Electrolyte Division, USA
| | - K.-E. Andersson
- Lund University, Division of Clinical Chemistry and Pharmacology, Lund, Sweden
| | - L.A. Birder
- University of Pittsburgh, Department of Medicine, Renal-Electrolyte Division, USA
| | - C.H. Fry
- University of Bristol, School of Physiology, Pharmacology, and Neuroscience, UK
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Anderson RM, Peña A, Johnson BS, Nowlin R, Hudson T, Vassar M. What's in a P-Value? A Fragility Analysis of RCTs in the AUA Guidelines for Benign Prostatic Hyperplasia. Urology 2023; 176:127-136. [PMID: 36894031 DOI: 10.1016/j.urology.2022.12.063] [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: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To use the fragility index (FI) and fragility quotient (FQ) to assess the strength of statistically significant findings for randomized controlled trials (RCTs) cited in the American Urological Association (AUA) guidelines for benign prostatic hyperplasia. METHODS Two investigators independently screened the AUA guidelines for management of benign prostatic hyperplasia for RCTs cited as evidence for recommendations. Investigators extracted data related to event rate per group and loss to follow-up which was compared against the FI. Stata 17.0 was used to calculate the FI and FQ which was then summarized and reported according to primary or secondary endpoints. RESULTS Among the 373 citations in the AUA guidelines, 24 RCTs met inclusion criteria with 29 distinct outcomes analyzed. The median fragility index was 12 (IQR = 4-38), indicating that twelve alternative events to either study arm would nullify statistical significance. Six studies had a FI of ≤2, indicating that only 1-2 outcomes would need to be changed in order to render nonsignificance of results. In 10/24 RCTs, the number of patients lost to follow-up was greater than the FI. CONCLUSION The AUA Clinical Practice Guidelines for management of benign prostatic hyperplasia cite RCTs with more robust findings when compared to previous studies assessing fragility in the field of Urology. While several included studies had high fragility, the median FI in our analysis was approximately 4-5 times higher than comparable studies of urologic RCTs. However, there are areas where improvement is necessary to support the highest quality of evidence-based medicine.
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Affiliation(s)
- Reece M Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Andriana Peña
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Bradley S Johnson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK; Department of Urology, Sparrow Hospital, Lansing, MI; Michigan State Urology, Michigan State University, East Lansing, MI
| | - Ross Nowlin
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Tillman Hudson
- Department of Urology, St. Francis Health System, Tulsa, OK
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
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Lin TC, Hou CP, Hsu YC, Chen Y, Yu KJ, Shao IH, Hsieh ML. Can the Sandwich Method Be an Alternative Treatment Choice for BPH Patients With Large Prostates? Urology 2023; 176:137-142. [PMID: 36963671 DOI: 10.1016/j.urology.2023.02.043] [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: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of the sandwich method with GreenLight photoselective vaporization (GLPVP) and bipolar transurethral resection (B-TURP) with those of the enucleation method in patients with BPH and a prostate volume ≥ 80 g. METHODS Patients with BPH who underwent either the sandwich method with GLPVP and B-TURP or the enucleation method between 2014 and 2021 were included in the analysis. The primary outcome was the comparison of uroflowmetry results between the 2 groups. Safety analysis of the complication rates was also compared. RESULTS The cohort included 55 patients in the sandwich group and 41 patients in the enucleation group. In the efficacy analysis, both groups showed comparable uroflowmetry results, except for a higher postoperative average flow rate in the enucleation group. Regarding perioperative parameters, the sandwich method required a longer operating time, and the enucleation group had a higher incidence of manual Foley irrigation. Both groups demonstrated similar postoperative complications. CONCLUSION The sandwich method exhibited comparable efficacy and safety to the enucleation method in patients with BPH with a prostate volume ≥ 80 g. Thus, for surgeons who are familiar with GLPVP and B-TURP, the sandwich method may be an alternative surgical approach for BPH patients with large prostates.
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Affiliation(s)
- Tsu-Chen Lin
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Pang Hou
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Yu-Chao Hsu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu Chen
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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