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AlShammari A, Benzouak T, Khogeer A, AlHaidey R, Arezki A, Fahmy N, Andonian S, Carrier S, Aubé-Peterkin M, Hamouche F. Understanding current ergonomics setup for urologists conducting anatomical endoscopic enucleation of the prostate surgeries: Survey analysis from the endourological society. Am J Surg 2024; 235:115701. [PMID: 38448320 DOI: 10.1016/j.amjsurg.2024.02.044] [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] [Received: 12/15/2023] [Revised: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Ensuring ergonomic posture and safety for surgeons is key to preventing work-related injuries and promoting sustained practice. We evaluated ergonomic aspects of Anatomic Endoscopic Enucleation of the Prostate (AEEP) and its relation to musculoskeletal injuries. METHOD A two-month online survey involving 119 Endourological Society members provided an in-depth analysis of AEEP practices and their musculoskeletal impacts. RESULTS The sample experienced general (65.5%), back (32.8%), neck (35.3%) and shoulder (37%) pain. Female AEEP surgeons reported greater back pain. Experience and age were inversely related to MSK injuries, and operative times over 2 h increased back pain. AEEP procedures predominantly involved sitting (86%) on backless stools (58%), with most surgeons wearing protective eyewear (75.6%) and using large resectoscopes (76.5%). Monitors were usually above eye-level (57%) and beyond 1 m (68.9%). CONCLUSION Musculoskeletal complaints are prevalent among AEEP endourologists. More awareness and further studies on risk factors are necessary to limit work-related injuries in urology.
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Affiliation(s)
- Ahmad AlShammari
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada.
| | - Tarek Benzouak
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Abdulghani Khogeer
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada; Department of Surgery, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan AlHaidey
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Adel Arezki
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Nader Fahmy
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Sero Andonian
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Serge Carrier
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Mélanie Aubé-Peterkin
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Fadl Hamouche
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
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Zorn KC, Chakraborty A, Chughtai B, Mehan R, Elterman D, Nguyen DD, Bouhadana D, Glaser AP, Marhamati S, Barber N, Helfand BT. Safety and Efficacy of Same Day Discharge for Men Undergoing Contemporary Robotic-Assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting - First Global Experience. Urology 2024:S0090-4295(24)00658-7. [PMID: 39159759 DOI: 10.1016/j.urology.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE To investigate the feasibility, safety and efficacy of same day discharge (SDD) after Aquablation specifically in an ambulatory surgery center (ASC). METHODS A prospective cohort of men with significant BPH underwent Aquablation at a single ASC. Comprehensive preoperative assessments were conducted, including uroflowmetry, IPSS, and PVR. Aquablation was performed as morning cases by a single experienced surgeon. Following the procedure, men were assessed for immediate postoperative outcomes, including pain levels, hematuria, and voiding efficiency. Patients meeting discharge criteria were allowed to return home on the same calendar day. RESULTS A total of 60 consecutive men with a mean prostate size of 115ml underwent Aquablation, 59 (98%) of whom were discharged the dame day. No transfusions or return to the OR occurred. The procedure demonstrated a significant improvement in urinary flow rates and a substantial reduction in IPSS scores at the 1-month post-operative period. Pain scores were found to be minimal, and the incidence of postoperative complications, including hematuria and urinary retention was low and comparable to previously published outcomes. Despite more meticulous focal cautery, no differences in erectile, ejaculatory or adverse outcomes were observed. CONCLUSIONS Aquablation for BPH at an ASC appears to be a safe and effective approach. Morning procedures and attentive cautery and streamlined patient pathways seem essential for SDD. Despite electrosurgical hemostasis, ejaculatory, sexual and post-operatively pain were not compromised.
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Affiliation(s)
- Kevin C Zorn
- BPHCanada Prostate Center, Mont-Royal Surgical Center, Montreal, QC, Canada.
| | | | - Bilal Chughtai
- Division of Urology, Northwell Health, Plainview, New York
| | | | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David-Dan Nguyen
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Bouhadana
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Alexander P Glaser
- Endeavor Health (Formerly NorthShore University HealthSystem), Department of Surgery, Division of Urology, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Department of Surgery, Division of Urology, Chicago, IL, USA
| | | | | | - Brian T Helfand
- Endeavor Health (Formerly NorthShore University HealthSystem), Department of Surgery, Division of Urology, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Department of Surgery, Division of Urology, Chicago, IL, USA
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Chakraborty A, Elterman D, Corsi N, Bouhadana D, Bailly G, Patel P, McLellan R, Hickey L, Costa D, Andrews M, Evans H, Forbes CM, Elmansy H, Meskawi M, Bhojani N, Chughtai B, Zorn KC. An analysis of benign prostatic hyperplasia surgical treatment reimbursement trends across Canada Examining provincial changes over the recent decade with comparison to cost of living changes. Can Urol Assoc J 2024; 18:268-273. [PMID: 38587981 PMCID: PMC11326725 DOI: 10.5489/cuaj.8638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
INTRODUCTION A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examined trends in surgeon compensation for these treatments within Canada. METHODS The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examined first the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35-44. RESULTS Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35-44. CONCLUSIONS The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.
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Affiliation(s)
- Anindyo Chakraborty
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC; Canada
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nicholas Corsi
- Wayne State University School of Medicine, Detroit, MI, United States
| | - David Bouhadana
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Gregory Bailly
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Rowen McLellan
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Liam Hickey
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Daniel Costa
- Division of Urology, Queen Elizabeth Hospital, Charlottetown, PEI, Canada
| | - Matthew Andrews
- Division of Urology, Memorial University, St. John's, NL, Canada
| | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Connor M Forbes
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Kevin C Zorn
- Department of Urology, Université de Montréal, Montreal, QC, Canada
- BPH Canada Prostate Surgery Institute, Centre de chirurgie Mont-Royal, Montreal, QC, Canada
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Halawani A, Paterson R, Zhong T, Du K, Ren R, Forbes CM. Risks and side effects in the medical management of benign prostatic hyperplasia. Prostate Int 2024; 12:57-64. [PMID: 39036761 PMCID: PMC11255900 DOI: 10.1016/j.prnil.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 07/23/2024] Open
Abstract
Benign prostatic hyperplasia affects up to 80% of men in their lifetime. It causes bladder outflow obstruction, leading to lower urinary tract symptoms, which can have a large impact on quality of life. Lifestyle modifications and pharmacotherapy are often offered as first-line treatments for patients. These include alpha blockers, 5-alpha-reductase inhibitors, phosphodiesterase-5 inhibitors, anticholinergics, B3-agonists, and desmopressin. While often well tolerated, these pharmacotherapies do have significant side effects, which both clinicians and patients should understand and discuss in order to make an informed treatment decision among alternatives. The purpose of this review is to provide a current overview of the risks and side effects of commonly used medications in benign prostatic hyperplasia management.
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Affiliation(s)
- Abdulghafour Halawani
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ryan Paterson
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tianshuang Zhong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Katie Du
- University of Alberta, Edmonton, Alberta, Canada
| | - Runhan Ren
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Connor M. Forbes
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
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Bal DS, Urichuk M, Panchendrabose K, Ramjiawan R, Shah J, Gebru N, Pandian A, Patel P. Anesthetic options for Rezūm water vapor therapy Is minimal sedation tolerable for a minimally invasive procedure? Can Urol Assoc J 2024; 18:E137-E141. [PMID: 38319606 PMCID: PMC11152594 DOI: 10.5489/cuaj.8535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
INTRODUCTION There has been a rapid expansion of the armamentarium for managing benign prostatic hyperplasia (BPH). Due to the invasiveness and complication risks of traditional surgical management, minimally invasive procedures have emerged. Rezūm water vapor therapy is a safe, effective alternative. Given the minimally invasive nature, there is interest in administering conscious sedation over general anesthesia to decrease procedural times and costs and increase accessibility by completing procedures in an office-based setting. We sought to assess and describe patient-reported tolerability for Rezūm completed under oral and deep intravenous sedation. METHODS Patients who underwent Rezūm between April and November of 2022 under conscious sedation with oral sedation and local anesthesia (OSLA) or deep intravenous sedation (DIS) were enrolled. Baseline information was collected, and followup interviews were conducted where patient tolerability scores, future anesthetic preferences, and complication data was prospectively obtained. RESULTS Fourteen patients were enrolled in each group. The OSLA and DIS cohorts had a median tolerability score of 8 (interquartile range [IQR] 3.5) and 9 (IQR 1.75), respectively, indicating highly tolerable experiences. There was no significant difference between groups (p=0.13). On followup, 85.7% of patients in the OSLA and 100% in DIS groups expressed their future preference for conscious sedation over general anesthetic, with no significant difference between the two groups (p=0.46). CONCLUSIONS Our study demonstrates OSLA and DIS are both viable conscious sedation methods for Rezūm, with patients reporting high tolerability to the procedure regardless of sedation choice. Almost all patients receiving conscious sedation would choose to undergo Rezūm using conscious sedation again and had minimal complications.
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Affiliation(s)
- Dhiraj S. Bal
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Urichuk
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Ryan Ramjiawan
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jainik Shah
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Naomi Gebru
- Department of Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Alagarsamy Pandian
- Department of Anesthesiology, University of Manitoba, Winnipeg, MB, Canada
| | - Premal Patel
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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Nguyen DD, Li T, Ferreira R, Baker Berjaoui M, Nguyen ALV, Chughtai B, Zorn KC, Bhojani N, Elterman D. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis 2024; 27:22-28. [PMID: 37081044 DOI: 10.1038/s41391-023-00669-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function. METHODS In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies. RESULTS Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function. CONCLUSIONS Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tiange Li
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Nguyen ALV, Verma I, Ferreira R, Nguyen DD, Zorn KC, Bhojani N, Lerner LB, Gauhar V, Chughtai B, Elterman DS. A scoping review of office-based prostatic stents: past, present, and future of true minimally invasive treatment of benign prostatic hyperplasia. World J Urol 2023; 41:2925-2932. [PMID: 37479913 DOI: 10.1007/s00345-023-04508-7] [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] [Received: 01/06/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE To conduct a scoping review of the existing literature and recent developments on prostatic stents for the treatment of benign prostatic hyperplasia (BPH). METHODS A comprehensive search was performed on Embase, MEDLINE, and Web of Science to identify English literature on prostatic stents for the treatment of BPH. Additional studies and upcoming devices were identified through grey literature search and expert consultation. Study characteristics and stent information were extracted and tabulated narratively. RESULTS Of the 1171 search results, 64 studies were included in this review. iTiND was the prostatic stent with the most long-term evidence. iTiND is a safe and effective minimally invasive treatment for BPH that preserves sexual function. Adverse events are mild and transitory. Emerging stents (e.g. Zenflow, Butterfly, Urocross, and Exime) had 7/64 eligible studies, where no studies had long-term follow-up. These newer stents show promising results for quality of life and BPH symptom management; however, long-term monitoring and head-to-head comparisons are needed. CONCLUSION Over the last 50 years, prostatic stents have evolved and demonstrated improved clinical efficacy. iTiND provides a safe and effective outpatient treatment of LUTS secondary to BPH preserving erectile and ejaculatory function. Emerging prostatic stents are a promising, effective, and safe intervention in well-selected patients interested in its benefits.
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Affiliation(s)
- Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Isha Verma
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Lori B Lerner
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Vineet Gauhar
- Division of Urology, Ng Teng Fong General Hospital, National University Health System, Jurong East, Singapore
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York City, NY, USA
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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CALABRÒ GIOVANNAELISA, D’AMBROSIO FLORIANA, ORSINI FRANCESCA, PAPPALARDO CIRO, SCARDIGNO ANNA, RUMI FILIPPO, FIORE ALESSANDRA, RICCIARDI ROBERTO, CICCHETTI AMERICO. Feasibility study on a new enhanced device for patients with intermittent catheterization (LUJA). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E1-E89. [PMID: 38125911 PMCID: PMC10730013 DOI: 10.15167/2421-4248/jpmh2023.64.3s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - FLORIANA D’AMBROSIO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FRANCESCA ORSINI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - CIRO PAPPALARDO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - ANNA SCARDIGNO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FILIPPO RUMI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ALESSANDRA FIORE
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ROBERTO RICCIARDI
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - AMERICO CICCHETTI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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Murad L, Bouhadana D, Nguyen DD, Chughtai B, Zorn KC, Bhojani N, Elterman DS. Treating LUTS in Men with Benign Prostatic Obstruction: A Review Article. Drugs Aging 2023; 40:815-836. [PMID: 37556075 DOI: 10.1007/s40266-023-01054-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/10/2023]
Abstract
Benign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient's quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive overview of relevant studies, as well as the surgical and medical management guidelines from the Canadian Urological Association (CUA), American Urological Association (AUA), and European Association of Urology (EAU). By synthesizing the existing literature, this review purports to summarize the current body of knowledge surrounding BPO and male LUTS, and support healthcare providers in making informed decisions about the management of male LUTS secondary to BPO, ultimately improving patient outcomes and quality of life.
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Affiliation(s)
- Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
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Sahakyan Y, Erman A, Bhojani N, Chughtai B, Zorn KC, Sander B, Elterman DS. Cost-utility of minimally invasive therapies vs. pharmacotherapy as initial therapy for benign prostatic hyperplasia A Canadian healthcare payer perspective. Can Urol Assoc J 2023; 17:103-110. [PMID: 36486181 PMCID: PMC10073529 DOI: 10.5489/cuaj.8045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Recently, minimally invasive surgical therapies (MIST s) have become an alternative to surgery or pharmacotherapy to manage benign prostatic hyperplasia (BPH ). This study evaluated the cost-utility of water vapor thermal therapy (WVTT ) and prostatic urethral lift (PUL) compared to pharmacotherapy as initial treatment for patients with moderate-to-severe BPH. METHODS In this model-based economic evaluation, we simulated BPH progression in men (mean age 65 years, average International Prostate Symptom Score 16.6) over their lifetime and estimated healthcare costs (from the Canadian healthcare payer perspective) per quality-adjusted life year (QALY), discounted at 1.5% annually. In the model, men could receive up to three lines of therapy: 1) initial pharmacotherapy with MIST as second-line, and TURP or pharmacotherapy as third-line; 2) initial MIST (WVTT or PUL) with MIST again, TURP, or pharmacotherapy as second-line, and TURP as third-line. The model was populated using data from the published literature. RESULTS The expected lifetime QALYs and costs were 15.50 QALYs and $14 626 for initial treatment with WVTT, 15.35 QALYs and $11 795 for pharmacotherapy followed by WVTT, 15.29 QALYs and $13 582 for pharmacotherapy followed by PUL, and 15.29 QALYs and $19 151 for initial treatment with PUL. Strategies involving PUL procedures were dominated by strategies involving WVTT. The incremental cost per QALY gained was $18 873 for initial WVTT compared to initial pharmacotherapy followed by WVTT. CONCLUSIONS WVTT appears to be a cost-effective procedure and may be an appropriate first-line alternative to pharmacotherapy for patients with BPH and prostate volume less than 80 cm3 who seek faster improvement and no lifelong commitment to daily medications.
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Affiliation(s)
- Yeva Sahakyan
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Aysegul Erman
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Naeem Bhojani
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Kevin C Zorn
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology Krembil Research Institute, University Health Network, Toronto, ON, Canada
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Attia KAM, Abdel-Raoof AM, Serag A, Eid SM, Abbas AE. Innovative electrochemical electrode modified with Al 2O 3 nanoparticle decorated MWCNTs for ultra-trace determination of tamsulosin and solifenacin in human plasma and urine samples and their pharmaceutical dosage form. RSC Adv 2022; 12:17536-17549. [PMID: 35765456 PMCID: PMC9192163 DOI: 10.1039/d2ra01962k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/06/2022] [Indexed: 12/17/2022] Open
Abstract
A simple, cheap, sensitive, and time-saving square wave voltammetric (SWV) procedure using a carbon paste electrode modified with aluminum oxide nanoparticle decorated multi-walled carbon nanoparticles (Al2O3-NPs/MWCNTs/CPE) is presented for the ultra-sensitive determination of tamsulosin (TAM) and solifenacin (SOL), one of the most prescribed pharmaceutical combinations in urology. Characterization of the developed electrode was performed using scanning electron microscopy (SEM), X-ray diffraction (XRD) patterns, energy dispersive X-ray analysis (EDX), transmission electron microscopy (TEM) and FT-IR spectrophotometry. The voltammetric behavior of TAM/SOL was evaluated using Al2O3-NPs in different content and electrode compositions. The use of Al2O3 functionalized MWCNTs as a CPE modifier increased the process of electron transfer as well as improved the electrode active surface area therefore, ultra-sensitive results were acquired with a linear range of 10–100 and 12–125 ng ml−1 for TAM and SOL respectively, and a limit of the detection value of 2.69 and 3.25 ng ml−1 for TAM and SOL, respectively. Interestingly, the proposed method succeeded in quantifying TAM and SOL with acceptable percentage recoveries in dosage forms having diverged concentration ranges and in the biological fluids with very low peak plasma concentration (Cmax). Furthermore, the proposed method was validated, according to the ICH criteria, and shown to be accurate and reproducible. A SWV method using a carbon paste electrode modified with aluminum oxide nanoparticle-decorated multi-walled carbon nanoparticles is presented for ultra-sensitive determination of tamsulosin and solifenacin, one of the most prescribed pharmaceutical combinations in urology.![]()
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Affiliation(s)
- Khalid A M Attia
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University Nasr City Cairo Egypt
| | - Ahmed M Abdel-Raoof
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University Nasr City Cairo Egypt
| | - Ahmed Serag
- Pharmaceutical Analytical Chemistry Department, Faculty of Pharmacy, Al-Azhar University Nasr City Cairo Egypt
| | - Sherif M Eid
- Analytical Chemistry Department, Faculty of Pharmacy, October 6 University 6 October City Giza Egypt
| | - Ahmed E Abbas
- Analytical Chemistry Department, Faculty of Pharmacy, October 6 University 6 October City Giza Egypt
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