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Worthington J, Frost J, Sanderson E, Cochrane M, Wheeler J, Cotterill N, MacNeill SJ, Noble S, Avery M, Clarke S, Fader M, Hashim H, McGeagh L, Macaulay M, Rees J, Robles L, Taylor G, Taylor J, Thompson J, Lane JA, Ridd MJ, Drake MJ. Lower urinary tract symptoms in men: the TRIUMPH cluster RCT. Health Technol Assess 2024; 28:1-162. [PMID: 38512051 PMCID: PMC11017146 DOI: 10.3310/gvbc3182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background Conservative therapies are recommended as initial treatment for male lower urinary tract symptoms. However, there is a lack of evidence on effectiveness and uncertainty regarding approaches to delivery. Objective The objective was to determine whether or not a standardised and manualised care intervention delivered in primary care achieves superior symptomatic outcome for lower urinary tract symptoms to usual care. Design This was a two-arm cluster randomised controlled trial. Setting The trial was set in 30 NHS general practice sites in England. Participants Participants were adult men (aged ≥ 18 years) with bothersome lower urinary tract symptoms. Interventions Sites were randomised 1 : 1 to deliver the TReatIng Urinary symptoms in Men in Primary Health care using non-pharmacological and non-surgical interventions trial intervention or usual care to all participants. The TReatIng Urinary symptoms in Men in Primary Health care using non-pharmacological and non-surgical interventions intervention comprised a standardised advice booklet developed for the trial from the British Association of Urological Surgeons' patient information sheets, with patient and expert input. Patients were directed to relevant sections by general practice or research nurses/healthcare assistants following urinary symptom assessment, providing the manualised element. The healthcare professional provided follow-up contacts over 12 weeks to support adherence to the intervention. Main outcome measures The primary outcome was the validated patient-reported International Prostate Symptom Score 12 months post consent. Rather than the minimal clinically important difference of 3.0 points for overall International Prostate Symptom Score, the sample size aimed to detect a difference of 2.0 points, owing to the recognised clinical impact of individual symptoms. Results A total of 1077 men consented to the study: 524 in sites randomised to the intervention arm (n = 17) and 553 in sites randomised to the control arm (n = 13). A difference in mean International Prostate Symptom Score at 12 months was found (adjusted mean difference of -1.81 points, 95% confidence interval -2.66 to -0.95 points), with a lower score in the intervention arm, indicating less severe symptoms. Secondary outcomes of patient-reported urinary symptoms, quality of life specific to lower urinary tract symptoms and perception of lower urinary tract symptoms all showed evidence of a difference between the arms favouring the intervention. No difference was seen between the arms in the proportion of urology referrals or adverse events. In qualitative interviews, participants welcomed the intervention, describing positive effects on their symptoms, as well as on their understanding of conservative care and their attitude towards the experience of lower urinary tract symptoms. The interviews highlighted that structured, in-depth self-management is insufficiently embedded within general practitioner consultations. From an NHS perspective, mean costs and quality-adjusted life-years were similar between trial arms. The intervention arm had slightly lower mean costs (adjusted mean difference of -£29.99, 95% confidence interval -£109.84 to £22.63) than the usual-care arm, and a small gain in quality-adjusted life-years (adjusted mean difference of 0.001, 95% confidence interval -0.011 to 0.014). Conclusions The intervention showed a small, sustained benefit for men's lower urinary tract symptoms and quality of life across a range of outcome measures in a UK primary care setting. Qualitative data showed that men highly valued the intervention. Intervention costs were marginally lower than usual-care costs. Limitations of the study included that trial participants were unmasked, with limited diversity in ethnicity and deprivation level. Additional research is needed to assess the applicability of the intervention for a more ethnically diverse population.. Trial registration This trial is registered as ISRCTN11669964. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/90/03) and is published in full in Health Technology Assessment; Vol. 28, No. 13. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Jo Worthington
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Frost
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Sanderson
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Madeleine Cochrane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Stephanie J MacNeill
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Miriam Avery
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Samantha Clarke
- Clinical Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Lucy McGeagh
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Margaret Macaulay
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Luke Robles
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | - Jodi Taylor
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanne Thompson
- Clinical Research Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - J Athene Lane
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew J Ridd
- Centre of Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Ito H, Sakamaki K, Young GJ, Blair PS, Hashim H, Lane JA, Kobayashi K, Clout M, Abrams P, Chapple C, Malde S, Drake MJ. Predicting Prostate Surgery Outcomes from Standard Clinical Assessments of Lower Urinary Tract Symptoms To Derive Prognostic Symptom and Flowmetry Criteria. Eur Urol Focus 2024; 10:197-204. [PMID: 37455216 DOI: 10.1016/j.euf.2023.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Assessment of male lower urinary tract symptoms (LUTS) needs to identify predictors of symptom outcomes when interventional treatment is planned. OBJECTIVE To develop a novel prediction model for prostate surgery outcomes and validate it using a separate patient cohort and derive thresholds for key clinical parameters. DESIGN, SETTING, AND PARTICIPANTS From the UPSTREAM trial of 820 men seeking treatment for LUTS, analysis of bladder diary (BD), International Prostate Symptom Score (IPSS), IPSS-quality of life, and uroflowmetry data was performed for 176 participants who underwent prostate surgery and provided complete data. For external validation, data from a retrospective database of surgery outcomes in a Japanese urology department (n = 227) were used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Symptom improvement was defined as a reduction in total IPSS of ≥3 points. Multiple logistic regression, classification tree analysis, and random forest models were generated, including versions with and without BD data. RESULTS AND LIMITATIONS Multiple logistic regression without BD data identified age (p = 0.029), total IPSS (p = 0.0016), and maximum flow rate (Qmax; p = 0.066) as predictors of outcomes, with area under the receiver operating characteristic curve (AUC) of 77.1%. Classification tree analysis without BD data gave thresholds of IPSS <16 and Qmax ≥13 ml/s (AUC 75.0%). The random forest model, which included all clinical parameters except BD data, had an AUC of 94.7%. Internal validation using the bootstrap method showed reasonable AUCs (69.6-85.8%). Analyses using BD data marginally improved the model fits. External validation gave comparable AUCs for logistic regression, classification tree analysis, and random forest models (all without BD; 70.9%, 67.3%, and 68.5%, respectively). Limitations include the significant number of men with incomplete baseline data and limited assessments in the external validation cohort. CONCLUSIONS Outcomes of prostate surgery can be predicted preoperatively using age, total IPSS, and uroflowmetry data, with prognostic thresholds of 16 for IPSS and 13 ml/s for Qmax. PATIENT SUMMARY This study identified key preoperative factors that can predict outcomes of prostate surgery for bothersome urinary symptoms, including which patients are at risk of a poor outcome.
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Affiliation(s)
- Hiroki Ito
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Urology, Yokohama City University, Yokohama, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Grace J Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter S Blair
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hashim Hashim
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Madeleine Clout
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Christopher Chapple
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Sachin Malde
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Surgery and Cancer, Imperial College, London, UK.
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Bove AM, Brassetti A, Ochoa M, Anceschi U, Ferriero M, Tuderti G, Misuraca L, Mastroianni R, Cartolano S, D’Annunzio S, Torreggiani G, Simone G. Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes. Ther Adv Urol 2023. [DOI: 10.1177/17562872221147104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. Objectives: The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. Design: This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Methods: Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max >15 ml/s, IPSS score < 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ > 0) and the erectile function maintenance (∆IEEF < 6). Results: Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p < 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ ( p < 0.01). Conclusion: RASP provides an effective and durable relief of obstructive symptoms at long-term follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement.
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Affiliation(s)
- Alfredo Maria Bove
- Urology Department, IRCCS ‘Regina Elena’ National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | - Aldo Brassetti
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Mario Ochoa
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Marilia Ferriero
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | | | - Silvia Cartolano
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Simone D’Annunzio
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Giulia Torreggiani
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
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Cheng F, Watton PN, Pederzani G, Kurobe M, Takaoka EI, Chapple C, Birder L, Yoshimura N, Robertson AM. A constrained mixture-micturition-growth (CMMG) model of the urinary bladder: Application to partial bladder outlet obstruction (BOO). J Mech Behav Biomed Mater 2022; 134:105337. [PMID: 35863296 PMCID: PMC9835014 DOI: 10.1016/j.jmbbm.2022.105337] [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: 09/15/2021] [Revised: 04/13/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023]
Abstract
We present a constrained mixture-micturition-growth (CMMG) model for the bladder. It simulates bladder mechanics, voiding function (micturition) and tissue adaptations in response to altered biomechanical conditions. The CMMG model is calibrated with both in vivo and in vitro data from healthy male rat urinary bladders (cystometry, bioimaging of wall structure, mechanical testing) and applied to simulate the growth and remodeling (G&R) response to partial bladder outlet obstruction (BOO). The bladder wall is represented as a multi-layered, anisotropic, nonlinear constrained mixture. A short time scale micturition component of the CMMG model accounts for the active and passive mechanics of voiding. Over a second, longer time scale, G&R algorithms for the evolution of both cellular and extracellular constituents act to maintain/restore bladder (homeostatic) functionality. The CMMG model is applied to a spherical membrane model of the BOO bladder utilizing temporal data from an experimental male rodent model to parameterize and then verify the model. Consistent with the experimental studies of BOO, the model predicts: an initial loss of voiding capacity followed by hypertrophy of SMC to restore voiding function; bladder enlargement; collagen remodeling to maintain its role as a protective sheath; and increased voiding duration with lower average flow rate. This CMMG model enables a mechanistic approach for investigating the bladder's structure-function relationship and its adaption in pathological conditions. While the approach is illustrated with a conceptual spherical bladder model, it provides the basis for application of the CMMG model to anatomical geometries. Such a mechanistic approach has promise as an in silico tool for the rational development of new surgical and pharmacological treatments for bladder diseases such as BOO.
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Affiliation(s)
- Fangzhou Cheng
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States
| | - Paul N Watton
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States; Department of Computer Science & Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom.
| | - Giulia Pederzani
- Department of Computer Science & Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Masahiro Kurobe
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Ei-Ichiro Takaoka
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Chris Chapple
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Lori Birder
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Department of Medicine, University of Pittsburgh, United States
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh, Pittsburgh, United States
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, United States
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Kim HB, Han CH, Jeon JH, Kim E, Kwon O, Choi YE, Yang C, Park YC, Kim YI. Effectiveness and safety of electroacupuncture and its cotreatment with electronic moxibustion in the treatment of patients with moderate benign prostatic hyperplasia using alpha blocker: An assessor-blinded, randomized, controlled pilot study. Medicine (Baltimore) 2022; 101:e30386. [PMID: 36086755 PMCID: PMC10980475 DOI: 10.1097/md.0000000000030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a disease that affects the quality of life by causing lower urinary tract symptoms (LUTS) in men. Electroacupuncture (EA) and moxibustion therapy have been suggested as an adjunct therapy for improving LUTS in patients with BPH, but clinical studies evaluating the effectiveness of EA and its cotreatment with electronic moxibustion (EM) in patients who have been prescribed alpha blockers have yet to be reported. Therefore, this study aimed to evaluate the effectiveness and safety of EA and EM. METHODS Twenty-eight patients diagnosed with BPH were randomized to treatment group (TG, n = 14) or control group (CG, n = 14). The TG continued to use the previously prescribed alpha blocker and received the cotreatment of EA and EM 3 times a week for 6 weeks. The CG continued to use the previously prescribed alpha blocker alone for 6 weeks. The primary outcome was the mean change in the international prostate symptom score (IPSS) from baseline to week 6. The secondary outcomes were IPSS at week 3 and 12, clinical relevance, IPSS life satisfaction, EuroQol-Five dimensions, average urinary flow rate, maximum urinary flow rate, and prostate volume. RESULTS The IPSS decreased at all time points with a statistically significant difference between the 2 groups (3W: P = .0313; 6W: P = .0010; 12W: P = .0304). Based on the minimal clinically important difference (MCID, 3 points), there were significant differences between the TG and the CG at week 3, 6, and 12 (3W: P = .0461; 6W: P = .0123; 12W: P = .0216). Significant group × week interaction effects were found for the IPSS score (P = .0018), as determined from analyses using repeated measures analysis of variance. There were no significant differences between the 2 groups in IPSS life satisfaction, EuroQol-Five dimensions, average urinary flow rate, maximum urinary flow rate, and prostate volume. CONCLUSION EA and its cotreatment with EM might have a beneficial effect as an adjunct therapy in improving LUTS in patients with BPH. Large-scale randomized controlled trials are warranted to confirm the effectiveness and safety of EA and its cotreatment with EM.
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Affiliation(s)
- Hyo Bin Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ju Hyun Jeon
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Eunseok Kim
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Ojin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Yang Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Young Il Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
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Young GJ, Metcalfe C, Lane JA, Lewis AL, Abrams P, Blair PS, Ito H, Chapple C, Drake MJ. Prostate Surgery for Men with Lower Urinary Tract Symptoms: Do We Need Urodynamics to Find the Right Candidates? Exploratory Findings from the UPSTREAM Trial. Eur Urol Focus 2022; 8:1331-1339. [PMID: 34922898 PMCID: PMC9705260 DOI: 10.1016/j.euf.2021.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/21/2021] [Accepted: 11/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Identifying men whose lower urinary tract symptoms (LUTS) may benefit from surgery is challenging. OBJECTIVE To identify routine diagnostic and urodynamic measures associated with treatment decision-making, and outcome, in exploratory analyses of the UPSTREAM trial. DESIGN, SETTING, AND PARTICIPANTS A randomised controlled trial was conducted including 820 men, considering surgery for LUTS, across 26 hospitals in England (ISCTRN56164274). INTERVENTION Men were randomised to a routine care (RC) diagnostic pathway (n = 393) or a pathway that included urodynamics (UDS) in addition to RC (n = 427). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Men underwent uroflowmetry and completed symptom questionnaires, at baseline and 18 mo after randomisation. Regression models identified baseline clinical and symptom measures that predicted recommendation for surgery and/or surgical outcome (measured by the International Prostate Symptom Score [IPSS]). We explored the association between UDS and surgical outcome in subgroups defined by routine measures. RESULTS AND LIMITATIONS The recommendation for surgery could be predicted successfully in the RC and UDS groups (area under the receiver operating characteristic curve 0.78), with maximum flow rate (Qmax) and age predictors in both groups. Surgery was more beneficial in those with higher symptom scores (eg, IPSS >16), age <74 yr, Qmax <9.8 ml/s, bladder outlet obstruction index >47.6, and bladder contractility index >123.0. In the UDS group, urodynamic measures were more strongly predictive of surgical outcome for those with Qmax >15, although patient-reported outcomes were also more predictive in this subgroup. CONCLUSIONS Treatment decisions were informed with UDS, when available, but without evidence of change in the decisions reached. Despite the small group sizes, exploratory analyses suggest that selective use of UDS could detect obstructive pathology, missed by routine measures, in certain subgroups. PATIENT SUMMARY Baseline clinical and symptom measurements were able to predict treatment decisions. The addition of urodynamic test results, while useful, did not generally lead to better surgical decisions and outcomes over routine tests alone.
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Affiliation(s)
- Grace J. Young
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - J. Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Amanda L. Lewis
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Peter S. Blair
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Trials Centre (BRTC), University of Bristol, Bristol, UK
| | - Hiroki Ito
- Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Christopher Chapple
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Marcus J. Drake
- Bristol Medical School, University of Bristol, Bristol, UK,Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK,Corresponding author. University of Bristol and Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK. Tel. +44 7764662017.
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Olaniyi P, Cotterill N, Drake MJ, Frost J, Lane JA, Ridd M, Robles L, Taylor G, Worthington J, Wheeler J. Qualitative Assessment of the Conservative Management of Nocturia with Standardised Written Materials for Lower Urinary Tract Symptoms in Men Treated in Primary Care. Eur Urol Focus 2022; 8:75-80. [PMID: 35034867 DOI: 10.1016/j.euf.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many men prefer conservative treatment of lower urinary tract symptoms (LUTS) but education and self-help guidance are limited in primary care. OBJECTIVE To report qualitative interview findings for men reporting nocturia in a primary care setting for LUTS. DESIGN, SETTING, AND PARTICIPANTS TRIUMPH (Treating Urinary Symptoms in Men in Primary Healthcare) is a multicentre cluster randomised trial of standardised manualised care (a booklet delivered by a health care professional) versus usual care for LUTS. The participants (524 in the intervention arm and 553 in the usual care arm) were men presenting for primary care for LUTS at 30 general practice (GP) sites in the UK. INTERVENTION Delivery of a LUTS self-management booklet by health care staff in comparison to usual care for men with LUTS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The qualitative component included 58 early-stage (0-3 mo after study enrolment) and 33 late-stage (3-9 mo later) interviews with participants to assess their experience of LUTS and conservative treatment in primary care. Purposive sampling was used to select participants for interview. RESULTS AND LIMITATIONS Nocturia is a common driver for seeking health care and is perceived by men as relatively acceptable to discuss. Information and self-help guidance were largely absent from descriptions of GP consultations, other than reducing evening caffeine and fluid intake. The TRIUMPH LUTS intervention booklet offers explanations and self-management guidance. Men with long-term disruptive symptoms, a perception that the booklet content was novel or worthwhile, and a belief that self-management might help, were more receptive to the intervention. In follow-up, improvements in nocturia were related to successful implementation of several aspects of the guidance. Most men were willing to complete a bladder diary, but some found it inconvenient, especially men in employment. The characteristics of the trial population mean that the findings may not apply to all men. CONCLUSIONS Reassuring men that nocturia is part of ageing without offering them information and support risks reinforcing the tendency to discount problematic LUTS. The trial booklet and the training of health care professionals support guidance on nocturia self-management, which is most effective for men receptive to this approach. However, the nature of the trial population means that the findings may not apply to all men. PATIENT SUMMARY Men are more comfortable in discussing waking at night to urinate than talking about other urinary symptoms with their GP. This problem should lead to a detailed discussion of all urinary symptoms rather than being thought of as a sign of ageing. An information booklet and nurse consultation helped many men to improve this symptom.
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Affiliation(s)
- Patrick Olaniyi
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jessica Frost
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Luke Robles
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gordon Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jo Worthington
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Ito H, Abrams P, Lewis AL, Young GJ, Blair PS, Cotterill N, Lane JA, Drake MJ. Use of the International Consultation on Incontinence Questionnaires Bladder Diary in Men Seeking therapy for Lower Urinary Tract Symptoms. Eur Urol Focus 2022; 8:66-74. [PMID: 35027329 DOI: 10.1016/j.euf.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Completion rates and correspondence to other measures need to be established for the International Consultation on Incontinence Questionnaire (ICIQ) bladder diary (ICIQ-BD) in the assessment of male lower urinary tract symptoms (LUTS). OBJECTIVE To evaluate ICIQ-BD completion rates, frequency, volume, and sensation reporting for men. DESIGN, SETTING, AND PARTICIPANTS Baseline data from the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) randomised controlled trial evaluating 820 men at 26 UK hospitals, looking at the ICIQ-BD, uroflowmetry, International Prostate Symptom Score, and ICIQ symptom score for male LUTS (ICIQ-MLUTS), were assessed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The ICIQ-BD, IPSS, ICIQ-MLUTS, and uroflowmetry data at baseline obtained from UPSTREAM were assessed. Correlations were analysed by Pearson's correlation coefficient, and comparison between groups were performed using paired or unpaired t tests or Tukey's test. All statistical tests were two sided and the strength of evidence was presented using p values. RESULTS AND LIMITATIONS Of the participants, 25.0% (205/820) provided complete voiding and bedtime information for 3 d, 41.2% (338/820) omitted bedtime information, and the remainder omitted some or all voiding information. Median values (minimum - maximum) of 24-h, daytime, and night-time frequencies were 9.7 (3.3-24.0), 7.7 (3.3-22.7), and 1.7 (0.0-5.7), respectively. The mean voided volume per micturition for day and night times were 175.8 ± 74.2 and 264.4 ± 150.7 ml (p < 0.001), respectively. For fully completed diaries, day- and night-time frequency showed a weak-to-moderate correlation with symptom score questionnaires. More severe nocturia was generally reported in symptom scores than in the ICIQ-BD. In patients with high bother for increased daytime frequency (symptom), the mean daytime frequency (ICIQ-BD) was 9.6 ± 3.2 versus 7.6 ± 2.2 for low bother (p < 0.001). High bother for nocturia showed night-time frequency of 2.3 ± 1.2 versus 1.5 ± 1.1 for low bother (p < 0.001). For fully and partially completed diaries, ICIQ-BD sensation scores correlated weakly with symptom scores. Voided volumes from the bladder diary and uroflowmetry correlated weakly. CONCLUSIONS Two-thirds of men (543/820) fully completed voiding information in the ICIQ-BD, but many omitted bedtime information, limiting the ability to quantify nocturia and diagnose nocturnal polyuria. PATIENT SUMMARY Most men with urinary symptoms complete a bladder diary fully but may fail to indicate bedtimes. Extra information from a diary helps support symptom questionnaires to explain a patient's urinary habits.
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Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan; Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Paul Abrams
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Amanda L Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK
| | - Grace J Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK
| | - Peter S Blair
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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Lewis AL, Young GJ, Selman LE, Rice C, Clement C, Ochieng CA, Abrams P, Blair PS, Chapple C, Glazener CM, Horwood J, McGrath JS, Noble S, Taylor GT, Lane JA, Drake MJ. Urodynamics tests for the diagnosis and management of bladder outlet obstruction in men: the UPSTREAM non-inferiority RCT. Health Technol Assess 2020; 24:1-122. [PMID: 32902375 DOI: 10.3310/hta24420] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) in men may indicate bladder outlet obstruction (BOO) or weakness, known as detrusor underactivity (DU). Severe bothersome LUTS are a common indication for surgery. The diagnostic tests may include urodynamics (UDS) to confirm whether BOO or DU is the cause, potentially reducing the number of people receiving (inappropriate) surgery. OBJECTIVES The primary objective was to determine whether a care pathway including UDS is no worse for symptom outcome than one in which it is omitted, at 18 months after randomisation. Rates of surgery was the key secondary outcome. DESIGN This was a pragmatic, multicentre, two-arm (unblinded) randomised controlled trial, incorporating a health economic analysis and qualitative research. SETTING Urology departments of 26 NHS hospitals in England. PARTICIPANTS Men (aged ≥ 18 years) seeking further treatment, potentially including surgery, for bothersome LUTS. Exclusion criteria were as follows: unable to pass urine without a catheter, having a relevant neurological disease, currently undergoing treatment for prostate or bladder cancer, previously had prostate surgery, not medically fit for surgery and/or unwilling to be randomised. INTERVENTIONS Men were randomised to a care pathway based on non-invasive routine tests (control) or routine care plus invasive UDS (intervention arm). MAIN OUTCOME MEASURES The primary outcome was International Prostate Symptom Score (IPSS) at 18 months after randomisation and the key secondary outcome was rates of surgery. Additional secondary outcomes included adverse events (AEs), quality of life, urinary and sexual symptoms, UDS satisfaction, maximum urinary flow rate and cost-effectiveness. RESULTS A total of 820 men were randomised (UDS, 427; routine care, 393). Sixty-seven men withdrew before 18 months and 11 died (unrelated to trial procedures). UDS was non-inferior to routine care for IPSS 18 months after randomisation, with a confidence interval (CI) within the margin of 1 point (-0.33, 95% CI -1.47 to 0.80). A lower surgery rate in the UDS arm was not found (38% and 36% for UDS and routine care, respectively), with overall rates lower than expected. AEs were similar between the arms at 43-44%. There were more cases of acute urinary retention in the routine care arm. Patient-reported outcomes for LUTS improved in both arms and satisfaction with UDS was high in men who received it. UDS was more expensive than routine care. From a secondary care perspective, UDS cost an additional £216 over an 18-month time horizon. Quality-adjusted life-years (QALYs) were similar, with a QALY difference of 0.006 in favour of UDS over 18 months. It was established that UDS was acceptable to patients, and valued by both patients and clinicians for its perceived additional insight into the cause and probable best treatment of LUTS. LIMITATIONS The trial met its predefined recruitment target, but surgery rates were lower than anticipated. CONCLUSIONS Inclusion of UDS in the diagnostic tests results in a symptom outcome that is non-inferior to a routine care pathway, but does not affect surgical rates for treating BOO. Results do not support the routine use of UDS in men undergoing investigation of LUTS. FUTURE WORK Focus should be placed on indications for selective utilisation of UDS in individual cases and long-term outcomes of diagnosis and therapy. TRIAL REGISTRATION Current Controlled Trials ISRCTN56164274. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda L Lewis
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Grace J Young
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy E Selman
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caoimhe Rice
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cynthia A Ochieng
- Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Peter S Blair
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - J Athene Lane
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Reply to Sachin Malde, Arun Sahai, and Eskinder Solomon's Letter to the Editor re: Marcus J. Drake, Amanda L. Lewis, Grace J. Young, et al. Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals. Eur Urol 2020;78:701-10. Eur Urol 2020; 78:e234-e235. [PMID: 32900552 DOI: 10.1016/j.eururo.2020.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
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Uren AD, Cotterill N, Pardoe M, Abrams P. The International Consultation on Incontinence Questionnaires (ICIQ): An update on status and direction. Neurourol Urodyn 2020; 39:1889-1896. [PMID: 32573011 DOI: 10.1002/nau.24437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/07/2020] [Indexed: 11/08/2022]
Abstract
AIMS In its 22nd year, the International Consultation on Incontinence Questionnaire (ICIQ) project continues to promote its primary objective; the development and dissemination of patient completed questionnaires for the standardized, high-quality assessment of urinary, bowel, and vaginal symptoms. The paper gives an update on the ICIQ in the context of current scientific developments of PROM design and regulatory requirements, and plans are outlined for its future direction. METHODS An online library of all questionnaires, including over 300 translations has been launched to facilitate access through a semi-automated registration system. The ICIQ project continues to update its protocol to meet current scientific standards and incorporate methodological advances within PROM development. RESULTS Nineteen psychometrically validated patient-reported outcome measures (PROMs) are published for use in clinical practice and research, including amongst others, a bladder diary, male and female lower urinary tract symptoms, long term catheter, pad use, and bowel symptom questionnaires. The original ICIQ-UI Short Form for the assessment of urinary incontinence continues to be the most internationally used questionnaire and has been translated into over 60 languages. New questionnaires which are under development include the ICIQ-Underactive Bladder and ICIQ-Satisfaction. We anticipate the new website and online library will further facilitate the ease of dissemination and availability of the questionnaires for clinical practice and research. CONCLUSION The ICIQ continues to successfully achieve its primary objective. Going forward, a greater focus on promoting routine clinical use and the potential for electronic integration into databases and medical records is envisaged.
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Affiliation(s)
- Alan D Uren
- Department of Urology, Southmead Hospital, Bristol Urological Institute, Bristol, UK
| | - Nikki Cotterill
- Department of Urology, Southmead Hospital, University of the West of England and the Bristol Urological Institute, Bristol, UK
| | - Megan Pardoe
- Department of Urology, Southmead Hospital, Bristol Urological Institute, Bristol, UK
| | - Paul Abrams
- Department of Urology, Southmead Hospital, Bristol Urological Institute, Bristol, UK
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Biers S, Walton T, Belal M, Keeley FX, Alnajjar HM, Muneer A. Urology highlights 2017 to 2018. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819887050] [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
The final clinical session of the British Association of Urological Surgeons (BAUS) annual meeting is the Updates and Highlights session, where the most important advances in the main urological sub-specialities are summarised and presented by sub-specialist experts representing each BAUS section. The aim of the session is to disseminate knowledge on the latest research, new guidelines and changes to general and specialist clinical practice. This paper covers contemporary urological advances as presented at the Liverpool BAUS meeting in June 2018.
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Affiliation(s)
- Suzanne Biers
- Urology Department, Addenbrooke’s Hospital, Cambridge, UK
| | - Tom Walton
- Urology Department, Nottingham City Hospital, UK
| | - Mohammed Belal
- Urology Department, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Asif Muneer
- Division of Surgery and Interventional Science UCL, NIHR Biomedical Research Centre University College London Hospitals, UK
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14
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Aiello M, Jelski J, Lewis A, Worthington J, McDonald C, Abrams P, Gammie A, Harding C, Biers S, Hashim H, Lane JA, Drake MJ. Quality control of uroflowmetry and urodynamic data from two large multicenter studies of male lower urinary tract symptoms. Neurourol Urodyn 2020; 39:1170-1177. [PMID: 32187720 DOI: 10.1002/nau.24337] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
AIM The International Continence Society (ICS) has standardized quality control and interpretation of uroflowmetry and urodynamics. We evaluated traces from two large studies of male lower urinary tract symptoms (UPSTREAM and UNBLOCS) against ICS standards of urodynamic equipment and practice. METHODS Ten percent of uroflowmetry and urodynamics traces were selected at random from hospital sites. A data capture template was designed from the ICS Fundamentals of Urodynamic Practice checklist. Two pretrained blinded assessors extracted the data, with a third assessor to arbitrate. Departmental records of calibration checks and equipment maintenance were scrutinized. RESULTS Seven out of twenty-five (28%) departments reported no calibration checks. Four sites (16%) could not provide annual service records. In 32 out of 296 (10.8%) uroflowmetry traces, findings were affected by artifact. One hundred ten urodynamic study traces were reviewed; in 11 records (10%), key pressure traces were incompletely displayed. In 30 (27.2%), reference zero was not set to atmospheric pressure. Resting pressures were outside the expected range for 36 (32.7%). Pressure drift was seen in 18 traces (16.4%). At pressure-flow study commencement, permission to void was omitted in 15 (13.6%). Cough testing after voiding was done in 71.2%, but the resulting cough spikes were significantly different in 16.5%. Erroneous diagnosis of bladder outlet obstruction (BOO) was identified in six cases (5.5%). CONCLUSIONS Erroneous diagnosis of BOO is a serious error of interpretation, as it could lead to unnecessary surgery. Other errors of standardization, testing, and interpretation were identified with lower risk of adverse implications. Inconsistent documentation of service records mean equipment accuracy is uncertain.
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Affiliation(s)
- Martino Aiello
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Joseph Jelski
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Amanda Lewis
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jo Worthington
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charlotte McDonald
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Chris Harding
- Urology Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Suzanne Biers
- Urology Department, Addenbrooke's Hospital, Cambridge, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Urology Department, Freeman Hospital, Newcastle upon Tyne, UK.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Lee HY, Bae GE, Lee SD, Nam JK, Yun YJ, Han JY, Lee DH, Choi JY, Park SH, Kwon JN. Moxibustion as an adjunct for lower urinary tract symptoms associated with benign prostate enlargement: A randomized controlled pilot trial. Medicine (Baltimore) 2020; 99:e18918. [PMID: 31977907 PMCID: PMC7004691 DOI: 10.1097/md.0000000000018918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Benign prostatic enlargement (BPE) causes discomfort in daily life, including lower urinary tract symptoms (LUTSs) caused by the enlarged prostate, and requires long-term management as a chronic, irreversible disease. To improve LUTS, certain complementary therapies have been used with or without doctors' directions. Conventional treatments and complementary therapies tend to be combined unsystematically, depending on patient preference; thus, research for safe and efficient combination therapy is warranted. METHODS Twenty-nine participants were randomly assigned to an integrative group (IG, n = 15) or a conventional group (CG, n = 14). The IG received moxibustion (twice weekly for 4 weeks, at the acupuncture points SP6, LR3, and CV4) and conventional medication for 4 weeks, followed by conventional medication alone for 8 weeks. The CG received conventional medication alone for 12 weeks. The outcome measures were International Prostate Symptom Score (IPSS), patient's global impression of changes (PGIC), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and frequency-volume chart. RESULTS Total IPSS (IG, -2.4 ± 4.2; CG, 0.9 ± 4.0; P = .039), PGIC-A (IG, 3.5 ± 1.0; CG, 2.2 ± 1.0; P = .001), and PGIC-B (IG, 3.5 ± 0.1; CG, 4.7 ± 0.6; P = .004) were significantly improved in the IG compared with the CG, 4 weeks after baseline. Among the IPSS items, incomplete emptying (IG, -0.6 ± 0.7; CG, 0.4 ± 1.2; P = .019), straining (IG, -0.6 ± 0.8; CG, 0.2 ± 1.2; P = .046), and nocturia (IG, -0.8 ± 1.4; CG, 0.1 ± 1.0; P = .045) showed significant differences. The Qmax and PVR volume did not differ significantly at 12 weeks after the baseline. CONCLUSION Moxibustion can be considered an adjunct therapy to improve LUTS in BPE patients. A full-sized randomized controlled trial would be feasible with comparator modifications and an extended study period. The study design should include a placebo group and narrow the eligibility to subjects who do not respond well to conventional treatments.
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Affiliation(s)
- Hye-Yoon Lee
- School of Korean medicine, Pusan National University
| | - Go-Eun Bae
- School of Korean medicine, Pusan National University
| | - Sang-Don Lee
- Department of Urology, Pusan National University Yangsan Hospital
- Department of Urology, Pusan National University School of Medicine, Yangsan
| | - Jong-Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital
- Department of Urology, Pusan National University School of Medicine, Yangsan
| | - Young-Ju Yun
- School of Korean medicine, Pusan National University
- Department of Korean Internal Medicine, Pusan National University Korean Medicine Hospital
| | - Ji-Yeon Han
- Department of Urology, Pusan National University Yangsan Hospital
- Department of Urology, Pusan National University School of Medicine, Yangsan
| | - Dong-Hoon Lee
- Department of Urology, Pusan National University Yangsan Hospital
- Department of Urology, Pusan National University School of Medicine, Yangsan
| | - Jun-Young Choi
- School of Korean medicine, Pusan National University
- Department of Korean Internal Medicine, Pusan National University Korean Medicine Hospital
| | - Seong-Ha Park
- School of Korean medicine, Pusan National University
- Department of Korean Internal Medicine, Pusan National University Korean Medicine Hospital
| | - Jung-Nam Kwon
- School of Korean medicine, Pusan National University
- Department of Korean Internal Medicine, Pusan National University Korean Medicine Hospital
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Gammie A, Almeida F, Drake M, Finazzi Agrò E, Kirschner-Hermanns R, Lemos N, Martens F, Mehnert U, Rosier P, Valentini F, Abrams P. Is the value of urodynamics undermined by poor technique?: ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S35-S39. [PMID: 31821637 DOI: 10.1002/nau.23978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/18/2019] [Accepted: 03/04/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The quality of urodynamic measurements in clinical practice has been debated as a matter of concern. It is considered plausible that this has a direct bearing on patient care and the perceived value of urodynamic testing. METHODS This is a report of the proceedings of the Think Tank: "Is the value of urodynamics undermined by poor technique?" from the Annual International Consultation on Incontinence-Research Society, which took place in June 2018 in Bristol, UK. The Think Tank discussed the evidence for deficiencies in urodynamic test quality and considered the implications of improvements for clinical diagnosis and practice. RESULTS There is evidence that technique affects urodynamic quality, and that urodynamic practice is variable. Factors such as team skill set, technologies used, and training received will also affect the quality of urodynamic service. Questions exist regarding the influence of technique on the utility and perceived value of urodynamics. CONCLUSIONS We suggest research questions that will provide the necessary evidence on the link between technique, reporting, and outcome, and clarify the role of good practice in the utility of urodynamic testing.
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Affiliation(s)
| | | | | | | | | | | | - Frank Martens
- Radboud University Medical Centre, Nijmegen, The Netherlands
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17
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Frost J, Lane JA, Cotterill N, Fader M, Hackshaw-McGeagh L, Hashim H, Macaulay M, MacNeill SJ, Noble S, Rees J, Ridd MJ, Robles L, Taylor G, Taylor J, Drake MJ, Worthington J. TReatIng Urinary symptoms in Men in Primary Healthcare using non-pharmacological and non-surgical interventions (TRIUMPH) compared with usual care: study protocol for a cluster randomised controlled trial. Trials 2019; 20:546. [PMID: 31477160 PMCID: PMC6720870 DOI: 10.1186/s13063-019-3648-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) can relate to urinary storage or voiding. In men, the prevalence and severity of LUTS increases with age, with a significant impact on quality of life. The majority of men presenting with LUTS are managed by their general practitioner (GP) in the first instance, with conservative therapies recommended as the initial treatment. However, the provision of conservative therapies in primary care is variable and can be time and resource limited. GPs require practical resources to enhance patient engagement with such interventions. TRIUMPH aims to determine whether a standardised and manualised care intervention delivered in primary care achieves superior symptomatic outcome for LUTS versus usual care. METHODS/DESIGN TRIUMPH is a two-arm, cluster randomised controlled trial (RCT) being conducted in 30 National Health Service (NHS) general practices in England. The TRIUMPH intervention comprises a standardised LUTS advice booklet developed for the trial with patient and healthcare professional (HCP) consultation. The booklet is delivered to patients by nurses/healthcare assistants following assessment of their urinary symptoms. Patients are directed to relevant sections of the booklet, providing the manualised element of the intervention. To encourage adherence, HCPs provide follow-up contacts over 12 weeks. Practices are randomised 1:1 to either deliver the TRIUMPH intervention or a usual care pathway. The patient-reported International Prostate Symptom Score (IPSS) at 12 months post consent is the primary outcome. Secondary outcomes include cost-effectiveness, patient-reported outcomes on LUTS, quality of life, and patient and HCP acceptability and experience of the intervention. Primary analyses will be conducted on an intention-to-treat basis. DISCUSSION It is unclear whether conservative therapies for male LUTS are effectively delivered in primary care using current approaches. This can lead to men being inappropriately referred to secondary care or experiencing persistent symptoms. Primary care, therefore, holds the key to effective treatment for these men. The TRIUMPH intervention, through its standardised and manualised approach, has been developed to support GP practices in delivering effective conservative care. This pragmatic, cluster RCT should provide robust evidence in a primary-care setting to inform future guidelines. TRIAL REGISTRATION ISCRTN registry, ID: ISRCTN11669964 . Registered on 12 April 2018.
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Affiliation(s)
- Jessica Frost
- 0000 0004 1936 7603grid.5337.2Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - J. Athene Lane
- 0000 0004 1936 7603grid.5337.2Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Nikki Cotterill
- 0000 0004 0417 1173grid.416201.0Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB UK
| | - Mandy Fader
- 0000 0004 1936 9297grid.5491.9Faculty of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Lucy Hackshaw-McGeagh
- 0000 0004 1936 7603grid.5337.2NIHR Bristol Biomedical Research Centre, University of Bristol, Level 3, University Hospitals Bristol Education Centre, Upper Maudlin Street, Bristol, BS2 8AE UK
| | - Hashim Hashim
- 0000 0004 0417 1173grid.416201.0Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB UK
| | - Margaret Macaulay
- 0000 0004 1936 9297grid.5491.9Faculty of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Stephanie J. MacNeill
- 0000 0004 1936 7603grid.5337.2Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Sian Noble
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jonathan Rees
- NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, Brockway Medical Centre, Backwell and Nailsea Medical Group, 8 Brockway, Nailsea, Bristol, BS48 1BZ UK
| | - Matthew J. Ridd
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Luke Robles
- 0000 0004 1936 7603grid.5337.2Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Gordon Taylor
- Public and Patient Involvement Representative, Bristol, UK
| | - Jodi Taylor
- 0000 0004 1936 7603grid.5337.2Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Marcus J Drake
- 0000 0004 1936 7603grid.5337.2Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol Urological Institute, Level 3 Learning and Research Building, Bristol, BS10 5NB UK
| | - Jo Worthington
- 0000 0004 1936 7603grid.5337.2Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Swavely NR, Speich JE, Stothers L, Klausner AP. New Diagnostics for Male Lower Urinary Tract Symptoms. CURRENT BLADDER DYSFUNCTION REPORTS 2019; 14:90-97. [PMID: 31938079 PMCID: PMC6959483 DOI: 10.1007/s11884-019-00511-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms (LUTS) is a common constellation of symptoms that affect the aging male population with an astonishing prevalence. New technology and new uses of established technology are being used to help further evaluate LUTS in the male population and help guide treatment options. This review focuses on the developments and future directions in diagnostic modalities for evaluation of male LUTS, focusing on evaluation of both the filling and voiding phases of micturition. RECENT FINDINGS New techniques in evaluating the voiding phase include penile cuff test, external pressure sensing condom catheter, ultrasound measurement of detrusor wall thickness, ultrasound measurement of intravesical prostatic protrusion, doppler ultrasound and NIRS technology. Evaluation of the filling phase is still undergoing much development and requires additional validation studies. The techniques undergoing evaluation include sensation meters during UDS, assessing bladder micromotion and wall rhythm, assessing detrusor wall biomechanics, ultrasound measurement of detrusor wall thickness, pelvic doppler ultrasound, as well as functional brain imaging including fNIRS and fMRI. SUMMARY The development of novel, non-invasive, diagnostic tools have the potential for better evaluation of LUTS with earlier and enhanced treatments. This will likely improve the quality of life for men with LUTS.
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Affiliation(s)
- Natalie R Swavely
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - John E Speich
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
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Malling B, Røder MA, Lindh M, Frevert S, Brasso K, Lönn L. Palliative Prostate Artery Embolization for Prostate Cancer: A Case Series. Cardiovasc Intervent Radiol 2019; 42:1405-1412. [DOI: 10.1007/s00270-019-02227-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/19/2019] [Indexed: 12/15/2022]
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20
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Chapple C. What is New in Functional Urology? Eur Urol Focus 2019; 5:307-309. [DOI: 10.1016/j.euf.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
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21
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Lewis AL, Young GJ, Abrams P, Blair PS, Chapple C, Glazener CMA, Horwood J, McGrath JS, Noble S, Taylor GT, Ito H, Belal M, Davies MC, Dickinson AJ, Foley CL, Foley S, Fulford S, Gammal MM, Garthwaite M, Harris MRE, Ilie PC, Jones R, Sabbagh S, Mason RG, McLarty E, Mishra V, Mom J, Morley R, Natale S, Nitkunan T, Page T, Payne D, Rashid TG, Saeb-Parsy K, Sandhu SS, Simoes A, Singh G, Sullivan M, Tempest HV, Viswanath S, Walker RMH, Lane JA, Drake MJ. Clinical and Patient-reported Outcome Measures in Men Referred for Consideration of Surgery to Treat Lower Urinary Tract Symptoms: Baseline Results and Diagnostic Findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). Eur Urol Focus 2019; 5:340-350. [PMID: 31047905 DOI: 10.1016/j.euf.2019.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/10/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical evaluation of male lower urinary tract symptoms (MLUTS) in secondary care uses a range of assessments. It is unknown how MLUTS evaluation influences outcome of therapy recommendations and choice, notably urodynamics (UDS; filling cystometry and pressure flow studies). OBJECTIVE To report participants' sociodemographic and clinical characteristics, and initial diagnostic findings of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). UPSTREAM is a randomised controlled trial evaluating whether symptoms are noninferior and surgery rates are lower if UDS is included. DESIGN, SETTING, AND PARTICIPANTS A total of 820 men (≥18 yr of age) seeking treatment for bothersome LUTS were recruited from 26 National Health Service hospital urology departments. INTERVENTION Care pathway based on routine, noninvasive tests (control) or routine care plus UDS (intervention arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome is International Prostate Symptom Score (IPSS) and the key secondary outcome is surgery rates 18 mo after randomisation. International Consultation on Incontinence Questionnaires were captured for MLUTS, sexual function, and UDS satisfaction. Baseline clinical and patient-reported outcome measures (PROMs), and UDS findings were informally compared between arms. Trends across age groups for urinary and sexual PROMs were evaluated with a Cuzick's test, and questionnaire items were compared using Pearson's correlation coefficient. RESULTS AND LIMITATIONS Storage LUTS, notably nocturia, and impaired sexual function are prominent in men being assessed for surgery. Sociodemographic and clinical evaluations were similar between arms. Overall mean IPSS and quality of life scores were 18.94 and 4.13, respectively. Trends were found across age groups, with older men suffering from higher rates of incontinence, nocturia, and erectile dysfunction, and younger men suffering from increased daytime frequency and voiding symptoms. Men undergoing UDS testing expressed high satisfaction with the procedure. CONCLUSIONS Men being considered for surgery have additional clinical features that may affect treatment decision making and outcomes, notably storage LUTS and impaired sexual function. PATIENT SUMMARY We describe initial assessment findings from a large clinical study of the treatment pathway for men suffering with bothersome urinary symptoms who were referred to hospital for further treatment, potentially including surgery. We report the patient characteristics and diagnostic test results, including symptom questionnaires, bladder diaries, flow rate tests, and urodynamics.
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Affiliation(s)
- Amanda L Lewis
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, Canynge Hall, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, UK
| | - Grace J Young
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, Canynge Hall, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Peter S Blair
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, Canynge Hall, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, UK
| | - Christopher Chapple
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Cathryn M A Glazener
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, Scotland, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, Canynge Hall, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, UK
| | - John S McGrath
- University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Hiroki Ito
- Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Mohammed Belal
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Melissa C Davies
- Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, Wiltshire, UK
| | | | - Charlotte L Foley
- East and North Hertfordshire NHS Trust, Urology Department, Ashwell Block, Lister Hospital, Stevenage, Hertfordshire, UK
| | - Steve Foley
- Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Simon Fulford
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Mohsen M Gammal
- Southport and Ormskirk Hospital NHS Trust, Southport, Merseyside, UK
| | - Mary Garthwaite
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Mark R E Harris
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Petre C Ilie
- The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Robert Jones
- Urology Department, Taunton and Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK
| | - Samer Sabbagh
- St George's University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - Robert G Mason
- Torbay and South Devon NHS Foundation Trust, Torbay Hospital, Torquay, UK
| | - Ester McLarty
- Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - Vibhash Mishra
- Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Jaswant Mom
- North Cumbria University Hospitals NHS Trust, West Cumberland Hospital, Hensingham, Whitehaven, Cumbria, UK
| | - Roland Morley
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Tharani Nitkunan
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK
| | - Tobias Page
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, High Heaton, Newcastle Upon Tyne, UK
| | - David Payne
- Kettering General Hospital NHS Foundation Trust, Kettering, Northants, UK
| | - Tina G Rashid
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Kasra Saeb-Parsy
- Urology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Adrian Simoes
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK
| | - Gurpreet Singh
- Southport and Ormskirk Hospital NHS Trust, Southport, Merseyside, UK
| | - Mark Sullivan
- Nuffield Department of Surgical Sciences, Oxford University, Headington, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK
| | - Heidi V Tempest
- Nuffield Department of Surgical Sciences, Oxford University, Headington, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Headington, Oxford, UK
| | - Srinivasa Viswanath
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Roger M H Walker
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, Canynge Hall, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Level 3, Learning and Research Building, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
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Gürbüz C, Drake MJ. Where can urodynamic testing help assess male lower urinary tract symptoms? Turk J Urol 2019; 45:157-163. [PMID: 30817272 DOI: 10.5152/tud.2019.82783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/05/2018] [Indexed: 01/23/2023]
Abstract
Urodynamic studies assess the function of the bladder and bladder outlet. They are often useful in the assessment and diagnosis of patients presenting with lower urinary tract symptoms (LUTS). The evidence regarding the value and risks of invasive urodynamics remains insufficient. However, men with LUTS who are assessed by invasive urodynamics are more likely to have their management changed and less likely to undergo surgery. This review discusses the role of urodynamic diagnosis and application in the diagnosis and treatment of male LUTS.
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Affiliation(s)
- Cenk Gürbüz
- Department of Urology Medistate Hospital, Beykoz University, İstanbul, Turkey
| | - Marcus J Drake
- Bristol Urological Institute and Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
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Selman LE, Ochieng CA, Lewis AL, Drake MJ, Horwood J. Recommendations for conducting invasive urodynamics for men with lower urinary tract symptoms: Qualitative interview findings from a large randomized controlled trial (UPSTREAM). Neurourol Urodyn 2018; 38:320-329. [PMID: 30311686 PMCID: PMC6334271 DOI: 10.1002/nau.23855] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
Aims To capture in‐depth qualitative evidence regarding attitudes to and experiences of urodynamic testing among men with lower urinary tract symptoms (LUTS) at each end of the clinical pathway. Methods Semi‐structured interview study conducted within the Urodynamics for Prostate Surgery: Randomized Evaluation of Assessment Methods (UPSTREAM) trial, which randomized men to a care pathway including urodynamics or routine non‐invasive tests from 26 secondary care urology sites across England. Men were interviewed after assessments but prior to treatment, or after surgery for LUTS. Men were purposively sampled to include those who had urodynamics and those who did not, and diversity in demographic characteristics and symptom burden. Interviews were analyzed using inductive thematic analysis. Results Forty‐one men participated (25 pre‐treatment, 16 post‐surgery), ages 52‐89. The 16 men who had not previously experienced urodynamics said they would accept the test in their assessment, but some were apprehensive or wanted more information. The 25 men who had experienced urodynamics all found it acceptable, though some reported pain, infection, or embarrassment. Embarrassment was minimized by informing patients what the procedure would be like, and ensuring privacy. Urodynamics was valued for its perceived diagnostic insight. Information deficits were reported before, during, and after the test. How and when results were explained and the adequacy of explanations varied. Conclusions Urodynamics is acceptable to men with LUTS and generally well‐tolerated. To ensure patients are prepared and informed, good communication before and during the procedure is essential. Privacy should be prioritized, and test results discussed promptly and in sufficient detail. Staff require training and guidance in these areas.
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Affiliation(s)
- Lucy E Selman
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Cynthia A Ochieng
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Amanda L Lewis
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, North Bristol NHS Trust, Level 3 Learning and Research Building, Bristol, UK.,Translational Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
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Finazzi-Agro E, Gammie A, Kessler TM, van Koeveringe G, Serati M, Solomon E, de Wachter S, Kirschner-Hermanns R. Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense-A European Expert Consensus. Eur Urol Focus 2018; 6:137-145. [PMID: 30061075 DOI: 10.1016/j.euf.2018.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Routine use of urodynamics (UDS) for the assessment of female stress urinary incontinence (SUI) appears to be in decline across Europe. The reasons for this trend appear multifactorial, but the implications are of significant concern. OBJECTIVES To achieve an expert consensus viewpoint on the value of UDS in female SUI and current barriers to its use. METHODOLOGY A multidisciplinary group of UDS experts from six European countries was convened, and a modified version of the Delphi method was utilised to reach a consensus viewpoint structured around five key questions. RESULTS Consensus was achieved on all five questions. The group was unanimous that the decline in routine use of UDS is unjustified and misguided, driven by restrictions in funding and accelerated by the publication-and subsequent influence-of two trials that had major limitations. LIMITATIONS The authors comprised a selected group of UDS experts and the analysis is not a formal systematic review. CONCLUSIONS Extensive experience and observational studies have demonstrated the value of UDS for the assessment of female SUI and the dangers of empiric management. This evidence base should not be eclipsed by the findings of two randomised controlled trials that had numerous shortcomings. PATIENT SUMMARY A group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment-even surgery-without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped.
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Affiliation(s)
- Enrico Finazzi-Agro
- Department of Experimental Medicine and Surgery, Unit for Functional Urology, Tor Vergata University Hospital, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Thomas M Kessler
- Neuro-urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, Urogynaecology Unit, University of Insubria, Varese, Italy.
| | | | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, University of Antwerp, Belgium
| | - Ruth Kirschner-Hermanns
- Neuro-urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Centre, Bonn, Germany
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Bae GE, Lee SH, Hong JW, Lee I, Kim SY, Choi JY, Han CW, Yun YJ, Park SH, Kwon JN. Moxibustion for Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2018. [DOI: 10.22246/jikm.2018.39.3.372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Drake MJ. Is Urodynamics Necessary when Assessing a Patient with Male Lower Urinary Tract Symptoms? Eur Urol Focus 2018; 4:54-56. [PMID: 29705282 DOI: 10.1016/j.euf.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
Urodynamics can distinguish bladder outlet obstruction from detrusor underactivity. Clear identification of the mechanism of a man's voiding symptoms can help give the best chance of good outcome from surgery. Publication of results from the UPSTREAM study will help in establishing the exact place for urodynamic testing in male lower urinary tract symptoms.
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Affiliation(s)
- Marcus J Drake
- Bristol Urological Institute, University of Bristol, Southmead Hospital, Bristol, UK.
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The promise of new urological procedures and medications to manage lower urinary tract symptoms related to benign prostatic obstruction. Curr Opin Urol 2018. [PMID: 29538169 DOI: 10.1097/mou.0000000000000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Drake MJ. Early Surgical Intervention May Be More Likely to Cause Complications in Patients with Male Lower Urinary Tract Symptoms than To Prevent Them. Eur Urol Focus 2018. [PMID: 29526701 DOI: 10.1016/j.euf.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
There is no evidence that early surgical intervention will prevent complications due to bladder outlet obstruction, and a high likelihood that the surgery will bring its own complications.
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Affiliation(s)
- Marcus J Drake
- Bristol Urological Institute, University of Bristol, Bristol, UK.
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30
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Gravas S, Kyriazis I, Klausner AP. Lower Urinary Tract Symptoms Including Bladder Outlet Obstruction: What’s New in Diagnostics? Eur Urol Focus 2018; 4:14-16. [DOI: 10.1016/j.euf.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/12/2018] [Accepted: 04/01/2018] [Indexed: 02/07/2023]
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Young GJ, Lewis AL, Lane JA, Winton HL, Drake MJ, Blair PS. Statistical analysis plan for the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM). Trials 2017; 18:455. [PMID: 28974250 PMCID: PMC5627464 DOI: 10.1186/s13063-017-2206-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/21/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Current management for men with lower urinary tract symptoms (LUTS) is a pathway that results in prostate surgery in a significant proportion. While helpful in relieving benign prostatic obstruction (BPO), surgery may be ineffective for men suffering from difficulties not relating to BPO. The UPSTREAM trial started recruitment in October 2014 with the aim of establishing whether a care pathway including urodynamics (a diagnostic tool for BPO and thus an indication of whether surgery is needed) is no worse for men, in terms of symptomatic outcome, than one without (routine care). METHODS/DESIGN This analysis plan outlines the main outcomes of the study and specific design choices, such as non-inferiority margins. The trial is currently recruiting in 26 hospitals across the UK, randomising men to either urodynamics or routine care, with recruitment set to end on the 31 December 2016. All outcomes will be measured 18 months after randomisation to allow sufficient time for surgical procedures and recovery. The primary outcome is based on a non-inferiority design with a margin of 1 point on the International Prostate Symptom Score (IPSS) scale. The key secondary outcome for this trial is surgery rate per arm, which is estimated to be at least 18% lower in the urodynamics arm. Surgery rates, adverse events, flow rate, urinary symptoms and sexual symptoms are secondary outcomes to be assessed for superiority. This is an update to the UPSTREAM protocol, which has already been published in this journal. DISCUSSION This a priori statistical analysis plan aims to reduce reporting bias by allowing access to the trial's objectives and plans in advance of recruitment end. The results of the trial are expected to be published soon after the trial end date of 30 September 2018. TRIAL REGISTRATION ISRCTN registry, ISRCTN56164274 . Registered on 8 April 2014.
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Affiliation(s)
- Grace J Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Amanda L Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Helen L Winton
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Marcus J Drake
- North Bristol NHS Trust, Bristol Urological Institute, Level 3, Learning and Research Building, Southmead Hospital, Bristol, BS10 5NB, UK. .,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Peter S Blair
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Rademakers K, Drake MJ, Gammie A, Djurhuus JC, Rosier PFWM, Abrams P, Harding C. Male bladder outlet obstruction: Time to re-evaluate the definition and reconsider our diagnostic pathway? ICI-RS 2015. Neurourol Urodyn 2017; 36:894-901. [PMID: 28444709 DOI: 10.1002/nau.23178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/01/2016] [Indexed: 11/09/2022]
Abstract
The diagnosis of bladder outlet obstruction (BOO) in the male is dependent on measurements of pressure and flow made during urodynamic studies. The procedure of urodynamics and the indices used to delineate BOO are well standardized largely as a result of the work of the International Continence Society. The clinical utility of the diagnosis of BOO is however, less well defined and there are several shortcomings and gaps in the currently available medical literature. Consequently the International Consultation on Incontinence Research Society (ICI-RS) held a think tank session in 2015 entitled "Male bladder outlet obstruction: Time to re-evaluate the definition and reconsider our diagnostic pathway?" This manuscript details the discussions that took place within that think tank setting out the pros and cons of the current definition of BOO and exploring alternative clinical tests (alone or in combination) which may be useful in the future investigation of male patients with lower urinary tract symptoms. The think tank panel concluded that pressure-flow studies remain the diagnostic gold-standard for BOO although there is still a lack of high quality evidence. Newer, less invasive, investigations have shown promise in terms of diagnostic accuracy for BOO but similar criticisms can be levelled against these tests. Therefore, the think tank suggests further research with regard to these alternative indicators to determine their clinical utility.
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Affiliation(s)
- Kevin Rademakers
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | | | | | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Christopher Harding
- Department of Urology, Freeman Hospital, Newcastle Upon-Tyne, United Kingdom
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Brewster S, Biers S, Challacombe B, Cresswell J, Sinclair A, Smith D. Advances in urology 2015–2016. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816681238] [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
It has become customary that a session is held at the British Association of Urological Surgeons (BAUS) annual meeting wherein the most important advances in the major urological sub-specialities are summarised by British opinion leaders for the benefit of the core urologist. It gives us pleasure to present in this paper (to which the six authors contributed equally) the topics covered at the Liverpool BAUS meeting in June 2016.
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Affiliation(s)
| | | | | | - Jo Cresswell
- James Cook University Hospital, Middlesbrough, UK
| | | | - Daron Smith
- Institute of Urology, University College Hospital, London, UK
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34
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Cornu JN. Alternatives to Pressure Flow Studies for Assessment of Benign Prostatic Obstruction: Many Weak Solutions for What May Be a Critical Issue. Eur Urol 2016; 71:403-404. [PMID: 27839779 DOI: 10.1016/j.eururo.2016.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022]
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Urodynamic Testing for Men with Voiding Symptoms Considering Interventional Therapy: The Merits of a Properly Constructed Randomised Trial. Eur Urol 2016; 69:759-60. [PMID: 26847139 DOI: 10.1016/j.eururo.2016.01.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/19/2016] [Indexed: 11/21/2022]
Abstract
Insufficient evidence exists regarding the role of invasive urodynamics in routine practice in the clinical assessment of male lower urinary tract symptoms. UPSTREAM, a multicentre randomised trial, will inform patients, clinicians, and policy-makers about whether urodynamics should be more widely used for such patients.
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