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Shin YS, Park HJ. Catheter-Related Bladder Discomfort: The Unsolved Problem after Transurethral Resection of Prostate. World J Mens Health 2023; 41:976-977. [PMID: 37118961 PMCID: PMC10523116 DOI: 10.5534/wjmh.230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/11/2023] [Indexed: 04/30/2023] Open
Affiliation(s)
- Yu Seob Shin
- Department of Urology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea.
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Stoddard MD, Cho A, Te AE, Chughtai B. A Systematic Review on the Timing of Surgical Intervention for Benign Prostatic Enlargement (BPE). Curr Urol Rep 2020; 21:64. [PMID: 33230722 DOI: 10.1007/s11934-020-01016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Surgical intervention for benign prostatic enlargement (BPE) is typically reserved for those who fail medical therapy (i.e., α-blocker or 5-α reductase inhibitor treatment). We conducted a systematic review to determine whether timing of surgical intervention for BPE affects patient outcomes. RECENT FINDINGS The studies we reviewed suggested that patients who undergo surgical intervention for BPE after failing medical therapy may have worse outcomes. Increased age, worsened bladder function, and worse overall health may contribute to worsened outcomes. To date, there are few high-quality studies on the timing of surgical intervention for BPE in the literature. Further prospective trials are needed to determine ideal timing for intervention.
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Affiliation(s)
| | - Ahra Cho
- Weill Cornell Medicine, New York, NY, 10065, USA
| | - Alexis E Te
- Weill Cornell Medicine, New York, NY, 10065, USA
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A COMPARISON OF THE EFFECTS OF GENERAL ANESTHESIA VERSUS SPINAL ANESTHESIA ON CATHETER-RELATED BLADDER DISCOMFORT AFTER HoLEP: A PROSPECTIVE TRIAL. JOURNAL OF MEN'S HEALTH 2020. [DOI: 10.15586/jomh.v16isp1.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Shin YS, Karna KK, Choi BR, Park JK. Finasteride and Erectile Dysfunction in Patients with Benign Prostatic Hyperplasia or Male Androgenetic Alopecia. World J Mens Health 2018; 37:157-165. [PMID: 30209896 PMCID: PMC6479090 DOI: 10.5534/wjmh.180029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 05/08/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022] Open
Abstract
Finasteride is primarily used to treat benign prostatic hyperplasia (BPH) and male androgenetic alopecia (MAA). Five-alpha reductase inhibitors (5α-RIs) could induce male sexual dysfunction due to their effects on testosterone and dihydrotestosterone. There is evidence suggesting that 5α-RIs may independently increase the risk of erectile dysfunction (ED). However, many investigators believe that side effects of 5α-RIs will disappear with continuous treatment. Considerable controversy exists regarding the severity and persistence of side effects of finasteride on ED. The aim of this review was to summarize current research studies on finasteride associated with ED. The search strategy used each term of finasteride and ED against PubMed database to identify related studies. ED data reported from available trials for finasteride were summarized and reviewed. Although there is not enough evidence to prove the relationship between finasteride and ED, most studies in this review found that finasteride for BPH was correlated with ED. However, most studies included in this review revealed that finasteride for MAA was not correlated with ED. On the other hand, some studies reported side effects of finasteride associated with sexual dysfunction, including ED, male infertility, ejaculation problem, and loss of libido, even in MAA patients. Well-designed randomized controlled trials are needed to further determine the mechanism and effects of finasteride on ED. However, physicians should discuss with their patients possible long-term effects of finasteride on sexual function, although we do not have evidence showing that adverse events of sexual dysfunction are absolutely associated with 5α-RIs.
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Affiliation(s)
- Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Keshab Kumar Karna
- Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Bo Ram Choi
- Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University Hospital, Jeonju, Korea.
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Elkoushy MA, Elshal AM, Elhilali MM. Changing patients' profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective. Can Urol Assoc J 2015; 9:372-8. [PMID: 26788224 DOI: 10.5489/cuaj.3066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We assessed the change of patients' profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time. METHODS We reviewed a prospectively maintained database of patients treated with laser for symptomatic BPH since March 1998. Patients were divided into 3 consecutive time-based groups: Group 1 for patients who underwent surgery before April 2004; Group 2, between April 2004 and March 2009; and for Group 3 from April 2009 to August 2014. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications. RESULTS A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (r = 0.62, p < 0.001), total energy used (r = 0.47, p < 0.001), and total operative time (r = 0.47, p < 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, p <0.001), were more coagulopathic (18.7% Group 3 vs. 12.3% Group 2 vs. 5.9% Group 1, p < 0.001), and had significantly larger prostates (87.96 ± 49.80 in Group 3 vs. 78.44 ± 50.84 in Group 2 vs. 74.50 ± 46.53 Group 1, p < 0.001). Preoperative prostatic medications significantly increased over time (72.6% in Group 1 vs. 85.5% in Group 2, vs. 87.4% Group 3, p < 0.001). IPSS, QoL and Qmax were significantly abnormal in patients in Group 3 (p < 0.001). After a mean follow-up of 3 years, the number of patients who did not require reoperation progressively increased (94.1% Group 1 vs. 96.1% Group 2 vs. 98.3% Group 3). Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with postoperative urinary incontinence. CONCLUSIONS Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.
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Affiliation(s)
- Mohamed A Elkoushy
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC;; Department of Urology, Suez Canal University, Ismailia, Egypt
| | - Ahmed M Elshal
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC;; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mostafa M Elhilali
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC
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Comparison of Harmful Gases Produced During GreenLight High-performance System Laser Prostatectomy and Transurethral Resection of the Prostate. Urology 2012; 79:1118-24. [DOI: 10.1016/j.urology.2011.11.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 11/29/2011] [Accepted: 11/29/2011] [Indexed: 11/18/2022]
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Mayer EK, Kroeze SG, Chopra S, Bottle A, Patel A. Examining the ‘gold standard’: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int 2012; 110:1595-601. [DOI: 10.1111/j.1464-410x.2012.11119.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chung JH, Yu JH, Sung LH, Noh CH, Chung JY. Effect of prostatitis on lower urinary tract symptoms: retrospective analysis of prostate biopsy tissue. Korean J Urol 2012; 53:109-13. [PMID: 22379590 PMCID: PMC3285705 DOI: 10.4111/kju.2012.53.2.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 10/13/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose Most patients, even some urologists, assume that prostate volume is the most important prognostic factor for lower urinary tract symptoms (LUTS). In some cases, however, prostatic inflammation is a more important factor in LUTS than is prostate volume. For this reason, comparison of the impact on LUTS of inflammation and prostate volume is an attractive issue. Materials and Methods From January 2000 to May 2009, 1,065 men aged between 47 and 91 years (who underwent transrectal ultrasound-guided prostate needle biopsy and transurethral prostatectomy) were retrospectively investigated. Components such as age, serum prostate-specific antigen (PSA) level, prostate volume, and the presence of prostatitis were investigated through independent-sample t-tests, chi-square tests, and univariate and multivariate analyses. Results Chi-square tests between prostatitis, prostate volume, serum PSA, and severe LUTS showed that prostate volume (R=0.173; p=0.041) and prostatitis (R=0.148; p<0.001) were related to LUTS. In particular, for a prostate volume under 50 ml, prostatitis was a stronger risk factor than was prostate volume. Among the multivariate predictors, prostatitis (odds ratio [OR]: 1.945; p<0.001) and prostate volume (OR, 1.029; p<0.001) were found to be aggravating factors of LUTS. Conclusions For patients with prostate volume less than 50 ml, prostatitis was found to be a more vulnerable factor for LUTS. For those with prostate volume over 50 ml, on the other hand, the volume itself was a more significant risk factor than was prostatitis. In conclusion, the presence of prostatitis is one of the risk factors for LUTS with increased prostate volume.
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Affiliation(s)
- Jai Hyun Chung
- Department of Urology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Choi SY, Kim TH, Myung SC, Moon YT, Kim KD, Kim YS, Kim HR, Chang IH. Impact of changing trends in medical therapy on surgery for benign prostatic hyperplasia over two decades. Korean J Urol 2012; 53:23-8. [PMID: 22323970 PMCID: PMC3272552 DOI: 10.4111/kju.2012.53.1.23] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/16/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Following the introduction of medical therapy for benign prostatic hyperplasia (BPH), we determined the effect of the change in trends in medical therapy on the indication and outcome of surgical intervention for BPH. MATERIALS AND METHODS We compared the basic characteristics of, weight of resected tissue of, transfusions in, and postoperative complications of patients who underwent surgery between 1985 and 1989 (before the advent of medical therapy for BPH), between 1995 and 1999 (when medical therapy was developed and became widely used as alternative treatment), and between 2005 and 2009 (when medical therapy superseded surgical intervention to become first-line treatment and when combination therapy became widely adopted). RESULTS At our institution, the mean age and BMI of patients increased over the past two decades (p<0.001). Hypertension, operation history, and other comorbidities also increased significantly (p<0.001, p=0.005, and p<0.001, respectively). The indications for surgery in 1985 to 1989, 1995 to 1999, and 2005 to 2009 were as follows: acute urinary retention in 34.7%, 20.2%, and 15.1% of patients and symptomatic deterioration in 61.1%, 72.3%, and 73.0% of patients, respectively. Prostate volume and the weight of resected tissue increased from 34.4±14.5 ml to 61.3±32.4 ml and from 7.2±6.4 g to 10.8±7.6 g, respectively, over two decades. Patients who underwent surgery in 2005 to 2009 had their catheters removed earlier (p<0.001). Secondary hemorrhage within four postoperative weeks and repeat transurethral resection of the prostate within 1 year decreased significantly (p=0.03 and p=0.003, respectively). No statistically significant change in impaired detrusor contractility was found (p=0.523). CONCLUSIONS Although patients who underwent surgery were older after widespread use of medical therapy for BPH, advancements in surgical techniques have benefitted these patients.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
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Jang DG, Yoo C, Oh CY, Kim SJ, Kim SI, Kim CI, Kim HS, Park JY, Seong DH, Song YS, Yang WJ, Cho IR, Cho SY, Cheon SH, Im H, Cho JS. Current status of transurethral prostatectomy: a korean multicenter study. Korean J Urol 2011; 52:406-9. [PMID: 21750752 PMCID: PMC3123817 DOI: 10.4111/kju.2011.52.6.406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/23/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose We aimed to verify the current status of transurethral resection of the prostate (TURP) in Korea. Materials and Methods The medical records of 1,341 men who underwent TURP in 9 Korean medical centers between 2004 and 2008 were reviewed. The patients were divided into two groups according to time periods: 2004-2005 (group 1) and 2006-2008 (group 2). To verify differences in the two patient groups, age, prostate volume, indications for TURP, preoperative International Prostate Symptom Score (IPSS), and resected tissue weight were evaluated. Results The mean age of the patients was 71.2 years and the mean IPSS was 22.7. The patients' characteristics were not significantly different between the two groups. The annual cases of TURP increased over the study period. The proportion of lower urinary tract symptoms (LUTS) as an indication for TURP increased up to 58.3% in group 2 compared with 51.6% in group 1 (p=0.019). However, the proportion of patients who presented with acute urinary retention decreased from 35.5% to 30.3% with marginal statistical significance (p=0.051). Other indications such as hematuria, bladder stone, recurrent urinary tract infection, and hydronephrosis were not significantly different between the groups. The mean resected weights of the prostate were similar (17.5 g in group 1 and 18.3 g in group 2, respectively; p>0.05). Conclusions TURP has been steadily performed in patients with benign prostatic hyperplasia and it is expected to remain constant. LUTS was the most common indication for TURP in recent years.
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Affiliation(s)
- Dong Gyu Jang
- Department of Urology, College of Medicine, Hallym University, Chuncheon, Korea
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