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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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2
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Khalil IA, Aldeeb M, Mohammed A, Awad K, Ibrahim T, Al-Zoubi RM, Aboumarzouk OM, Al-Rumaihi K. The role of Rezum in the management of refractory urinary retention due to benign prostate hyperplasia: A literature review. Arab J Urol 2023; 21:185-189. [PMID: 37521455 PMCID: PMC10373601 DOI: 10.1080/2090598x.2023.2178104] [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: 07/24/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023] Open
Abstract
Background Benign prostatic hyperplasia is the most common cause of urinary retention in men (BPH). The gold standard surgical treatment is transurethral resection of the prostate (TURP). However, due to the morbidity and mortality associated with TURP, more minimally invasive treatments, such as vaporizing the prostate with the Rezum system, have been introduced. We investigated the efficacy of Rezum in the treatment of refractory urinary retention due to BPH in this review. Methodology and materials To conduct this review, the Cochrane methodology for systematic reviews was used. All studies that used Rezum to treat catheter-dependent patients with enlarged prostates were included. The literature search showed 111 studies, 84 of which were excluded due to non-relevance based on titles and 18 due to lack of relevance based on abstract review. Full manuscripts were reviewed in nine studies, three of which were excluded because they did not meet the inclusion criteria. Results This review included 301 patients in total. The rate of a successful trial of voiding post Rezum therapy was 85%. The complication rated between 3.8 and 4.3% all of which were mild and self-limited. As there was no major complication of Rezum (clavien dindo >2), the procedure-related morbidity is negligible. Conclusion In this review, Rezum was found to be an efficacious and safe alternative in the treatment of refractory retention with mild complications and minimal morbidity.
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Affiliation(s)
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mohammed
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Awad
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Tarek Ibrahim
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar M Aboumarzouk
- Department of Surgery, Surgical Research Section, Hamad Medical Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Veterinary and Life Science, The University of Medicine, University of Glasgow, Scotland, UK
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3
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Endoscopic Enucleation of Prostate Could Increase Testosterone Levels in Hypotestosteronemic Patients with Bladder Outlet Obstruction. J Clin Med 2022; 11:jcm11226808. [PMID: 36431285 PMCID: PMC9696526 DOI: 10.3390/jcm11226808] [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] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background: We evaluated the impact of endoscopic enucleation of the prostate on testosterone levels in hypotestosteronemic patients with bladder outlet obstruction. Methods: We enrolled 294 men with lower urinary tract symptoms (LUTS) who received surgery between January 2019 and December 2020 in simple tertiary centre. The inclusion criteria were as follows: being a male patient aged 45−95 years and having recurrent urinary tract infection, having previously failed medical treatment for LUTS or urine retention, and undergoing bipolar or thulium laser enucleation of the prostate. The preoperative and postoperative data were retrospectively reviewed. Results: This study included 112 men with a mean age of 69.4 years. The mean preoperative and postoperative testosterone levels were 4.8 and 4.98, respectively. Of the patients, 88 (78.6%) received ThuLEP and 24 received BipolEP. We divided the patients into two groups according to preoperative serum testosterone levels: normal-testosterone (≥3 ng/mL) and low-testosterone (<3 ng/mL) groups. A significant change in testosterone levels (p = 0.025) was observed in the low-testosterone group. In contrast, no significant difference in testosterone levels was noted in the normal-testosterone group (p = 0.698). Conclusions: Endoscopic enucleation surgery of the prostate could improve postoperative testosterone levels in hypotestosteronemic patients with bladder outlet obstruction.
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Du W, Wang T, Zhang W, Xiao Y, Wang X. Genetically supported causality between benign prostate hyperplasia and urinary bladder neoplasms: A mendelian randomization study. Front Genet 2022; 13:1016696. [PMID: 36468030 PMCID: PMC9713637 DOI: 10.3389/fgene.2022.1016696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/31/2022] [Indexed: 08/11/2024] Open
Abstract
Background: Observational studies have suggested a possible association between benign prostate hyperplasia (BPH) and bladder cancer (BLCA). However, these studies are prone to errors and limitations or confounding factors, making them unsuitable for assessing the causal relationship between BPH and BLCA. Objective: Two-sample Mendelian randomization (MR) was performed to determine a possible association between genetically predicted BPH and the risk of BLCA. Methods: A two-sample MR analysis was performed utilizing the Integrative Epidemiology Unit genome-wide association (GWAS) database of the Medical Research Council, United Kingdom A series of control steps, including five primary methods, were performed to identify the most suitable instrumental variables (IVs) for MR analysis. Sensitivity analysis was conducted to avoid statistical errors, including heterogeneity and pleiotropic bias. Results: Genetic variants associated with BPH (P < 5 × 10-8) and BLCA (P < 5 × 10-6) were identified as instrumental variables and assessed using GWAS summary data (BPH, 4,670 cases vs. 458,340 controls; BLCA, 1,279 cases vs. 372,016 controls). BPH exhibited a positive effect on the occurrence of BLCA (inverse variance weighted (IVW), odds ratio (OR) = 1.095, 95% confidence interval (CI) = 1.030-1.165, p = 0.003), but there was no causal effect for BLCA on BPH (IVW, OR = 1.092, 95% CI = 0.814-1.465, p = 0.554). Conclusion: Genetically predicted BPH was associated with a higher risk of BLCA in all histological subtypes. In contrast, the evidence was not significant to back the causality of genetically induced BLCA on BPH. These findings indicate that BPH plays a key role in developing BLCA in the European population. Further studies are needed to uncover the underlying mechanisms.
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Affiliation(s)
- Wenzhi Du
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Tianyi Wang
- Department of Internal Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Wenxiu Zhang
- Department of Pediatrics, Maternal and Child Health Care Hospital of Shandong Province, Jinan, China
| | - Yu Xiao
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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5
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Maresca G, Mc Clinton S, Swami S, El‐Mokadem I, Donaldson JF. Do men with bladder stones benefit from treatment of benign prostatic obstruction? BJU Int 2022; 130:619-627. [PMID: 35482471 PMCID: PMC9790555 DOI: 10.1111/bju.15761] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO). PATIENTS AND METHODS A regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal-Wallis and chi-squared statistical tests were used. RESULTS A total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow-up. Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378). CONCLUSION This is the largest reported cohort of men, with the longest follow-up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an 'absolute indication' for BPO surgery, as is stated in the Non-neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates.
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Affiliation(s)
- Gianluca Maresca
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Samuel Mc Clinton
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Satchi Swami
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Ismail El‐Mokadem
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - James F. Donaldson
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
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6
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Powell K. Critical thinking and diagnostic reasoning when assessing problems with the genitourinary system. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:28-32. [PMID: 35019737 DOI: 10.12968/bjon.2022.31.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Urological conditions have become increasingly common and early diagnosis is key to achieving better outcomes. This article discusses the importance of having a comprehensive understanding of urological disorders, having the skills to interpret relevant information, and recognising the relationships among given elements to make an appropriate clinical diagnosis.
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Affiliation(s)
- Karen Powell
- Clinical Nurse Manager, Clinisupplies Limited and Visiting Lecturer, Birmingham City University
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7
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Zhang W, Zhang W, Guo Q, Chen L, Meng Z, Xu Y, Cao N, Hu B, Qian B. The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia. Front Surg 2021; 8:755957. [PMID: 34733883 PMCID: PMC8558367 DOI: 10.3389/fsurg.2021.755957] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Transurethral resection of the prostate (TURP) is regarded as the “gold standard” for the treatment of benign prostatic hyperplasia (BPH) in elderly men. However, ~15% of patients who had undergone TURP had intraoperative and postoperative complications, such as bleeding, urinary incontinence and urethral stricture. Transperineal percutaneous laser ablation (TPLA) is a method that places the optical fibre directly into the prostate with the guidance of ultrasound imaging, and the percutaneous transperineal approach is performed distal to the urethra and rectum to protect these structures and reduce urethral or postoperative infection. Several studies on TPLA for BPH treatment have been reported recently; however, high-quality randomised controlled trial (RCT) to evaluate its efficacy, safety, and long-term follow up remain absent. Methods: This study is a multicentre, open-label RCT to assess the efficacy and safety of TPLA vs. TURP to treat BPH. We hypothesise that the TPLA has non-inferior efficacy to TURP in the International Prostate Symptom Score (IPSS) at 3 months changing from the baseline and lower incidence of post-surgery complications. One hundred and fourteen patients with BPH will be recruited at 19 sites and randomly assigned at 1:1 to TPLA or TURP groups. The patients will be followed up at 1, 3, 6, 12, and 24 months after the procedure. Discussion: The study will be the first multicentre clinical trial including 16 participating centres in China, Italy, Switzerland, and Poland with relatively large sample size 114. By comprehensively compare the safety and efficacy of TPLA with TURP in patients with BPH, especially concerning the improvement of lower urinary tract symptoms (LUTS) and complication incidence, the study will help to illustrate the clinical value of TPLA and provide a beneficial alternative treatment for BPH patients. Clinical Trial Registration: The study has been registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn), identifier [ChiCTR1900022739].
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Affiliation(s)
- Wei Zhang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Weituo Zhang
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Guo
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Lei Chen
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Zheying Meng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Nailong Cao
- Department of Urology, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital, Shanghai, China
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8
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Garman T, Cho A, Stoddard MD, Kilemnik I, Malka V, Elterman D, Chughtai B. The Mechanism of Action of cTIND for Minimally Invasive Ischemic Incision of the Prostate: In Vivo Study. Urology 2021; 157:217-221. [PMID: 34058242 DOI: 10.1016/j.urology.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To understand the histologic changes of prostate tissue induced by temporary implantable nitinol device (cTIND) in a canine model. METHODS The cTIND is a small, symmetric device comprised of nitinol wire loops welded together on an axis, which exert radial force on the tissue to induce a targeted ischemic effect. The cTIND was implanted in three live canine models, which were monitored for 14 days post-index procedure. Device placement was monitored via serial fluoroscopy and biologic effects of cTIND were studied via histopathology. RESULTS The cTIND was successfully placed in the canine models and remained securely in position until the animal was sacrificed on postoperative day 14. The cTIND treated tissue demonstrated an abrupt transition from normal, viable prostatic glandular tissue to an area of shrunken necrosis and fibrosis between the two. CONCLUSION In the canine models, the cTIND created focal areas of ischemic necrosis resulting in incisions in the peri-urethral prostate with minimal inflammation.
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Affiliation(s)
- Tyler Garman
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY
| | - Ahra Cho
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY
| | - Michelina D Stoddard
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY
| | | | | | - Dean Elterman
- Department of Urology, University Health Network, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY.
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9
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The Effect of Pre-TURP Bladder Irrigation with 0.2% Chlorhexidine in Patients with Foley Catheter Regarding Postoperative Bacteremia Decrease. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.101296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Transurethral resection of the prostate (TURP) has been widely used for patients suffering from bladder colonization with bacteria, increasing the probability of bacteremia and sepsis despite consuming prophylaxis antibiotics. Objectives: The study aimed to evaluate the effect of pre- TURP bladder irrigation with 0.2% chlorhexidine in reducing postoperative bacteremia. Methods: This clinical trial study was conducted on 60 benign prostatic hyperplasia (BPH) patients who were candidates for TURP in the urology department of Al-Zahra Hospital. All patients suffered from urinary catheters, and they were allocated into two groups (n = 30). Antibiotic prophylaxis was prescribed for all the patients. In the case group, the bladder was rinsed by chlorhexidine 0.2% before TURP; however, and the bladder in the control group was rinsed by distilled water. Postoperative bacteremia were evaluated using procalcitonin (PCT) measurement and BACTEC automated blood culture six hours after surgery. Results: Positive BACTEC blood culture was observed in three (10%) and no (0%) patients in the control and case groups, respectively (P = 0.071). Moreover, 6.6 % and 46.6 % of the patients in the control group had low and high PCT levels, respectively. Furthermore, 40 % and 6.66 % of the patients in the case group had low and high PCT levels, respectively. There was a significant difference between the two groups in terms of the PCT level (P < 0.01). Conclusions: The frequency of patients with a high PCT level was higher in the control group than in the case group, suggesting that chlorhexidine in the catheterized patients undergoing TURP reduced the number of bacteria in the bladder.
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10
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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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11
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Stoddard MD, Cho A, Te AE, Chughtai B. A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE). Curr Urol Rep 2020; 21:64. [PMID: 33230722 DOI: 10.1007/s11934-020-01016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Surgical intervention for benign prostatic enlargement (BPE) is typically reserved for those who fail medical therapy (i.e., α-blocker or 5-α reductase inhibitor treatment). We conducted a systematic review to determine whether timing of surgical intervention for BPE affects patient outcomes. RECENT FINDINGS The studies we reviewed suggested that patients who undergo surgical intervention for BPE after failing medical therapy may have worse outcomes. Increased age, worsened bladder function, and worse overall health may contribute to worsened outcomes. To date, there are few high-quality studies on the timing of surgical intervention for BPE in the literature. Further prospective trials are needed to determine ideal timing for intervention.
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Affiliation(s)
| | - Ahra Cho
- Weill Cornell Medicine, New York, NY, 10065, USA
| | - Alexis E Te
- Weill Cornell Medicine, New York, NY, 10065, USA
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12
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Johnston MJ, Noureldin M, Abdelmotagly Y, Paramore L, Gehring T, Nedas TG, Rajkumar G, Emara A, Hindley RG. Rezum water vapour therapy: promising early outcomes from the first UK series. BJU Int 2020; 126:557-558. [PMID: 32777175 DOI: 10.1111/bju.15203] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Maximilian J Johnston
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Department of Surgery & Cancer, Imperial College London, London, UK
| | - Mohamed Noureldin
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Yehia Abdelmotagly
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Louise Paramore
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Tina Gehring
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Timothy G Nedas
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Govindaraj Rajkumar
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Amr Emara
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK.,Department of Health and Wellbeing, University of Winchester, Winchester, UK
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13
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Subrata SA. Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sumarno A. Subrata
- Doctoral Candidate in Doctor of Philosophy Program in NursingInternational and Collaborative Program with Foreign University Program, Mahidol University Nakhon Pathom Thailand
- Department of Nursing and Wound Research Center, Faculty of Health SciencesUniversitas Muhammadiyah Magelang Magelang Indonesia
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14
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Flatharta TÓ, Mulkerrin EC. Back to Basics: Giant Challenges to Addressing Isaac's "Geriatric Giants" Post COVID-19 Crisis. J Nutr Health Aging 2020; 24:705-707. [PMID: 32744565 PMCID: PMC7306493 DOI: 10.1007/s12603-020-1425-1] [Citation(s) in RCA: 8] [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: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 01/06/2023]
Abstract
The COVID-19 pandemic, being the greatest challenge to our healthcare system for over a century, has its greatest impact on older patients. This subgroup has higher morbidity and mortality than younger age groups. Superimposed on this, the major preventative intervention resulting in social isolation has negative consequences. Prof. Bernard Isaacs described the "Geriatric Giant Symptoms" in 1965 and encouraged the development of interventions for immobility, instability, incontinence and impaired intellect/memory with careful management of these symptoms resulting in better outcomes for older patients including reduced admissions to Nursing Homes and mortality. The author's explore the impact of the current pandemic and, most particularly its aftermath on the provision of such interventions. In the context of a major economic crisis, resources for highly effective interventions such as joint replacement surgery, urological interventions, cataract surgery will be all be limited after this crisis. Moreover delayed access to day patient services with suboptimal access to assessments for conditions such as cognitive decline and falls as well as social care will likewise militate against addressing the "Geriatric Giant Symptoms". Thus the "Founding Fathers" of Geriatric Medicine including Prof Isaacs would be justifiably concerned regarding our ability to deliver interventions to address the "Geriatric Giant Symptoms". Current leaders in geriatric medicine, healthcare workers, funders and providers as well as advocacy groups must redouble their efforts to ensure gains made in management of older patients over 2 generations are not lost in the aftermath of this pandemic.
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Affiliation(s)
- T Ó Flatharta
- Dr. Tomás Ó Flatharta, Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland,
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15
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Association between Bladder Outlet Obstruction and Bladder Cancer in Patients with Aging Male. J Clin Med 2019; 8:jcm8101550. [PMID: 31569597 PMCID: PMC6832159 DOI: 10.3390/jcm8101550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 12/28/2022] Open
Abstract
The associations between the treatment outcomes of benign prostatic hyperplasia/benign prostatic obstruction and lifelong health status, including urologic cancer incidence as well as geriatric adverse events (AEs), are unknown. This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan’s Longitudinal Health Insurance Database 2000. Patients who received transurethral resection of the prostate (TURP) were prioritized, and the remaining patients who were prescribed alpha-blockers were, subsequently, identified. Patients in the TURP and medication-only groups were further divided into two groups, according to the presence or absence of AEs during the first six-month follow-up. Outcomes of primary interest were all-cause mortality, occurrence of prostate cancer, transurethral resection of the bladder tumor, and radical cystectomy for bladder cancer. Compared with patients in the AE-free TURP group, those in the TURP with AEs had a higher risk of lifelong bladder cancer (subdistribution hazard ratio: 2.3, 95% confidence interval (CI): 1.56–3.39), whereas the risk of prostate cancer was comparable between the two groups (SHR: 1.2, 95% CI: 0.83–1.74). In the medication cohorts, patients undergoing alpha-blocker treatment who had AEs had a higher risk of all-cause mortality (hazard ratio: 1.63, 95% CI: 1.49–1.78) and a higher risk of lifelong bladder cancer (SHR: 2.72, 95% CI: 1.99–3.71) when compared with those without AE. Our study reveals that unfavorable treatment outcomes of benign prostate hyperplasia, whether caused by medication or surgical treatment, are associated with a higher incidence of bladder cancer. Unfavorable outcomes of surgical treatment are associated with higher risk of geriatric AEs, and unfavorable outcomes of medication treatment are associated with a higher risk of all-cause mortality.
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16
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Mühlstädt S, Oelke M. [Acute urinary retention in men: efficacy of alpha-blockers in catheter removal after urinary retention]. Urologe A 2019; 58:680-685. [PMID: 31069453 DOI: 10.1007/s00120-019-0945-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- S Mühlstädt
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland. .,UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Deutschland. .,Arbeitskreis Benignes Prostatasyndrom der DGU, Berlin, Deutschland.
| | - M Oelke
- Arbeitskreis Benignes Prostatasyndrom der DGU, Berlin, Deutschland.,Klinik für Urologie, Kinderurologie und Urologische Onkologie, Prostatazentrum Nord-West, St. Antonius-Hospital, Gronau, Deutschland
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