1
|
Hashim H, Tarcan T, Acar O, Malde S, Wein A, Abrams P. Evaluation of new treatments for benign prostatic obstruction: ICI-RS 2023. Neurourol Urodyn 2024; 43:1409-1419. [PMID: 38078704 DOI: 10.1002/nau.25345] [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: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 07/03/2024]
Abstract
AIMS To address how invasive therapies for benign prostatic obstruction (BPO) have been evaluated, what their effect is on BPO, if they can prevent progression to BPO and how new therapies need to be evaluated before implementation into clinical practice. METHODS The think tank conducted a literature review and looked at the previous and current American Urological Association, European Association of Urology and the International Consultation on Urological Diseases guidelines to see what procedures have been used to treat BPO. They then assessed whether trials have been conducted before implementation of the procedures and whether they have been compared to a "gold" standard treatment. The use of urodynamics has also been addressed in the think tank in relation the clinical trials as well as terminology. RESULTS Guidelines vary in the use of terminology when it comes to BPO with some continuing to use the term benign prostatic hyperplasia (BPH). There are several procedures for example, TUNA, which have become obsolete although continues to be mentioned in the guidelines until recently. Majority of procedures have been introduced without comparing to "gold" standard treatment and without any long-term data. There continues to be many unknowns with regard to the success of some of the BPO procedures and why some of the adverse events develop. CONCLUSION There needs to be more robust long-term clinical trials conducted of new BPO therapies, with men who have both lower urinary tract symptoms and urinary retention, before introduction into clinical practice.
Collapse
Affiliation(s)
| | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Omer Acar
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alan Wein
- Desai Sethi Institute of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | |
Collapse
|
2
|
Holm-Larsen T, Van den Ende M, Wendelboe HG, Verbakel I, Kheir GB, Hervé F, Everaert K. The cost of lifelong LUTS-A systematic literature review. Neurourol Urodyn 2024; 43:1058-1065. [PMID: 38270351 DOI: 10.1002/nau.25389] [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: 10/02/2023] [Revised: 12/08/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are highly prevalent and very bothersome. To support the best possible allocation of health care resources and to avoid unnecessary expenditures, it is important to understand and quantify the wide-ranging health care costs affecting people suffering from LUTS. We aimed at creating a foundation for exploring the cost of LUTS. METHOD In this systematic literature review, we explored the costs of illness of the LUTS umbrella. We used the online literature review tool Silvi.ai for transparent decision-making and literature management. RESULTS A total of 1821 original articles were screened. Forty had explored the cost of illness of a LUTS disease since 2013. The studies were conducted in 18 countries. A number of different study designs were applied, including both retrospective and prospective studies. In total, seven LUTS indications were explored. None of them focused on lifelong LUTS. None of them were conducted in infants or children. Eighty-two percent were conducted in adults and 18% in frail elderly. Most cost of illness studies focused on the cost of hospitalization and use of medicine. CONCLUSION We have created the groundwork for understanding the cost of LUTS illness. To fully understand the cost of illness of lifelong LUTS, the main gap in research is to investigate the cost of LUTS in infants and children.
Collapse
Affiliation(s)
- Tove Holm-Larsen
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Mauro Van den Ende
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | | | - Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - 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
| |
Collapse
|
3
|
Ditonno F, Manfredi C, Licari LC, Bologna E, Franco A, Pandolfo SD, De Sio M, De Nunzio C, Fiori C, Cherullo EE, Olweny EO, Antonelli A, Autorino R. Benign Prostatic Hyperplasia Surgery: A Snapshot of Trends, Costs, and Surgical Retreatment Rates in the USA. Eur Urol Focus 2024:S2405-4569(24)00058-0. [PMID: 38670842 DOI: 10.1016/j.euf.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND An increasing number of novel surgical treatments (NSTs) for benign prostatic hyperplasia (BPH) have been proposed over time to achieve similar functional outcomes, but better perioperative and sexual outcomes than traditional procedures. OBJECTIVE To assess the trends in the utilization and costs of BPH surgical procedures over the past decade, and to analyze the need for surgical retreatment after each procedure. DESIGN, SETTING, AND PARTICIPANTS A retrospective observational population-based analysis was conducted using the PearlDiver Mariner (PearlDiver Technologies, Colorado Springs, CO, USA) database, including all-payer nationally available claims records collected from 2011 to 2022. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The number and type of BPH surgical procedures per year, costs associated with each BPH surgical treatment, incidence of BPH surgical retreatment rate, and time to BPH surgical retreatment were assessed. Negative binomial regression and Cochran-Armitage test were used for the temporal trend analysis. A multivariable logistic regression analysis evaluated the predictors of BPH surgical retreatment. RESULTS AND LIMITATIONS In the study period, 274 808 patients received surgical treatment for BPH. The most common procedure was transurethral resection of the prostate (TURP; 71.7%). The overall utilization of BPH surgical treatment increased over the study period. Traditional surgery remained most performed for the entire period (87.8%), but a statistically significantly rising trend of NSTs was recorded. The mean reimbursements paid per procedure was 1.43 times higher (p < 0.001) for NSTs than for traditional procedures. The surgical retreatment rate was 9.4%. The mean time to surgical retreatment was 25.3 mo, with 85.5% of cases re-treated within 5 yr. At the multivariable analysis, transurethral incision of the prostate, photoselective vaporization of the prostate, prostatic urethral lift, convective water vapor energy, and prostatic artery embolization had a significantly greater likelihood of surgical retreatment than TURP. Holmium/thulium laser enucleation of the prostate (HoLEP/ThuLEP), open simple prostatectomy (SP), and laparoscopic/robot-assisted SP were associated with a lower probability of resurgery than TURP, but a similar probability between these procedures. Retrospective design and a lack of relevant clinical data were the main limitations. CONCLUSIONS Over the past decade, there has been a progressive increase in the adoption of NSTs. The rate of surgical retreatment appears <10%, with patients undergoing SP and HoLEP/ThuLEP experiencing a statistically significantly lower probability of surgical retreatment. PATIENT SUMMARY We investigated the trends, costs, and surgical retreatments of benign prostatic hyperplasia surgery. Transurethral resection of the prostate remains the most common procedure. Novel surgical treatments are associated with an upward trend, despite appearing more expensive overall. Retreatment is necessary in <10% of patients and generally within 5 yr.
Collapse
Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA; Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA; Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Savio D Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cristian Fiori
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | | | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | | |
Collapse
|
4
|
Salmivalli A, Boström P, Nurminen P, Kinnala P, Kytö V, Ettala O. National trends of surgery for benign prostatic hyperplasia in Finland. Scand J Urol 2024; 59:70-75. [PMID: 38647246 DOI: 10.2340/sju.v59.32425] [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: 11/28/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To investigate national trends of surgical treatment for benign prostatic obstruction (BPO). METHODS The Care Register for Healthcare in Finland was used to investigate the annual numbers and types of surgical procedures, operation incidence and duration of hospital stay between 2004 and 2018 in Finland. Procedures were classified using the Nordic Medico-Statistical Committee Classification of Surgical Procedures coding. Trends in incidence were analyzed with two-sided Cochran-Armitage test. Trends in duration of hospital stay and patient age were analyzed with linear regression. RESULTS Transurethral resection of the prostate (TURP) was the most common operation type during the study period, covering over 70% of operations for BPO. Simultaneous with the implementation of photoselective vaporization of the prostate (PVP), the incidence of TURP, minimally invasive surgical therapies, transurethral vaporization of the prostate (TUVP) and open prostatectomies decreased (p < 0.05). The mean operation incidence rate in the population between 2004 and 2018 was 263 per 100,000. The duration of hospital stay shortened (p < 0.05), and the average age of operated patients increased by 2 years (p < 0.0001). CONCLUSION The implementation of PVP did not challenge the dominating position of TURP in Finland, but it has probably influenced the overall use of other surgical therapies, excluding transurethral incision of the prostate. The results might suggest that the conservative treatment is accentuated, patient selection is more thorough, and surgical intervention might be placed at a later stage of BPO.
Collapse
Affiliation(s)
- Alisa Salmivalli
- Doctoral Programme in Clinical Research, University of Turku, Turku, Finland; Department of Urology, Satasairaala Central Hospital, Wellbeing Services County of Satakunta, Pori, Finland; Department of Urology, Turku University and Turku University Hospital, Turku, Finland.
| | - Peter Boström
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Pekka Kinnala
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Services, Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Otto Ettala
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| |
Collapse
|
5
|
Herzberg H, Savin Z, Fahoum I, Lifshitz K, Schwarztuch Gildor O, Veredgorn Y, Marom R, Yossepowitch O, Sofer M. Revisiting the issue of "beach balls" in holmium laser enucleation of prostate: clinical and histological characterization. World J Urol 2024; 42:201. [PMID: 38546885 DOI: 10.1007/s00345-024-04902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE To clinically and histologically characterize prostatic nodules resistant to morcellation ("beach balls," BBs). PATIENTS AND METHODS We reviewed a consecutive cohort of 559 holmium laser enucleation of the prostate (HoLEP) procedures performed between January 2020 and November 2023. The BBs group comprised 55 men (10%) and the control group comprised 504 men (90%). The clinical, intraoperative, outcome, and histologic data were statistically processed for the prediction of the presence of BBs and their influence on the perioperative course and outcome. RESULTS The BBs group in comparison to the controls was older (75 vs 73 years, respectively, p = 0.009) and had higher rates of chronic retention (51 vs 29%, p = 0.001), larger prostates on preoperative abdominal ultrasound (AUS) (140 vs 80 cc, p = 0.006E-16), longer operating time (120 vs 80 min, p = 0.001), higher weights of removed tissue (101 vs 60 gr, p = 0.008E-10), higher complication rates (5 vs 1%, p = 0.03), and longer hospitalization (p = 0.014). A multivariate analysis revealed that larger prostates on preoperative AUS and older age independently predicted the presence of BBs which would prolong operating time. ROC analyses revealed that a threshold of 103 cc on AUS predicted BBs with 94% sensitivity and 84% specificity. BBs were mostly characterized histologically by stromal component (p = 0.005). CONCLUSIONS BBs are expected in older patients and cases of chronic retention. Prostatic volume is the most reliable predictor of their presence. They contribute to prolonged operating time and increased risk of complications. The predominantly stromal composition of the BBs apparently confers their resistance to morcellation.
Collapse
Affiliation(s)
- Haim Herzberg
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ziv Savin
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ibrahim Fahoum
- Department of Pathology, Faculty of Medial & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Karin Lifshitz
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Omri Schwarztuch Gildor
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Yotam Veredgorn
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ron Marom
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Mario Sofer
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel.
| |
Collapse
|
6
|
Pyrgidis N, Mykoniatis I, Lusuardi L, Schulz GB, Sokolakis I, Stief C, Sountoulides P. Enucleation of the prostate as retreatment for recurrent or residual benign prostatic obstruction: a systematic review and a meta-analysis. Prostate Cancer Prostatic Dis 2023; 26:693-701. [PMID: 37193777 DOI: 10.1038/s41391-023-00677-z] [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: 01/07/2023] [Revised: 03/27/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Anatomical endoscopic enucleation of the prostate (AEEP) is recommended for first line surgical treatment of benign prostatic obstruction (BPO) caused by moderate and large prostatic adenoma. However, its role in the retreatment setting after failed previous surgical treatment for BPO remains uncaptured. In this scope, we performed a systematic review and meta-analysis aiming to assess the safety and efficacy of AEEP in the retreatment setting. METHODS We searched PubMed, Cochrane Library and Embase databases from inception to March 2022 for prospective or retrospective studies involving patients undergoing prostatic enucleation for recurrent or residual BPO after previous standard or minimally invasive surgical treatments for BPO. Based on data availability, we performed a meta-analysis comparing AEEP in patients with recurrent or residual BPO versus AEEP for primary BPO. PROSPERO CRD42022308941). RESULTS We included 15 studies in the systematic review and 10 in the meta-analysis (6553 patients, 841 with recurrent or residual BPO and 5712 with primary BPO). All included studies involved patients undergoing HoLEP or ThuLEP. In terms of Qmax, post-void residual, International Prostate Symptom Score, removed adenoma, operative time, duration of catheterization and hospital stay, as well as complications, HoLEP for recurrent or residual BPO was equally effective compared to HoLEP for primary BPO up to 1 year postoperatively. Importantly, the beneficial effect of HoLEP on the retreatment setting was observed after previous standard or minimally invasive surgical treatments for BPO. The overall strength of evidence for all outcomes was deemed very low. CONCLUSIONS HoLEP may be safely and effectively used in experienced hands for the surgical treatment of recurrent or residual BPO in patients with large or moderate prostates following previous open, endoscopic or minimally invasive surgical treatment for BPO.
Collapse
Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Ioannis Mykoniatis
- 1st Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University (PMU) Hospital, Salzburg, Austria
| | | | - Ioannis Sokolakis
- 2nd Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Petros Sountoulides
- 1st Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
7
|
Baboudjian M, Cornu JN, Gondran-Tellier B, Fourmarier M, Robert G, Peyronnet B, Misrai V, Pradere B. Pharmacologic and Surgical Retreatment After Office-based Treatments for Benign Prostatic Hyperplasia: A Systematic Review. Eur Urol Focus 2023; 9:727-733. [PMID: 36906484 DOI: 10.1016/j.euf.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
CONTEXT Office-based treatments are increasingly offered as an optional step to replace medical treatment or delay surgery for male lower urinary tract symptoms (LUTS). Nevertheless, little is known regarding the risks of retreatment. OBJECTIVE To systematically evaluate the current evidence regarding retreatment rates after water vapor thermal therapy (WVTT), prostatic urethral lift (PUL), and temporarily implanted nitinol device (iTIND) procedures. EVIDENCE ACQUISITION A literature search was conducted up to June 2022 using the PubMed/Medline, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify eligible studies. The primary outcomes were the rates of pharmacologic and surgical retreatment during follow-up. EVIDENCE SYNTHESIS A total of 36 studies including 6380 patients met our inclusion criteria. Surgical and minimally invasive retreatment rates were generally well reported in the studies included and reached up to 5% after 3 yr of follow-up for iTIND, and up to 4% for WVTT and 13% for PUL after 5 yr of follow-up. The types and rates of pharmacologic retreatment are poorly reported in the literature, with the latter reaching up to 7% after 3 yr of follow-up for iTIND, and up to 11% after 5 yr of follow-up for WVTT and PUL. The main limitations of our review are the unclear to high risk of bias in most of the studies included and the lack of long-term (>5 yr) data on retreatment risks. CONCLUSIONS Our results highlight the low retreatment rates at mid-term follow-up after office-based treatments for LUTS, supporting the development of these strategies as an intermediate step between BPH medication and conventional surgery. Pending more robust data with longer follow-up, these results should be used to improve patient information and facilitate shared decision-making. PATIENT SUMMARY Our review highlights the low risk of mid-term retreatment after office-based treatments for benign enlargement of the prostate that is affecting urinary function. For well-selected patients, these results support the increasing use of office-based treatment as an intermediate option before conventional surgery.
Collapse
Affiliation(s)
- Michael Baboudjian
- Department of Urology, APHM, La Conception Hospital, Marseille, France; Department of Urology, APHM, North Academic Hospital, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | | | - Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
8
|
Koudonas A, Anastasiadis A, Tsiakaras S, Langas G, Savvides E, Mykoniatis I, Memmos D, Baniotis P, Vakalopoulos I, de la Rosette J, Dimitriadis G. Overview of current pharmacotherapeutic options in benign prostatic hyperplasia. Expert Opin Pharmacother 2023; 24:1609-1622. [PMID: 37448198 DOI: 10.1080/14656566.2023.2237406] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) represents the histological entity of prostate cell proliferation, which inflicts a gradually increasing obstruction of the bladder outlet and is accompanied by a progressing manifestation of lower urinary tract symptoms (LUTS). BPH management algorithm includes conservative measures, pharmaceutical agents, and surgical procedures. AREAS COVERED A comprehensive literature review was performed using PubMed, Scopus, and Google Scholar databases to identify publications written in English, analyzing BPH pharmaceutical treatment. The search was conducted from January 2000 to January 2023. Six main drug classes can be administered, either as monotherapy or in combination. Furthermore, the authors provide current direction of research on future medications, which focuses on a more etiological interference to the BPH pathophysiological mechanism. EXPERT OPINION The available medications represent an effective first-line step of BPH/LUTS therapy. Currently, the administration of BPH medications is tailored to patient/disease characteristics and entails long-time adherence to therapy. The emergence of new surgical modalities, which combine significantly lower morbidity compared to standard procedures and more durable effects than the available medications, seems to challenge the current treatment algorithm. More direct comparisons and the increasing experience with these surgical modalities will delineate the switch points between various therapy levels along the BPH management sequence.
Collapse
Affiliation(s)
- Antonios Koudonas
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - Stavros Tsiakaras
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - Georgios Langas
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | | | - Ioannis Mykoniatis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - Dimitrios Memmos
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - Panagiotis Baniotis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - Ioannis Vakalopoulos
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | - Georgios Dimitriadis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| |
Collapse
|
9
|
Jain A, Nassour AJ, Khannani H, Wines MP, Chalasani V, Katelaris P, Bergersen P, Symons JL, Baskaranathan S, Woo H. Australian surgical revision rate for benign prostatic obstruction. BJU Int 2023; 131 Suppl 4:43-47. [PMID: 37346012 DOI: 10.1111/bju.16031] [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: 06/23/2023]
Abstract
OBJECTIVE To evaluate the rate of revision surgery following commonly performed procedures for benign prostatic hyperplasia (BPH) is hyperplasia of both glandular and stromal components of prostate especially in periurethral transitional gland, using real-world data from Medicare Australia. METHODS Prospection is a Healthcare Data Analytics firm that has negotiated access with the Medicare Benefits Schedule (MBS) to provide longitudinal data on the use of specific procedural item codes. We identified patients over the age of 40 years who had undergone primary transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP) or photoselective vaporization of the prostate (PVP) between 2005 and 2010 using MBS item numbers 37203, 37207 and 36854, respectively. Using longitudinal MBS data, primary outcomes included need for revision surgery at 5-years follow-up (2015). The release of these data was approved by Medicare Australia upon application. Data analysis was conducted using chi-squared tests and statistical significance was defined at P < 0.05. RESULTS The distribution of primary surgical procedures performed between 2005 and 2010 was: TURP 5579 (90%), TUIP 345 (6%) and PVP 258 (4%). TURP was also the most prevalent procedure for treatment of lower urinary tract symptoms in men with BPH requiring revision surgery (75%). At 5-year follow-up the rate of revision surgery for TURP (573/5579), TUIP (47/345) and PVP (30/258) was 10.3%, 13.6% and 11.6%, respectively. The difference was not statistically significant (P = 0.12). There was no significant change (P = 0.59) observed over the years in number of men requiring revision surgery. CONCLUSION This study indicates that TURP and PVP have a similar durability after 5 years of follow-up.
Collapse
Affiliation(s)
- Anika Jain
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - Anthony-Joe Nassour
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - Hadia Khannani
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - Michael P Wines
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - Venu Chalasani
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - Phillip Katelaris
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - Philip Bergersen
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - James L Symons
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Sris Baskaranathan
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
| | - Henry Woo
- Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Wahroonga, NSW, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
10
|
Franco JV, Tesolin P, Jung JH. Update on the management of benign prostatic hyperplasia and the role of minimally invasive procedures. Prostate Int 2023; 11:1-7. [PMID: 36910900 PMCID: PMC9995694 DOI: 10.1016/j.prnil.2023.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/24/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Lower urinary tract symptoms due to benign prostatic hyperplasia constitute a substantial burden, affecting the quality of life of those affected by this condition. While watchful waiting and medical management using a wide array of pharmaceuticals can be effective, surgery has been one of the most definite solutions for those highly affected by this condition. Transurethral resection of the prostate (TURP) is the gold standard surgical procedure, but other alternatives using laser (HoLEP and ThuLEP) and robotic water jets (Aquablation) are emerging treatments aimed at reducing postoperative morbidity. Minimally invasive procedures conducted in outpatient settings and under local anesthesia or sedation are increasingly being used, especially in those patients with high surgical risk due to comorbidities. These procedures include prostatic arterial embolization, water vapor thermal therapy (Rezum), prostatic urethral lift (Urolift), temporary implantable nitinol device (TIND/iTIND), and transurethral microwave thermotherapy (TUMT). The evidence supporting these treatments is growing, but some uncertainties remain as to what is the magnitude of their advantages and disadvantages compared to TURP. Innovations in the technologies involved in these new procedures may improve their profile for effectiveness and safety. Moreover, new devices are being investigated for marketing approval. Issues around costs and patients' preferences are also yet to be elucidated, thus their evolving role needs to be weighed against the aforementioned considerations.
Collapse
Affiliation(s)
- Juan V.A. Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Corresponding author. Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Pablo Tesolin
- Family and Community Division, Hospital Italiano de Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Korea
| |
Collapse
|
11
|
Franco JVA, Jung JH, Liquitay CME, Dahm P. What is the role of minimally invasive surgical treatments for benign prostatic enlargement? BMJ 2022; 377:e069002. [PMID: 35613726 DOI: 10.1136/bmj-2021-069002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Juan Victor Ariel Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | | | - Philipp Dahm
- Minneapolis VAMC, Urology Section and Department of Urology, University of Minnesota, Minneapolis, USA
| |
Collapse
|
12
|
Coman R, Anract J, Pinar U, Sibony M, Peyromaure M, Delongchamps B. Is the systematic histological analysis of benign prostatic hyperplasia surgical specimen always necessary? Int Urol Nephrol 2022; 54:1485-1489. [PMID: 35536389 DOI: 10.1007/s11255-022-03220-6] [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: 11/22/2021] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION After most surgical management of benign prostatic hyperplasia (BPH), the resected tissue undergoes a histological examination. This examination is performed for the risk of finding an incidental prostate cancer (iPCa). The improvement of prostate cancer detection in the past few years decreased the global iPCa rate. This raises the question of the real benefit for all patients of a systematic histological analysis. The aim of our study was to evaluate the iPCa detection rate on a large contemporary cohort of patients treated for BPH, and to define predictive factors of iPCa detection. PATIENTS AND METHODS We retrospectively analyzed the medical charts of all consecutive patients who underwent surgical treatment for BPH in our academic center from 2012 to 2018. Patients with prostate cancer diagnosed before surgery were not included. All the resected tissue underwent standard histopathological examination. iPCa was defined by any grade or stage of prostate cancer identified on the resected tissue by the histological examination. The following variables were analyzed using an uni- and multi-variable logistic regression as potential risk factors of iPCa: age, total PSA, PSA density (PSAd), prostate volume, technique used, weight of resected tissue and use of 5ARI medication. RESULTS 1045 patients were included in the study. Of them, 439 (42.0%), 206 (19.7%) and 400 (38.3%) underwent HoLEP, OP and TURP, respectively. iPCa was diagnosed in 94 (9.0%) of the 1045. Among them 15 (1.4%) were clinically significant (ISUP score ≥ 2). The multivariable logistic regression analysis identified age (p = 0.03) and PSA density (p < 0.001) as independent predictive factors for the detection of iPCa. Using the median of age and PSAd, we identified a population with 0% of iPCa in our cohort (age < 70 year-old and PSAd < 0.05 ng/mL/mL). CONCLUSION The global iPCa rate was 9% in this contemporary large cohort of patients who underwent surgical treatment for BPH, with 1.4% of clinically significant cancer. Age and PSAd were independent predictive factors to find iPCa. Patients younger than 70 with a PSAd < 0.05 ng/mL/mL had 0% of iPCA in our cohort. In this specific population, we could probably avoid a systematical histological examination of the resected tissue.
Collapse
Affiliation(s)
- R Coman
- Urology Department, Cochin Hospital, Paris, France.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J Anract
- Urology Department, Cochin Hospital, Paris, France. .,Institut Necker Enfants Malades (INEM), INSERM U1151, Université de Paris, Paris, France.
| | - U Pinar
- Urology Department, Pitié-Salpétrière Hospital, Paris, France
| | - M Sibony
- Pathology Department, Cochin Hospital, Paris, France
| | - M Peyromaure
- Urology Department, Cochin Hospital, Paris, France.,Institut Necker Enfants Malades (INEM), INSERM U1151, Université de Paris, Paris, France
| | - Barry Delongchamps
- Urology Department, Cochin Hospital, Paris, France.,Institut Necker Enfants Malades (INEM), INSERM U1151, Université de Paris, Paris, France
| |
Collapse
|
13
|
Narang G, Kellner D, Krambeck A, Humphreys M. Reimbursement of surgical procedures for benign prostatic hyperplasia: are we disincentivizing complex care? Curr Opin Urol 2022; 32:318-323. [PMID: 35249967 DOI: 10.1097/mou.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of how surgical benign prostatic hyperplasia (BPH) procedures are compensated in the United States and the implications of the current reimbursement system on the care of patients. RECENT FINDINGS The resource-based relative value care system is Medicare's current reimbursement model. There is strong evidence that the current system does not adequately account for complex care. Consequently, for BPH surgical procedures, treatment options best suited for complex patients are not adequately reimbursed which may have implications on healthcare delivery and outcomes. SUMMARY Inadequate reimbursement for certain BPH procedures may disincentivize the care of complex patients. Procedures such a holmium laser enucleation of the prostate are well suited for complex patients but have a steep learning curve. The incentive to learn and offer such procedures to complex patients may be unfairly influenced by reimbursement levels, which in the end penalizes patients and the treatments available to them.
Collapse
Affiliation(s)
- Gopal Narang
- Mayo Clinic Arizona Department of Urology, Phoenix, Arizona
| | | | - Amy Krambeck
- Northwestern Department of Urology, Chicago, Illinois, USA
| | | |
Collapse
|
14
|
Petov V, Babaevskaya D, Taratkin MS, Chuvalov L, Lusuardi L, Misrai V, Sukhanov R, Scoffone C, Enikeev D. Thulium fiber laser enucleation of the prostate (ThuFLEP). Prospective study of mid- and long-term outcomes in 1328 patients. J Endourol 2022; 36:1231-1236. [PMID: 35414204 DOI: 10.1089/end.2022.0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). MATERIALS AND METHODS We analysed patients who underwent ThuFLEP due to LUTS related to BPO. Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, post-void residual (PVR), Qmax, IPSS and QoL, PSA level and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization and data on hospital stays were also collected. A sub-group analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. RESULTS A total of 1328 patients were included in the analysis. The mean age was 66.9±7.5 years. Mean prostate volume was 86.9±41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p<0.05) and showed durable improvement up to 3-years of follow-up. The frequency of late complications was as follows: stress urinary incontinence - 1.2%; urethral stricture -1.1%; bladder neck contracture - 0.9%. Sub-group analyses revealed increased UTI frequency in older patients (3.5% vs 0.8%, p=0.003) as well as higher rate of SUI (0.4% vs 1.8%, p=0.002) and higher rate of clot retention (11.3% vs 4.4%, p<0.001) in those with larger glands. CONCLUSIONS Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be considered to be a promising alternative to HoLEP for treatment of LUTS associated with BPO.
Collapse
Affiliation(s)
- Vladislav Petov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Diana Babaevskaya
- Sechenov University, 68477, Institute for Clinical Medicine, Trubetskaya, 8, Moscow, Russian Federation, 119048;
| | - Mark Sergeevich Taratkin
- Sechenov University, Institute for Urology and Reproductive Health, 2/1 Bolshaya Pirogovskaya St., Moscow, Russian Federation, 119991;
| | - Leonid Chuvalov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Lukas Lusuardi
- Paracelsius Medical University, Urology and Andrology, Müllner Hauptstraße 48, Salzburg, Austria, 5020;
| | - Vincent Misrai
- Clinique Pasteur, 54918, Service d'Urologie, Toulouse, Midi-Pyrénées, France;
| | - Roman Sukhanov
- Sechenov University, 68477, Institute for Urology and Reproductive Health, Moskva, Moskva, Russian Federation;
| | - Cesare Scoffone
- Cottolengo Hospital, Division of Urology, via Cottolengo 9, Torino, Torino, Italy, 10152;
| | - Dmitry Enikeev
- I.M. Sechenov First Moscow State Medical University, Research Institute of Uronephrology and Reproductive Health, Bolshaya Pirogovskaya street 2, building 1, Moscow, Russian Federation, 119435;
| |
Collapse
|
15
|
Kim DK, Park JJ, Yang WJ, Doo SW, Kim JH, Song YS. Changes in diagnosis rate and treatment trends of benign prostatic hyperplasia in Korea: A nationwide population-based cohort study. Prostate Int 2021; 9:215-220. [PMID: 35059360 PMCID: PMC8740390 DOI: 10.1016/j.prnil.2021.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/24/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to evaluate benign prostatic hyperplasia (BPH) diagnosis rate and the changing landscape of medical and surgical management of BPH over the last decade using national population data of South Korea. Methods The present study analyzed data of patients diagnosed with BPH (N40) who underwent medical treatment or surgery in 3% of the national patient sample of the Health Insurance and Review Assessment database each year between 2012 and 2018. The primary outcome was the proportion of medical and surgical treatment for BPH. It was evaluated each year between 2012 and 2018. Secondary outcomes included total BPH diagnosis rate in each year of the study period. BPH diagnosis rate by age group was evaluated. The proportion of medical and surgical treatment for BPH according to the type of medical institution was investigated. Results The proportion of surgical treatment was 1.2% in 2012, 1.0% in 2013, 1.0% in 2014, 0.9% in 2015, 0.8% in 2016, 0.7% 2018, and 0.8% 2018, showing a progressive overall decrease from 2012 to 2018. The rate of surgical treatment for BPH increased with increasing age during the study period, showing a progressive overall increase (from 9,202 per 100,000 men in 2012 to 11,610 per 100 000 men in 2018). The number of patients with BPH was increased steadily from 2012 to 2018 in all age groups. The rate of surgical treatment in tertiary referral hospitals was the highest during the study period, followed by that in general hospitals, hospitals, and clinics. Conclusions In Korea, the diagnosis rate of BPH was steadily increasing during the study period. Overall surgical treatment gradually decreased compared with an increase in medical treatment among all treatments for BPH. Thus, a comprehensive treatment plan for BPH should be established considering this trend.
Collapse
Affiliation(s)
- Do Kyung Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Jae Joon Park
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
- Urological Biomedicine Research Institute, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, Korea
- Corresponding author. Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, 59, Daesagwan-ro, Yongsan-gu, Seoul, Korea.
| |
Collapse
|
16
|
Cui J, Cao D, Bai Y, Wang J, Yin S, Wei W, Xiao Y, Wang J, Wei Q. Efficacy and Safety of 12-week Monotherapy With Once Daily 5 mg Tadalafil for Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: Evidence-based Analysis. Front Med (Lausanne) 2021; 8:744012. [PMID: 34712682 PMCID: PMC8545998 DOI: 10.3389/fmed.2021.744012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Tadalafil has been approved for the treatment of benign prostatic hyperplasia (BPH) for nearly 10 years. However, there are insufficient evidence-based studies of the efficacy and safety of tadalafil in treating lower urinary tract symptoms of BPH (LUTS/BPH). Objective: To evaluate the therapeutic effect and clinical safety of tadalafil monotherapy (5 mg once daily for 12 weeks) for LUTS/BPH. Methods: A total of 13 studies (15 randomized clinical trials [RCTs]) were extracted from the following databases: PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science for the period up to July 2021. The quality of the included RCTs was evaluated independently by two authors, who, respectively, extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles. Conflicts were settled by a discussion with two-third of senior authors. All data analyses were conducted by the Review Manager, version 5.4. Results: Regarding efficacy, 12-week trials indicated that 5 mg once daily tadalafil showed a significantly lower and, consequently, better total International Prostate Symptom Score (IPSS) than the placebo did (mean difference [MD]: -1.97, 95% CI: -2.24 to -1.70; P < 0.00001). In addition, significant differences were found between the tadalafil regimen and the placebo in the IPSS voiding subscore (MD: -1.30, 95% CI: -1.48 to -1.11; P < 0.00001), the IPSS storage subscore (MD: -0.70, 95% CI: -0.82 to -0.58; P < 0.00001), the IPSS quality of life (MD: -0.29, 95% CI: -0.35 to -0.22; P < 0.00001), and BPH impact index (MD: -0.58, 95% CI: -0.76 to -0.40; P < 0.00001). The safety analysis did not show a significant difference in serious adverse events between the two groups (risk ratio: 1.27, 95% CI: 0.80-2.01; P = 0.31), although the adverse events occurred at a higher incidence in the tadalafil group than in the placebo. Conclusions: This study demonstrates that once daily 5 mg tadalafil is a potentially effective and safe treatment choice with excellent tolerability for patients with LUTS/BPH. Systematic Review Registration: Identifier (CRD42021228840).
Collapse
Affiliation(s)
- Jianwei Cui
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Jiahao Wang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Shan Yin
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Wuran Wei
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
17
|
Adhikari B, Shrestha A, Basnet RB, Shrestha PM, Gharti BB, Shah AK. Monopolar Transurethral Resection of Prostate for Benign Prostatic Hyperplasia in Patients With and Without Preoperative Urinary Catheterization: A Prospective Comparative Study. Cureus 2021; 13:e16705. [PMID: 34466330 PMCID: PMC8397814 DOI: 10.7759/cureus.16705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background A significant proportion of patients undergo surgery for benign prostatic hyperplasia following acute urinary retention. Studies have reported conflicting results of improvement following transurethral surgery in these patients. Objective To compare perioperative complications and postoperative voiding parameters in patients undergoing monopolar transurethral resection of prostate with and without preoperative Foley catheterization. Methods A prospective non-randomized study was conducted in patients undergoing monopolar transurethral resection of prostate for symptomatic benign prostatic hyperplasia. Patients were divided into those with Foley catheterization preoperatively (n=52), and those without catheters (n=90). Change in hemoglobin level, the resected volume of prostate, complications and the need for postoperative catheterization were compared. Postoperative symptoms score using International Prostate Symptom Score, maximum flow rate and post-void residual volume were assessed at three months follow up. Results The mean operative duration, length of stay and resected volume were higher in those patients with catheters; however, no significant differences were noted for mean hemoglobin level change and need for postoperative recatheterization. Three patients in each group required recatheterization and, all were catheter-free at one week postoperatively. Complications developed in 16.1% (n=23) with most of them being Clavien I. Patients with catheters had a lower postoperative maximum flow rate than those without it (16.90 vs 19.75 mL/sec). Patients with catheters had a significantly better postoperative quality of life and symptom score. Conclusion Monopolar transurethral resection of prostate in patients with preoperative per-urethral Foley catheter for acute urinary retention had similar postoperative voiding parameters with comparable complication rates to those without a catheter.
Collapse
Affiliation(s)
- Baikuntha Adhikari
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Anil Shrestha
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Robin B Basnet
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Parash M Shrestha
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Binod B Gharti
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Arvind K Shah
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| |
Collapse
|
18
|
Misrai V, Rijo E, Cottenceau JB, Zorn KC, Enikeev D, Elterman D, Bhojani N, De La Taille A, Herrmann TRW, Robert G, Pradere B. A Standardized Method for Estimating the Carbon Footprint of Disposable Minimally Invasive Surgical Devices: Application in Transurethral Prostate Surgery. ANNALS OF SURGERY OPEN 2021; 2:e094. [PMID: 37635829 PMCID: PMC10455069 DOI: 10.1097/as9.0000000000000094] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
Objective To propose a standardized methodology for estimating the embodied carbon footprint (CF) of disposable minimally-invasive surgical devices (MISDs) and their application in new benign prostatic hyperplasia (BPH) MISDs. Summary of Background Data The estimation of the CO2e emissions of disposable surgical devices is central to empowering the healthcare supply chain. Methods The proposed methodology relied on a partial product lifecycle assessment and was restricted to a specific part of scope 3, which comprised the manufacturing of surgical device- and non-device-associated products (NDAPs), including packaging and user manual. The process-sum inventory method was used, which involves collecting data on all the component processes underpinning disposable MISDs. The seven latest disposable MISDs used worldwide for transurethral prostatic surgery were dismantled, and each piece was categorized, sorted into the appropriate raw material group, and weighed. The CF was estimated according to the following formula: activity data (weight of raw material) × emission factors of the corresponding raw material (kg CO2e/kg). Results The total weights of disposable packaging and user manuals ranged from 0.062 to 1.013 kg. Plastic was the most common and least emissive raw material (2.38 kg CO2e/kg) identified. The estimated embodied CF of MISDs ranged from 0.07 to 3.3 kg CO2e, of which 9% to 86% was attributed to NDAPs. Conclusions This study described a simple and independent calculation method for estimating the embodied CF of MISDs. Using this method, our results showed a wide discrepancy in the estimated CO2 emissions of the most recent disposable MISDs for transurethral BPH surgery. Thus, the lack of CF information should be of major concern in the development of future MISDs.
Collapse
Affiliation(s)
- Vincent Misrai
- From the Department of Urology, Clinique Pasteur, Toulouse, France
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | | | - Kevin C. Zorn
- Division of Urology, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | | | | | - Gregoire Robert
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
19
|
Enikeev D, Misrai V, Rijo E, Sukhanov R, Chinenov D, Gazimiev M, Taratkin M, Azilgareeva C, Morozov A, Herrmann TRW, Glybochko P. EAU, AUA and NICE Guidelines on Surgical and Minimally Invasive Treatment of Benign Prostate Hyperplasia: A Critical Appraisal of the Guidelines Using the AGREE-II Tool. Urol Int 2021; 106:1-10. [PMID: 34350885 DOI: 10.1159/000517675] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To critically appraise the methodological rigour of the clinical practice guidelines (CPGs) vis-à-vis BPH surgery as used by specialist research associations in the US, Europe and UK, and to compare whether the guidelines cover all or only some of the available treatments. METHODS The current guidelines issued by the EUA, AUA and NICE associations have been analyzed by 4 appraisers using the AGREE-II instrument. We also compared the recommendations given in the guidelines for surgical and minimally invasive treatment to find out which of these CPGs include most of the available treatment options. RESULTS According to the AGREE II tool, the median scores of domains were: domain 1 scope and purpose 66.7%, domain 2 stakeholder involvement 50.0%, domain 3 rigor of development 65.1%, domain 4 clarity of presentation 80.6%, domain 5 applicability 33.3%, domain 6 editorial independence 72.9%. The overall assessment according to AGREE II is 83.3%. The NICE guideline scored highest on 5 out of 6 domains and the highest overall assessment score (91.6%). The EAU guideline scored lowest on 4 out of 6 domains and has the lowest overall assessment score (79.1%). CONCLUSIONS The analyzed CPGs comprehensively highlight the minimally invasive and surgical treatment options for BPH. According to the AGREE II tool, the domains for clarity of presentation and editorial independence received the highest scores. The stakeholder involvement and applicability domains were ranked as the lowest. Improving the CPG in these domains may help to improve the clinical utility and applicability of CPGs.
Collapse
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Enrique Rijo
- Department of Urology, Hospital Quirón Salud, Barcelona, Spain
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Denis Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Camilla Azilgareeva
- International School "Medicine of the Future", Sechenov University, Moscow, Russian Federation
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Department of Urology, Hanover Medical School (MHH), Hanover, Germany
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| |
Collapse
|
20
|
|
21
|
Franco JV, Garegnani L, Escobar Liquitay CM, Borofsky M, Dahm P. Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2021; 6:CD004135. [PMID: 34180047 PMCID: PMC8236484 DOI: 10.1002/14651858.cd004135.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) has been the gold-standard treatment for alleviating urinary symptoms and improving urinary flow in men with symptomatic benign prostatic hyperplasia (BPH). However, the morbidity of TURP approaches 20%, and less invasive techniques have been developed for treating BPH. Transurethral microwave thermotherapy (TUMT) is an alternative, minimally-invasive treatment that delivers microwave energy to produce coagulation necrosis in prostatic tissue. This is an update of a review last published in 2012. OBJECTIVES To assess the effects of transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. SEARCH METHODS We performed a comprehensive search using 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 31 May 2021, with no restrictions by language or publication status. SELECTION CRITERIA We included parallel-group randomized controlled trials (RCTs) and cluster-RCTs of participants with BPH who underwent TUMT. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias and GRADE assessments of the certainty of the evidence (CoE). 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 symptoms scores, quality of life, major adverse events, retreatment, and ejaculatory and erectile function. MAIN RESULTS In this update, we identified no new RCTs, but we included data from studies excluded in the previous version of this review. We included 16 trials with 1919 participants, with a median age of 69 and moderate lower urinary tract symptoms. The certainty of the evidence for most comparisons was moderate-to-low, due to an overall high risk of bias across studies and imprecision (few participants and events). TUMT versus TURP Based on data from four studies with 306 participants, when compared to TURP, TUMT probably results in little to no difference in urologic symptom scores measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms at short-term follow-up (mean difference (MD) 1.00, 95% confidence interval (CI) -0.03 to 2.03; moderate certainty). There is likely to be little to no difference in the quality of life (MD -0.10, 95% CI -0.67 to 0.47; 1 study, 136 participants, moderate certainty). TUMT likely results in fewer major adverse events (RR 0.20, 95% CI 0.09 to 0.43; 6 studies, 525 participants, moderate certainty); based on 168 cases per 1000 men in the TURP group, this corresponds to 135 fewer (153 to 96 fewer) per 1000 men in the TUMT group. TUMT, however, probably results in a large increase in the need for retreatment (risk ratio (RR) 7.07, 95% CI 1.94 to 25.82; 5 studies, 337 participants, moderate certainty) (usually by repeated TUMT or TURP); based on zero cases per 1000 men in the TURP group, this corresponds to 90 more (40 to 150 more) per 1000 men in the TUMT group. There may be little to no difference in erectile function between these interventions (RR 0.63, 95% CI 0.24 to 1.63; 5 studies, 337 participants; low certainty). However, TUMT may result in fewer cases of ejaculatory dysfunction compared to TURP (RR 0.36, 95% CI 0.24 to 0.53; 4 studies, 241 participants; low certainty). TUMT versus sham Based on data from four studies with 483 participants we found that, when compared to sham, TUMT probably reduces urologic symptom scores using the IPSS at short-term follow-up (MD -5.40, 95% CI -6.97 to -3.84; moderate certainty). TUMT may cause little to no difference in the quality of life (MD -0.95, 95% CI -1.14 to -0.77; 2 studies, 347 participants; low certainty) as measured by the IPSS quality-of-life question on a scale from 0 to 6, with higher scores indicating a worse quality of life. We are very uncertain about the effects on major adverse events, since most studies reported no events or isolated lesions of the urinary tract. TUMT may also reduce the need for retreatment compared to sham (RR 0.27, 95% CI 0.08 to 0.88; 2 studies, 82 participants, low certainty); based on 194 retreatments per 1000 men in the sham group, this corresponds to 141 fewer (178 to 23 fewer) per 1000 men in the TUMT group. We are very uncertain of the effects on erectile and ejaculatory function (very low certainty), since we found isolated reports of impotence and ejaculatory disorders (anejaculation and hematospermia). There were no data available for the comparisons of TUMT versus convective radiofrequency water vapor therapy, prostatic urethral lift, prostatic arterial embolization or temporary implantable nitinol device. AUTHORS' CONCLUSIONS TUMT provides a similar reduction in urinary symptoms compared to the standard treatment (TURP), with fewer major adverse events and fewer cases of ejaculatory dysfunction at short-term follow-up. However, TUMT probably results in a large increase in retreatment rates. Study limitations and imprecision reduced the confidence we can place in these results. Furthermore, most studies were performed over 20 years ago. Given the emergence of newer minimally-invasive treatments, high-quality head-to-head trials with longer follow-up are needed to clarify their relative effectiveness. Patients' values and preferences, their comorbidities and the effects of other available minimally-invasive procedures, among other factors, can guide clinicians when choosing the optimal treatment for this condition.
Collapse
Affiliation(s)
- Juan Va Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Garegnani
- Research Department, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | | | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
22
|
McClintock G, Wong E, Mancuso P, Lalak N, Gassner P, Haghighi K, Rathore P, McAulay L, Jeffery N. Music during flexible cystoscopy for pain and anxiety - a patient-blinded randomised control trial. BJU Int 2021; 128 Suppl 1:27-32. [PMID: 34174137 DOI: 10.1111/bju.15527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To assess the role of music in reducing the pain and anxiety associated with flexible cystoscopy using a blinded trial design. PATIENTS AND METHODS A patient-blinded randomised control trial of music during flexible cystoscopy was performed comparing the pain, measured by visual analogue scale (VAS), anxiety, measured by the State-Trait Anxiety Inventory (STAI), and vital signs of 109 patients across two public hospitals in New South Wales, Australia. The purpose and hypothesis of the study was concealed from patients until after results had been collected. RESULTS There were no statistically significant differences detected between the No Music and Music groups in VAS pain score (mean [SD] 2.04 [1.94] vs 2.10 [1.90], P = 0.86), change in STAI anxiety score (mean [SD] 4.87 [9.87] vs 6.8 [11.07], P = 0.33) or post-procedural vital signs (mean [SD] heart rate 74 [14] vs 72 [13] beats/min, P = 0.66; systolic blood pressure 144 [20] vs 141 [19] mmHg, P = 0.47) between the two groups. CONCLUSION Music does not appear to decrease perceived pain or anxiety when used during flexible cystoscopy. These findings may differ from the literature due to several factors, most significantly blinding of participants, but also potentially due to the ethnic composition of the study population or lack of choice of music.
Collapse
Affiliation(s)
| | - Eddy Wong
- Liverpool Hospital, Sydney, NSW, Australia
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Atamian A, Fourmarier M, Alegorides C, Bottet F, Arroua F, Eghazarian C, Baboudjian M. Holmium laser enucleation and water vapor thermal therapy for the treatment of symptomatic benign prostatic hyperplasia: A cost analysis. Prog Urol 2021; 32:198-204. [PMID: 34148770 DOI: 10.1016/j.purol.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To perform a cost analysis of the current gold standard operation of Holmium Laser Enucleation of the prostate (HoLEP) compared to the new technique of water vapor thermal therapy with the Rezum™ system for the treatment of symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between October 2017 and January 2020, consecutive patients with invalidating lower urinary tract symptoms due to BPH who underwent Rezūm™ and HoLEP procedures from the Aix regional hospital were identified. The outcome of each technique was assessed in terms of cost from the institutional perspective. Detailed expense reports based were provided by the accounts department of the hospital. These were used to compare in-hospital costs for each procedure. RESULTS A total of 53 and 94 consecutive patients underwent respectively water vapor thermal therapy and HoLEP. The median costs for the surgical procedure were €1344 (IQR 1331-1361) and €669 (IQR 584-824), respectively for Rezūm™ and HoLEP (median difference €675; P<0.001). The median costs of the hospital stay were €869 (IQR 869-869) for Rezūm™ and €1295 (IQR 1295-1330) for HoLEP (median difference €426; P<0.001). Finally, the median total costs per patient were lower for HoLEP (€2005 [IQR 1902-2150]) than for Rezūm™ (€2228 [IQR 2209-2243]) procedure, and the median difference of €233 was significant (P<0.001). CONCLUSIONS One of the anticipated benefits of Rezūm™, reduced length of hospital stay with an associated reduction in cost, did not materialize within this study. The patient's clinical condition and expectations should also be taken into account when deciding between Rezum™ and standard therapies. LEVEL OF PROOF 3.
Collapse
Affiliation(s)
- A Atamian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Fourmarier
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Alegorides
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Bottet
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Arroua
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Eghazarian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Baboudjian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France; Department of urology and kidney transplantation, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France.
| |
Collapse
|
24
|
Phua TJ. The Etiology and Pathophysiology Genesis of Benign Prostatic Hyperplasia and Prostate Cancer: A New Perspective. MEDICINES 2021; 8:medicines8060030. [PMID: 34208086 PMCID: PMC8230771 DOI: 10.3390/medicines8060030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/31/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
Background: The etiology of benign prostatic hyperplasia and prostate cancer are unknown, with ageing being the greatness risk factor. Methods: This new perspective evaluates the available interdisciplinary evidence regarding prostate ageing in terms of the cell biology of regulation and homeostasis, which could explain the timeline of evolutionary cancer biology as degenerative, inflammatory and neoplasm progressions in these multifactorial and heterogeneous prostatic diseases. Results: This prostate ageing degeneration hypothesis encompasses the testosterone-vascular-inflamm-ageing triad, along with the cell biology regulation of amyloidosis and autophagy within an evolutionary tumorigenesis microenvironment. Conclusions: An understanding of these biological processes of prostate ageing can provide potential strategies for early prevention and could contribute to maintaining quality of life for the ageing individual along with substantial medical cost savings.
Collapse
Affiliation(s)
- Teow J Phua
- Molecular Medicine, NSW Health Pathology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| |
Collapse
|
25
|
Andreis F, Bryant R, Giorgi E, Williamson AE, Ward A. Prescribing patterns for medical treatment of suspected prostatic obstruction: a longitudinal register-based study of the Scottish Health and Social Care Open Data. BMJ Open 2021; 11:e042606. [PMID: 33589459 PMCID: PMC7887341 DOI: 10.1136/bmjopen-2020-042606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services; however, there is limited knowledge of differences in pharmacotherapy prescribing for this condition based on geography. OBJECTIVE To investigate potential variation in drug prescribing for suspected bladder outflow obstruction in Scotland, based on analysis of publicly available data, to identify trends and inform future prescribing. STUDY DESIGN A longitudinal register-based data study of prescribing and patient data publicly available from Scottish registries. All information is available as monthly aggregates at the level of single general practices. SETTING AND PARTICIPANTS 903 (97%) general practices in Scotland, over a 50-month period (October 2015 to November 2019). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We analysed numbers of daily doses of drugs for suspected bladder outflow obstruction prescribed per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements. RESULTS Prescriptions for suspected bladder outflow obstruction medications increased during the observation period (overall average rate of change 1.24±0.28, ranging from 0.893 in Orkney to 1.95 in Lanarkshire). While some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice-specific and patient-specific characteristics such as deprivation and rurality. CONCLUSIONS Inequalities in prescribing for suspected bladder outflow obstruction medications exist in Scotland, partially ascribable to accepted sociodemographic and geographic factors.
Collapse
Affiliation(s)
| | - Richard Bryant
- Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
- Urology, Churchill Hospital, Oxford, UK
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Andrea E Williamson
- GPPC, School of Medicine, Dentistry and Nursing, MVLS, University of Glasgow, Glasgow, UK
| | - Ashleigh Ward
- School of Health Sciences, University of Dundee, Dundee, UK
| |
Collapse
|
26
|
Peng ZF, Zhou J, Song P, Yang LC, Yang B, Ren ZJ, Wang LC, Wei Q, Dong Q. Retrospective analysis of the changes in the surgical treatment of benign prostatic hyperplasia during an 11-year period: a single-center experience. Asian J Androl 2021; 23:294-299. [PMID: 33159026 PMCID: PMC8152423 DOI: 10.4103/aja.aja_68_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The present study aimed to determine whether the number of patients with symptomatic benign prostatic hyperplasia (BPH) who preferred surgery decreased during the past 11 years at our center (West China Hospital, Chengdu, China), and whether this change affected the timing of surgery and the physical condition of surgical patients. This retrospective study included 57 557 patients with BPH treated from January 2008 to December 2018. Of these, 5427 patients were treated surgically. Surgical patients were divided into two groups based on the time of treatment (groups 8–13 and groups 13–18). The collected data comprised the percentage of all patients with BPH who underwent surgery, baseline characteristics of surgical patients, rehabilitation time, adverse events, and hospitalization costs. The surgery rates in groups 8–13 and groups 13–18 were 10.5% and 8.5% (P < 0.001), respectively. The two groups did not clinically differ regarding patient age and prostate volume. The rates of acute urinary retention and renal failure decreased from 15.0% to 10.6% (P < 0.001) and from 5.2% to 3.1% (P < 0.001), respectively. In groups 8–13 and groups 13–18, the mean catheterization times were 4.0 ± 1.7 days and 3.3 ± 1.6 days (P < 0.001), respectively, and the mean postoperative hospitalization times were 5.1 ± 2.4 days and 4.2 ± 1.8 days (P < 0.001), respectively. The incidences of unplanned second surgery and death reduced during the study period. The surgery rate decreased over time, which suggests that medication was chosen over surgery. However, the percentage of late complications of BPH also decreased over time, which indicates that the timing of surgery was not delayed.
Collapse
Affiliation(s)
- Zhu-Feng Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jing Zhou
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pan Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lu-Chen Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zheng-Ju Ren
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin-Chun Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Dong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
27
|
Morton A, Gordon L, Fowler R, Esler R, Dunglison N, Roberts MJ. Images - Acute urinary retention due to urethral steinstrasse. Can Urol Assoc J 2020; 15:E299-E300. [PMID: 33119499 DOI: 10.5489/cuaj.6725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew Morton
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Lachlan Gordon
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Ross Fowler
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Rachel Esler
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Nigel Dunglison
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia.,The University of Queensland Centre for Clinical Research, Herston, Australia
| |
Collapse
|
28
|
Lawrentschuk N. COVID-19 and urology in Australia and New Zealand: uncertain times. BJU Int 2020; 126 Suppl 1:4-5. [PMID: 32935444 DOI: 10.1111/bju.15189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nathan Lawrentschuk
- University of Melbourne, Melbourne, Vic., Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, Vic., Australia
| |
Collapse
|
29
|
Bladder infusion versus standard catheter removal for trial of void: a systematic review and meta-analysis. World J Urol 2020; 39:1781-1788. [PMID: 32797262 DOI: 10.1007/s00345-020-03408-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare the efficacy and time-to-discharge of two methods of trial of void (TOV): bladder infusion versus standard catheter removal. METHODS Electronic searches for randomized controlled trials (RCTs) comparing bladder infusion versus standard catheter removal were performed using multiple electronic databases from dates of inception to June 2020. Participants underwent TOV after acute urinary retention or postoperatively after intraoperative indwelling catheter (IDC) placement. Quality assessment and meta-analyses were performed, with odds ratio and mean time difference used as the outcome measures. RESULTS Eight studies, comprising 977 patients, were included in the final analysis. Pooled meta-analysis demonstrated that successful TOV was significantly higher in the bladder infusion group compared to standard TOV (OR 2.41, 95% CI 1.53-3.8, p = 0.0005), without significant heterogeneity (I2=19%). The bladder infusion group had a significantly shorter time-to-decision in comparison to standard TOV (weighted mean difference (WMD)-148.96 min, 95% CI - 242.29, - 55.63, p = 0.002) and shorter time-to-discharge (WMD - 89.68 min, 95% CI - 160.55, - 18.88, p = 0.01). There was no significant difference in complication rates between the two groups. CONCLUSION The bladder infusion technique of TOV may be associated with a significantly increased likelihood of successful TOV and reduced time to discharge compared to standard TOV practices.
Collapse
|
30
|
Morton A, Williams M, Perera M, Ranasinghe S, Teloken PE, Williams M, Chung E, Roberts MJ. A National Analysis of Temporal Changes in Prescribing of Testosterone Replacement Therapy Considering Methods of Delivery and Government Regulation. World J Mens Health 2020; 39:83-89. [PMID: 32777869 PMCID: PMC7752513 DOI: 10.5534/wjmh.190166] [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: 12/29/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Testosterone replacement therapy (TRT) is commonly used for various causes of androgen deficiency and subsidized by the Pharmaceutical Benefits Scheme (PBS) in Australia when appropriate. In response to a sharp increase in the prescribing of subsidized TRT, the Australian government instituted new, stricter prescription criteria in April 2015. We aim to demonstrate longitudinal changes in the prescription patterns of subsidized TRT over time. Materials and Methods The publicly available PBS database was accessed for TRT prescription data between 1992–2018. Population estimate data was collected from the Australian Bureau of Statistics for population-adjustment. Data analysis was performed according to class and specific formulation of TRT. Total and population-adjusted trends were considered, as was indexation to 2015 when restrictions were implemented. Results Longitudinal trends in subsidized TRT prescription demonstrated a progressive overall increase since 2000, according to total prescriptions and population-adjusted estimates, with greater use of topical formulations (gel, patch, cream/spray) and injections. Since 2015, a 37% decline in total population-adjusted prescriptions was observed (1,399–883 per 100,000 persons). Since 2015, relatively increased use of injections (50%) and 1% gel (30%) comprise the majority of contemporary TRT. Annual financial burden due to TRT was $AU16,768 per 100,000 persons prior to 2000 (mean cost 1992–2000), increasing to $AU112,539 in 2018 (due to use of injections). The rate of change in costs slowed after the restrictions were introduced in 2015. Conclusions The restrictions in subsidized TRT eligibility enforced by the PBS have reduced overall TRT prescriptions and slowed the cumulative financial burden.
Collapse
Affiliation(s)
- Andrew Morton
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michael Williams
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marlon Perera
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Sachinka Ranasinghe
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Patrick E Teloken
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Eric Chung
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Andro Urology Centre, Brisbane, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Nepean Urology Research Group, Nepean Hospital, Kingswood, Australia.,Centre for Clinical Research and Faculty of Medicine, The University of Queensland, Herston, Australia.
| |
Collapse
|
31
|
Madersbacher S, Roehrborn CG, Oelke M. The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU Int 2020; 126:317-326. [DOI: 10.1111/bju.15154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Stephan Madersbacher
- Department of Urology; Kaiser Franz Josef Hospital; Sigmund Freud Private University; Vienna Austria
| | | | - Matthias Oelke
- Department of Urology; St. Antonius Hospital; Gronau Germany
| |
Collapse
|