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Heiman J, Snead WM, DiBianco JM. Persistent Lower Urinary Tract Symptoms After BPH Surgery. Curr Urol Rep 2024; 25:125-131. [PMID: 38578550 DOI: 10.1007/s11934-024-01202-y] [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: 03/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms (LUTS) after surgical management for BPH pose a significant clinical challenge for urologists. Despite high success rates in relieving LUTS, there is a subset of patients who experience persistent symptoms after intervention. In this review article, we describe the management of patients with new or persistent LUTS after endoscopic bladder outlet surgery. RECENT FINDINGS Previously, the goal for BPH management was to remove as much adenomatous tissue as possible. While potentially effective, this may lead to unwanted side effects. There has been a recent paradigm shift for new minimally invasive surgical therapies (MIST) that strategically treat adenomatous tissue, adding potential complexity in managing patients with new or residual symptoms in the postoperative setting. There is a paucity of literature to guide optimal workup and care of patients with persistent LUTS after surgical management. We characterize patients into distinct groups, defined by types of symptoms, irritative versus obstructive, and timing of the symptomatology, short term versus long term. By embracing this patient-centered approach with shared decision management, clinicians can optimize outcomes efficiently improving their patients' quality of life.
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Affiliation(s)
- Joshua Heiman
- Department of Urology, Indiana University, Indianapolis, IN, USA.
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Kairambayev Y, Bulegenov T, Omarov N, Kuderbayev M, Syzdykbayev M, Glushkova N, Akhmetzhanova D, Kaskabayeva A, Muzdubayeva Z, Akimzhanov K, Pivina L. Prevention of Postoperative Urethral Strictures by Irrigation with 5-Fluorouracil via a Modified Urinary Catheter. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:102. [PMID: 38256363 PMCID: PMC10819259 DOI: 10.3390/medicina60010102] [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: 12/10/2023] [Revised: 12/25/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Urethral strictures are the most common complications after surgical treatments of benign prostatic hyperplasia (BPH). Despite various preventive measures, the search for medications with antiproliferative activity and the development of surgical procedures to prevent the development of urethral strictures are still relevant. We evaluated the preventive efficacy of 5-fluorouracil against urethral strictures in patients undergoing surgery for BPH. Materials and Methods: A non-randomized clinical trial including 246 male patients with an average age of 70.0 ± 8.0 years was conducted. The main study group included 124 patients who, in addition to the standard treatment, received lavage with a 5-fluorouracil solution (1000 mg/20 mL per 500 mL of 0.9% isotonic saline) using a modified three-way urethral catheter. The monitoring of clinical, laboratory, and instrumental parameters was carried out 10 days, 3 months, and 6 months after surgery. Results: The evaluation of severity for dysuria symptoms in patients using the IPSS scale throughout the entire follow-up period showed a statistically significant decrease in ischuria and stranguria, prolongation of the interval between urinations, a decrease in intermittent urination, urinary incontinence, and straining before urination in the main group in comparison with the control patients. The patients of both study groups noted an improvement in the quality of life. It was found statistically significant decrease in the maximum urinary flow rate in the main group (p < 0.001). In the control group, after three months, four cases of urethral strictures and stenosis were recorded; after six months, this rate reached nine cases (7.3%), while in the main group, only one patient with infravesical obstruction was found (0.8%) (χ2 = 3.855, p < 0.05). Conclusions: The results of our study could indicate the effectiveness of the antiproliferative drug 5-fluorouracil in combination with use of a modified catheter in relation to the development of postoperative urethral strictures.
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Affiliation(s)
- Yerbol Kairambayev
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Tolkyn Bulegenov
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Nazarbek Omarov
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Muratkan Kuderbayev
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Marat Syzdykbayev
- Department of Anesthesiology and Reanimatology, Semey Medical University, Semey 071400, Kazakhstan;
| | - Natalya Glushkova
- Health Policy and Organization Department, Al-Farabi Kazakh National University, Almaty 050040, Kazakhstan;
| | | | - Alida Kaskabayeva
- Department of Internal Medicine, Semey Medical University, Semey 071400, Kazakhstan; (A.K.); (Z.M.)
| | - Zhanna Muzdubayeva
- Department of Internal Medicine, Semey Medical University, Semey 071400, Kazakhstan; (A.K.); (Z.M.)
| | - Kuat Akimzhanov
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Lyudmila Pivina
- Department of Emergency Medicine, Semey Medical University, Semey 071400, Kazakhstan
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Lee CL, Kuo HC. Treating overactive bladder symptoms after transurethral prostatic surgery for benign prostatic hyperplasia - Which medication to choose? Tzu Chi Med J 2023; 35:312-316. [PMID: 38035054 PMCID: PMC10683516 DOI: 10.4103/tcmj.tcmj_123_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Overactive bladder (OAB) symptoms are often encountered in patients after transurethral resection of the prostate (TUR-P) or transurethral incision of the prostate (TUI-P) for benign prostatic obstruction (BPO). Either antimuscarinics or β-3 agonist has been found effective in relieving OAB symptoms. However, urologists usually do not prescribe such medication immediately after TUR-P or TUI-P to avoid an increase in postvoid residual and risk of urinary tract infection. If OAB medication can be used and adverse events (AEs) can be reduced to minimum, patients' quality of life after bladder outlet obstruction surgery could be improved. This study compared the safety and efficacy between solifenacin and mirabegron in men undergoing TUR-P or TUI-P. Materials and Methods This prospective, randomized trial compared the safety and efficacy of OAB medication on the reduction in Urgency Severity Score (USS), OAB Symptoms Score (OABSS), International Prostate Symptom Score, and urgency urinary incontinence episodes in men with BPO undergoing surgical intervention. All patients could void smoothly after catheter removal and were randomly received daily solifenacin 5 mg, mirabegron 50 mg, or no interventions for 4 weeks. At 2 and 4 weeks postoperatively, participants' OAB symptoms and AEs were evaluated. Results A total of 57 men were enrolled in this study with a mean age of 70.8 ± 6.1 years. At 2 weeks postoperatively, USS (1.56 ± 1.72 vs. 2.39 ± 1.72 vs. 2.26 ± 1.73, P < 0.011) and OABSS (5.33 ± 3.65 vs. 7.67 ± 4.19 vs. 8.58 ± 4.31, P < 0.000) were significantly reduced in patients taking solifenacin, mirabegron, or control, respectively. Two patients in the solifenacin group developed urinary retention. However, the changes of variables at 4 weeks postoperatively were insignificant among the three groups. Conclusion Solifenacin and mirabegron are two different drug classes both equally effective in treating immediate OAB symptoms after TUR-P or TUI-P. However, OAB symptoms could be relieved at 4 weeks without any medication. Considering AEs, β-3 agonist has a more favorable safety profile than antimuscarinics.
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Affiliation(s)
- Cheng-Ling Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Rieken M, de Nunzio C, Cornu JN, Ramasamy R, Misrai V, Malde S, Oelke M, Gacci M, Madersbacher S. Medical Treatment Incidence and Persistence After Surgical Relief of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Obstruction: A Critical Analysis of the Literature. Eur Urol Focus 2023:S2405-4569(23)00193-1. [PMID: 37758614 DOI: 10.1016/j.euf.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT The incidence and risk factors for persisting pharmacotherapy following surgical treatment of benign prostatic obstruction (BPO) remain unclear. OBJECTIVE To evaluate the evidence on persisting pharmacotherapy of lower urinary tract symptoms (LUTS) following surgical treatment of BPO. EVIDENCE ACQUISITION A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PROSPERO ID CRD42022310598). PubMed and EMBASE databases were searched in February 2022, with an updated search in October 2022. Studies evaluating pharmacotherapy in men aged >18 yr following surgical treatment of BPO were included. EVIDENCE SYNTHESIS Overall, ten nonrandomized studies and one post hoc analysis of two randomized controlled trials were included. The incidence of persisting medical treatment or medical retreatment varied strongly between time points and investigated surgical techniques. Among the investigated techniques, most data were available for transurethral resection of the prostate (TURP). Persistence of pharmacotherapy after TURP at 6 mo ranged from 8.7% to 57% for the use of alpha-blockers. The use of 5-alpha reductase inhibitors after TURP ranged from 5.5% at 6 mo to 19% at 6-24 mo, whereas the use of antimuscarinics ranged from 3.4% to 28.1% at 6 mo. Data on initiation of pharmacotherapy after TURP also differed between study and type of medication. At 12 yr, the use of alpha-blockers after TURP ranged from 12% to 38%. The risk factors associated with medication after BPO surgery were age, history of diabetes mellitus, history of cerebrovascular accident, preoperative medication use, as well as surgical techniques other than laser enucleation of the prostate. CONCLUSIONS Pharmacotherapy for LUTS is common after BPO surgery. The outcomes following different surgical techniques are heterogeneous, with limited data from randomized controlled trials. Future studies on surgical treatment of BPO should include the use of LUTS-related pharmacotherapy after BPO surgery as a secondary endpoint. PATIENT SUMMARY In the present systematic review, we investigated the risk of ongoing or novel therapy with drugs following surgery for benign prostate enlargement. We found that a non-negligible proportion of men will need to take drug therapy after surgery. Certain risk factors can be identified, which are associated with a higher risk of drug therapy after surgery.
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Affiliation(s)
- Malte Rieken
- alta uro AG, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Cosimo de Nunzio
- U.O.C. di Urologia, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | | | | | | | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matthias Oelke
- Department of Urology, Prostate Center North-West, St. Antonius-Hospital, Gronau, Germany
| | - Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Takeuchi Y, Sawada Y, Watanabe S, Ni-Itsu Y, Sekido N. Age-specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score. Low Urin Tract Symptoms 2023; 15:38-49. [PMID: 36507559 DOI: 10.1111/luts.12469] [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: 10/07/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the age-specific effect of transurethral holmium laser enucleation of the prostate (HoLEP) on overactive bladder (OAB). METHODS A total of 186 consecutive patients who underwent HoLEP were included. They were divided into three groups: patients aged less than 65 years, between 65 and 74, and 75 or older. The OAB symptom score as well as other relevant variables of lower urinary tract symptoms and function were assessed before and 1, 3, 6, and 12 months after surgery. Age-specific prevalence of OAB, the proportion of resolution of OAB, and de novo OAB were evaluated. RESULTS The mean age of patients was 70.7 years, and the mean total prostate volume was 75.8 ml. The mean OAB symptom scores before surgery of patients aged less than 65 years, between 65 and 74, and 75 or older were 6.0, 5.2, and 5.7, respectively. At 12 months after surgery, the scores for the respective groups had significantly decreased to 2.1, 2.5, and 3.5. The prevalence of OAB based on the score in the respective groups was 45.8%, 56.9%, and 54.0% (p = .6391) preoperatively and 9.1%, 11.3%, and 15.8% at 12 months after the surgery (p = .7613). Of those with preoperative OAB, 75.0%, 79.2%, and 75.0% of the respective groups showed resolution of OAB at 12 months postoperatively (p = .9427). CONCLUSIONS In candidates for surgical deobstruction of benign prostatic hyperplasia, HoLEP has potential to improve OAB symptoms regardless of age.
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Affiliation(s)
- Yasuharu Takeuchi
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshitomo Sawada
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shoutarou Watanabe
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuo Ni-Itsu
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
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Gild P, Vetterlein MW, Daoud I, Ludwig TA, Soave A, Marks P, Chun FKH, Ahyai S, Dahlem R, Fisch M, Rink M, Meyer CP, Becker A. Which Men Do or Do Not Achieve Long-Term Symptom Relief After Holmium Laser Enucleation of the Prostate (HoLEP): 11 Years of HoLEP Experience. J Endourol 2023; 37:316-322. [PMID: 36352826 DOI: 10.1089/end.2022.0396] [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: 11/11/2022] Open
Abstract
Purpose: Apart from the existing level-one evidence, few centers have reported on long-term outcomes after Holmium Laser Enucleation of the Prostate (HoLEP). Against this backdrop we aimed to report on our treatment experience and identify predictors of persistent/recurrent lower urinary tract symptoms (LUTS) after the procedure. Materials and Methods: From 2006 to 2017, 2566 men underwent HoLEP at our institution. Only patients with available, cross-sectional follow-up (F/u) ≥6 months were included. Perioperative and F/u characteristics were compared by duration of F/u in months (quartiles). Multivariable logistic regression models (MVAs) were used to identify predictors of persistent/recurring symptoms, defined as International Prostate Symptom Score (IPSS) >7 at F/u. Results: A total of 774 patients with a median age of 70 years (interquartile range [IQR] = 66-75), prostate volume of 80 mL (IQR = 60-105), American Society of Anesthesiologists score 2 (IQR = 2-3), IPSS of 19 (IQR = 14-24), and quality of life (QoL) of 4 (3-5) at the time of operation were analyzed. Median F/u was 52 months (IQR = 32-77), overall current median prostate-specific antigen was 0.91 mg/dL (0.5-1.8), median IPSS and QoL were 3 (IQR = 1-7) and 1 (IQR 0-2), respectively. LUTS medication was present in 20 patients (2.6%), 15 (2%) patients required reoperation, and permanent urinary incontinence was present in 17 (2.2%) patients. On MVA age at operation (odds ratio [OR] = 1.04; 95% confidence interval [CI], 1.01-1.1; p = 0.013), prostate volume (OR = 0.99 [95% CI, 0.98-0.99;], p = 0.003), body mass index (OR = 1.06 [95% CI, 1.0-1.1], p = 0.043), presence of indwelling catheter (OR = 0.51 [95% CI, 0.32-0.81], p = 0.004), and anticholinergics before procedure (OR = 1.74 [95% CI, 1.01-3.0], p = 0.046) were predictors of persistent/recurring symptoms. Conclusions: Our HoLEP experience confirms durable and profound symptom relief in the vast majority men. A small fraction of patients complained about subjective persistent/recurring LUTS stressing the need for proper patient selection and timing of surgical intervention.
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Affiliation(s)
- Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ihab Daoud
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Medical Center Frankfurt, Frankfurt, Germany
| | - Sascha Ahyai
- Department of Urology, Medical University Graz, Graz, Austria
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, Ruhr-University Bochum, Herford Hospital, Herford, Germany
| | - Andreas Becker
- Department of Urology, University Medical Center Frankfurt, Frankfurt, Germany
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Yoo S, Jeong H, Son H, Oh SJ, Paick JS, Cho MC. Does Preoperative Bladder Compliance Affect Long-Term Functional Outcomes after Laser Prostatectomy? World J Mens Health 2023:41.e35. [PMID: 37118952 DOI: 10.5534/wjmh.220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/26/2022] [Accepted: 01/23/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE We assessed the effects of preoperative bladder compliance on the long-term functional outcomes, especially focused on postoperative storage symptom changes, after laser prostatectomy. MATERIALS AND METHODS From January 2008 to March 2014, 1,608 men who underwent laser prostatectomy, including holmium laser enucleation or photo-vaporization of the prostate, were included in the analysis. We divided patients into 3 groups according to bladder compliance on a baseline urodynamic study: <12.5, 12.5-25, ≥25 mL/cmH2O. A multivariable analysis was performed to determine the impact of bladder compliance on changes in long-term functional outcomes after laser prostatectomy. RESULTS Bladder compliance was less than 12.5 mL/cmH2O in 50 (3.1%), 12.5-25 mL/cmH2O in 232 (14.4%) patients. As bladder compliance decreased, the baseline International Prostate Symptom (IPSS) total score and storage sub-score were increased; the voiding sub-score remain unchanged. At postoperative 12 and 36 months, absolute improvements in the IPSS total score and storage sub-score were higher in <12.5 mL/cmH2O group compared to other groups, although those were equivalent at postoperative 1 months. On the multivariable analysis, decreased bladder compliance <12.5 mL/cmH2O was significantly associated with superior improvement in storage sub-score at postoperative 36 months, although it was not associated with voiding sub-score. CONCLUSIONS In patients with preoperative bladder compliance <12.5 mL/cmH2O, storage symptoms could be further improved at 36 months after laser prostatectomy compared to others. Thus, laser prostatectomy could be a considerable treatment option for patients with severely decreased bladder compliance.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Mediplex Sejong Hospital, Incheon, Korea
| | - Min Chul Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
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Hsueh CH, Chang LW, Chiu KY, Hung SC, Chen JP, Li JR. Chronic kidney disease, preoperative use of antispasmodics and lower resected prostate volume ratios are risk factors for postoperative use of adrenergic Alpha-blockers and antispasmodics. PLoS One 2023; 18:e0282745. [PMID: 36893185 PMCID: PMC9997983 DOI: 10.1371/journal.pone.0282745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES Transurethral resection of prostate (TURP) and laser prostate surgery are common surgeries for benign prostate hyperplasia (BPH). We conducted an investigation using hospital database to evaluate the clinical factors associated with post-operative usage of alpha-blockers and antispasmodics. METHODS This study was conducted using retrospective clinical data from the hospital database, which contained newly diagnosed BPH patients between January 2007 and December 2012 who subsequently received prostate surgery. The study end-point was the use of alpha-blockers or antispasmodics for at least 3 months duration after 1 month of surgery. The exclusion criteria was prostate cancer diagnosed before or after the surgery, recent transurethral surgeries, history of open prostatectomy, and history of spinal cord injury. Clinical parameters, including age, body mass index, preoperative prostate specific antigen value, comorbidities, preoperative usage of alpha-blockers, anstispasmodics and 5-alpha reductase inhibitors, surgical methods, resected prostate volume ratios, and preoperative urine flow test results, were evaluated. RESULTS A total of 250 patients receiving prostate surgery in the database and confirmed pathologically benign were included. There was significant association between chronic kidney disease (CKD) and the usage of alpha-blockers after prostate surgery (OR = 1.93, 95% CI 1.04-3.56, p = 0.036). Postoperative antispasmodics usage was significantly associated with preoperative usage of antispasmodics (OR = 2.33, 95% CI 1.02-5.36, p = 0.046) and resected prostate volume ratio (OR = 0.12, 95% CI 0.02-0.63, p = 0.013). CONCLUSIONS BPH patients with underlying CKD were more likely to require alpha-blockers after surgery. In the meantime, BPH patients who required antispasmodics before surgery and who received lower prostate volume resection ratio were more liable to antispasmodics after prostate surgery.
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Affiliation(s)
- Chen-Hsun Hsueh
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-Wen Chang
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Yuan Chiu
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Sheng-Chun Hung
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Peng Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jian-Ri Li
- Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Intensive Care, Division of Surgical Intensive Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, Hungkuang University, Taichung, Taiwan
- * E-mail:
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Costa Silva A, Abreu-Mendes P, Morgado A, Dinis P, Martins Silva C. Analysis of benign prostatic obstruction surgery: A long-term evaluation in a real-life context. Arch Ital Urol Androl 2022; 94:295-299. [DOI: 10.4081/aiua.2022.3.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: Surgery is the treatment for male lower urinary tract symptoms (LUTS) relat-ed to benign prostatic obstruction (BPO) refractory to pharma-cological treatment or with complications. This study aimed to assess factors associated with the need for surgical reinterven-tion and/or continuation of pharmacological treatment. Materials and methods: A retrospective analysis of patients who underwent prostatic surgery for male LUTS associated with BPO between 1 May 2015 and 1 May 2016, with a minimum follow-up of five years, in an academic tertiary hospital. The type of surgery, preoperative, postoperative and follow-up analysis were collected in a database. Results: A total of 212 patients were included with a mean age of 70 ± 8.66 years at five years follow-up. At 5 years, a total of 86.9% of patients do not need pharmacological treatment and 12% required surgical reintervention. Of the preoperative parameters, it was found a relationship between prior prostatitis and the need for second surgery with an odds ratio of 4.6.
Conclusions: Patients should be informed of the potential need for pharmacological treatment following surgery, or even of the need for reintervention. History of prostatitis seems to be a risk factor for reintervention.
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Predictive factors for alpha blocker use after transurethral prostatectomy: Can preoperative urodynamic outcome predict alpha blocker medication after surgery? PLoS One 2022; 17:e0274399. [PMID: 36129917 PMCID: PMC9491595 DOI: 10.1371/journal.pone.0274399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To analyze the diagnostic value of conducting urodynamic study (UDS) and show predictors for alpha blocker use 12 months after transurethral prostatectomy. Materials and methods Our study includes 406 participants that had a transurethral prostatectomy at our hospital between 2010 and 2019. All participants took alpha blockers for more than a month. We collected the participants’ preoperative international prostatic symptom score (IPSS), uroflowmetry, transrectal ultrasound, and serum prostatic antigen (PSA) level. A total of 254 patients conducted UDS. After surgery, participants visited our hospital at 1,3,6, and 12 months. Results 133 patients (32.6%) took alpha blockers continuously for 12 months after surgery. They reported poor preoperative IPSS scores and uroflowmetry outcomes. They also had high postoperative PVR (40.68±24.56 vs 29.34±25.11, p<0.001) and total IPSS score (10.35±7.96 vs 8.43±6.74, p = 0.018) compared to the group which discontinued alpha blockers. A multivariate analysis (Table 2) found that conducting preoperative UDS (Odds ratio (OR) 6.067, p<0.001) Age>75 (OR 2.463, p<0.001), a history of taking 5-alpha reductase inhibitors (5-ARI) before surgery (OR 2.186 [95% CI 1.334–3.583], p = 0.002), IPSS item straining (OR 1.224, p = 0.003), duration of taking alpha blockers [OR 1.009, p = 0.020), and Qmax (OR 0.926, p = 0.018), PVR (OR 1.002, p = 0.022) were confirmed as a strong predictors of persistent alpha blocker use. Conclusion Conducting preoperative UDS, Age>75, history of taking 5-ARI before surgery, IPSS item straining, duration of alpha blocker medication, Qmax, and PVR are possible determinant factors of alpha blocker use after surgery. By comparing UDS outcomes, detrusor underactivity can be a strong predictor of persisting alpha blocker therapy 12 months after surgery.
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Spivak L, Morozov A, Shpikina A, Enikeev D, Rapoport L. Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem? Curr Opin Urol 2021; 31:451-455. [PMID: 34175875 DOI: 10.1097/mou.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life. RECENT FINDINGS Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR. SUMMARY A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).
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Affiliation(s)
| | | | - Anastasia Shpikina
- International School 'Medicine of the Future', Sechenov University, Moscow, Russia
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12
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Persistent use of medical therapy after surgery for lower urinary tract symptoms: a retrospective database analysis. World J Urol 2021; 40:169-175. [PMID: 34435214 DOI: 10.1007/s00345-021-03819-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine how many men are able to remain off of medical therapy for lower urinary tract symptoms (LUTS) following surgery for benign prostatic obstruction (BPO). METHODS The TriNetX Analytics Network was used to identify men who were taking medical therapy for BPO (at least one of: alpha-1 blockers, anticholinergics, B3 agonists, or 5-alpha-reductase inhibitors) and subsequently underwent surgery for BPO. They were then placed into one of six cohorts, classified based on the type of surgery they received: transurethral resection of the prostate (TURP), Laser vaporization of prostate (PVP), transurethral incision of the prostate (TUIP), prostatic urethral lift (PUL), water-vapor thermal therapy (WV), or Laser enucleation of the prostate (LEP). Our primary outcome was persistent use of medical therapy at 6-months-2-years postoperatively. Secondary outcome was surgical retreatment by 2 years postoperatively. Propensity-score matching (PSM) was used to control for various risk factors for lower urinary tract symptoms (LUTS). RESULTS A total of 21,475 men were identified who were on medical therapy and subsequently underwent surgery, which included 12,294 TURP, 5290 PVP, 397 WV, 1308 PUL, 346 TUIP, and 1840 LEP. Medication use between 6 months and 2 years after surgery was 38% for LEP, 50% for WV, 61% for TURP, 63% for PUL, 65% for TUIP and 66% for PVP. All surgical modalities had higher odds of using medications when compared to LEP (p < 0.001). This remained significant after PSM for 9 potentially confounding variables. CONCLUSION A large percentage of men continue medical therapy after surgery for BPO. Amongst multiple surgical modalities available, LEP appears to have the highest rates of medication discontinuation after surgery. In men who wish to avoid medications or who have cardiac risk factors, a discussion with their urologist to select the best option to minimize medical therapy should occur.
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Miernik A, Fritzsche J, Libutzki B, Malka V, Kilemnik I, Mohebbi D, May M, Gratzke C, Suarez-Ibarrola R. Real-world data and treatment patterns of patients with lower urinary tract symptoms due to benign prostatic hyperplasia in Germany: an observational study using health insurance claims data. World J Urol 2021; 39:4381-4388. [PMID: 34292368 DOI: 10.1007/s00345-021-03787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Benign prostatic hyperplasia (BPH) is associated with lower urinary tract symptoms (LUTS), representing one of the most common urological conditions. However, insights into the actual healthcare of this patient cohort in Germany are scarce. We aimed to retrospectively analyse management patterns of patients with LUTS in Germany using health insurance claims databases. METHODS A retrospective, longitudinal cohort analysis was conducted obtaining claims data from the German InGef health insurance database containing approximately five million member-records from over 60 nationwide statutory health insurances. First, a cross-sectional prevalence analysis was performed on all individuals with a diagnosis on LUTS (ICD-10 GM N40) in 2018. Second, a longitudinal analysis of individuals with either a newly started BPH medication or initial BPH surgery who were indexed in 2014 and followed-up for 4 years. RESULTS In 2018, 132,386 (6.7%) prevalent BPH patients were identified from 1,979,916 continuously insured males. A potential overcoding bias could not be assessed which may influence the outpatient sector estimation. 10,361 (0.7%) patients were identified with incident BPH medication and 1768 (0.1%) patients with incident BPH surgery out of 1,575,604 males (2013-2018). Alpha-blockers were the drug of choice (95.6%) in the first year. Half of patients received specific BPH medications four years after index, while almost 98% of initial BPH surgeries were performed within the inpatient setting. TURP was the most frequent surgical intervention (76%). CONCLUSIONS A widespread diffusion of alternative individualized minimally invasive approaches in the outpatient sector might address pharmacotherapy discontinuation and patient-access barriers to other treatments.
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Affiliation(s)
- Arkadiusz Miernik
- Faculty of Medicine, Department of Urology, Medical Centre - University of Freiburg, Freiburg, Germany
| | | | - Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Düsseldorf, Germany.
| | | | | | - Damon Mohebbi
- HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Düsseldorf, Germany
| | - Melanie May
- HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Düsseldorf, Germany
| | - Christian Gratzke
- Faculty of Medicine, Department of Urology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Faculty of Medicine, Department of Urology, Medical Centre - University of Freiburg, Freiburg, Germany
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14
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De Nunzio C, Franco A, Lombardo R, Baldassarri V, Borghesi A, Li Marzi V, Trucchi A, Agrò EF, Tubaro A. Phamacological treatment of persistant lower urinary tract symptoms after a transurethral resection of the prostate is predictive of a new surgical treatment: 10 years follow-up study. Neurourol Urodyn 2021; 40:722-727. [PMID: 33508153 DOI: 10.1002/nau.24616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 01/25/2023]
Abstract
AIM To evaluate possible risk factors of re intervention in patients with benign prostatic enlargement (BPE) undergoing transurethral resection of the prostate (TURP). MATERIALS AND METHODS A consecutive series of patients with LUTS and BPE underwent TURP in our center in 2004 and 2005 and they were then followed up to September 2016. Patients were assessed at baseline, 3-, 6-month postoperatively and yearly thereafter with medical history, international prostate symptom score, prostate specific antigen, maximal urinary flow rate, post void residual urine. Reoperation was defined as the requirement of a new TURP to relieve bothersome LUTS. Cox regression was used to determine covariates associated with reoperation rate and the Kaplan-Meier curve assessed the time to reoperation. RESULTS Overall, 92 patients were enrolled. Median follow up was 142 months. 13 patients underwent a second TURP during the follow-up period (reoperation rate was 14%); out of them 9/13 (69%) received medical treatment for persistent LUTS (p = .001). The need of LUTS/BPE pharmacological treatment after TURP is an independent risk factor for a second surgical procedure (odds ratio 9,3; p = .001). Out of the 13 patients treated with a re-TURP, 12 (92%) underwent surgery within 5 years of follow-up. CONCLUSION In our single center study, the need of LUTS/BPE pharmacological treatment was a predictive factor of a re-TURP. Considering that more than 90% of re-TURP were performed during the first 5 years of follow-up, it is assumable that a follow-up longer than 5 years is not needed in these patients.
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Affiliation(s)
- Cosimo De Nunzio
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | - Antonio Franco
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | | | | | | | - Vincenzo Li Marzi
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alberto Trucchi
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | | | - Andrea Tubaro
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
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15
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The Evidence For and Against Prostate-Reducing Procedures for Men with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Campbell RA, Gill BC. Medication Discontinuation Following Transurethral Prostatectomy: an Unrecognized Effectiveness Measure? Curr Urol Rep 2020; 21:61. [PMID: 33159617 DOI: 10.1007/s11934-020-01015-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Freedom from medication is a common goal for patients undergoing surgical treatment of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). Knowing medication discontinuation rates following various forms of transurethral prostatectomy may aid patient counseling and assessing the comparative effectiveness of different approaches. This review examined discontinuation rates of BPH/LUTS medications following transurethral prostatectomy. RECENT FINDINGS Rates of BPH/LUTS medication use after transurethral resection of the prostate varied from 15% to 55%, and discontinuation rates were 54-95% across medications and follow-up periods. For laser prostatectomy, approximately 18% of patients continued medications postoperatively and discontinuation rates ranged from 53% to 75%. Minimal data on holmium laser enucleation existed. For reference, medication discontinuation rates after transurethral needle ablation or microwave therapy were only 15-28%. No recommendations or best practices inform the use of medical therapy following BPH surgery. Rates of BPH/LUTS medication use following transurethral prostatectomy are considerable.
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Affiliation(s)
- Rebecca A Campbell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Bradley C Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Mail Stop Q10-1, 9500 Euclid Ave, Cleveland, OH, 44195, USA. .,Department of Urology, Cleveland Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH, USA. .,Section of Urology, Surgical Service, Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.
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17
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Enikeev D, Taratkin M, Morozov A, Singla N, Gabdulina S, Tarasov A, Sukhanov R, Rivas JG, Laukhtina E, Arshiev M, Mikhailov V, Glybochko P. Long-Term Outcomes of Holmium Laser Enucleation of the Prostate: A 5-Year Single-Center Experience. J Endourol 2020; 34:1055-1063. [DOI: 10.1089/end.2020.0347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Svetlana Gabdulina
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Alexander Tarasov
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Vasiliy Mikhailov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Clinical outcome of transurethral enucleation of the prostate using the 120-W thulium Laser (Vela™ XL) compared to bipolar transurethral resection of the prostate (TURP) in aging male. Aging (Albany NY) 2020; 12:1888-1898. [PMID: 31991402 PMCID: PMC7053585 DOI: 10.18632/aging.102720] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
This study compared the surgical outcomes of the 120-W Thulium laser (Vela™ XL) enucleation of the prostate and bipolar transurethral resection of the prostate (TURP) in terms of efficacy, safety, and improvements of quality of life (QoL) in patients with benign prostate hyperplasia (BPH). Records were obtained from January 2014 to September 2018 for selected patients with symptomatic BPH who underwent 120-W Thulium laser (Vela™XL) prostate enucleation and bipolar TURP in our institution. All the patients selected met the surgical criteria for TURP and had received medical treatment for at least 3 months. Patients were excluded if their ECOG performance status was >1, if they had active malignant disease, of if they had a history of prostate surgery or reconstruction surgery of the urinary system. Patients decided which treatment option would be performed. Both the procedures were conducted by a single surgeon. Clinical outcomes such as changes in the International Prostate Symptom Score (IPSS) score, urodynamic parameters, drug consumption, pain scores, and QoL were evaluated. The rate of urinary tract infection, recatheterization, additional analgesic requirement, return to the emergency department for treatment, and other surgical complications was analyzed and compared between the two cohorts. A total of 276 patients met the inclusion criteria. Among them, 141 patients received bipolar TURP, where as 135 decided to receive laser vaporesection. No significant difference was observed in age, PSA level, prostate volume, and comorbidities between the two cohorts. Pre-operative (pre-op) urodynamic parameters were also identical, except that the laser surgery group had a higher rate of admission with a urinary catheter (24.4% vs. 14.2%, p=0.044). The operating time was longer in the laser surgery group (79.3 minutes vs. 62.4 minutes, p<0.001). However, enucleation using the Thulium laser was superior to bipolar TURP in terms of post-operative (post-op) pain status, including the numeric rating scale of pain, rate of additional narcotic use, and oral analgesic requirement. Compared with bipolar TURP, laser enucleation achieved a higher improvement in the QoL score at post-op follow-up at 2 weeks and 3 months. Nevertheless, the complication rate, changes in IPSS score, Qmax, and post-op medication-free survival were statistically identical in the two cohorts. Our data revealed that compared with bipolar TURP, 120-W Thulium laser (Vela™ XL) enucleation of the prostate achieved lower post-op pain and higher improvement in the short-term QoL of patients after surgery.
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Association between Bladder Outlet Obstruction and Bladder Cancer in Patients with Aging Male. J Clin Med 2019; 8:jcm8101550. [PMID: 31569597 PMCID: PMC6832159 DOI: 10.3390/jcm8101550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 12/28/2022] Open
Abstract
The associations between the treatment outcomes of benign prostatic hyperplasia/benign prostatic obstruction and lifelong health status, including urologic cancer incidence as well as geriatric adverse events (AEs), are unknown. This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan’s Longitudinal Health Insurance Database 2000. Patients who received transurethral resection of the prostate (TURP) were prioritized, and the remaining patients who were prescribed alpha-blockers were, subsequently, identified. Patients in the TURP and medication-only groups were further divided into two groups, according to the presence or absence of AEs during the first six-month follow-up. Outcomes of primary interest were all-cause mortality, occurrence of prostate cancer, transurethral resection of the bladder tumor, and radical cystectomy for bladder cancer. Compared with patients in the AE-free TURP group, those in the TURP with AEs had a higher risk of lifelong bladder cancer (subdistribution hazard ratio: 2.3, 95% confidence interval (CI): 1.56–3.39), whereas the risk of prostate cancer was comparable between the two groups (SHR: 1.2, 95% CI: 0.83–1.74). In the medication cohorts, patients undergoing alpha-blocker treatment who had AEs had a higher risk of all-cause mortality (hazard ratio: 1.63, 95% CI: 1.49–1.78) and a higher risk of lifelong bladder cancer (SHR: 2.72, 95% CI: 1.99–3.71) when compared with those without AE. Our study reveals that unfavorable treatment outcomes of benign prostate hyperplasia, whether caused by medication or surgical treatment, are associated with a higher incidence of bladder cancer. Unfavorable outcomes of surgical treatment are associated with higher risk of geriatric AEs, and unfavorable outcomes of medication treatment are associated with a higher risk of all-cause mortality.
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20
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Åkerla J, Pesonen JS, Pöyhönen A, Häkkinen J, Koskimäki J, Huhtala H, Tammela TLJ, Auvinen A. Impact of lower urinary tract symptoms on mortality: a 21-year follow-up among middle-aged and elderly Finnish men. Prostate Cancer Prostatic Dis 2018; 22:317-323. [PMID: 30410016 DOI: 10.1038/s41391-018-0108-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The usefulness of lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. Repeated assessments are required to take into account symptom fluctuation and de novo symptom appearance. The study objective was to evaluate mortality in relation to three urinary storage symptoms-urgency, daytime frequency, and nocturia-in middle-aged and elderly men, considering also other time-varying factors during follow-up. METHODS A mail survey of a population-based cohort of men initially aged 50, 60, and 70 years was conducted in Finland in 1994, 1999, 2004, and 2009. The questionnaire included assessments of LUTS based on the Danish Prostatic Symptom Score and comorbidities. The men were followed up for mortality through the population registry through 2014. LUTS-related hazard ratios (HR) were analyzed with time-dependent Cox regression adjusted for the year of birth and comorbidities using variable values updated every 5 years. Sensitivity analyses were conducted using values of all variables fixed to the baseline assessment of 1994. RESULTS Of the 1332 eligible men with data on LUTS from each preceding survey, 514 (38.6%) died during the 21-year follow-up. In time-dependent analyses, daytime frequency, and nocturia were significantly associated with increased mortality: the adjusted HR was 1.42 (95% CI 1.11-1.83) for daytime frequency, 1.38 (1.07-1.79) for nocturia and 1.19 (0.94-1.50) for urgency. In sensitivity analyses with fixed baseline characteristics, only nocturia was suggestively associated with an increased risk of death: the adjusted HR was 1.09 (0.84-1.42) for daytime frequency, 1.41 (0.99-2.02) for nocturia and 0.94 (0.52-1.68) for urgency. CONCLUSIONS Among aging men, LUTS are more accurate predictors of short-term than longer-term mortality risk. Repeated assessments are needed to detect clinically relevant and persistent symptoms, often associated with ill health. Accordingly, men with daytime frequency or nocturia exhibit a 1.4-fold risk of death and therefore, should be evaluated for underlying comorbidity.
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Affiliation(s)
- Jonne Åkerla
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland. .,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Jori S Pesonen
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Antti Pöyhönen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Jukka Häkkinen
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Juha Koskimäki
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Prise en charge de l’obstacle sous vésical lié à une HBP chez les patients à terrain particulier et/ou ayant une complication. Prog Urol 2018; 28:868-874. [DOI: 10.1016/j.purol.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022]
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Surgical Management of Anatomic Bladder Outlet Obstruction in Males with Neurogenic Bladder Dysfunction: A Systematic Review. Eur Urol Focus 2018; 5:875-886. [PMID: 29551557 DOI: 10.1016/j.euf.2018.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/24/2018] [Accepted: 02/20/2018] [Indexed: 11/22/2022]
Abstract
CONTEXT Surgical treatment of anatomic bladder outlet obstruction (BOO) may be indicated in males with neurogenic bladder dysfunction. A bothersome complication after surgery is urinary incontinence. OBJECTIVE To identify the optimal practice in the surgical treatment of anatomic BOO in males with neurogenic bladder dysfunction, due to multiple sclerosis, Parkinson disease, spinal cord injury (SCI), spina bifida, or cerebrovascular accident (CVA). EVIDENCE ACQUISITION A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Medline, Embase, Cochrane controlled trial databases, Web of Science, and Google Scholar were searched for publications until January 2017. EVIDENCE SYNTHESIS A total of 930 abstracts were screened. Eight studies were included. The types of anatomic BOO discussed were benign prostate obstruction, urethral stricture, and bladder neck sclerosis. The identified surgical treatments were transurethral resection of the prostate (TURP) in patients with Parkinson, CVA or SCI, endoscopic treatment of urethral stricture by laser ablation or urethrotomy (mainly in SCI patients), and bladder neck resection (BNR) in SCI patients. The outcome of TURP may be highly variable, and includes persistent or de novo urinary incontinence, regained normal micturition control, and urinary continence. Good results were seen in BNR and endoscopic urethrotomy studies. Laser ablation and cold knife urethrotomy resulted in restarting intermittent catheterization or adequate voiding. Overall, a high risk of bias was found. CONCLUSIONS This systematic review provides an overview of the current literature on the outcome of several surgical approaches of different types of anatomic BOO in males with neurogenic bladder dysfunction. Identifying the optimal practice was impossible due to limited availability of high-quality studies. PATIENT SUMMARY The outcome of several surgical approaches in males with neurogenic bladder dysfunction with benign prostate obstruction, urethral stricture, or bladder neck sclerosis is overviewed. The optimal practice could not be identified.
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Gacci M, Sebastianelli A, Spatafora P, Corona G, Serni S, De Ridder D, Gravas S, Abrams P. Best practice in the management of storage symptoms in male lower urinary tract symptoms: a review of the evidence base. Ther Adv Urol 2017; 10:79-92. [PMID: 29434675 DOI: 10.1177/1756287217742837] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/16/2017] [Indexed: 01/28/2023] Open
Abstract
Storage lower urinary tract symptoms (LUTS) are characterized by an altered bladder sensation, increased daytime frequency, nocturia, urgency and urgency incontinence. Some evidence underlines the role of metabolic factors, pelvic ischemia, prostatic chronic inflammation and associated comorbidities in the pathophysiology of storage LUTS. A detailed evaluation of the severity of storage LUTS, and the concomitance of these symptoms with voiding and postmicturition symptoms, is mandatory for improving the diagnosis and personalizing treatment. A detailed medical history with comorbidities and associated risk factors, a physical examination, a comprehensive analysis of all the features of LUTS, including their impact on quality of life, and a frequency-volume chart (FVC) or bladder diary, are recommended for men with storage LUTS. Several drugs are available for the treatment of LUTS secondary to benign prostatic obstruction (BPO). Alpha-blockers (α-blockers), 5-α-reductase inhibitors and phosphodiesterase type 5 inhibitors are commonly used to manage storage LUTS occurring with voiding symptoms associated with BPO. Muscarinic receptor antagonists and Beta 3-agonists (β3-agonists) alone, or in combination with α-blockers, represent the gold standard of treatment in men with predominant storage LUTS. There is no specific recommendation regarding the best treatment options for storage LUTS after prostatic surgery.
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Affiliation(s)
- Mauro Gacci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, AOUC, University of Florence, Largo Brambilla 3 - 50134 Florence
| | - Arcangelo Sebastianelli
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Sergio Serni
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Dirk De Ridder
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Stavros Gravas
- Department of Urology, University of Thessaly, Larissa, Greece
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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24
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[Outcomes of transcutaneous posterior tibial nerve stimulation for overactive bladder in diabetic patients]. Prog Urol 2017; 27:1091-1097. [PMID: 28964687 DOI: 10.1016/j.purol.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/30/2017] [Accepted: 08/17/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Treatment with transcutaneous posterior tibial neurostimulation (NTPT) has been shown to be effective in the treatment of overactive bladder (OAB), but its outcomes in diabetic patients have never been assessed. The aim of this study was to compare the efficacy of NTPT in diabetic OAB patients and in OAB patients without diabetes. METHODS A single-center prospective study included all patients treated with NTPT for lower urinary tract storage symptoms between 2012 and 2016. The primary endpoint was symptoms improvement≥50% assessed using a Visual Analog Scale (VAS) two months after starting NTPT. Treatment consisted in a daily 20-minute NTPT single-session. The secondary endpoints were lower urinary tract symptoms reported by bladder diary, the Urinary Symptom Profile, the impact on mood and on daily activities. RESULTS Seventy-one patients were included, 10 of whom were diabetic. The efficacy rate (EVA>50%) was not significantly different in the diabetic group (70% vs. 44.1%, P=0.17), like the mean EVA efficacy was similar in both groups (4/10 vs. 4/10, P=0.98). OAB USP sub-score diminished significantly in both groups at 2 months (-3 points in the diabetic group; -1.9 points in the non-diabetic group; P=0.03 and P<0.0001, respectively). There was no significant difference between the groups, except for the rate of patients who stopped treatment at 6 months, higher in diabetic patients (100% vs. 63.5%, P=0.04). CONCLUSION The functional outcomes of NTPT appear to be similar in the treatment of OAB in diabetic patients and in non-diabetic patients. LEVEL OF EVIDENCE 4.
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Lee YJ, Lee JW, Park J, Seo SI, Chung JI, Yoo TK, Son H. Nationwide incidence and treatment pattern of benign prostatic hyperplasia in Korea. Investig Clin Urol 2016; 57:424-430. [PMID: 27847916 PMCID: PMC5109794 DOI: 10.4111/icu.2016.57.6.424] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the incidence of benign prostatic hyperplasia (BPH) in Korea and treatment patterns for 3 years after the diagnosis in a nationwide database. MATERIALS AND METHODS We created a cohort of patients diagnosed of BPH between 2007 and 2011 from the Health Insurance Review & Assessment database, a nationwide database of reimbursement. The diagnosis of BPH was defined as having the diagnosis of BPH (N40.0 in International Classification of Diseases, 10th revision) as a primary or secondary diagnosis ≥2 times in 2008. The incidence of BPH in 2008 was calculated. Treatment patterns were determined in 3 months interval and traced for 3 years. The incidence and timing of surgery were also determined. For patients taking medications preoperatively, medication-free rate was calculated. RESULTS The incidence of BPH was 2,105 per 100,000 men (mean age, 59.7±11.4 years), and increased with age. Surgery was performed for 7,955 patients (2.1%), half of the surgery being performed within the first 6 months. Transurethral resection of the prostate was the most commonly performed surgery. The proportion of treatment increased with age until the 7th decade of life. The patients taking medication for >1 year after the initial diagnosis was 21.4%. On average, 82% of patients became medication-free at postoperative 1 year. For patients taking preoperative anticholinergics, 1 year medication-free rate was 73.3%. CONCLUSIONS The incidence of BPH increased with age. Surgery was performed in 2.1% of patients. More than 4/5 patients discontinued medication after surgery, while patients taking preoperative anticholinergics were less likely to.
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Affiliation(s)
- Young Ju Lee
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Woo Lee
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Juhyun Park
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Seoul, Korea
| | - Jae Il Chung
- Department of Urology, Inje University Busan Paik Hospital, Busan, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji General Hospital, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Shin YS, Zhang LT, You JH, Choi IS, Zhao C, Park JK. Efficacy and safety of tamsulosin hydrochloride 0.2 mg and combination of tamsulosin hydrochloride 0.2 mg plus solifenacin succinate 5 mg after transurethral resection of the prostate: a prospective, randomized controlled trial. Clin Interv Aging 2016; 11:1301-1307. [PMID: 27698559 PMCID: PMC5034924 DOI: 10.2147/cia.s115042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objective The objective of this study was to evaluate the safety and efficacy of tamsulosin hydrochloride 0.2 mg (TAM) and its combination with solifenacin succinate 5 mg (SOL) after transurethral resection of the prostate (TURP). Patients and methods The patients were randomized into three groups: TURP (group 1), TURP plus TAM (group 2), and TURP plus TAM + SOL (group 3). Patients in group 2 and group 3 received medication for 4 weeks. The primary efficacy end points were the mean change in total International Prostate Symptom Score (IPSS) and IPSS subscores. The secondary end points included quality-of-life score, Overactive Bladder Symptom Score, and short-form voiding and storage score of International Continence Society. Results In total, 37 men (31.8%) in group 1, 37 men (31.8%) in group 2, and 42 men (36.2%) in group 3 completed the study. In total IPSS, no significant improvement was seen from baseline to the end of treatment in groups 2 and 3 compared with group 1. However, in group 2, the decrement in the IPSS storage score was smaller than group 1 (P=0.02), and in group 3, the decrement in the IPSS voiding score was smaller than group 1 (P=0.05). In groups 2 and 3 compared with group 1, improvements in the quality of life score, total score of Overactive Bladder Symptom Score, and short-form voiding score and storage score of International Continence Society were not statistically significant. Conclusion Treatment with TAM and combination of TAM and SOL did not have significant additional benefits for lower urinary tract symptoms during the early recovery period after TURP.
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Affiliation(s)
- Yu Seob Shin
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Medical Device Clinical Trial Center of Chonbuk National University, Jeonju, Republic of Korea
| | - Li Tao Zhang
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Medical Device Clinical Trial Center of Chonbuk National University, Jeonju, Republic of Korea
| | - Jae Hyung You
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Medical Device Clinical Trial Center of Chonbuk National University, Jeonju, Republic of Korea
| | - In Sung Choi
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Medical Device Clinical Trial Center of Chonbuk National University, Jeonju, Republic of Korea
| | - Chen Zhao
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and Shanghai Institute of Andrology, Shanghai, People's Republic of China
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Medical Device Clinical Trial Center of Chonbuk National University, Jeonju, Republic of Korea
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Singla N, Singla AK. Evaluation and Management of Lower Urinary Tract Symptoms After Outlet Surgery for Benign Prostatic Hyperplasia. CURRENT BLADDER DYSFUNCTION REPORTS 2016; 11:242-247. [PMID: 32362986 DOI: 10.1007/s11884-016-0376-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are many options available in the surgical treatment of outlet obstruction secondary to benign prostatic hyperplasia (BPH). While most patients exhibit improvement in their lower urinary tract symptoms (LUTS) following intervention, up to 35 % of patients may exhibit persistent or recurrent LUTS. In the present review, we discuss the patho-physiology of LUTS after bladder outlet surgery and discuss considerations in evaluating and managing such patients. We highlight the crucial role of thorough evaluation with complete urodynamics testing, as pure obstruction only accounts for a minority of post-operative LUTS. Hence, detrusor contractility, detrusor overactivity, urethral sphincter function, and urinary incontinence must be assessed to appropriately guide subsequent therapy and improve patients' quality of life.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas, Southwestern Medical Center, 5201 Harry Hines Blvd, Dallas, TX 75235, USA
| | - Ajay K Singla
- Department of Urology, University of Toledo Medical Center, 3000 Arlington Avenue, MS1091, Toledo, OH 43614, USA
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Liu X, Huang G, Chen P, Li Y, Xiang J, Chen T, Wang R. Comparative effects of Yi Jin Jing versus Tai Chi exercise training on benign prostatic hyperplasia-related outcomes in older adults: study protocol for a randomized controlled trial. Trials 2016; 17:319. [PMID: 27422168 PMCID: PMC4947249 DOI: 10.1186/s13063-016-1448-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS) occur very commonly in older men. BPH and LUTS cause substantial physical and psychological impairment that could seriously affect the quality of late life and greatly cost the health-care systems. Current surgical and pharmacological therapies are expensive, may not effectively improve prostate function and health but cause adverse effects. There is an urgent need to find new and effective non-pharmacological preventions and treatments. Yi Jin Jing and Tai Chi are two common traditional Chinese mind-body exercises with different movements and techniques, but both emphasize regulating functional homeostasis and keeping whole body harmony. Yi Jin Jing and Tai Chi have not been studied much for potentially use in the treatment of BPH-related problems. The primary purpose of this protocol is to assess the effectiveness of Yi Jin Jing versus Tai Chi on the monographic and functional changes of prostate in older men. METHODS/DESIGN A prospective single-center randomized controlled trial will be conducted. A total of 150 old men (60-70 years old) will be recruited from the urban tertiary of Shanghai, China. Of these, 50 eligible participants will be randomly assigned to a control group and two intervention groups with either Yi Jin Jing or Tai Chi exercise training. They will undergo 30 minutes for each exercise for five times a week for 6 months. The primary outcomes are changes of signs and symptoms in BPH and lower urinary tract from baseline to post-intervention. The main secondary outcomes are exercise-induced effects on the circulating levels of estrogen and androgen. All the outcome measures will be assessed at baseline, immediately after the 6-month intervention, and at the 3-month post-intervention follow-up. DISCUSSION This proposed study will be the first comparative randomized clinical trial to evaluate the effectiveness of Yi Jin Jing versus Tai Chi exercise on prostate health among older adults. The results will provide an evidence-based recommendation for Chinese older men on the use of Yi Jin Jing and Tai Chi training to promote prostatic function and health. Potential mechanisms for the regulatory effect of the two exercises elucidated by multiple outcomes are also explored. A clarification of the effects and mechanisms may provide information for the development of new strategies in the prevention and treatment of BPH-related conditions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: ChiCTR-IOR-16007698 . This trial was registered on 4 January 2016.
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Affiliation(s)
- XiangYun Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education at the Shanghai University of Sport, 188 Hengren Road, Shanghai, 200438, China
| | - Guoyuan Huang
- Pott College of Science, Engineering & Education, University of Southern Indiana, Evansville, USA
| | - Peijie Chen
- Key Laboratory of Exercise and Health Sciences of Ministry of Education at the Shanghai University of Sport, 188 Hengren Road, Shanghai, 200438, China
| | - Yong Li
- FuDan University, 130 Dongan Road, Shanghai, 200032, China
| | - JiuLin Xiang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education at the Shanghai University of Sport, 188 Hengren Road, Shanghai, 200438, China
| | - Ting Chen
- Key Laboratory of Exercise and Health Sciences of Ministry of Education at the Shanghai University of Sport, 188 Hengren Road, Shanghai, 200438, China
| | - Ru Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education at the Shanghai University of Sport, 188 Hengren Road, Shanghai, 200438, China.
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Is benign prostatic obstruction surgery indicated for improving overactive bladder symptoms in men with lower urinary tract symptoms? Curr Opin Urol 2016; 26:17-21. [DOI: 10.1097/mou.0000000000000249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Capon G, Caremel R, de Sèze M, Even A, Fontaine S, Loche CM, Bart S, Castel-Lacanal E, Duchêne F, Karsenty G, Mouracade P, Perrouin-Verbe MA, Phé V, Rey D, Scheiber-Nogueira MC, Gamé X. [The impact of mellitus diabetes on the lower urinary tract: A review of Neuro-urology Committee of the French Association of Urology]. Prog Urol 2015; 26:245-53. [PMID: 26452712 DOI: 10.1016/j.purol.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Specify urinary functional impairment associated with diabetic pathology. Propose guidance for screening, monitoring of clinical signs of lower urinary tract (LUTS) and describe the specifics of the urological treatment of patients. METHODS A review of literature using PubMed library was performed using the following keywords alone or in combination: "diabetes mellitus", "diabetic cystopathy", "overactive bladder", "bladder dysfunction", "urodynamics", "nocturia". RESULTS LUTS are more common in the diabetic population with an estimated prevalence between 37 and 70 %, and are probably underevaluated in routine practice. They are heterogeneous and are frequently associated with other diabetic complications. Both storage and voiding symptoms can coexist. Despite a major evaluation in the literature, no recommendation supervises the assessment and management of LUTS in this specific population. An annual screening including medical history, bladder and kidney ultrasound and post-void residual measurement is required in the follow-up of diabetic patients. Specific urologial referral and urodynamic investigations will be performed according to the findings of first-line investigations. The type of bladder dysfunction, the risk of urinary tract infections and dysautonomia should be considered in the specific urological management of these patients. CONCLUSION Diabetes mellitus significantly impacts on the lower urinary tract function. A screening of LUTS is required as well as other complications of diabetes. The management of LUTS must take into consideration the specific risks of the diabetic patient regarding the loss of bladder contractility, the possibility of dysautonomia and infectious complications.
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Affiliation(s)
- G Capon
- Service d'urologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
| | - R Caremel
- Service d'urologie, hôpital Charles-Nicolle, 76000 Rouen, France
| | - M de Sèze
- Cabinet de neuro-urologie, urodynamique et pelvipérinéologie, clinique Saint-Augustin, 33000 Bordeaux, France
| | - A Even
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, 92340 Garches, France
| | - S Fontaine
- Service de médecine interne, endocrinologie, diabète, nutrition, hôpital Joseph-Ducuing, 31300 Toulouse, France
| | - C-M Loche
- Service de rééducation neurolocomotrice, CHU Henri-Mondor, AP-HP, 94010 Créteil, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, 95300 Cergy-Pontoise, France
| | - E Castel-Lacanal
- Service de médecine physique et réadaptation, CHU Rangueil, 31400 Toulouse, France
| | - F Duchêne
- Service d'urologie, clinique de l'Alliance, 37540 Saint-Cyr-sur-Loire, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de la Conception, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - P Mouracade
- Service d'urologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - M-A Perrouin-Verbe
- Service d'urologie, hôpital de la Cavale-Blanche, CHU de Brest, 29609 Brest, France
| | - V Phé
- Service d'urologie, hôpital de la Pitié-Salpêtrière, AP-HP, université Paris VI, 75013 Paris, France
| | - D Rey
- Clinique Saint-Augustin, 33000 Bordeaux, France
| | - M-C Scheiber-Nogueira
- Services d'urologie et d'explorations neurologiques, CHU Lyon Sud, 69495 Pierre-Bénite, France
| | - X Gamé
- Service d'urologie, CHU Rangueil, 31400 Toulouse, France
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Strope SA, Vetter J, Elliott S, Andriole GL, Olsen MA. Use of Medical Therapy and Success of Laser Surgery and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia. Urology 2015; 86:1115-22. [PMID: 26375848 DOI: 10.1016/j.urology.2015.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/01/2015] [Accepted: 07/18/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the impact of surgery for benign prostatic hyperplasia (BPH) on use of medication (5-alpha reductase inhibitors, alpha blockers, antispasmodics), we assessed preoperative and postoperative medication utilization among surgically treated men. PATIENTS AND METHODS Using the Truven Health Analytics MarketScan Commercial Claims Database, we defined a cohort of men aged <65 years who had surgical therapy for BPH with either transurethral resection of the prostate (TURP) or laser procedures from 2007 through 2009. Primary outcomes included freedom from medical or surgical intervention by 4 months after surgery (chi-square and multivariable logistic regression) and subsequent use of medical or surgical intervention in initial responders (Kaplan-Meier and multivariable Cox regression). RESULTS We identified 6430 patients treated with either TURP (3096) or laser procedure (3334) for BPH. Presurgical antispasmodic use was associated with the highest risk of medication use at 4 months after surgery (odds ratio, 5.19; 95% confidence interval (CI), 3.16-8.53 vs no medication use before surgery). At 3 years after surgery, 6% (95% CI, 4%-8%) of laser-treated and 4% (95% CI, 2%-5%) of TURP-treated patients had repeat surgical intervention, and both laser- and TURP-treated patients had an estimated new use of medication rate of 22% (95% CI, 18%-25% laser and 20%-25% TURP). The strongest predictor of intervention after surgery was preoperative antispasmodic use (hazard ratio, 2.49; 95% CI, 1.41-4.43). CONCLUSION Our results show a need for effective patient counseling about continued or new use of medical therapy after laser and TURP procedures. However, most patients experience durable improvement after surgical intervention for BPH.
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Affiliation(s)
- Seth A Strope
- Division of Urology, Department of Surgery, Washington University, St. Louis, MO.
| | - Joel Vetter
- Division of Urology, Department of Surgery, Washington University, St. Louis, MO
| | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Gerald L Andriole
- Division of Urology, Department of Surgery, Washington University, St. Louis, MO
| | - Margaret A Olsen
- Department of Internal Medicine, Washington University, St. Louis, MO
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Lin ATL. Optimizing pharmacotherapy of overactive bladder – Targeting muscarinic receptor or beta-adrenergic receptor, or both? UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Qian X, Yu G, Qian Y, Xu D, Liu H, Kong X, Zhu Y, Wang Z, Zheng J, Qi J. Efficacy of 5α-reductase inhibitors for patients with large benign prostatic hyperplasia (>80 mL) after transurethral resection of the prostate. Aging Male 2015. [PMID: 26225794 DOI: 10.3109/13685538.2015.1068750] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To prospectively evaluate 5α-reductase inhibitors (5αRIs) for benign prostatic hyperplasia (BPH) patients with a large prostate (>80 mL) after transurethral resection of the prostate (TURP). MATERIALS AND METHODS Eighty-seven patients were recruited from January 2007 to October 2014. Patients were randomized into a trial and a control group. The trial group was treated with 5αRIs for 3 years after TURP, while the control group received a placebo. We evaluated the indicators before, peri and after TURP. RESULTS There were no significant differences in the indicators before and peri-TURP. Six months later, there were significant differences in PSA and hematuria (HU). Three years after TURP, there were significant differences in prostate volume (PV), level of prostate-specific antigen (PSA), the maximum flow rate (Qm), and HU between the trial and control groups. Additionally, there were significant differences in the PV, PSA, international prostate symptom score (IPSS), patient quality of life (QoL) in the trial group alone between those treated with finasteride and those treated with dutasteride. CONCLUSIONS After TURP for large BPH, administration of 5αRIs for 3 years improved PV, PSA, Qm and HU. Additionally, dutasteride produced superior improvements in PV, PSA, IPSS and QoL compared with finasteride.
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Affiliation(s)
- Xiaoqiang Qian
- a Department of Urology , Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Guopeng Yu
- a Department of Urology , Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Yu Qian
- b Department of Urology , Kongjiang Hospital , Shanghai , P.R. China
| | - Ding Xu
- a Department of Urology , Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Hailong Liu
- a Department of Urology , Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Xiangjie Kong
- a Department of Urology , Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Yunkai Zhu
- c Department of Ultrasound in Medicine , Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Zhong Wang
- d Department of Urology , Ninth Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China , and
| | - Junhua Zheng
- e Department of Urology , Tenth Hospital Affiliated to Shanghai Tongji University School of Medicine , Shanghai , P.R. China
| | - Jun Qi
- a Department of Urology , Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
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Re: Han et al.: Factors associated with continuing medical therapy after transurethral resection of prostate (Urology 2014;84:675-680). Urology 2014; 85:275. [PMID: 25530402 DOI: 10.1016/j.urology.2014.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 11/21/2022]
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