1
|
Hamed Ibrahim W, Abduljawad H, Mohamed H, Jamsheer N, Elsayed Elnaggar M. Prostatic Artery Embolization for the Treatment of Benign Prostate Hyperplasia: Initial Experience From Bahrain. Cureus 2022; 14:e22593. [PMID: 35371804 PMCID: PMC8958120 DOI: 10.7759/cureus.22593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/05/2022] Open
|
2
|
Clements HA, Nabi G. Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes. Scott Med J 2021; 67:30-37. [PMID: 34939516 DOI: 10.1177/00369330211068123] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are limited options for men with large benign prostates (>150cc) and bladder outflow obstruction due to benign prostatic hyperplasia (BPH). Management options include surgery (open or minimal access) and endoscopic procedures. There is a paucity of literature on outcomes for prostates >150cc. METHODS In this case series we describe a step-by-step, illustrated, modified extra-peritoneal technique of laparoscopic prostatectomy with preservation of the posterior prostatic urethra. This involves creation of extra-peritoneal space, transverse incision of prostate capsule, progressive adenoma dissection, resection, and closure of the capsule. RESULTS Ten patients underwent this procedure between 2015 and 2019. The mean age was 72.4 years and mean prostate size was 215.5cc. Mean procedure duration was 200 min and there were no intraoperative complications. Most patients were discharged on postoperative day 1. Mean intraoperative blood loss was 120 ml with no patient requiring blood transfusion. At follow up (mean 37 months) no patients had residual symptoms of BPH. CONCLUSION We describe a novel extraperitoneal laparoscopic technique for benign prostates of >150cc with very good outcomes. The transferability of this technique to centres with laparoscopic expertise at minimal extra cost and future adaptability in the robotic setting are some of the advantages of this technique.
Collapse
Affiliation(s)
- Hollie A Clements
- Foundation Doctor, 59805Ninewells Hospital and Medical School, Dundee
| | - Ghulam Nabi
- Professor of Surgical Uro-oncology, 59805Ninewells Hospital and Medical School, Dundee
| |
Collapse
|
3
|
Letkiewicz S, Pilis K, Ślęzak A, Pilis A, Pilis W, Żychowska M, Langfort J. Eight Days of Water-Only Fasting Promotes Favorable Changes in the Functioning of the Urogenital System of Middle-Aged Healthy Men. Nutrients 2020; 13:nu13010113. [PMID: 33396948 PMCID: PMC7824351 DOI: 10.3390/nu13010113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to determine whether, after 8 days of water-only fasting, there are changes in the efficiency of the lower urinary tract, the concentration of sex hormones, and the symptoms of prostate diseases in a group of middle-aged men (n = 14). For this purpose, before and after 8 days of water-only fasting (subjects drank ad libitum moderately mineralized water), and the following somatic and blood concentration measurements were made: total prostate specific antigen (PSA-T), free prostate specific antigen (PSA-F), follicle stimulating hormone (FSH), luteotropic hormone (LH), prolactin (Pr), total testosterone (T-T), free testosterone (T-F), dehydroepiandrosterone (DHEA), sex hormone globulin binding (SHGB), total cholesterol (Ch-T), β-hydroxybutyrate (β-HB). In addition, prostate volume (PV), volume of each testis (TV), total volume of both testes (TTV), maximal urinary flow rate (Qmax), and International Prostate Symptom Score (IPSS) values were determined. The results showed that after 8 days of water-only fasting, Qmax and IPSS improved but PV and TTV decreased significantly. There was also a decrease in blood levels of PSA-T, FSH, P, T-T, T-F, and DHEA, but SHGB concentration increased significantly. These results indicate that 8 days of water-only fasting improved lower urinary tract functions without negative health effects.
Collapse
Affiliation(s)
- Sławomir Letkiewicz
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
- Urological and Andrological Clinic “Urogen”, 42-600 Tarnowskie Góry, Poland
| | - Karol Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
- Correspondence: ; Tel.: +48-34-365-5983 or +48-508-204-403
| | - Andrzej Ślęzak
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Anna Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Wiesław Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Małgorzata Żychowska
- Faculty of Physical Education, Department of Sport, Kazimierz Wielki University in Bydgoszcz, 85-091 Bydgoszcz, Poland;
| | - Józef Langfort
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
| |
Collapse
|
4
|
Wong A, Mahmalji W. The role of Rezūm ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review. Aging Male 2020; 23:1620-1626. [PMID: 33818292 DOI: 10.1080/13685538.2021.1901273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Acute urinary retention (AUR) is one of the most significant complication of benign prostatic hyperplasia (BPH). The gold standard surgical treatment for BPH, transurethral resection of the prostate (TURP), is not without significant side effects and a prolonged hospital stay. The aim of this study is to evaluate the role of Rezūm ™ steam ablation in the treatment of patients with AUR secondary to BPH. METHODS Patients who developed AUR and failed their trial without a catheter (TWOC) were recruited. They were counselled about the procedure and offered the treatment. Pre-operative, intraoperative and post operate data were collected. RESULTS All patients were followed up for a mean period of 7.2 months. 100% of patients passed their TWOC and stopped taking any BPH medications after. There was an average of 43.8% decrease in TRUS volume and a fall of 52.5% in PSA value after intervention. The mean operation time was 8.8 min and mean duration in hospital was 5.8 h. No deterioration in sexual function was reported. CONCLUSIONS Rezūm ™ steam ablation of the prostate is safe, fast and effective day case procedure in treating patients with AUR secondary to BPH. All patients were satisfied with the functional outcomes.
Collapse
Affiliation(s)
- Anton Wong
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Wasim Mahmalji
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| |
Collapse
|
5
|
Abstract
OBJECTIVES To present historical and contemporary hypotheses on the pathogenesis of benign prostatic hyperplasia (BPH), and the potential implications for current medical therapies. METHODS The literature on BPH was reviewed. BPH is a prevalent disease with significant health and economic impacts on patients and health organisations across the world, whilst the cause/initiation of the disease process has still not been fully determined. RESULTS In BPH, pathways involving androgens, oestrogens, insulin, inflammation, proliferative reawakening, stem cells and telomerase have been hypothesised in the pathogenesis of the disease. A number of pathways first described >40 years ago have been first rebuked and then have come back into favour. A system of an inflammatory process within the prostate, which leads to growth factor production, stem cell activation, and cellular proliferation encompassing a number of pathways, is currently in vogue. This review also highlights the physiology of the prostate cell subpopulations and how this may account for the delay/failure in treatment response for certain medical therapies. CONCLUSION BPH is an important disease, and as the pathogenesis is not fully understood it impacts the effectiveness of medical therapies. This impacts patients, with further research potentially highlighting novel therapeutic avenues.
Collapse
Affiliation(s)
- Conor M Devlin
- Cancer Research Unit, Department of Biology, University of York, York, UK.,Urology Department, Castle Hill Hospital, Cottingham, UK
| | | | - Norman J Maitland
- Cancer Research Unit, Department of Biology, University of York, York, UK
| |
Collapse
|
6
|
Burnett AL, Walker DR, Feng Q, Johnston KM, Lozano-Ortega G, Nimke D, Hairston JC. Undertreatment of overactive bladder among men with lower urinary tract symptoms in the United States: A retrospective observational study. Neurourol Urodyn 2020; 39:1378-1386. [PMID: 32383533 PMCID: PMC7384148 DOI: 10.1002/nau.24348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/21/2020] [Indexed: 01/18/2023]
Abstract
Aims To characterize the epidemiology and treatment patterns of adult men (≥40 years) diagnosed with, or treated for, overactive bladder (OAB) and/or benign prostatic hyperplasia (BPH). Methods This retrospective observational study used data extracted from the IBM MarketScan Commercial Claims and Encounters database and the Medicare Supplemental Coordination of Benefits database. Men with BPH and/or OAB were identified and observed to assess treatment and diagnostic patterns. Results Within the entire study sample (N = 462 400), BPH diagnosis (61.5%) and BPH treatment (73.7%) were more common than the corresponding values for OAB (25.8% and 7.0%, respectively). Notably, among diagnosed individuals, the dispensation of a corresponding treatment was more likely in individuals diagnosed with BPH (183 672 out of 284 416 = 64.6%) compared with OAB (16 468 out of 119 236 = 13.8%). Among newly diagnosed and/or treated patients (n = 196 576), only 60.3% received treatment. Among treated patients, most experienced only a single type of treatment (93.4%), 6.6% went on to receive a secondary treatment and 3.5% a tertiary. The most common primary treatment was alpha‐blocker monotherapy (76.9%) followed by tadalafil monotherapy (16.4%). Among those untreated at first diagnosis, the median time between diagnosis and treatment initiation was 128 days. Conclusions Diagnosis and management of OAB among males are challenging given the inherent overlap in symptoms observed with BPH. Unsurprisingly, we found that BPH is diagnosed and treated more frequently than OAB; but the differences between diagnosis and treatment patterns for the two conditions highlight the potential undertreatment of OAB and misdirection of therapy for men with a combination of voiding and storage symptoms.
Collapse
Affiliation(s)
- Arthur L Burnett
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David R Walker
- Department of Urology, Astellas Pharma Global Development Inc, Northbrook, Illinois
| | - Qi Feng
- Department of Urology, Astellas US LLC, Northbrook, Illinois
| | - Karissa M Johnston
- Department of Urology, Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada
| | - Greta Lozano-Ortega
- Department of Urology, Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada
| | - David Nimke
- Department of Urology, Astellas US LLC, Northbrook, Illinois
| | - John C Hairston
- Department of Urology, Astellas Pharma Global Development Inc, Northbrook, Illinois
| |
Collapse
|
7
|
Shim M, Bang WJ, Oh CY, Lee YS, Cho JS. Correlation between prostatic urethral angulation and symptomatic improvement after surgery in patients with lower urinary tract symptoms according to prostate size. World J Urol 2019; 38:1997-2003. [PMID: 31646381 DOI: 10.1007/s00345-019-02990-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/13/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To investigate the effect of prostate anatomical factors on the changes in lower urinary tract symptoms (LUTS) and uroflowmetric values after surgery. METHODS The medical records of 448 patients who underwent transurethral resection of the prostate (TURP) from January 2006 to December 2018 were analyzed retrospectively. Changes in the International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual urine volume (PVR) at 3 months after TURP were evaluated. Prostate volume, intravesical prostatic protrusion (IPP), and prostatic urethral angulation (PUA) were measured using transrectal ultrasonography, and their effect on the changes in LUTS after TURP was analyzed using multivariable linear regression. RESULTS Among patients with prostate volume < 50 mL, preoperative IPSS total score (IPSS-t), voiding symptom score (IPSS-vs), and storage symptom score (IPSS-ss) were significantly better in patients with a smaller PUA (< 51°) than in those with a larger PUA (≥ 51°) (p = 0.001, < 0.001, and 0.020, respectively). Changes in IPSS-t, IPSS-vs, IPSS-ss, and PVR at 3 months after TURP were significantly correlated with PUA (p ≤ 0.001, < 0.001, 0.048, and 0.012, respectively). Multivariable linear regression revealed PUA to be independently associated with changes in IPPS-t and IPSS-vs (p = 0.025 and < 0.001, respectively) only in patients with prostate volume < 50 mL. CONCLUSION Prostatic urethral angulation was significantly associated with postoperative changes in LUTS only in patients with small prostate, and had no clinical significance in patients with large prostate. In patients with small prostate and large PUA, surgery should actively be considered.
Collapse
Affiliation(s)
- Myungsun Shim
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Cheol Young Oh
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea.
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| |
Collapse
|
8
|
Abstract
Background: Transurethral resection of the prostate (TURP) is 'Gold Standard' treatment for moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) with bladder-outlet obstruction (BOO). However, TURP is associated with a risk of complications, so minimally invasive methods have been developed. Prostate artery embolization (PAE) is a new minimally invasive procedure. This study reports the outcomes of PAE when introduced in a 'real life' clinical setting in a Swedish County hospital. Methods: A prospective, single-center, single-arm study in a consecutive vascular-anatomy 'all comers' population, eligible for TURP or adenomaenukleation, but unsuitable for this, treated with PAE from January 2015 to June 2018. Defined improvement of IPSS/QoL scores, or freedom from urinary catheter if previous urinary catheter-dependent, or clean intermittent catheterization (CIC) were considered as clinically successful treatments. PAE was performed until arterial stasis using the Perfected technique. Most patients were treated during a day-care procedure. Results: Of 37 treated men, bilateral PAEs were achieved in 32 patients, unilateral PAEs in four patients, and bilateral failure in one patient due to difficult vascular anatomy. Clinically successful treatment was achieved in 84%, without serious adverse events. Conclusions: PAE was introduced in Sweden, showing PAE as a novel and good minimally invasive alternative in treatment of symptomatic BPH, possible to perform as a day-care procedure.
Collapse
Affiliation(s)
- Hans Lindgren
- a Department of Clinical Sciences, Faculty of Medicine , Lund University , Lund , Sweden.,b Department of Surgery, Section of Interventional Radiology , Helsingborg Hospital , Helsingborg , Sweden
| | - Mats Bläckberg
- a Department of Clinical Sciences, Faculty of Medicine , Lund University , Lund , Sweden.,c Department of Urology , Helsingborg Hospital , Helsingborg , Sweden
| |
Collapse
|
9
|
Verze P, Califano G, Sokolakis I, Russo GI, Hatzichristodoulou G, Musi G, Creta M. The impact of surgery for lower urinary tract symptoms/benign prostatic enlargement on both erectile and ejaculatory function: a systematic review. Int J Impot Res 2019; 31:319-327. [DOI: 10.1038/s41443-019-0140-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/09/2019] [Accepted: 03/21/2019] [Indexed: 11/09/2022]
|
10
|
Moon HW, Yang JH, Choi JB, Bae WJ, Cho HJ, Hong SH, Lee JY, Kim SW, Park SH, Han K, Ha US. Prescription pattern of alpha-blockers for management of lower urinary tract symptoms/benign prostatic hyperplasia. Sci Rep 2018; 8:13223. [PMID: 30185936 PMCID: PMC6125595 DOI: 10.1038/s41598-018-31617-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/17/2018] [Indexed: 11/09/2022] Open
Abstract
This study investigated trends in the prescription of α-blockers for patients with BPH, focusing on changing patterns of prescriptions during 2002–2013 using National Health Insurance Service-National Sample Cohort data. A total of 65,596 Korean males over 50 years old diagnosed with BPH were identified from the NHIS-NSC database between 2002–2013. Patterns of each α -blocker prescription were analyzed and persistence rate, switch rate, and return rate during a follow-up period of 3 years after the first prescription were calculated. A total of 28,318 men over 50 years old (64.95 ± 9.12), changed medication within six months following the first prescription of α -blocker. (1) Tamsulosin showed the highest persistence rate when compared with other α-blockers (2) Among patients who switched to a second α-blocker, tamsulosin showed the highest return rate when compared with other α-blockers. Tamsulosin has been the most commonly prescribed α1-blocker since the mid-2000s, in line with its demonstrated highest persistence and return rates. These data probably reflect patient satisfaction with α1-blockers in the management of BPH, in which the decision to stop and switch pharmacological treatments is primarily based on changes in symptoms or side effects.
Collapse
Affiliation(s)
- Hyong Woo Moon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hyup Yang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Bong Choi
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Hyun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
11
|
Helo S, Holland B, McVary KT. Convective Radiofrequency Water Vapor Thermal Therapy with Rezūm System. Curr Urol Rep 2018; 18:78. [PMID: 28780635 DOI: 10.1007/s11934-017-0728-1] [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] [Indexed: 11/28/2022]
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are amongst the most commonly treated conditions by urologists. Minimally invasive therapies for the treatment of BPH/LUTS have garnered increased interest as new technology has emerged, improving durability, efficacy, and safety. This paper reviews the most recent literature regarding water vapor therapy, a convective thermal therapy that ablates prostatic tissue. RECENT FINDINGS The current literature includes a pilot study of 65 men and a randomized controlled trial (RCT) of 197 men investigating the efficacy and safety profile of water vapor therapy up to 2 years. Subjects treated with water vapor therapy demonstrated a 51% reduction in IPSS from baseline, sustained at 24 months (p < 0.0001). Durable improvements in max flow rate (Qmax) and quality of life (QoL) were also achieved, while no changes in sexual function were observed. Reporting of adverse events (AEs) reveals predominantly Clavien grade I complications that were self-limited. The clinical efficacy and safety of water vapor therapy are durable to 24 months making it an attractive alternative for patients seeking a minimally invasive treatment for LUTS due to BPH.
Collapse
Affiliation(s)
- Sevann Helo
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Bradley Holland
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA.
| |
Collapse
|
12
|
Park S, Kwon T, Park S, Moon KH. Efficacy of Holmium Laser Enucleation of the Prostate in Patients with a Small Prostate (≤30 mL). World J Mens Health 2017; 35:163-169. [PMID: 29164833 PMCID: PMC5746487 DOI: 10.5534/wjmh.17011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/14/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose We investigated the effects of holmium laser enucleation of the prostate (HoLEP) in patients with a small prostate (≤30 mL) in whom medical treatment was ineffective. Materials and Methods Data from 132 patients who underwent HoLEP by a single surgeon between 2012 and 2015 were retrospectively analyzed. All patients received benign prostatic hyperplasia medication for at least 6 months before surgery. The patients were divided into 2 groups according to prostate size: group 1, ≤30 mL (n=30); and group 2, >30 mL (n=102). Clinical characteristics and the International Prostate Symptom Score (IPSS), including quality of life (QoL), peak urinary flow rate (Qmax), and postvoid residual urine (PVR), before surgery and 3 months postoperatively, were compared between the 2 groups. Results In group 1, the IPSS, QoL, and PVR significantly decreased and the Qmax significantly increased 3 months after surgery. The voiding subscore also significantly decreased 3 months after surgery (p<0.001), but the storage subscore was not significantly different (p=0.055). In group 2, hemoglobin, the IPSS, QoL, and PVR significantly decreased and the Qmax significantly increased 3 months after surgery. In these patients, both the storage subscore and voiding subscore significantly decreased after surgery (both p<0.001). There were no significant differences between the groups in hemoglobin, IPSS, QoL, Qmax, and PVR either before or 3 months after surgery. Conclusions When other medical treatments are ineffective, HoLEP is an effective intervention for patients with a small prostate.
Collapse
Affiliation(s)
- Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. urofirst@hanm ail.net
| |
Collapse
|
13
|
Bardoli AD, Taylor WSJ, Mahmalji W. Can the UroLift prostatic implant device treat the symptoms of benign prostatic hypertrophy, avoid sexual dysfunction and reduce hospital TURP waiting times? A single centre, single surgeon experience and review of the literature. Aging Male 2017; 20:192-197. [PMID: 28609136 DOI: 10.1080/13685538.2017.1336531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BPH associated with LUTS and sexual dysfunction is common. We performed UroLift on 11 patients, average age 71 years (range 56-90). IPSS improved by an average of 9 points post-procedure. Pre-operatively their post-void residuals were 306.3 ml (range 120-499 ml SD [120.6]) and their QMAX was 7 ml/s (range 4-14 SD [2.8] ml/s). Post-procedure the post-void residual decreased by 35.4% at 4 months (mean difference - 106.3 ml). QMAX improved by an average of 1.7 ml/s, which was not statistically significant. No patients suffered any sexual dysfunction side effects and all patients were satisfied with their result. Hospital stay and theatre time were significantly reduced. Average length of stay was just 10.6 (6-18) hours and average theatre time just 18.7 (12-30) min. This is significantly faster than other surgery for LUTS. We therefore feel that there are significant benefits for both the patients, who are able to go home much faster, and also the hospital, who are able to perform far more surgeries for their patients. Patients also do not require an inpatient bed so patients should not be cancelled on the day of theatre.
Collapse
Affiliation(s)
- Antonio D Bardoli
- a College of Medical & Dental Sciences , University of Birmingham Medical School , Birmingham , UK
| | | | | |
Collapse
|
14
|
The significance of histological analysis following laser transurethral resection of the prostate. Int Urol Nephrol 2017; 49:1343-1346. [PMID: 28508246 DOI: 10.1007/s11255-017-1617-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Monopolar transurethral resection of the prostate is the gold standard for the treatment of benign prostatic hyperplasia. However, due to the associated risks of bleeding and TUR syndrome, laser prostate surgery is gaining popularity. We perform thulium-laser vaporesection of the prostate (TmLRP), where histological samples are generated in every case. We determined postoperative incidence and significance of prostate cancer detection, by retrospective histological examination of our cases. METHODOLOGY Between October 2006 and August 2012, 223 patients underwent TmLRP by a single surgeon in our institution. With a background of a benign DRE, and no suspicion of CaP, histological results were studied. RESULTS Mean age was 71 years (range 46-91), mean PSA was 4.1 ng/mL (range 0.1-20). 4.9% (11/223) had cancer prostate (CaP) diagnosed, with mean PSA of 6.9 ng/mL (range 0.7-14). Of these: 91% (10/11) had pT1b disease while 9% (1/11) had pT1a disease. Gleason score was 6 in 28% (3/11); 7 in 36% (4/11); 8 in 18% (2/11); 9 in and 18% (2/11). CONCLUSION 4.9% of patients had unexpected CaP, with significant disease in 4.4% (pT1b) and 3.6% (Gleason score ≥7). Hence, patients should be advised of the small risk of missing significant unsuspected CaP after laser prostatectomy.
Collapse
|
15
|
Abstract
Lower urinary tract symptoms (LUTS) are a common problem in men especially with aging. The International Continence Society (ICS) revealed an overall prevalence of LUTS of about two-thirds of men age 40 years and above. The treatment approach depends on accurate determination of the underlying etiology. LUTS is not unique to benign prostate enlargement (BPE) and can be secondary to other causes. In the era where quality of care is important, accurate diagnosis and counseling to meet patients' expectations is of extreme paramount. Thus, proper assessment of patients who present with BPE and LUTS should be an important part of the work up process. Accurate diagnosis and identification of the cause will help to improve quality of treatment, optimize counseling, and improve treatment outcomes. Pressure flow urodynamic studies (PFUDs) are not only important tools that help to identify the underlying causes of LUTS; it is considered the "gold standard" for diagnosis of bladder outlet obstruction (BOO) in patients with enlarged prostate [1, 2]. However, there is a continuous debate on the value of using PFUDs and its association with improved outcomes.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Lane A, Metcalfe C, Young GJ, Peters TJ, Blazeby J, Avery KNL, Dedman D, Down L, Mason MD, Neal DE, Hamdy FC, Donovan JL. Patient-reported outcomes in the ProtecT randomized trial of clinically localized prostate cancer treatments: study design, and baseline urinary, bowel and sexual function and quality of life. BJU Int 2016; 118:869-879. [PMID: 27415448 PMCID: PMC5113698 DOI: 10.1111/bju.13582] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives To present the baseline patient‐reported outcome measures (PROMs) in the Prostate Testing for Cancer and Treatment (ProtecT) randomized trial comparing active monitoring, radical prostatectomy and external‐beam conformal radiotherapy for localized prostate cancer and to compare results with other populations. Materials and Methods A total of 1643 randomized men, aged 50–69 years and diagnosed with clinically localized disease identified by prostate‐specific antigen (PSA) testing, in nine UK cities in the period 1999–2009 were included. Validated PROMs for disease‐specific (urinary, bowel and sexual function) and condition‐specific impact on quality of life (Expanded Prostate Index Composite [EPIC], 2005 onwards; International Consultation on Incontinence Questionnaire‐Urinary Incontinence [ICIQ‐UI], 2001 onwards; the International Continence Society short‐form male survey [ICSmaleSF]; anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), generic mental and physical health (12‐item short‐form health survey [SF‐12]; EuroQol quality‐of‐life survey, the EQ‐5D‐3L) were assessed at prostate biopsy clinics before randomization. Descriptive statistics are presented by treatment allocation and by men's age at biopsy and PSA testing time points for selected measures. Results A total of 1438 participants completed biopsy questionnaires (88%) and 77–88% of these were analysed for individual PROMs. Fewer than 1% of participants were using pads daily (5/754). Storage lower urinary tract symptoms were frequent (e.g. nocturia 22%, 312/1423). Bowel symptoms were rare, except for loose stools (16%, 118/754). One third of participants reported erectile dysfunction (241/735) and for 16% (118/731) this was a moderate or large problem. Depression was infrequent (80/1399, 6%) but 20% of participants (278/1403) reported anxiety. Sexual function and bother were markedly worse in older men (65–70 years), whilst urinary bother and physical health were somewhat worse than in younger men (49–54 years, all P < 0.001). Bowel health, urinary function and depression were unaltered by age, whilst mental health and anxiety were better in older men (P < 0.001). Only minor differences existed in mental or physical health, anxiety and depression between PSA testing and biopsy assessments. Conclusion The ProtecT trial baseline PROMs response rates were high. Symptom frequencies and generic quality of life were similar to those observed in populations screened for prostate cancer and control subjects without cancer.
Collapse
Affiliation(s)
- Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Grace J Young
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Tim J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK.,Collaboration for Leadership in Applied Health Research and Care West, United Hospitals Bristol, Bristol, UK
| | - Jane Blazeby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kerry N L Avery
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daniel Dedman
- Clinical Practice Research Datalink Group, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Liz Down
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - David E Neal
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Collaboration for Leadership in Applied Health Research and Care West, United Hospitals Bristol, Bristol, UK
| | | |
Collapse
|
18
|
DiBello JR, Ioannou C, Rees J, Challacombe B, Maskell J, Choudhury N, Kastner C, Kirby M. Prevalence of metabolic syndrome and its components among men with and without clinical benign prostatic hyperplasia: a large, cross-sectional, UK epidemiological study. BJU Int 2015; 117:801-8. [PMID: 26392030 DOI: 10.1111/bju.13334] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Jonathan Rees
- Backwell and Nailsea Medical Group; North Somerset UK
| | - Ben Challacombe
- Department of Urology; Guy's and St Thomas' Hospital; London UK
| | | | | | | | - Mike Kirby
- Faculty of Health and Human Sciences; University of Hertfordshire; Hatfield UK
| |
Collapse
|
19
|
Ilo D, Raluy-Callado M, Graham-Clarke P, Sadasivan R, Birt J, Donaldson R, Zhu E, Kirby MG, Neasham D. Patient characteristics and treatment patterns for patients with benign prostatic hyperplasia, erectile dysfunction or co-occurring benign prostatic hyperplasia and erectile dysfunction in general practices in the UK: a retrospective observational study. Int J Clin Pract 2015; 69:853-62. [PMID: 26011100 DOI: 10.1111/ijcp.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of this study was to assess patient characteristics, medication treatment patterns and healthcare resource utilization among men with existing erectile dysfunction (ED) or benign prostatic hyperplasia (BPH), who are newly diagnosed with the second condition (BPH or ED) compared with those with only one condition. METHODS This retrospective cohort study utilized the Clinical Practice Research Datalink. Males, aged 40 years or older, newly diagnosed with ED or symptomatic BPH between 1 June 2010 and 31 May 2011, were selected. Patient demographics, existing comorbidities and baseline medication use were analysed. Treatments initiated for the incident condition and treatment patterns were reported at 6, 12, 18 and 24-months postdiagnosis. Referrals to urologists and visits to general practitioners were reported around diagnosis and during follow-up. RESULTS This study included 11,501 incident patients with BPH, of which 23% had a prior ED diagnosis and 9,734 incident patients with ED, of which 17% had a prior BPH diagnosis. The average age at diagnosis of BPH was similar across both cohorts. Among incident patients with ED, those with prior diagnosis of BPH were diagnosed at an older average age (65 ± 9.2 years) compared to those without BPH (57 ± 9.1 years). The majority of patients in both incident BPH cohorts (62.9-65.5%) were prescribed alpha-blockers as initial treatment. The majority of patients in both incident ED cohorts (49.6-51.6%) were prescribed sildenafil as initial treatment followed by tadalafil (24.3-26.0%). At 12 months, 50% of incident patients with BPH and 80% of patients with ED had discontinued the therapy initiated. CONCLUSION This study found that in the UK, patients with co-occurring BPH and ED when newly diagnosed with the second condition initiated the same treatments as those without prior ED or BPH. During the first year, treatment patterns including discontinuation were comparable in the groups with one of the conditions and co-occurring BPH and ED.
Collapse
Affiliation(s)
- D Ilo
- Lilly UK, Basingstoke Hampshire, UK
| | | | | | | | - J Birt
- Eli Lilly & Company, Indianapolis, IN, USA
| | | | - E Zhu
- Eli Lilly & Company, Indianapolis, IN, USA
| | - M G Kirby
- University of Hertfordshire and the Prostate Centre, London, UK
| | | |
Collapse
|
20
|
Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, De Nunzio C, Schips L. Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol 2014; 68:418-25. [PMID: 25465970 DOI: 10.1016/j.eururo.2014.11.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about drug adherence in men treated for lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia (BPH) is one of the causes of LUTS. OBJECTIVE To examine adherence to pharmacological therapy and its clinical value in men with LUTS. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study using an administrative prescription database and hospital discharge codes for 1.5 million men aged ≥40 yr treated with alpha blockers (ABs) and 5-alpha reductase inhibitors (5ARIs) alone or in combination (CT). INTERVENTIONS Therapy with ABs and/or 5ARIs. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The 1-yr and long-term adherence; hospitalization rates for BPH and BPH surgery. Multivariate Cox proportional hazards regression model, propensity score matching, and sensitivity analyses. RESULTS AND LIMITATIONS The 1-yr adherence was 29% in patients exposed to at least 6-mo therapy. Patients on CT had a higher discontinuation rate in the first 2 yr compared to those on monotherapy (p<0.0001). Overall hospitalization rates for BPH and BPH surgery were 9.04 and 12.6 per 1000 patient-years, respectively. A lower risk of hospitalization was observed for 5ARI compared to AB therapy (hazard ratio [HR] 0.46 and 0.23; p<0.0001). CT was associated with a reduced risk of hospitalization for BPH surgery (HR 0.94; p<0.0001) compared to AB. Discontinuation of drug treatment was an independent risk factor for hospitalization for BPH and BPH surgery (HR 1.65 and 2.80; p<0.0001) regardless of therapeutic group. Limitations include the paucity of clinical measures and the absence of patient-reported outcomes. CONCLUSIONS Adherence to pharmacological therapy for BPH is low and could affect clinical outcomes. Long-term 5ARI and CT use was associated with an independent reduced risk of hospitalization for BPH surgery. Our findings suggest the need for new strategies to increase patient adherence to prescribed treatment and more appropriate prescribing by physicians. PATIENT SUMMARY Our research shows that adherence to prescribed pharmacological therapy is crucial in the management of patients suffering from lower urinary tract symptoms. Moreover, pharmacological therapy can prevent disease progression.
Collapse
Affiliation(s)
- Luca Cindolo
- Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Italy.
| | - Luisella Pirozzi
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Caterina Fanizza
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Marilena Romero
- Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy
| | - Luigi Schips
- Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Italy
| |
Collapse
|
21
|
Speakman M, Kirby R, Doyle S, Ioannou C. Burden of male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) - focus on the UK. BJU Int 2014; 115:508-19. [PMID: 24656222 DOI: 10.1111/bju.12745] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
KEY MESSAGES Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) can be bothersome and negatively impact on a patient's quality of life (QoL). As the prevalence of LUTS/BPH increases with age, the burden on the healthcare system and society may increase due to the ageing population. This review unifies literature on the burden of LUTS/BPH on patients and society, particularly in the UK. LUTS/BPH is associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning, and through its negative impact on QoL for patients and partners. LUTS/BPH is often underdiagnosed and undertreated. Men should be encouraged to seek medical advice for this condition and should not accept it as part of ageing, while clinicians should be more active in the identification and treatment of LUTS/BPH. To assess the burden of illness and unmet need arising from lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH) from an individual patient and societal perspective with a focus on the UK. Embase, PubMed, the World Health Organization, the Cochrane Database of Systematic Reviews and the York Centre for Reviews and Dissemination were searched to identify studies on the epidemiological, humanistic or economic burden of LUTS/BPH published in English between October 2001 and January 2013. Data were extracted and the quality of the studies was assessed for inclusion. UK data were reported; in the absence of UK data, European and USA data were provided. In all, 374 abstracts were identified, 104 full papers were assessed and 33 papers met the inclusion criteria and were included in the review. An additional paper was included in the review upon a revision in 2014. The papers show that LUTS are common in the UK, affecting ≈3% of men aged 45-49 years, rising to >30% in men aged ≥85 years. European and USA studies have reported the major impact of LUTS on quality of life of the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning. While treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial. LUTS associated with BPH is a highly impactful condition that is often undertreated. LUTS/BPH have a major impact on men, their families, health services and society. Men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their physicians if they have bothersome symptoms.
Collapse
Affiliation(s)
- Mark Speakman
- Department of Urology, Musgrove Park Hospital, Taunton, UK
| | | | | | | |
Collapse
|
22
|
Abstract
In this article, the value of urodynamic studies in the evaluation of treatment of male lower urinary tract symptoms is appraised based on current evidence. The information gained by urodynamics can be a valuable tool for counseling patients considering invasive outlet reduction procedures.
Collapse
|
23
|
Zumrutbas AE, Bozkurt AI, Tas E, Acar CI, Alkis O, Coban K, Cetinel B, Aybek Z. Prevalence of lower urinary tract symptoms, overactive bladder and urinary incontinence in western Turkey: Results of a population-based survey. Int J Urol 2014; 21:1027-33. [DOI: 10.1111/iju.12519] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/01/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Ali E Zumrutbas
- Department of Urology; Pamukkale University School of Medicine; Denizli Turkey
| | - Ali I Bozkurt
- Department of Public Health; Pamukkale University School of Medicine; Denizli Turkey
| | - Erdogan Tas
- Denizli Provincial Health Directory; Denizli Turkey
| | - Cenk I Acar
- Department of Urology; Acibadem University School of Medicine; Istanbul Turkey
| | - Okan Alkis
- Department of Urology; Pamukkale University School of Medicine; Denizli Turkey
| | - Kazim Coban
- Department of Public Health; Pamukkale University School of Medicine; Denizli Turkey
| | - Bulent Cetinel
- Department of Urology; Istanbul University Cerrahpasa School of Medicine; Istanbul Turkey
| | - Zafer Aybek
- Department of Urology; Pamukkale University School of Medicine; Denizli Turkey
| |
Collapse
|
24
|
Cindolo L, Pirozzi L, Fanizza C, Romero M, Sountoulides P, Roehrborn CG, Mirone V, Schips L. Actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia: temporal trends of prescription and hospitalization rates over 5 years in a large population of Italian men. Int Urol Nephrol 2013; 46:695-701. [DOI: 10.1007/s11255-013-0587-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/05/2013] [Indexed: 02/02/2023]
|
25
|
Lukacs B, Cornu JN, Aout M, Tessier N, Hodée C, Haab F, Cussenot O, Merlière Y, Moysan V, Vicaut E. Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia in Real-life Practice in France: A Comprehensive Population Study. Eur Urol 2013; 64:493-501. [DOI: 10.1016/j.eururo.2013.02.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 02/16/2013] [Indexed: 11/25/2022]
|
26
|
Veeratterapillay R, Pickard RS, Harding C. The role of uroflowmetry in the assessment and management of men with lower urinary tract symptoms – revisiting the evidence. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415813498874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uroflowmetry is variably used for the assessment of men with lower urinary tract symptoms (LUTS). There is discrepancy in practice guidelines regarding recommendations for use of uroflowmetry in the initial assessment of men with LUTS. To explain this discrepancy, we systematically reviewed relevant literature to detail currently available evidence and identify evidence gaps requiring further research. PubMED, EMBASE and Medline literature databases were searched for the period between January 1970 and July 2012 to identify articles pertaining to uroflowmetry and outcomes of treatment for men with LUTS. We identified 30 studies for inclusion – none of which had a randomised design. The majority of the studies were prospective or retrospective cohort studies with some cross-sectional and observational reports. The methodology of measurement and reporting urine flow rate has been standardised by reports from the International Continence Society. The current available literature on the reproducibility of urine flow rate is inconclusive and suggests that there may be variability between measurements for a number of different reasons and that repeated tests could be of value clinically. There is also general agreement that a Qmax cut-off of 10 ml/s−1 is suggestive of bladder outlet obstruction. Despite guideline recommendations, there remains a lack of high-quality evidence from studies with robust design to fully ascertain the clinical utility of uroflowmetry and its place in the care pathway for men with LUTS. Future well-designed studies should focus on this evidence gap.
Collapse
Affiliation(s)
- R Veeratterapillay
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, UK
| | - RS Pickard
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, UK
| | - C Harding
- Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, UK
| |
Collapse
|
27
|
Mayer EK, Kroeze SG, Chopra S, Bottle A, Patel A. Examining the ‘gold standard’: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int 2012; 110:1595-601. [DOI: 10.1111/j.1464-410x.2012.11119.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
28
|
Williams N, Hughes LJ, Turner EL, Donovan JL, Hamdy FC, Neal DE, Martin RM, Metcalfe C. Prostate-specific antigen testing rates remain low in UK general practice: a cross-sectional study in six English cities. BJU Int 2011; 108:1402-8. [PMID: 21481132 DOI: 10.1111/j.1464-410x.2011.10163.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To estimate rates of prostate-specific antigen (PSA) testing in UK general practices by age, deprivation index and geographical location. SUBJECTS AND METHODS • Practice-based, retrospective data on PSA testing patterns in 2007 were collected from a random sample of 87 general practices using EMIS LV computer systems within the passively observed non-intervention arm of a cluster-randomized controlled trial. • Information for a total of 126 716 men aged 45-89 years with no recorded diagnosis of prostate cancer prior to 1 January 2007 was collected. RESULTS • In all, 7902 (6.2%) of 126 716 men aged 45-89 without a prior diagnosis of prostate cancer underwent at least one PSA test from their general practitioner during 2007 [95% confidence interval (CI) 5.6-7.0%; practice-based inter-quartile range 3.6-8.4%]. • PSA testing rates were 1.4% (95% CI 1.1-1.6%) in men aged 45-49, rising to 11.3% (95% CI 10.0-12.9%) at age 75-79 years (P for trend <0.001). • Testing rates were lowest in the three northern centres (3.5-5.7%) vs the three more southern centres (7.1-8.9%; P < 0.001). • For every 20 points increase in the index of multiple deprivation score, the proportion of men tested fell by 1.7% (95% CI -2.5 to -0.8%; P < 0.001). • Lower proportions of men were subsequently diagnosed with prostate cancer in practices testing more men (odds ratio for a one unit increase in the natural log of testing 0.76; 95% CI 0.60-0.97; P= 0.025). CONCLUSION • Overall levels of PSA testing in UK general practice remain low, but for those tested there are important variations by age, deprivation and geographical location that do not appear to reflect clinical need or the intention of current policy. • PSA testing in general practice is currently skewed towards older men, and current policy enabling all men to make an informed choice about PSA testing is not being effectively implemented as uptake clearly varies by socioeconomic status. • This reinforces the need for robust evidence regarding the costs and benefits of using the PSA test for the detection of localized prostate cancer in the UK, a full assessment of the health economic implications and a revision of the current policy.
Collapse
Affiliation(s)
- Naomi Williams
- Nuffield Department of Surgical Sciences, University of Oxford based at the Royal Hallamshire Hospital, Sheffield, UK
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Duncan ME, Goldacre MJ. Mortality trends for benign prostatic hyperplasia and prostate cancer in English populations 1979-2006. BJU Int 2010; 107:40-5. [DOI: 10.1111/j.1464-410x.2010.09487.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
30
|
Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) is a highly prevalent chronic disease. The cost impact of treatment is high. The field of behavioural treatments which could be suitable in the majority of uncomplicated patients has rarely been assessed. We summarize the recent knowledge and data from behavioural interventions chiefly the randomized controlled trial (RCT) of a self-management programme for BPH. RECENT FINDINGS The self-management RCT has revealed that a rigorously structured behavioural programme can significantly reduce lower urinary tract symptoms severity and decrease objective symptoms like nocturia, urgency and frequency compared with standard care alone. The elements of the programme and their behavioural framework are carefully defined. The basis of the programme's effectiveness is yet unknown, but may involve changes in bladder capacity rather than simple fluid management. The sphere of behavioural interventions for BPH is lacking and requires more research. SUMMARY Elements of the self-management programme are already being used in watchful waiting. Improving quality of life of patients with BPH through self-management will help patients and may reduce the financial burden on healthcare systems. The promotion of multidisciplinary team is a key step in implementing self-management strategies. With larger scale trials, the limitations raised and questions posed by the RCT can be further addressed.
Collapse
|
31
|
Sexton CC, Coyne KS, Kopp ZS, Irwin DE, Milsom I, Aiyer LP, Tubaro A, Chapple CR, Wein AJ. The overlap of storage, voiding and postmicturition symptoms and implications for treatment seeking in the USA, UK and Sweden: EpiLUTS. BJU Int 2009; 103 Suppl 3:12-23. [DOI: 10.1111/j.1464-410x.2009.08369.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
32
|
Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD. Urinary Retention and Post-Void Residual Urine in Men: Separating Truth From Tradition. J Urol 2008; 180:47-54. [DOI: 10.1016/j.juro.2008.03.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Steven A. Kaplan
- Department of Urology, Weill Medical College, Cornell University, New York, New York
| | - Alan J. Wein
- Division of Urology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David R. Staskin
- Section of Voiding Dysfunction, New York-Presbyterian Hospital, Weill Medical College, Cornell University, New York, New York
- Department of Urology, Weill Medical College, Cornell University, New York, New York
- Department of Obstetrics/Gynecology, Weill Medical College, Cornell University, New York, New York
| | - Claus G. Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William D. Steers
- Department of Urology, University of Virginia Medical School, Charlottesville, Virginia
| |
Collapse
|
33
|
Morant SV, Reilly K, Bloomfield GA, Chapple C. Diagnosis and treatment of lower urinary tract symptoms suggestive of overactive bladder and bladder outlet obstruction among men in general practice in the UK. Int J Clin Pract 2008; 62:688-94. [PMID: 18355237 DOI: 10.1111/j.1742-1241.2008.01737.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the epidemiology and treatment of storage symptoms suggestive of overactive bladder (OAB) and voiding symptoms suggestive of bladder outlet obstruction (BOO) because of benign prostatic hyperplasia in UK general practice. PATIENTS AND METHODS This was a retrospective analysis of data collected between 2000 and 2006 and entered in The Health Improvement Network general practice database, containing medical records for > 1 million men (aged >or= 18 years) in the UK. Using Read codes, we analysed the prevalence of storage and voiding lower urinary tract symptoms (LUTS) as well as prescribing trends for 5alpha-reductase inhibitors (5ARIs) and alpha-blockers for LUTS secondary to BOO and antimuscarinics for OAB. RESULTS In 2006, the prevalence of diagnosed LUTS/OAB was only 0.3% and the recorded prevalence of LUTS/BOO was only 2.2%. Treatment rates also remained low throughout the study period. In the 12 months before 1 January 2006, only 25% of men diagnosed with OAB and 6-7% of men with storage LUTS received antimuscarinics, whereas 36% of men with a record of LUTS/BOO received alpha-blockers and/or 5ARIs. Alpha-blockers were prescribed to approximately 10% of men diagnosed with OAB or storage LUTS who did not have any recorded BOO diagnosis or symptoms. CONCLUSION Diagnosis of both storage and voiding LUTS occurs at much lower rates than indicated by prevalence estimates. Despite the availability of effective prescription therapies, many men with storage and/or voiding LUTS may not be receiving appropriate treatment in UK general practice.
Collapse
Affiliation(s)
- S V Morant
- Cygnus Biostatistics Ltd, Haddenham, UK.
| | | | | | | |
Collapse
|
34
|
|
35
|
Glasser DB, Carson C, Kang JH, Laumann EO. Prevalence of storage and voiding symptoms among men aged 40 years and older in a US population-based study: results from the Male Attitudes Regarding Sexual Health study. Int J Clin Pract 2007; 61:1294-300. [PMID: 17627708 DOI: 10.1111/j.1742-1241.2007.01454.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS Lower urinary tract symptoms (LUTS) are categorised as storage (urgency, frequency, nocturia and incontinence), voiding (sensation of incomplete emptying, hesitancy, weak stream and straining) or mixed symptoms. METHODS In this US population-based study, we investigated the prevalence of male LUTS and the relative frequency of the LUTS subtypes, and we evaluated associations between LUTS and age, race/ethnicity and erectile dysfunction (ED). The Male Attitudes Regarding Sexual Health study included a nationally representative sample of non-Hispanic black, non-Hispanic white and Hispanic men aged>or=40 years. Participants completed a questionnaire including items on ED and the International Prostate Symptom Score (IPSS). The prevalence and subtypes of LUTS were investigated post hoc by age, race/ethnicity and the presence of ED. RESULTS The overall prevalence rates of storage (13%) and mixed (9%) symptoms were higher than that of voiding symptoms (6%). The prevalence of storage symptoms was similar across age groups, whereas voiding and mixed symptoms increased with age. Among men with IPSS>or=8, the rates of storage (29%) and mixed (38%) symptoms were also higher than voiding symptoms (23%). Distributions of the LUTS subtypes were comparable among black, white and Hispanic respondents with IPSS>or=8. The overall prevalence rate of ED (40%) increased with age among those with IPSS>or=8. Isolated storage symptoms were more than twice as common as isolated voiding symptoms among US men>or=40 years of age. CONCLUSION Careful attention to individual symptoms may help distinguish storage LUTS from voiding LUTS, a distinction that has important implications for treatment.
Collapse
|
36
|
Hutchison A, Farmer R, Chapple C, Berges R, Pientka L, Teillac P, Borkowski A, Dobronski P. Characteristics of Patients Presenting with LUTS/BPH in Six European Countries. Eur Urol 2006; 50:555-61; discussion 562. [PMID: 16782265 DOI: 10.1016/j.eururo.2006.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 05/03/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Knowledge of the clinical profile of the population with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) is important for health care management, impacting on manpower requirements, pharmacologic demands and health service costs. Data collected by the TransEuropean Research Into the Use of Management Policies for LUTS suggestive of BPH in Primary Health care project were used to profile 4979 patients from six European countries newly presenting with LUTS/BPH to general practitioners or office-based urologists. METHODS At recruitment, the clinician completed a questionnaire detailing the treatment provided, examination results, and covariates including age, initial symptom severity and comorbidities. The patient completed an International Prostate Symptom Score/quality-of-life questionnaire. RESULTS The majority of patients (77%) sought medical advice because of the bothersomeness of their symptoms, and presented at ages between 58 and 71 years. Small but statistically significant differences among countries were found in initial symptom severity, initial quality of life and age at diagnosis, but these are not thought to be clinically significant. There were marked national differences in patient management, with, for example, 10% of patients in France reporting no examinations, compared with 0.5% in Poland, while free-flow measurements varied from less than 1% in France to 35% in Poland. CONCLUSIONS Patient heterogeneity does not explain the differences in patient management among countries, which undoubtedly is the result of differences in health care traditions, infrastructure and socioeconomic factors, as well as patient preference.
Collapse
Affiliation(s)
- Annie Hutchison
- Postgraduate Medical School, University of Surrey, Guildford, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Müntener M, Aellig S, Küttel R, Gehrlach C, Hauri D, Strebel RT. Peri-operative morbidity and changes in symptom scores after transurethral prostatectomy in Switzerland: results of an independent assessment of outcome. BJU Int 2006; 98:381-3. [PMID: 16879681 DOI: 10.1111/j.1464-410x.2006.06256.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess, in a prospective study, the contemporary outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) in Switzerland, by evaluating peri-operative morbidity and changes in lower urinary tract symptoms (LUTS). PATIENTS AND METHODS Between January 2000 and January 2005, 11 hospitals in Switzerland participated in the study. The hospitals were required to inform Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss healthcare system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTS Data on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively (P < 0.001). CONCLUSIONS The results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.
Collapse
Affiliation(s)
- Michael Müntener
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
38
|
Cathcart P, van der Meulen J, Armitage J, Emberton M. Incidence of Primary and Recurrent Acute Urinary Retention Between 1998 and 2003 in England. J Urol 2006; 176:200-4; discussion 204. [PMID: 16753401 DOI: 10.1016/s0022-5347(06)00509-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We report how the incidence of primary and recurrent acute urinary retention changed in England between 1998 and 2003. In addition, we present data on changes with time in the use of prostatectomy after acute urinary retention and recurrent acute urinary retention. MATERIALS AND METHODS Data were extracted from the Hospital Episode Statistics database of the Department of Health in England. Patients were included in the study if an International Classification of Diseases, Tenth Revision code for acute urinary retention or an operative procedure code for transurethral prostate resection was present in any diagnosis or procedure fields of the Hospital Episode Statistics database. A total of 165,527 men were identified to have been hospitalized with acute urinary retention in the study period. RESULTS The incidence of primary acute urinary retention was 3.06/1,000 men yearly. Acute urinary retention was spontaneous in 65.3% of cases. The incidence of acute urinary retention decreased from 3.17/1,000 men yearly in 1998 to 2.96/1,000 yearly in 2003. Surgical treatment following spontaneous acute urinary retention decreased 20% from 32% in 1998 to 26% in 2003. This trend coincided with a 20% increase in the rate of recurrent acute urinary retention. CONCLUSIONS The slight decrease in the incidence of primary acute urinary retention suggests that the shift away from surgical treatment for benign prostatic hyperplasia has not resulted in an increase in acute urinary retention. The increase in recurrent acute urinary retention suggests that the observed decrease in surgery after acute urinary retention may have put more men at risk for acute urinary retention recurrence.
Collapse
Affiliation(s)
- Paul Cathcart
- Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | | | | | | |
Collapse
|