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Yang F, Hashim R, Philippou J. Tamsulosin and Dutasteride Combination Therapy for Asian Men With Moderate-to-Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review of Clinical Considerations That Influence the Prescription. J Clin Med Res 2024; 16:385-397. [PMID: 39346571 PMCID: PMC11426169 DOI: 10.14740/jocmr5255] [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: 07/09/2024] [Accepted: 08/23/2024] [Indexed: 10/01/2024] Open
Abstract
The goal of combination therapy for moderate-to-severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) is to ease both the dynamic and static symptoms by using agents that have complementary mechanisms of action. Similar to prescribing other drugs, LUTS/BPH combination therapy has been affected by multiple factors. Previous qualitative research discussed the individual perspectives that influenced combination therapy administration. Yet, until recently, there has been limited interest in clinical reasons that physicians have to consider before prescribing LUTS/BPH combination treatment. This systematic review aimed to identify the clinical considerations that influence the decision to prescribe combination therapy of tamsulosin 0.4 mg + dutasteride 0.5 mg for Asian men with LUTS/BPH. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was performed in databases Medline, CINAHL, the Cochrane Library, and Embase from inception until January 2024 using Medical Subject Headings (MeSH) terms and keywords with truncation for alternative acronyms. A citation search was performed to gather works of literature on LUTS/BPH combination treatment in addition to the "PICO" framework for search terms. Five English-language primary randomized controlled trials (RCTs) were included in the narrative analysis using the Critical Appraisal Skills Program (CASP) checklist after critical appraisal. Several dosages of tamsulosin (0.2 mg and 0.4 mg) have been administered in LUTS/BPH combination treatment over the last few decades despite 0.2 mg tamsulosin being standardized as an effective regime in Asian countries. A remarkable correlation between prostate volume (PV) and prostate-specific antigen (PSA) was found in Asian men, which requires higher PSA secretion to enlarge each prostate unit and causes an increased risk of moderate-to-severe LUTS. Additionally, BPH baseline variables may lead to a different response to combination therapy, especially the PV and PSA differences. In conclusion, compared with Caucasian men, a significantly higher risk of moderate-to-severe LUTS was found in Asian men. Initiation of combination therapy, especially dutasteride, depends on a larger PV (≥ 30 mL); it is possible, therefore, that earlier PV and PSA examinations and baseline variables assessments ought to be performed by physicians before the combination therapy prescription. Alternative treatment options may be considered for a patient who prefers an active pattern of sexual activity during their BPH combined pharmacotherapy. These clinical considerations may influence the prescription of tamsulosin 0.4 mg + dutasteride 0.5 mg combination therapy for Asian men with moderate-to-severe LUTS/BPH. This study was registered on PROSPERO (CRD42024575528).
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Affiliation(s)
- Fan Yang
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England, UK
| | - Rahab Hashim
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England, UK
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Wang RL, Lin FF, Ruan DD, Li SJ, Zhou YF, Luo JW, Fang ZT, Tang Y. A correlation study between prostate necrosis rate calculated by 3D Slicer software and clinical efficacy of prostatic artery embolization, along with an analysis of predictors of clinical success after prostatic artery embolization. Abdom Radiol (NY) 2024; 49:927-938. [PMID: 38158423 DOI: 10.1007/s00261-023-04131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To analyze the correlation between the prostate necrosis rate at 1-month after prostatic artery embolization (PAE) and the clinical efficacy at 1-year after PAE, and to explore potential predictors of clinical success after PAE for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). METHODS The prostate magnetic resonance imaging data at 1-month after PAE were imported into 3D Slicer software for calculating the prostate necrosis rate and thus analyzing the relationship between the prostate necrosis rate at 1-month after PAE and the efficacy score ratio at 1-year after PAE. The 151 patients with PAE technical success were divided into a clinical success group (n = 126) and a clinical failure group (n = 25). Independent predictors of clinical success after PAE were analyzed by multifactorial logistic regression, and the predictive performance of each factor was evaluated by applying the receiver operating characteristic curve and the area under the curve (AUC). RESULTS There was a linear negative correlation between the prostate necrosis rate at 1-month after PAE and the efficacy score ratio at 1-year after surgery (P < 0.001). In the clinical success group, both the initial prostate volume (PV) and the prostate necrosis rate at 1-month after PAE were significantly higher than in the clinical failure group (P < 0.001), and acute urinary retention (AUR) and adenomatous-dominant BPH were also associated with clinical success (P < 0.05). Multifactorial logistic regression analysis revealed that larger initial PV, a higher prostate necrosis rate at 1-month after surgery, and AUR were independent predictors of clinical success after PAE. The AUC values for these three indicators and their combination were 0.720, 0.928, 0.599, and 0.951, respectively, in which the prostate necrosis rate at 1-month after PAE demonstrating a high predictive value. CONCLUSION The higher the prostate necrosis rate at 1-month after PAE, the better the clinical efficacy at 1-year after PAE is likely to be, and the prostate necrosis rate at 1-month after PAE is expected to become a predictor of clinical success after PAE.
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Affiliation(s)
- Ruo-Li Wang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Institute of Emergency Medicine, Fujian Emergency Medical Center, Fuzhou, 350001, China
| | - Fang-Fang Lin
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Radiology Department, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Dan-Dan Ruan
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Shi-Jie Li
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Yan-Feng Zhou
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Jie-Wei Luo
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
| | - Zhu-Ting Fang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China.
| | - Yi Tang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China.
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Al Rashed AA, Isa QM, Mahdi A, Ebrahim M, Abdulaziz K, Hasan O, Malalla BD, Ahmadi A, Awad N. Clinical Outcomes of Intravesical Prostatic Protrusion in Patients With Benign Prostatic Hyperplasia. Cureus 2024; 16:e52541. [PMID: 38371165 PMCID: PMC10874488 DOI: 10.7759/cureus.52541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Background Benign prostatic hyperplasia (BPH) is a disorder that is characterized by the hyperplasia of the cellular elements of the prostate, leading to an enlarged prostate. One of the parameters affecting urinary outflow is intravesical prostatic protrusion (IPP). It is a phenomenon wherein the enlargement of the prostate protrudes into the bladder along the plane of least resistance. This condition can lead to various clinical effects, including symptoms such as the feeling of incomplete void and weak, interrupted urine stream. Hence, investigating the potential associations between different grades of IPP and clinical urological outcomes holds crucial implications for optimizing patient care, refining risk stratification, and enhancing treatment approaches. Methodology We examined patients who were following up at the urology outpatient clinics due to BPH between June 1, 2021, and December 31, 2022. All patients included in this study were required to undergo a transabdominal prostate ultrasound. Patient records were reviewed for various factors, including demographic stratification, the presence of urine routine or culture with evidence of urinary tract infection (UTI) within the past two years, and whether patients were scheduled for surgical intervention. The radiological parameters were recorded by viewing the midsagittal and transverse ultrasound images retrospectively by two specialist radiology physicians. The parameters measured included IPP Grade, prostate volume (PV), presence of bladder stones, anatomical abnormalities (such as bladder diverticulum), and post-void volume. Results The total sample size was 184 patients. Out of these, 53 (28.8%) had IPP Grade I, 72 (39.1%) were classified as Grade II, 42 (22.8%) had Grade III, and 17 (9.2%) were categorized as Grade IV. The data collected also showed that 12 (6.5%) patients had bladder stones on ultrasound examination. Additionally, 17 (9.2%) patients had bladder diverticulum. Furthermore, when controlled for age and PV, multivariate analysis using logistic regression models to calculate the odds ratio (OR) showed that increasing IPP Grade is associated with an increased risk of developing UTIs, acute urinary retention, and the need for surgical intervention. The highest risk group of patients is IPP Grade IV, with odds ratios (ORs) of 6.8, 7.2, and 6.4 for developing UTIs, experiencing acute urinary retention, and requiring surgical intervention, respectively. Conclusions The results provide compelling evidence of the adverse relationships between higher grades of IPP and worsening urological outcomes and patient morbidity. Hence, we recommend further studies be conducted on the clinical effects of IPP and that these measurements should be considered as part of routine ultrasound prostate imaging to aid in the management of BPH cases.
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Affiliation(s)
| | - Qasim M Isa
- Urology, Salmaniya Medical Complex, Manama, BHR
| | - Amina Mahdi
- Radiology, Salmaniya Medical Complex, Manama, BHR
| | | | | | - Omran Hasan
- Urology, Salmaniya Medical Complex, Manama, BHR
| | | | | | - Nader Awad
- Urology, Salmaniya Medical Complex, Manama, BHR
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Gharbieh S, Reeves F, Challacombe B. The prostatic middle lobe: clinical significance, presentation and management. Nat Rev Urol 2023; 20:645-653. [PMID: 37188789 DOI: 10.1038/s41585-023-00774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
The role of the prostatic middle lobe in the presentation and management of benign prostatic hyperplasia (BPH) is under-appreciated. Middle lobe enlargement is associated with intravesical prostatic protrusion (IPP), which causes a unique type of bladder outlet obstruction (BOO) via a 'ball-valve' mechanism. IPP is a reliable predictor of BOO and the strongest independent factor for failure of medical therapy necessitating conversion to surgical intervention. Men with middle lobe enlargement tend to exhibit mixed symptoms of both the storage and the voiding types, but symptomatology will vary depending on the degree of IPP present. Initial assessments such as uroflowmetry and post-void residual volumes are inadequate to detect IPP and could confound the clinical picture. Radiological evaluation of prostate morphology is key to assessment as it provides important prognostic information and can help with operative planning. Treatment strategies employed for BPH should consider the shape and morphology of prostate adenomata, specifically the presence of middle lobe enlargement and the degree of associated IPP.
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Intravesical protrusion of giant median prostatic lobe: A case report. Urol Case Rep 2022; 44:102152. [PMID: 35832858 PMCID: PMC9272338 DOI: 10.1016/j.eucr.2022.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common disease in ageing men and the result of unregulated hyperplastic growth of the epithelial and stromal tissues of the prostate. Intravesical prostatic protrusion (IPP) of the median lobe is a phenomenon of overgrowth of the prostate adenoma into the bladder and associated with an increased risk for lower urinary tract symptoms (LUTS). This article reports an unusual case of severe intravesical protrusion of a giant median prostatic lobe in 85 years old male with progressive LUTS.
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Tan YG, Teo JS, Kuo TLC, Guo L, Shi L, Shutchaidat V, Aslim EJ, Ng LG, Ho HSS, Foo KT. A Systemic Review and Meta-analysis of Transabdominal Intravesical Prostatic Protrusion Assessment in Determining Bladder Outlet Obstruction and Unsuccessful Trial Without Catheter. Eur Urol Focus 2021; 8:1003-1014. [PMID: 34561198 DOI: 10.1016/j.euf.2021.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Urodynamic study (UDS) provides the most objective assessment of bladder outlet obstruction (BOO) but is impractical to be recommended routinely in outpatient services. Intravesical prostatic protrusion (IPP) had been described to obstruct urinary flow by creating an anatomical ball-valve effect, but there remains a lack of pooled evidence that can objectively correlate with BOO in benign prostatic hyperplasia. OBJECTIVE To update the current evidence on the predictive role of IPP in determining BOO and unsuccessful trial without catheter (TWOC). EVIDENCE ACQUISITION A comprehensive literature search was performed to identify studies that evaluated IPP in diagnosing UDS-determined BOO and TWOC. The search included the PubMed/MEDLINE, EMBASE, and Cochrane Library up to January 2021. An updated systemic review and meta-analysis was performed. EVIDENCE SYNTHESIS A total of 18 studies with 4128 patients were examined. Eleven studies with 1478 patients examined the role of IPP in UDS-determined BOO. The pooled area under the curve (AUC) was 0.83 (95% confidence interval [CI]: 0.79-0.86), and at a cut-off of >10 mm, the sensitivity (Sn) and specificity (Sp) were 0.71 (95% CI: 0.61-0.78) and 0.77 (95% CI: 0.68-0.84), respectively. The probability-modifying plot revealed positive and negative likelihood ratios of 3.34 (95% CI: 2.56-4.36) and 0.35 (95% CI: 0.26-0.45), respectively. Seven studies with 2650 patients examined IPP in predicting unsuccessful TWOC, with a pooled AUC of 0.74 (95% CI: 0.70-0.84), with Sn of 0.51 (95% CI: 0.43-0.60) and Sp of 0.79 (95% CI: 0.73-0.84) at an IPP cut-off of >10 mm. Five studies compared prostate volume (PV) and IPP and revealed a lower AUC of PV at 0.71 (95% CI: 0.67-0.75), which was an inferior parameter in diagnosing BOO (p < 0.001). CONCLUSIONS This systemic review provided evidence that IPP is a reliable clinical parameter that correlates strongly with underlying BOO and unsuccessful TWOC. PATIENT SUMMARY In this review, we comprehensively reviewed all the literature to date on evaluating the clinical utility of intravesical prostatic protrusion (IPP). We have demonstrated that IPP correlates strongly with urodynamic study (UDS)-determined bladder outlet obstruction and failure of trial without catheter (TWOC). Outpatient IPP measurement is a quick, inexpensive, and reproducible clinical parameter that can determine the severity of benign prostatic hyperplasia. The clinical role of IPP in predicting failure of TWOC selects patients who are best treated with aggressive surgical approaches rather than conservative medical therapies. More importantly, IPP can facilitate the discriminatory use of invasive UDS, reserved for patients with a strong suspicion of concomitant detrusor abnormalities.
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Affiliation(s)
- Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore.
| | | | | | - Liang Guo
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore; Cochrane, Singapore
| | - Luming Shi
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore; Cochrane, Singapore; Duke-NUS Medical School, Singapore
| | | | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | | | - Keong Tatt Foo
- Department of Urology, Singapore General Hospital, Singapore
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Eze BU, Ani CO, Mbaeri TU. Is intravesical prostatic protrusion associated with more complications in benign prostatic hyperplasia patients? Low Urin Tract Symptoms 2021; 13:468-474. [PMID: 34080315 DOI: 10.1111/luts.12394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Intravesical prostatic protrusion (IPP) is a noninvasive parameter that can predict disease progression and development of complications in benign prostatic hyperplasia (BPH). This study was to determine the relationship between IPP and the presence of complications in BPH patients. METHODS This was a cross-sectional study of BPH patients at Enugu State University of Science and Technology Teaching Hospital, Enugu. Patients were assessed for acute urinary retention (AUR), chronic urinary retention (CUR), epididymoorchitis, hematuria, hernia, urinary tract infection (UTI), serum creatinine, and prostate-specific antigen (PSA). They also had abdominal ultrasonography assessments for IPP, total prostate volume, bladder wall thickness (BWT), postvoid residual (PVR), hydronephrosis, bladder diverticulum, and urolithiasis using Sonoscape S11 with an abdominal-probe frequency of 3.5 MHz. IPP was measured in millimeter and divided into <10 mm and ≥10 mm. Data were analyzed using SPSS version 21 and were subjected to 1-way analysis of variance, chi-square test, and Pearson correlation. The odds ratios of development of complications at an IPP cutoff of 10 mm were calculated. P < .05 was considered significant. RESULTS A total of 118 patients with a mean age of 64.18 ± 10.96 years and a mean IPP of 14.29 ± 10.20 mm were included. Forty-eight patients had IPP < 10 mm and seventy patients ≥10 mm. Patients with IPP ≥10 mm had significantly higher mean BWT, International Prostate Symptom Score (IPSS), PSA, and PVR (P ≤ .05) and significantly more AUR, CUR, hematuria, hydronephrosis, and UTI (P ≤ .01). CONCLUSION Patients with IPP ≥ 10 mm have a significantly higher incidence of some complications.
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Affiliation(s)
- Balantine Ugochukwu Eze
- Department of Surgery, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Chinenye Obiageli Ani
- Department of Radiology, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Timothy Uzoma Mbaeri
- Department of Surgery, Faculty of Medical Sciences, Nnamdi Azikiwe University, Awka, Nigeria
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Bhat SA, Rather SA, Islam N. An overview of benign prostatic hyperplasia and its appreciation in Greco-Arab (Unani) system of medicine. Asian J Urol 2021; 9:109-118. [PMID: 35509487 PMCID: PMC9051355 DOI: 10.1016/j.ajur.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/30/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
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Chen X, Man Q, Wei X, Ren X, Li G, Lu Z, Zhang X, Qin C. Predictive value of preoperative comprehensive evaluation on the efficacy of HoLEP. Transl Androl Urol 2020; 9:1603-1610. [PMID: 32944522 PMCID: PMC7475670 DOI: 10.21037/tau-20-504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background With the aging of the population, prostate hyperplasia is more and more perplexing to the old men. This study aimed to evaluate the predictive value of international prostatic symptom score-voiding/storage score ratio (IPSS-V/S), urodynamic examination, intravesical prostatic protrusion (IPP) and residual urine volume (RUV) on the efficacy of holmium laser enucleation of the prostate (HoLEP) before operation. Methods Ninety-six patients with benign prostatic hyperplasia (BPH) were enrolled in this study. Each patient was diagnosed as BPH and completed all the evaluations as described above before the same urologist surgeon performed HoLEP. Three months later, another IPSS questionnaire would be finished by each patient to assess the efficacy of the operation. According to the results of IPSS after operation, the group with significant effect and the group with poor effect were divided. Then compare the difference of preoperative examination results between the two groups. Results In single factor analysis, the differences of the age, voiding symptom score, V/S, RUV, Qmax and IPP between the two groups were statistically significant (P<0.05). While there was no significant difference in IPSS score and score of urine storage period. In the logistic regression analysis, the age of patients, V/S, RUV, IPP and Qmax can establish a good prediction model. In this model, the younger the patients are, the less the RUV is, the larger the V/S and IPP are, the more likely they are to achieve good efficacy of HoLEP. Conclusions In conclusion, HoLEP was more effective in BPH patients with younger age, more IPP, less RUV, less Qmax and those whose IPSS score was mainly based on voiding symptoms.
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Affiliation(s)
- Xinglin Chen
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiuhong Man
- Department of Clinical Laboratory, Shanghai Fourth People's Hospital Affiliated to School of Medicine, Tongji University, Shanghai, China
| | - Xiyi Wei
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohan Ren
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guangyao Li
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongwen Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Qin
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kričković Z, Simatović M, Lukić D, Stanojević A, Škrbić V, Janjić G. Frequency of common complications during treatment of patients with benign prostate hyperplasia. SCRIPTA MEDICA 2020. [DOI: 10.5937/scriptamed51-25726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Foo KT. From evidence-based medicine to evidence-balanced medicine for individualized and personalized care: As applied to benign prostatic hyperplasia/male lower urinary tract symptoms. Int J Urol 2019; 24:94-95. [PMID: 28191718 DOI: 10.1111/iju.13285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/27/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Keong Tatt Foo
- Department of Urology, Singapore General Hospital, Singapore
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12
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What is a disease? What is the disease clinical benign prostatic hyperplasia (BPH)? World J Urol 2019; 37:1293-1296. [PMID: 30805683 PMCID: PMC6620380 DOI: 10.1007/s00345-019-02691-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/18/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Though clinical benign prostatic hyperplasia (BPH) is a common disease worldwide, there is still much confusion in the literature and the many clinical guidelines as to its definition. Often the disease is associated with lower urinary tract symptoms (LUTS) and managed according to only symptoms. This leads to undertreatment in some patients with severe bladder outlet obstruction (BOO) with no symptoms, and overtreatment in patients with LUTS but no clinical BPH. Definition of a Disease Fundamentally, a disease can be defined as an abnormal structure or function or a condition which may cause harm to the organism. Definition of clinical BPH Thus, clinical BPH can be defined as prostate adenoma/adenomata, causing a varying degree of BOO, which may eventually cause harm to the patients. With this definition, we are then able to differentiate the disease clinical BPH from the many other less common causes of LUTS, and then treat it according to its severity. Diagnosing clinical BPH Clinical BPH can be diagnosed with non-invasive ultrasound in the clinic, grading it according to the shape (intravesical prostatic protrusion) and size of the prostate. Clinical Significance Treatment can then be planned according to the disease severity using our staging system that classifies severity according to the presence or absence of significant obstruction and bothersomeness of symptoms. Conclusion This would lead to better individualised and cost-effective management of the disease clinical BPH.
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Gandhi J, Weissbart SJ, Kim AN, Joshi G, Kaplan SA, Khan SA. Clinical Considerations for Intravesical Prostatic Protrusion in the Evaluation and Management of Bladder Outlet Obstruction Secondary to Benign Prostatic Hyperplasia. Curr Urol 2018; 12:6-12. [PMID: 30374274 DOI: 10.1159/000447224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 01/23/2023] Open
Abstract
Background Intravesical prostatic protrusion (IPP) is a manifestation of benign prostatic hyperplasia marked by overgrowth of the prostatic median lobe into the bladder, producing bladder outlet obstruction and related storage and voiding symptoms. Methods A MEDLINE® database search of the current literature was guided using combination of "prostate" with the following terms: intravesical prostatic protrusion, bladder trabeculation, bladder outlet obstruction, lower urinary tract symptoms, alpha blockers, transrectal ultrasonography, and prostatectomy. Results Although IPP can be identified via a variety of imaging modalities, it is easily detected via transrectal ultrasonography (TRUS). Failing to detect IPP promptly by TRUS may result in refractory symptoms of benign prostatic hyperplasia, as the condition may not respond to typical α1-adrenoceptor antagonist therapy. In addition, depending on grade, IPP can influence outcomes and complications of prostatectomies. Conclusion Upon report of lower urinary tract symptoms, initial performance of TRUS along with digital rectal examination prevents delay in the appropriate evaluation and management of prostatic diseases.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University Medicine, Stony Brook, Southampton, New York.,Department of Medical Student Research Institute, St. George's University School of Medicine, St. George, Grenada
| | - Steven J Weissbart
- Department of Urology, Stony Brook University Medicine, Stony Brook, Southampton, New York
| | - Albert N Kim
- Department of Urology, Stony Brook University Medicine, Stony Brook, Southampton, New York
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, New York
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York.,Department of Men's Wellness Program, Mount Sinai Health System, New York, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University Medicine, Stony Brook, Southampton, New York.,Department of Urology, Stony Brook University Medicine, Stony Brook, Southampton, New York
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Topazio L, Perugia C, De Nunzio C, Gaziev G, Iacovelli V, Bianchi D, Vespasiani G, Finazzi Agrò E. Intravescical prostatic protrusion is a predictor of alpha blockers response: results from an observational study. BMC Urol 2018; 18:6. [PMID: 29394926 PMCID: PMC5797399 DOI: 10.1186/s12894-018-0320-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the efficacy of tamsulosin in patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) with intravesical prostatic protrusion (IPP). Ultrasound measurement of the IPP has been previously described as an effective instrument for the evaluation of benign prostatic obstruction (BPO) and could help in clarifying the role of alpha-blockers in patients with (BPE). METHODS Patients with BPE and LUTS were enrolled in this observational study. Intravesical prostatic protrusion was graded as grade 1 (< 5 ml), 2 (5 < IPP < 10 ml) and 3 (> 10 ml). Patients were treated with tamsulosin for twelve weeks. Evaluation was performed before and at the end of treatment by means of International Prostate Symptom Score (IPSS) and uroflowmetry. Patients were considered responders if a reduction of IPSS > 3 points was reported. RESULTS One hundred forty-two patients were enrolled. Twelve patients were excluded because of incomplete data. Fifty patients showed an IPP grade 1 (group A), 52 a grade 2 (group B) and 28 a grade 3 (group C). Treatment success was obtained in 82%, 38,5% and 7,1% of patients respectively; these differences (group A vs B-C and group B vs C) were highly significant. The odd ratio to obtain a treatment success was of 59 and 8.1 in group A and group B respectively, in comparison to group C. After a multivariate regression, the relationship between IPP grade and treatment success remained significant. Improvement of uroflowmetry parameters has been reported in all the groups especially in patients with a low grade IPP (p value = 0,016 group A vs group B; p value = 0,005 group A vs group C). Prostate volume seems not to influence this relationship. CONCLUSIONS Intravesical prostatic protrusion has found to be significantly and inversely correlated with treatment success in patients with LUTS and BPE under alpha-blockers therapy. Alpha blockers odd ratio of success is 59 times higher in patients with a low grade IPP in comparison to patients with a high grade.
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Affiliation(s)
- L Topazio
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy.
| | - C Perugia
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - C De Nunzio
- Department of Urology, Sant'Andrea Hospital, University "La Sapienza", Rome, Italy
| | - G Gaziev
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - V Iacovelli
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - D Bianchi
- School of Specialization in Urology, University "Tor Vergata", Rome, Italy
| | - G Vespasiani
- Department of Experimental Medicine and Surgery, University "Tor Vergata", Rome, Italy
| | - E Finazzi Agrò
- Department of Experimental Medicine and Surgery, University "Tor Vergata", Rome, Italy
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15
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Thomas D, Chughtai B, Kaplan S. Commentary on “Solving the benign prostatic hyperplasia puzzle”. Asian J Urol 2018; 5:10-11. [PMID: 29379729 PMCID: PMC5780282 DOI: 10.1016/j.ajur.2016.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 09/01/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Dominique Thomas
- Department of Urology, Weill Cornell Medicine/New-York Presbyterian Hospital, New York, NY, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine/New-York Presbyterian Hospital, New York, NY, USA
| | - Steven Kaplan
- Department of Urology, Weill Cornell Medicine/New-York Presbyterian Hospital, New York, NY, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Corresponding author. Icahn School of Medicine at Mount Sinai, 625 Madison Avenue, New York, NY 10022, USA.Icahn School of Medicine at Mount Sinai625 Madison AvenueNew YorkNY10022USA
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16
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Vasanwala FF, Wong MYC, Ho HSS, Foo KT. Benign prostatic hyperplasia and male lower urinary symptoms: A guide for family physicians. Asian J Urol 2017; 4:181-184. [PMID: 29264228 PMCID: PMC5717979 DOI: 10.1016/j.ajur.2017.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 01/04/2017] [Accepted: 03/08/2017] [Indexed: 11/26/2022] Open
Abstract
Male patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.
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Affiliation(s)
| | - Michael Yuet Chen Wong
- International Urology, Fertility and Gynaecology Centre, Mount Elizabeth Medical Centre, Singapore
| | - Henry Sun Sien Ho
- Department of Urology, Singapore General Hospital, SingHealth, Singapore
| | - Keong Tatt Foo
- Department of Urology, Singapore General Hospital, SingHealth, Singapore
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17
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Singapore Urological Association Clinical Guidelines for Male Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia. Singapore Med J 2017; 58:473-480. [PMID: 28848988 DOI: 10.11622/smedj.2017082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The first clinical guidelines for male lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) were published in 2005. An update is urgently needed in view of BPH being recognised as one of ten chronic illnesses by the Ministry of Health, Singapore. This review summarises the definition of BPH and the epidemiology of male LUTS/BPH in Singapore. BPH can be phenotyped with noninvasive transabdominal ultrasonography, according to intravesical prostatic protrusion and prostate volume, and classified according to severity (staging) for individualised treatment. At the initial evaluation, the majority of patients (59%) can be managed with fluid adjustment, exercise and diet; 32% with medications, using alpha blockers and/or 5-alpha reductase inhibitors for prostates weighing more than 30 g; and 9% with surgical intervention for more advanced disease. The 2015 guidelines comprise updated evidence that will help family medicine practitioners and specialists manage this common ailment more cost-effectively.
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18
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Braeckman J, Denis L. Management of BPH then 2000 and now 2016 - From BPH to BPO. Asian J Urol 2017; 4:138-147. [PMID: 29264222 PMCID: PMC5717990 DOI: 10.1016/j.ajur.2017.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/24/2017] [Accepted: 02/22/2017] [Indexed: 11/25/2022] Open
Abstract
The diagnosis and treatment of benign prostatic obstruction (BPO) is based on a number of well-known lower urinary tract symptoms (LUTS) feared by all ageing males with functional testes. The ascent of modern urology turned this disease from lethal into an annoying but treatable health problem in the previous century. We are able to relieve the great majority of patients from their bothersome symptoms to a respectable quality of life by medication or removal of the obstructive part of the enlarged prostate. We can be proud of some progress made in the new millennium to reach a correct diagnosis and subsequent choice of treatment aiming for quality of life and cost-efficiency for public health. Still it remains symptomatic treatment and we expect the new generation of urologists to close some gaps in our knowledge on the regulation of prostatic growth to focus on prevention and elimination of the disease in the foreseeable future.
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Affiliation(s)
| | - Louis Denis
- Oncology Center Antwerp (OCA), Antwerp, Belgium
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19
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Foo KT. Pathophysiology of clinical benign prostatic hyperplasia. Asian J Urol 2017; 4:152-157. [PMID: 29264224 PMCID: PMC5717988 DOI: 10.1016/j.ajur.2017.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 01/01/2023] Open
Abstract
A disease can be defined as an abnormal anatomy (pathology) and/or function (physiology) that may cause harm to the body. In clinical benign prostatic hyperplasis (BPH), the abnormal anatomy is prostate adenoma/adenomata, resulting in a varying degree of benign prostatic obstruction (BPO) that may cause harm to the bladder or kidneys. Thus clinical BPH can be defined as such and be differentiated from other less common causes of male lower urinary tract symptoms. Diagnosis of the prostate adenoma/adenomata (PA) can be made by measuring the intravesical prostatic protrusion (IPP) and prostate volume (PV) with non-invasive transabdominal ultrasound (TAUS) in the clinic. The PA can then be graded (phenotyped) according to IPP and PV. Multiple studies have shown a good correlation between IPP/PV and BPO, and therefore progression of the disease. The severity of the disease clinical BPH can be classified into stages from stage I to IV for further management. The classification is based on the effect of BPO on bladder functions, namely that of emptying, normal if post-void residual urine (PVRU) < 100 mL; and bladder storage, normal if maximum voided volume (MVV) > 100 mL. The effect of BPO on quality of life (QoL) can be assessed by the QoL index, with a score ≥3 considered bothersome. Patients with no significant obstruction and no bothersome symptoms would be stage I; those with no significant obstruction but has bothersome symptoms (QoL ≥ 3) would be stage II; those with significant obstruction (PVRU > 100 mL; or MVV < 100 mL), irrespective of symptoms would be stage III; those with complications of the disease clinical BPH such as retention of urine, bladder stones, recurrent bleeding or infections would be stage IV. After assessment, further management can then be individualised. A low grade and stage disease can generally be watched (active surveillance) while a high grade and stage disease would need more invasive management with an option for surgery. The final decision making would take into account the patient's age, co-morbidity, social economic background and his preferences/values. Proper understanding of pathophysiology of clinical BPH would lead to better selection of patients for individualised and personalised care and more cost effective management.
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Affiliation(s)
- Keong Tatt Foo
- Department of Urology, Singapore General Hospital, Singapore
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20
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Affiliation(s)
- Keong Tatt Foo
- Department of Urology, Singapore General Hospital, Yong Loo Lin School of Medicine, National University of Singapore, and DUKE-NUS Graduate Medical School, Singapore
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21
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Foo KT. Solving the benign prostatic hyperplasia puzzle. Asian J Urol 2015; 3:6-9. [PMID: 29264156 PMCID: PMC5730809 DOI: 10.1016/j.ajur.2015.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/12/2015] [Indexed: 10/26/2022] Open
Affiliation(s)
- Keong Tatt Foo
- Department of Urology, Singapore General Hospital, Singapore
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