Maximum Urine Flow Rate of Less than 15ml/Sec Increasing Risk of Urine Retention and Prostate Surgery among Patients with Alpha-1 Blockers: A 10-Year Follow Up Study

The epidemiology of male lower urinary tract symptoms associated with benign prostatic hyperplasia: Results of 20 years of Korean community care and surveys

PURPOSE

To investigate the prevalence of lower urinary tract symptoms/benign prostatic hyperplasia in a Korean population.

MATERIALS AND METHODS

The Korean Prostate & Voiding Health Association provided free prostate-related community health care and conducted surveys in all regions of Korea from 2001 to 2022 with the cooperation of local government public health centers. A total of 72,068 males older than 50 were surveyed and analyzed. History taking, International Prostate Symptom Score (IPSS), transrectal ultrasonography, prostate-specific antigen (PSA) testing, uroflowmetry, and urine volume testing were performed.

RESULTS

The mean prostate volumes in males in their 50s, 60s, 70s, and 80s or above were 24.7 g, 27.7 g, 31 g, and 33.7 g, respectively. The proportion of males with high PSA greater than 3 ng/mL was 3.8% among males in their 50s, 7.7% among males in their 60s, 13.1% among males in their 70s, and 17.9% among males 80 years of age or older. The mean IPSS total scores in males in their 50s, 60s, 70s, and 80s or above were 10.7, 12.7, 14.5, and 16, respectively. Severe symptoms were reported by 27.3% of males, whereas 51.7% reported moderate symptoms. The mean Qmax in males in their 50s, 60s, 70s, and 80s or above were 20 mL/s, 17.4 mL/s, 15.4 mL/s, and 13.8 mL/s, respectively.

CONCLUSIONS

In this population-based study, mean prostate volume, IPSS, PSA, and Qmax were 30.6±15.1 g, 14.8±8.2, 1.9±4.7 ng/mL, and 15.6±6.5 mL/s, respectively. Aging was significantly associated with increased prostate volume, PSA levels, and IPSS scores, and with decreased Qmax and urine volume.

A guide to diagnosing and treating benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH) is a condition where the prostate becomes enlarged. It affects all men and is part of the ageing process. Globally, the incidence rates of BPH have risen by 70% between 2000-2019. When left untreated, it can lead to acute urinary retention, impaired bladder emptying, urinary tract infections, bladder stones, kidney failure or gross haematuria. In this article, Linda Nazarko describes the causes and consequences of BPH along with treatment options that are available for it.

Comparison of Bipolar Plasma Vaporization versus Standard Holmium Laser Enucleation of the Prostate: Surgical Procedures and Clinical Outcomes for Small Prostate Volumes

Bipolar plasma vaporization of the prostate (BPVP) is an attractive alternative to resection. There are numerous studies comparing transurethral resection of prostate or photoselective vaporization of the prostate with BPVP; however, there is a lack of data comparing holmium laser enucleation of the prostate (HoLEP) with BPVP. We aimed to compare HoLEP and BPVP with a focus on functional outcomes, safety, and complications. Methods: From January 2017 to June 2018, patients who underwent HoLEP or BPVP for benign prostatic hypertrophy were enrolled in this study. Inclusion criteria were a prostate volume <40 mL measured by transrectal ultrasound, international prostate symptom score (IPSS) >7, maximum urinary flow rate (Qmax) <15 mL/s, and postvoiding residual volume (PVR) >100 mL. Perioperative and postoperative parameters including IPSS, Qmax, quality of life, PVR, and complications were compared between groups. Results: Sixty-three patients were enrolled in this study. There were small differences in perioperative parameters. Hospital stays and catheterization periods were significantly shorter in the BPVP group. The postoperative complications were comparable between groups. PVR was comparable in both groups except for 1 month postoperatively. The incontinence rate was higher in the HoLEP group, but without statistical significance. Conclusion: In terms of surgical safety and efficacy as well as patient comfort, BPVP is comparable with HoLEP for small prostate volumes. BPVP can be a viable alternative technique in small BPH surgical treatment.

5-alpha-reductase inhibitor therapy postpones urine retention and prostate surgery in patients with prostate enlargement and a maximum uroflow rate of less than 15 ml/sec

Background

This study investigated the risk of transurethral resection of prostate (TURP) and acute urine retention (AUR) in relation to 5-alpha-reductase inhibitor (5ARI) therapy.

Methods

We identified 22,687 patients who were newly diagnosed with PE and low urinary tract symptoms (LUTS) between January 1, 2002 and December 31, 2011. We further classified study subjects who had moderate to severe LUTS and a maximum uroflow rate of less than 15ml/sec into three groups by their defined daily dose (DDD) of 5ARI used. The control group consisted of 7–28 cumulative DDD (cDDD) 5ARI users, while the short-term treatment group was 29-179cDDD 5ARI users, and the long-term treatment group was users of more than 180cDDD 5ARI. Each patient was monitored to identify those who subsequently developed TURP and AUR.

Results

TURP and AUR are detected in 5.6% of control group, 7.6% of short-term treatment group and 5.5% of long-term treatment group during 10-year follow up. Compared with the control group, there was no difference in the risk of TURP and AUR in the short-term and long-term treatment groups (HR = 1.41, 95% CI 0.76 to 2.62 and HR = 0.81, 95% CI 0.42 to 1.56, respectively).

Conclusion

5ARI therapy did not change the risk of TURP and AUR events in patients with PE, moderate to severe LUTS and a maximum uroflow rate of less than 15 ml/sec in 10 years of follow-up. But long-term 5ARI used can postpone AUR and TURP for 8.16 months.

Relationship between Erectile Dysfunction, Comorbidity, and Parkinson's Disease: Evidence from a Population-Based Longitudinal Study

BACKGROUND AND PURPOSE

To determine the risk of Parkinson's disease (PD) in relation to erectile dysfunction (ED) based on the National Health Insurance Research Database in Taiwan.

METHODS

We identified 3,153 patients who were newly diagnosed with ED between January 1, 2004 and December 31, 2010. A total of 12,612 randomly selected people without ED served as healthy controls. All of the study subjects were followed-up from the index date to the date of PD diagnosis, withdrawal from the National Health Insurance program, or the end of 2012 whichever occurred first.

RESULTS

The incidence density rate of PD was 1.52-fold higher in the ED cohort than the non-ED cohort (3.44 vs. 1.64 per 1,000 person-years), with an adjusted hazard ratio (HR) of 1.52 [95% confidence interval (CI)=1.09-2.12]. The combined effects on patients with ED and diabetes as well as hypertension showed a significant combined association with the PD risk compared with patients without ED, counterpart comorbidities, or medication use. The adjusted HR of PD for ED was higher for diabetes (2.82, 95% CI=1.42-5.63) and hypertension (2.19, 95% CI = 1.35-3.55).

CONCLUSIONS

ED leads to an increased risk of PD. ED patients with diabetes or hypertension have an elevated risk of PD.