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Fourmarier M, Baboudjian M, Robert G, Lebdai S. Is there a best timing for benign prostatic hyperplasia surgery? THE FRENCH JOURNAL OF UROLOGY 2024; 34:102574. [PMID: 38717461 DOI: 10.1016/j.fjurol.2024.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/12/2023] [Accepted: 10/26/2023] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) has shifted over the last decades, with medical therapy becoming the primary treatment modality while surgery is being reserved mostly to patients who are not responding to medical treatment or presenting with complications from BPH. Here, we aim to to discuss the optimal timing of surgical management of LUTS/BPH. MATERIALS AND METHODS A literature search was conducted on Pub-Med/MEDLINE database to identify reports published from January 1990 until January 2022 by combining the following MeSH terms: "Lower Urinary Tract Symptoms"; "Prostatic Hyperplasia"; "Prostatic Hyperplasia/therapy"; "Prostatic Hyperplasia/complications"; "Treatment Outcome"; "Time-to-Treatment". Evidence supporting or not early surgical treatment of BPH was examined and reported in a pros and cons form. RESULTS The "pro early surgery" highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The "con early surgery" considered that medical therapy is efficient in well-selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects. CONCLUSIONS Clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involved in the treatment decision.
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Affiliation(s)
- Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix-en-Provence, France.
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - Gregoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Souhil Lebdai
- Urology Department, University Hospital of Angers, 49933 Angers cedex 9, France
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Park DJ, Kwon SY, Seo YJ, Byun HJ, Lee KS. Changes of resistance indices after medication in benign prostatic hyperplasia: a prospective study. Prostate Int 2023; 11:139-144. [PMID: 37745908 PMCID: PMC10513904 DOI: 10.1016/j.prnil.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
Background This study aimed to determine the relationship between resistive indices (RIs) and changes in prostate size after medical treatment in patients with benign prostatic hyperplasia (BPH). Methods A total of 86 patients with BPH were included in the study, excluding 42 patients with a total prostate volume (TPV) of <30 cc or taking α1-adrenergic blockers and 5α-reductase inhibitors (5ARI) before study participation. Therefore, the data for 44 patients were analyzed. All patients were treated with α1-adrenergic blockers and 5ARIs. The variables examined were prostate-specific antigen, International Prostate Symptom Score, quality of life score, maximal urinary flow rate, residual urine volume, TPV, transition zone volume, and RIs of the urethral artery and left and right capsular arteries. These variables were assessed at baseline and after 3 and 6 months of treatment. Results The mean TPV was 43.5 ± 10.9 and decreased to 35.2 ± 11.5 and 33.9 ± 9.8 after 3 and 6 months of treatment, respectively (p < 0.001). The mean RI of the urethral artery, right capsular artery, and left capsular artery at pretreatment did not decrease significantly. However, comparing the baseline with 3-month data, TPV at 3 months/TPV at baseline was significantly correlated with RI changes in the left capsular artery (r = 758; P < 0.001). Conclusion In patients with BPH, α1-adrenergic blocker and 5ARI medications for 3 and 6 months did not result in a significant reduction in the RI of the urethral artery and both capsular arteries. Larger scale, prospective studies are needed to evaluate the relationship between TPV and RI reductions.
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Affiliation(s)
- Dong Jin Park
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Se Yun Kwon
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young Jin Seo
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hye Jin Byun
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Seop Lee
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
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Glaser A, Shi Z, Wei J, Lanman NA, Ladson-Gary S, Vickman RE, Franco OE, Crawford SE, Lilly Zheng S, Hayward SW, Isaacs WB, Helfand BT, Xu J. Shared Inherited Genetics of Benign Prostatic Hyperplasia and Prostate Cancer. EUR UROL SUPPL 2022; 43:54-61. [PMID: 36353071 PMCID: PMC9638770 DOI: 10.1016/j.euros.2022.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background The association between benign prostatic hyperplasia (BPH) and prostate cancer (PCa) remains controversial, largely due to a detection bias in traditional observational studies. Objective To assess the association between BPH and PCa using inherited single nucleotide polymorphisms (SNPs). Design setting and participants The participants were White men from the population-based UK Biobank (UKB). Outcome measurements and statistical analysis The association between BPH and PCa was tested for (1) phenotypic correlation using chi-square, (2) genetic correlation (r g) based on genome-wide SNPs using linkage disequilibrium score regression, and (3) cross-disease genetic associations based on known risk-associated SNPs (15 for BPH and 239 for PCa), individually and cumulatively using genetic risk score (GRS). Results and limitations Among 214 717 White men in the UKB, 24 623 (11%) and 14 311 (6.7%) had a diagnosis of BPH and PCa, respectively. Diagnoses of these two diseases were significantly correlated (χ2 = 1862.80, p < 0.001). A significant genetic correlation was found (r g = 0.16; 95% confidence interval 0.03-0.28, p = 0.01). In addition, significant cross-disease genetic associations for established risk-associated SNPs were also found. Among the 250 established genome-wide association study-significant SNPs of PCa or BPH, 49 were significantly associated with the risk of the other disease at p < 0.05, significantly more than expected by chance (N = 12, p < 0.001; χ2 test). Furthermore, significant cross-disease GRS associations were also found; GRSBPH was significantly associated with PCa risk (odds ratio [OR] = 1.26 [1.18-1.36], p < 0.001), and GRSPCa was significantly associated with BPH risk (OR = 1.03 [1.02-1.04], p < 0.001). Moreover, GRSBPH was significantly and inversely associated with lethal PCa risk in a PCa case-case analysis (OR = 0.58 [0.41-0.81], p = 0.002). Only White men were studied. Conclusions BPH and PCa share common inherited genetics, which suggests that the phenotypic association of these two diseases in observational studies is not entirely caused by the detection bias. Patient summary For the first time, we found that benign prostatic hyperplasia and prostate cancer are genetically related. This finding may have implications in disease etiology and risk stratification.
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Affiliation(s)
- Alexander Glaser
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Zhuqing Shi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jun Wei
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Nadia A. Lanman
- Collaborative Core for Cancer Bioinformatics, Purdue Center for Cancer Research, Purdue University, West Lafayette, IN, USA
| | - Skylar Ladson-Gary
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Renee E. Vickman
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Omar E. Franco
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Susan E. Crawford
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - S. Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Simon W. Hayward
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - William B. Isaacs
- Department of Urology and the James Buchanan Brady Urologic Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian T. Helfand
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
- Corresponding authors. 1001 University Place, Evanston, IL 60201, USA. Tel. +1 (224) 264-7501; Fax: +1 (224) 364-7675.
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
- Corresponding authors. 1001 University Place, Evanston, IL 60201, USA. Tel. +1 (224) 264-7501; Fax: +1 (224) 364-7675.
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Fogaing C, Alsulihem A, Campeau L, Corcos J. Is Early Surgical Treatment for Benign Prostatic Hyperplasia Preferable to Prolonged Medical Therapy: Pros and Cons. ACTA ACUST UNITED AC 2021; 57:medicina57040368. [PMID: 33918818 PMCID: PMC8069902 DOI: 10.3390/medicina57040368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) has shifted over the last decades, with medical therapy becoming the primary treatment modality while surgery is being reserved mostly to patients who are not responding to medical treatment or presenting with complications from BPH. Here, we aim to explore the evidence supporting or not early surgical treatment of BPH as opposed to prolonged medical therapy course. Materials and Methods: The debate was presented with a “pro and con” structure. The “pro” side supported the early surgical management of BPH. The “con” side successively refuted the “pro” side arguments. Results: The “pro” side highlighted the superior efficacy and cost-effectiveness of surgery over medical treatment for BPH, as well as the possibility of worse postoperative outcomes for delayed surgical treatment. The “con” side considered that medical therapy is efficient in well selected patients and can avoid the serious risks inherent to surgical treatment of BPH including important sexual side effects. Conclusions: Randomized clinical trials comparing the outcomes for prolonged medical therapy versus early surgical treatment could determine which approach is more beneficial in the long-term in context of the aging population. Until then, both approaches have their advantages and patients should be involve in the treatment decision.
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Affiliation(s)
- Cora Fogaing
- Department of Surgery/Urology, McGill University, 845 Rue Sherbrooke Ouest, Montréal, QC H3A 0G4, Canada; (C.F.); (L.C.)
| | - Ali Alsulihem
- Department of Urology, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia;
| | - Lysanne Campeau
- Department of Surgery/Urology, McGill University, 845 Rue Sherbrooke Ouest, Montréal, QC H3A 0G4, Canada; (C.F.); (L.C.)
| | - Jacques Corcos
- Department of Surgery/Urology, McGill University, 845 Rue Sherbrooke Ouest, Montréal, QC H3A 0G4, Canada; (C.F.); (L.C.)
- Correspondence:
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Clinical Significance of the Resistive Index of Prostatic Blood Flow According to Prostate Size in Benign Prostatic Hyperplasia. Int Neurourol J 2016; 20:75-80. [PMID: 27032561 PMCID: PMC4819154 DOI: 10.5213/inj.1630390.195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/25/2015] [Indexed: 11/16/2022] Open
Abstract
Purpose: The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH). Methods: The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist. Results: The 110 patients were categorized according to IPSS (mild symptoms, 0–7; moderate symptoms, 8–19; and severe symptoms, 20–35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP. Conclusions: RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.
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Bozkurt A, Karabakan M, Keskin E, Hirik E, Balci MBC, Nuhoglu B. Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Urol Int 2015; 96:202-6. [PMID: 26613256 DOI: 10.1159/000441850] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/19/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH). The PUL procedure involves the placement of implants that retract the obstructing prostate lobes. This procedure achieves quantifiable improvements in functional outcomes and quality of life (QoL), while preserving erectile and ejaculatory functions. METHODS Seventeen patients diagnosed with BPH who had undergone the UroLift® procedure between March 2011 and June 2015 were retrospectively evaluated. The parameters evaluated in the pre-operative, intra-operative and 1-year post-operative period were demographic data, and pre-operative, intra-operative and 1-year post-operative results were obtained from the International Prostate Symptom Score (IPSS), Uroflowmetry QoL index, International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ) for ejaculatory function (MSHQ-EjD). RESULTS The average improvements from baseline to 12 months after intervention were significant for the total IPSS 9.6. There was a 4.2-point increase in Qmax, a 0.9-point improvement in QoL and a 32% decrease in PVR. No statistically significant difference was found in the IIEF and MSHQ-EjD scores when the pre-operative and post-operative 3rd and 12th month scores were evaluated (p > 0.05). CONCLUSIONS PUL offers rapid improvement in voiding and storage symptoms, QoL and flow rate that is durable to 12 months after intervention. PUL is a minimally invasive procedure that has the moderate effect in treating troublesome LUTS secondary to benign prostatic obstruction and preserving total sexual function.
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Affiliation(s)
- Aliseydi Bozkurt
- Erzincan University, Mengucek Gazi Training and Research Hospital, Urology Department, Erzincan, Turkey
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