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Bhojani N, Miller LE, Zorn KC, Chughtai B, Elterman DS, Bhattacharyya S, Chew BH. Prevalence and determinants of shared decision-making for PSA testing in the United States. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00843-x. [PMID: 38671083 DOI: 10.1038/s41391-024-00843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Shared decision-making (SDM) is recommended for prostate-specific antigen (PSA) testing but appears underutilized. This population-based study assessed the prevalence and determinants of SDM for PSA testing among US men. METHODS We assessed PSA testing rates and SDM engagement in men aged 40 and older without prostate cancer history using the 2019 National Health Interview Survey. SDM was defined as discussing the advantages and disadvantages of PSA testing with a physician. We used multivariable logistic regression with machine learning to identify factors associated with lack of SDM. RESULTS Among 9723 eligible participants (mean age 58 years), lifetime PSA testing prevalence was 45.9% and the 1-year testing incidence was 29.1%. Only 24.1% reported engaging in SDM with a physician, while 62.9% never discussed PSA testing. Younger age and lower education levels were the primary determinants of decreased SDM engagement. Men with less education engaged in SDM less than half as often as those with higher education levels across all age groups. CONCLUSIONS Societal guidelines recommend SDM for PSA testing. However, most men, regardless of age, have never engaged in SDM conversations with a healthcare provider about PSA testing, especially those with less education. More efforts are needed to improve patient-provider conversations about the potential benefits and harms of PSA testing.
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Affiliation(s)
- Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Larry E Miller
- Department of Biostatistics, Miller Scientific, Johnson City, TN, USA.
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bilal Chughtai
- Department of Urology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | | | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ferreira R, Otis-Chapados S, Alwashmi E, Bhojani N, Zorn KC, Chughtai B, Elterman DS. Sacral neuromodulation in the golden years: Treatment outcomes in elderly 75 years and older. Can Urol Assoc J 2024; 18:12-16. [PMID: 37931277 PMCID: PMC10841569 DOI: 10.5489/cuaj.8421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Despite high prevalence and increased severity and burden of overactive bladder (OAB) and fecal incontinence (FI) in the elderly, sacral neuromodulation (SNM) is often overlooked as a potential treatment option for this demographic. In this study, we report the outcomes of SNM in patients aged 75 years or older at the time of surgery. METHODS We conducted a retrospective cohort study of patients who underwent SNM implantation between 2013 and 2022 performed by a single, high-volume urologist at a tertiary center. Success, complication, and adjunct therapy rates were analyzed by Fisher's or Wilcox rank-sum test as appropriate. We compared outcomes between patients aged 75-79 years and octogenarians. RESULTS Of 632 patients, 50 were ≥75 years. Patients had a mean age of 78.4±2.6 years and were predominantly female (84%). The indications for SNM were 66% OAB, 16% FI, 16% non-obstructive urinary retention, and 4% pelvic pain. Within the first year, 94% of patients reported satisfaction and improvement in symptoms, while 76% continued to experience improvement beyond one year. SNM insertion led to reduced oral medication use from 68% to 24% (p<0.0001). The complication rate was 16% and mostly included device pain. No significant difference was observed in treatment success, complication, or adjunct therapy rate between age groups. CONCLUSIONS SNM is a safe and effective option in well-selected patients over the age of 75 years. Treatment success rate is comparable to younger cohorts. Advanced age should not preclude third-line therapy options in this population.
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Affiliation(s)
- Roseanne Ferreira
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Emad Alwashmi
- Division of Urology, University Health Network, Toronto, ON, Canada
- Department of Surgery, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, QC, Canada
| | - Bilal Chughtai
- New York Presbyterian Hospital-Weill Cornell, New York, NY, United States
| | - Dean S. Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
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Chughtai B, Ricker CN, Boldt RJ, Elterman D. Real-world onabotulinumtoxinA treatment patterns in patients with overactive bladder. Neurourol Urodyn 2024; 43:396-406. [PMID: 38149719 DOI: 10.1002/nau.25370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/31/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Utilization patterns of third-line onabotulinumtoxinA for overactive bladder (OAB) symptoms-including discontinuation and use of other therapeutic options during or after treatment-are not well understood. This retrospective analysis of administrative claims was designed to characterize the unmet need for OAB treatment. MATERIALS AND METHODS A retrospective claims analysis of Optum's deidentified Clinformatics® Data Mart Database (2009-2021) was performed among patients with diagnosis of OAB newly starting onabotulinumtoxinA injection (2015-2017). Study measures were evaluated during an 18-month pretreatment baseline and over a minimum of 36 months of follow-up. These included number of injections, days between injections, other measures of onabotulinumtoxinA utilization, use of second-line pharmacologic treatments, use of device and surgical treatment options, and complications. RESULTS Of 2505 eligible patients, 535 (21.4%; 66.8 ± 13.3 y, 87.3% females) continued onabotulinumtoxinA throughout the study. The remaining 1970 (78.6%; 71.4 ± 11.6 y, 79.1% females) were considered discontinuers. Of continuers, 57% received ≥5 treatments. Of discontinuers, 84% received ≤2 treatments. Anticholinergics and β3-adrenoceptor agonist medication use declined in all patients from baseline to follow-up; however, the absolute reduction in the proportion with any medication fill was similar across continuers versus discontinuers (21% vs. 18%, p < 0.0001). Sacral neuromodulation was initiated by 15/535 (3%) of continuers and 137/1970 (7%) of discontinuers (p < 0.0001). No patients initiated percutaneous tibial neuromodulation. CONCLUSIONS Early discontinuation of onabotulinumtoxinA therapy for OAB is common and most discontinuers do not receive alternative treatments. Providers have the opportunity to educate OAB patients with un- or undertreated symptoms regarding alternative options.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | | | | | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
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Hamouda A, Ibrahim A, Corsi N, Siena G, Elterman DS, Chughtai B, Bhojani N, Sessa F, Rivetti A, Secco S, Zorn KC. Use of the Schelin Catheter for transurethral intraprostatic anesthesia prior to Rezūm treatment. Can J Urol 2024; 31:11802-11808. [PMID: 38401260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
Minimally invasive surgery techniques (MIST) have become newly adopted in urological care. Given this, new analgesic techniques are important in optimizing patient outcomes and resource management. Rezūm treatment (RT) for BPH has emerged as a new MIST with excellent patient outcomes, including improving quality of life (QoL) and International Prostate Symptom Scores (IPSSs), while also preserving sexual function. Currently, the standard analgesic approach for RT involves a peri-prostatic nerve block (PNB) using a transrectal ultrasound (TRUS) or systemic sedation anesthesia. The TRUS approach is invasive, uncomfortable, and holds a risk of infection. Additionally, alternative methods such as, inhaled methoxyflurane (Penthrox), nitric oxide, general anesthesia, as well as intravenous (IV) sedation pose safety risks or mandate the presence of an anesthesiology team. Transurethral intraprostatic anesthesia (TUIA) using the Schelin Catheter (ProstaLund, Lund, Sweden) (SC) provides a new, non-invasive, and efficient technique for out-patient, office based Rezūm procedures. Through local administration of an analgesic around the prostate base, the SC has been shown to reduce pain, procedure times, and bleeding during MISTs. Herein, we evaluated the analgesic efficacy of TUIA via the SC in a cohort of 10 patients undergoing in-patient RT for BPH.
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Affiliation(s)
- Aalya Hamouda
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ahmed Ibrahim
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Nicholas Corsi
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Giampaolo Siena
- Department of Urology, University of Florence, Careggi, Florence, Italy
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, New York, USA
| | - Naeem Bhojani
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Francesco Sessa
- Department of Urology, University of Florence, Careggi, Florence, Italy
| | - Anna Rivetti
- Department of Urology, University of Florence, Careggi, Florence, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Kevin C Zorn
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
- BPH Canada Prostate Center, Mont-Royal Surgical Center, Montreal, Quebec, Canada
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Altman R, Ferreira R, Barragan C, Bhojani N, Lajkosz K, Zorn KC, Chughtai B, Annamalai G, Elterman DS. Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis. BMC Urol 2024; 24:22. [PMID: 38281906 PMCID: PMC10822184 DOI: 10.1186/s12894-023-01397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH). METHODS A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4. RESULTS Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term. CONCLUSION PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.
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Affiliation(s)
- Rachel Altman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Roseanne Ferreira
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Camilo Barragan
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network/Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kevin C Zorn
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Ganesan Annamalai
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Vascular and Interventional Radiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada.
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Sadri H, Oliaei A, Sadri S, Pezeshki P, Chughtai B, Elterman D. Systematic review and meta-analysis of urinary incontinence prevalence and population estimates. Neurourol Urodyn 2024; 43:52-62. [PMID: 37661792 DOI: 10.1002/nau.25276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Incontinence impacts the quality-of-life of people suffering from the disease. However, there is limited information on the prevalence of incontinence due to the stigma, lack of awareness, and underdiagnosis. OBJECTIVE This study aims to conduct a systematic review and meta-analysis of overactive bladder (OAB) and nonobstructive urinary retention (NOUR). METHODS The authors conducted a systematic review following the PRISMA guidelines using Embase, MEDLINE, and PubMed databases to identify the relevant publications in the English language. Two reviewers independently assessed the articles and extracted the data. Review papers were assessed for content and references. A meta-analysis of proportions was conducted using the RStudio software. To address the age heterogeneity, a subanalysis was conducted. Pooled data were overlayed on the Canadian population and a sample of 10 populous countries to estimate the number of people suffering from incontinence. RESULTS Twenty-eight and eight articles were selected for OAB and NOUR, respectively. The pooled prevalence of OAB in men and women was 12% (95% CI: 9%-16%) and 15% (95% CI: 12%-18%), respectively. The estimated prevalence of NOUR was 15.6%-26.1% of men over 60 and 9.3%-20% of women over 60. The subanalysis pooled prevalence of OAB in men and women was 11% (95% CI: 8%-15%) and 12% (95% CI: 9%-16%), respectively. We estimated that 1.4-2.5 million women and 1.3-2.2 million men suffer from OAB in Canada. CONCLUSION Urinary incontinence is an under-reported and underdiagnosed prevalent condition that requires appropriate treatment to improve a patient's quality-of-life.
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Affiliation(s)
- Hamid Sadri
- Department of Health Economics and Outcomes Research, Toronto, Ontario, Canada
| | - Ava Oliaei
- Department of Interdisciplinary Studies, Hamilton University, Hamilton, Ontario, Canada
| | - Salar Sadri
- Department of Law, University of Toronto, Toronto, Ontario, Canada
| | - Padina Pezeshki
- Department of Clinical and Medical Affairs, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Dean Elterman
- Department of Urology, University of Toronto, Toronto, Ontario, Canada
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Hamouda A, Ibrahim A, Corsi N, Elterman DS, Chughtai B, Bhojani N, Zorn KC. Peri-prostatic nerve block using Clarius EC7 HD₃ handheld ultrasound guidance. Can J Urol 2023; 30:11741-11746. [PMID: 38104332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Transrectal ultrasound (TRUS) is a common modality used during urological procedures that require real-time visualization of the prostate, such as prostate biopsy and peri-prostatic nerve blocks (PNB) for surgical procedures. Current practice for TRUS-guided PNB requires use of costly, fixed, and non-portable ultrasound machinery that can often limit workflow. The Clarius endocavity EC7 probe, a digital, handheld and pocket-sized endocavity ultrasound (US) device, is an alternative, portable technology which was recently shown to accurately visualize and measure prostate dimensions and volume. Moreover, in recent years, there has been a renaissance of office-based treatments for minimally invasive surgical therapies (MIST) for the treatment of benign prostate hyperplasia (BPH). More specifically, the Rezūm procedure has been demonstrated to offer men a short, outpatient therapy with excellent 5-year outcomes in durability and preservation of antegrade ejaculation. While other anesthetic techniques have been described for Rezūm, including inhaled methoxyflurane (Penthrox), nitrous oxide, IV sedation and general anesthesia (which often mandate the presence of an anesthesiology team), US-guided local blocks offer the urologist an independent method for pain management. While most urologists may not have direct access to expensive, cart-based ultrasound systems, point of care ultrasound (POCUS) technology, such as Clarius (Vancouver, BC, Canada) and Butterfly (Butterfly Network, Inc, Guilford, CT, USA), can provide high-resolution imaging in combination with smart phone technology. Herein, we sought to describe the technique for using Clarius EC7 for TRUS-guided PNB and its use in urological application with the Rezūm BPH procedure.
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Affiliation(s)
- Aalya Hamouda
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ahmed Ibrahim
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Nicholas Corsi
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, New York, USA
| | - Naeem Bhojani
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Kevin C Zorn
- Division of Urology, University of Montreal Hospital Center, Montreal, Quebec, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cornu JN, Chughtai B. Reply to Carlos Gustavo Trujillo, Sebastián Peña Rodríguez, and Cesar Díaz Ritter's Letter to the Editor re: Jean-Nicolas Cornu, Paul Zantek, Glyn Burtt, et al. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol 2023;83:534-47. Eur Urol 2023; 84:e117-e118. [PMID: 37353442 DOI: 10.1016/j.eururo.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen, France.
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
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11
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Sadri I, Chakraborty A, Nguyen DD, Arezki A, Oumedjbeur K, Bhojani N, Elterman D, Chughtai B, Gilling P, Barber N, Badlani G, Desai M, Doumanian L, Te AE, Roehrborn C, Zorn KC. Aquablation in Patients on Antithrombotics: Assessment of Safety, Postoperative Bleeding Rates and Clinical Outcomes. Urology 2023; 181:112-118. [PMID: 37574143 DOI: 10.1016/j.urology.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/01/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To analyze the impact of perioperative antithrombotic use on the bleeding outcomes following Aquablation. METHODS One hundred sixteen men with who underwent Aquablation as part of the WATER prospective trial (NCT02505919) were assigned to 2 groups based on perioperative antithrombotic status. Antithrombotic cessation and restart timing were based on the surgeon's discretion. Methods of achieving intraoperative hemostasis consisted of no-cautery balloon tamponade or cautery. Primary endpoints included immediate postoperative hematuria rates and changes in hemoglobin. Secondary endpoints included 90-day bleeding complications and nonbleeding postoperative adverse events. RESULTS Forty-one men took antithrombotic medications in the perioperative period while 75 men had no antithrombotic medication. Preoperative hemoglobin levels were comparable between both groups. Postoperative hemoglobin change from baseline (drop of 1.8 ± 1.5 g/dL among the antithrombotic group vs 1.8 ± 1.7 g/dL among the antithrombotic-naïve group) did not differ between both groups (P = .896). In total, 4 (9.8%) men in the antithrombotic group and 4 (5.3%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo grade 1 complication (P = .451) in the 3-month postoperative period. Eight (19.5%) patients in the antithrombotic group and 11 (14.7%) patients in the antithrombotic-naïve group experienced a Clavien-Dindo grade 2 complication (P = .601), none of which is associated with bleeding in both groups. No men in either group demonstrated de novo erectile dysfunction. One patient (2.4%) in the antithrombotic group and none in the antithrombotic-naïve group required blood products (P = .353). CONCLUSION Aquablation demonstrates comparable postoperative bleeding outcomes and other adverse effects for men with benign prostatic hypertrophy who are on antithrombotic therapy.
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Affiliation(s)
- Iman Sadri
- Department of Urology, McGill University, Montreal, Quebec, Canada
| | | | - David-Dan Nguyen
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Adel Arezki
- Department of Urology, McGill University, Montreal, Quebec, Canada
| | - Kussil Oumedjbeur
- Division of Urology, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Neil Barber
- Section of Urology, Department of Surgery, Frimley Health NHS Foundation Trust, Frimley, United Kingdom
| | - Gopal Badlani
- Department of Urology, Wake Forest University, Winston-Salem, NC
| | - Mihir Desai
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Claus Roehrborn
- Urology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada.
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Kaplan S, Kaufman RP, Mueller T, Elterman D, Chughtai B, Rukstalis D, Woo H, Roehrborn C. Retreatment rates and postprocedural complications are higher than expected after BPH surgeries: a US healthcare claims and utilization study. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00741-8. [PMID: 37884615 DOI: 10.1038/s41391-023-00741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Up to 50% of men over 50 and 80% over 80 are affected by BPH. Shared decision-making regarding BPH treatment options can benefit from an improved understanding of relative risks and benefits for various treatments. METHODS Data for this longitudinal retrospective population-based cohort study were obtained from a random sample of US Medicare and commercial claims (IBM Watson MarketScan) and restricted to men undergoing BPH surgery (TURP, PVP, PUL, WVTT) from 2015 to 2021 across all sites of service. Retreatments included Holmium laser enucleation and index procedures. Main outcomes were rates of retreatment and procedural complications over 1 year, identified via CPT and ICD-9/10CM codes. Procedural complications that occurred at least 1 day post-index treatment were assessed, as were surgical retreatments with patients who had at least 1 and 5 year's-worth of data. Baseline phenotype characterization did not control for symptomatology and was limited to age, comorbidities, and BMI. Univariate cumulative incidence estimates, cumulative proportion and log-rank tests justified inclusion for covariate (e.g., age, comorbidities) adjustment in Cox proportional hazard models. RESULTS 43,147 men diagnosed with BPH underwent 22,629 TURP, 11,392 PVP, 7,529 PUL, and 1,597 WVTT. At 1-year post-index: PUL was associated with the lowest rate of complication (PUL 15%, TURP 17%; PVP 19%, ; WVTT 26%); retreatment rates were not different (TURP 5.3%, PVP 5.3%, PUL 5.9%, WVTT 6.2%). At 5 years post-index: retreatment was lowest for TURP (7.0%) and was not significantly different between PVP and PUL (8.9% and 11.6%, respectively). CONCLUSIONS Real-world patients diagnosed with BPH may be selected to undergo one of the various available therapies based on patient preference or baseline phenotype. These therapies, however, are associated with different risks for complications. The results of this study suggest that within one year of BPH surgery, one-in-twenty patients may require retreatment regardless of treatment choice, and for some technologies as many as one-in-four may require treatment for a complication.
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Affiliation(s)
| | | | | | | | | | | | - Henry Woo
- University of Sydney, Sydney, Australia
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Codelia-Anjum AJ, Berjaoui MB, Khondker A, Elterman D, Zorn KC, Bhojani N, Lerner LB, Chughtai B. Procedural Intervention for Benign Prostatic Hyperplasia in Men ≥ Age 70 Years - A Review of Published Literature. Clin Interv Aging 2023; 18:1705-1717. [PMID: 37849957 PMCID: PMC10577238 DOI: 10.2147/cia.s414799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
Objective We set out to review studies reporting on the use of surgical intervention to treat Benign Prostatic Hyperplasia in elderly men ≥70 years of age. Methods A systematic literature search was conducted using Scopus, PubMed-MEDLINE, Cochrane, and Wiley Online Library databases including studies published between January 2012 through December 2022. This 10-year interval was chosen given the recent plethora of new modalities that have entered the BPH armamentarium, many of which have been marketed as appropriate for older and high-risk patients. The following database search words were used either individually or in conjunction: "BPH", "elderly", "surgical", "ablation", "resection", "embolization", and "aging". Results We identified 28 studies for inclusion in this review. The pros and cons of these modalities are presented, specifically as applicable to an older and higher risk population. Conclusion There are a wide variety of surgical procedures available for surgically treating BPH in elderly men with varying states of health. Each of these comes with different risks and benefits, supporting that individualized approaches are important. Long-term data and further studies comparing modalities, specifically as regards the elderly and frail, would enhance our approaches to BPH treatment in this patient population.
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Affiliation(s)
- Alia J Codelia-Anjum
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Mohamad Baker Berjaoui
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Lori B Lerner
- Department of Urology, VA Boston Healthcare System, Boston, MA, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
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Nguyen DD, Murad L, Nguyen AXL, Zorigtbaatar A, Bouhadana D, Deyirmendjian C, Zorn KC, Elterman D, Chughtai B, Sayyid RK, Labban M, Trinh QD, Wallis CJD, Bhojani N. Industry Payments to American Editorial Board Members of Major Urology Journals. Eur Urol 2023; 84:442-443. [PMID: 37127467 DOI: 10.1016/j.eururo.2023.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Anudari Zorigtbaatar
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY, USA
| | - Rashid K Sayyid
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Muhieddine Labban
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada.
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15
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Pierce H, Ahsan MD, Martinez Diaz S, Cho A, Asfaw T, Mao J, Anger J, Chughtai B. Adverse Event Reporting of Commonly Used Gender-Specific Implantable Medical Devices in the United States. J Patient Saf 2023; 19:465-468. [PMID: 37729644 DOI: 10.1097/pts.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Evidence suggests that more women are harmed by implantable medical devices than men. It is unknown whether this difference includes gender-specific devices. METHODS In this study, we examine the differences in reported adverse events between 6 female- and 5 male-specific implantable devices from the Manufacturer and User Facility Device Experience (MAUDE) database from 1993 to 2018. Primary endpoints were injury type (life-threatening, disability, death) and the rate of device evaluation by the manufacturer. Proportions of valid entries across these variables were compared using either the Fisher exact test or χ2 test. RESULTS Female-specific devices had higher rates of life-threatening outcomes (1.6% versus 0.3%, P < 0.001), disabilities (5.0% versus 4.3%, P < 0.001), and deaths (0.6% versus 0.1%, P < 0.001) compared with the male-specific devices. Of the 8159 devices that were evaluated by the manufacturer, 56% were female specific while 44% were male specific. Female-specific devices were evaluated far less frequently by the manufacturer (4.5% versus 38.2%, P < 0.001). CONCLUSIONS Increased adverse events reports for female-specific devices and associated high-grade complications necessitates improved postmarket surveillance.
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Affiliation(s)
- Hudson Pierce
- From the Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY
| | - Muhammad Danyal Ahsan
- From the Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY
| | - Susana Martinez Diaz
- From the Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY
| | - Ahra Cho
- From the Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY
| | - Tirsit Asfaw
- Department of Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian, New York, NY
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medical College-New York Presbyterian, New York, NY
| | - Jennifer Anger
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Beverly Hills, CA
| | - Bilal Chughtai
- From the Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY
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Oumedjbeur K, Corsi NJ, Bouhadana D, Ibrahim A, Nguyen DD, Matta I, Arezki A, Sadri I, Elsherbini T, Bhojani N, Elterman DS, Chughtai B, Helfand BT, Glaser AP, Misrai V, Kaplan S, Gilling P, Barber N, Desai M, Badlani GH, Te AE, Roehrborn CG, Zorn KC. Aquablation versus TURP: 5-year outcomes of the WATER randomized clinical trial for prostate volumes 50-80 mL. Can J Urol 2023; 30:11650-11658. [PMID: 37838991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
INTRODUCTION To report the 5-year efficacy and safety of Aquablation compared with transurethral resection of the prostate for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia in men with prostate volumes 50-80 mL. MATERIALS AND METHODS In a large double-blinded, multicenter, and prospective randomized controlled trial, 96 randomized men with 50-80 mL prostates who underwent Aquablation or transurethral prostate resection were prospectively identified for subgroup analysis. Follow up was performed for up to 5 years. The primary efficacy endpoint was the reduction in International Prostate Symptom Score (IPSS) at 6 months. The primary safety endpoint was the occurrence of Clavien-Dindo (CD) postoperative complications grade 1 persistent and grade 2 or higher at 3 months. RESULTS Both groups had comparable baseline characteristics. Reduction in IPSS score was significantly higher in the Aquablation group across 5 years of follow up (-14.1 vs. -10.8, p = 0.02). The Aquablation group achieved a significantly lower rate of CD1P and CD2 or higher events at 3 months follow up (risk difference of -23.1%). Among recorded adverse events, de novo postoperative ejaculatory dysfunction was notably lower in Aquablation (risk difference of -21.9%), while the risk of bleeding remained similar after 6 months. The surgical and medical retreatment rate at 6 months was also lower in Aquablation (risk difference of -14.4%). CONCLUSIONS In the 50-80 mL prostate volume subgroup, Aquablation yields superior long-term symptom relief and lower complication rates than standard transurethral resection, with notably lower rates of ejaculatory dysfunction. This further supports the adoption of Aquablation for men with medium-sized prostates.
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Affiliation(s)
- Kussil Oumedjbeur
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | | | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ahmed Ibrahim
- Division of Urology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - David-Dan Nguyen
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Imad Matta
- Division of Urology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Adel Arezki
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Iman Sadri
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Tawfik Elsherbini
- Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Dean S Elterman
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Brian T Helfand
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Alexander P Glaser
- Division of Urology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Steven Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Gilling
- Department of Urology, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Neil Barber
- Department of Urology, Frimley Park Hospital, Frimley, United Kingdom
| | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Gopal H Badlani
- Department of Urology, Wake Forest University, Winston Salem, North Carolina, USA
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Claus G Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
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Sze C, Zhang TR, Dreyfuss L, DeMeo G, Thorogood SL, Chughtai B, Te AE, Lee RK, Hu JC. US patterns of care for urodynamic evaluation for BPH. Neurourol Urodyn 2023; 42:1563-1568. [PMID: 37395472 DOI: 10.1002/nau.25239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/07/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Practice patterns around the use of urodynamic evaluation (UDS) for benign prostatic hyperplasia (BPH) surgery are largely undefined. As such, we investigated factors associated with the use of UDS for BPH. METHODS We used American Board of Urology case log data from 2008 to 2020, to compare patient- and surgeon-sided factors associated with UDS utilization and BPH surgeries. We performed logistic regression models to identify factors independently associated with UDS usage for BPH. RESULTS Among urologists performing UDS, the majority (80%) self-identified as general urologists and practiced in a private practice group (69%). Compared with urologists who performed no UDS, urologists who performed any UDS for BPH were more likely to be from the Mid-Atlantic (20.3% vs. 10.6%, p < 0.01) and practice in regions with populations of >1 000 000 (34.7% vs. 28.5%, p < 0.01). Overall, UDS utilization declined over time (odds ratio [OR]: 0.95 year-to-year, 95% confidence interval [CI]: 0.91-0.99). In adjusted analyses, the odds of performing UDS was higher among male (OR: 2.19, 95% CI: 1.17-4.09), older (OR: 1.05, 95% CI: 1.03-1.06), and female pelvic medicine and reconstructive surgery subspecialty (OR: 3.23, 95% CI: 2.01-5.2) urologists. Additionally, performing UDS for BPH was associated with higher BPH surgical case volume (OR: 1.004, 95% CI: 1.001-1.008). CONCLUSION There is a significant practice variation in use of UDS for BPH. Although overall BPH surgeries are increasing, urologists are increasingly less likely to perform UDS for BPH. Specifically, urologists who perform UDS have significantly higher BPH case volume than those who do not perform UDS, suggesting that UDS usage may not factor into BPH surgery decision-making.
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Affiliation(s)
- Christina Sze
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Tenny R Zhang
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Leo Dreyfuss
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Gina DeMeo
- Department of Medical Eduation, Touro University California College of Osteopathic Medicine, Vallejo, California, USA
| | - Samantha L Thorogood
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Alexis E Te
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Richard K Lee
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - Jim C Hu
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
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Siron N, Bouhadana D, Schwartz R, Deyermendjian C, Lafontaine ML, Cossette F, Jain M, Nguyen DD, Zorn KC, Khosa F, Elterman DS, Chughtai B, Bhojani N. Evaluation of Canadian urology residency and fellowship program websites. Can Urol Assoc J 2023; 17:E291-E296. [PMID: 37458744 PMCID: PMC10544403 DOI: 10.5489/cuaj.8292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Introduction: There is growing use of online resources in the postgraduate medical education application process to provide applicants program-specific details, thus allowing for informed decision-making. Given the variability and non-standardized electronic training descriptions and objectives, our goal was to assess the availability of program information through program websites for both residency and fellowship urology programs across Canada.
Methods: Using the Canadian Residency Matching Service (CaRMS) and the Canadian Urological Association (CUA) websites, we compiled a list of all Canadian urology residency and fellowship programs. We reviewed all programs’ website using a 40-item tool based on seven subcategories, including education, application process, faculty information, trainee/fellow information, research and extra-curricular activities, wellness, and both benefits and career planning. Each website was reviewed by two trained reviewers. Any inter-reviewer discrepancy was resolved by a third-party reviewer.
Results: Among 13 Canadian urology residency programs, all had program websites and met 48% of the criteria evaluated. None of the residency program websites reported information on work hours, surgical caseload statistics, or equity diversity and inclusion/community initiatives. Among 37 Canadian urology fellowship programs, 10 programs did not have websites, and the remaining 27 program websites met 28% of the criteria evaluated. Scores were highest for the application process subcategory, while scores were lowest for the wellness and benefits/career planning subcategories among both residency and fellowship programs.
Conclusions: With growing reliance and dependence on web resources to access residency and fellowship program information, there is a clear need to standardize and improve Canadian training websites for prospective applicants.
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Affiliation(s)
- Nicolas Siron
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ryan Schwartz
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Claudia Deyermendjian
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Marie-Lyssa Lafontaine
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - François Cossette
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Mehr Jain
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Kevin C. Zorn
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, United States
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mueller ER, Weiss JP, Bosch JLHR, Chughtai B, Rosenberg MT, Bacci ED, Simeone JC, Andersson FL, Juul K, Coyne KS, Chapple CR. Nocturnal polyuria in women: results from the EpiNP study. Int Urogynecol J 2023; 34:1743-1751. [PMID: 36708403 DOI: 10.1007/s00192-022-05432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/22/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Data from a large US population-based, cross-sectional, epidemiological study (the EpiNP Study) were used to assess the symptoms and bother experienced by women with nocturnal polyuria (NP). METHODS Consenting participants recruited from an online panel completed the baseline EpiNP survey online (Lower Urinary Tract Symptoms Tool and urological comorbidities). All reporting ≥2 voids/night and a random sample of 100 respondents, each reporting 0 or 1 void/night were asked to complete a 3-day web-based bladder diary recording time, volume, and urgency rating of each void. NP was calculated by the proportion of urine production that occurred during nocturnal hours using a Nocturnal Polyuria Index (NPI33) threshold of >0.33 or nocturnal urine production of >90 ml/h (NUP90). The frequency of participants reporting LUTS and bother was determined by age and NP: idiopathic NP, NP associated with overactive bladder (NPOAB), NP associated with comorbidities (NPCom), and no NP (did not meet NP criteria). RESULTS A total of 5,290 women completed the baseline survey. Mean age (range) was 54.9 (30-95) years; 1,841 (34.8%) reported ≥2 nocturnal voids. The prevalence of LUTS increased across the lifespan; however, bother associated with each LUTS decreased with increasing age. The percentage of women rating bother by nocturia episodes ≥2 "> somewhat" ranged from 40.3% to 68.3%, with bother ratings highest in the NPOAB and No NP groups. CONCLUSIONS NP is prevalent in women with considerable bother and is often associated with other urinary symptoms. Multifactorial causes and potential treatments of NP should be considered, particularly at a later age.
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Affiliation(s)
| | - Jeffrey P Weiss
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | | | | | | | | | | | | | - Karin S Coyne
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
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21
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Elterman D, Bhojani N, Chughtai B, Zorn KC. Change in Prostate Volume and Symptom Improvement in Men Treated With Rezūm Water Vapor Therapy. Urology 2023; 177:142-147. [PMID: 37076022 DOI: 10.1016/j.urology.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/05/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To evaluate the change in prostate volume (PV) and relationship to improvement in urinary symptom scores following Rezūm therapy. METHODS Quality of life outcomes and PV were assessed at baseline and 12months postprocedure. Percent change from baseline in outcomes and PV were calculated, as was the number of Rezum injection to baseline PV ratio. Association between total number of injections and changes in outcomes and PV were evaluated using linear regression models. RESULTS A total of 49 men (mean age=67.8; standard deviation=9.4) underwent the procedure between April 2019 and September 2020, with a median baseline PV of 71.5 cc (range 24-150) and median number of vapor injections of 11.0 (range 4-21). At 12months, the median percent change in PV was - 34.0% (interquartile range: -49.2%, -16.7%), with 45/49 (91.8%) patients having reduced volume. Among the 45 patients with reduced volume at 12months, every 10% increase in volume reduction was associated with a 7.5% (95% confidence interval, 1.4%-13.6%; P = .02) improvement in the International Prostate Symptom Score. There was no significant association between total number of injections or injection to baseline volume ratio and change in PV. CONCLUSION In this cohort of men treated with Rezūm therapy for benign prostatic hyperplasia, it was demonstrated that there is a correlation between greater PV reduction and greater symptomatic improvement. This study showed no association between more injections or the ratio of injections to PV changes, refuting the claim that more injections are better.
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Affiliation(s)
- Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, NY
| | - Kevin C Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
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22
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Nguyen DD, Fellouah M, Nguyen ALV, Kazu DC, Baltzan I, Labban M, De S, Zorn KC, Chughtai B, Elterman DS, Trinh QD, Bhojani N. Litigation associated with 5-alpha-reductase-inhibitor use: A Canadian legal database review. Can J Urol 2023; 30:11546-11550. [PMID: 37344466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
INTRODUCTION 5α-reductase inhibitors (5ARI) are commonly prescribed medications. There is ongoing controversy about the adverse events of these medications. The aim of this study is to characterize lawsuits in Canada involving medical complications of 5ARIs use. MATERIALS AND METHODS Legal cases were queried from CanLII. Cases were included if they involved a party taking a 5ARI who alleged an adverse event. Relevant full cases were retained, and pertinent characteristics were extracted with the help of a legal expert. RESULTS Our deduplicated search yielded 67 unique legal documents from December 2013 to February 2019. Twelve of these documents met the inclusion criteria (representing 3 cases, considering each case had several hearings). The medical complaints filed by the plaintiffs were all related to medication side effects (n = 3, 100%). The plaintiffs were commonly patients themselves. Defendants were exclusively pharmaceutical companies. Persistent erectile dysfunction after stopping the medication was cited as a side effect in all complaints. The prescriptions were made for male pattern hair loss (n = 3, 100%) in all cases. All cases represent class actions brought by the plaintiffs, and they have been certified by their respective court. However, the cases are still ongoing. CONCLUSION While 5ARI use has been linked to undesired sexual side effects, there have been few litigations on this issue in Canada. Persisting sexual dysfunction after stopping the medication is the only complaint presented in legal action. To date, no judgment against a physician or pharmaceutical company was identified. Cases are still ongoing.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Massine Fellouah
- Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Anna-Lisa V Nguyen
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | | | - Isabel Baltzan
- Faculty of Law, McGill University, Montréal, Quebec, Canada
| | - Muhieddine Labban
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, New York, USA
| | - Dean S Elterman
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Quebec, Canada
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23
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Elterman DS, Gao B, Zorn KC, Bhojani N, Te A, Chughtai B, Kaplan SA. How I Do It: Optilume BPH catheter system. Can J Urol 2023; 30:11568-11573. [PMID: 37344470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Benign prostatic hyperplasia (BPH) is a common and progressive disease affecting aging men which has a significant impact on quality of life. The Optilume BPH Catheter System (Optilume BPH) is a prostatic dilation system that combines balloon dilation with a localized transfer of paclitaxel to maintain long term patency. Optilume BPH can be deployed using standard rigid cystoscopy without general anesthesia in an office setting. Prospective data indicate that Optilume BPH has favorable functional and sexual patient outcomes. Readers will familiarize themselves with Optilume BPH, significant historical studies and the technique for deploying Optilume BPH.
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Affiliation(s)
- Dean S Elterman
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Ontario, Canada
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York, USA
| | - Steven A Kaplan
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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24
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Cornu JN, Zantek P, Burtt G, Martin C, Martin A, Springate C, Chughtai B. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol 2023; 83:534-547. [PMID: 36964042 DOI: 10.1016/j.eururo.2023.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
CONTEXT Minimally invasive surgical therapies for male lower urinary tract symptoms secondary to benign prostatic obstruction were developed to be safer and more tolerable than standard ablative techniques. These treatments have not been compared with each other in a randomised fashion, and for some treatments, there are no trials against a reference technique. OBJECTIVE To compare the efficacy, safety, and tolerability of water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device (iTIND), transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP). EVIDENCE ACQUISITION A systematic search of MEDLINE/PubMed, Embase, Cochrane Library, and grey literature for randomised controlled trials was performed. Trials meeting the selection criteria were assessed for the risk of bias using the Cochrane RoB2 tool. Treatments were compared, using a network meta-analysis, in terms of outcomes including symptom score, quality of life, maximum urinary flow rate, postvoid residual urine, International Index of Erectile Function (IIEF-5), and scales from the Male Sexual Health Questionnaire. EVIDENCE SYNTHESIS The search identified 63 trials. Symptoms and quality of life for PAE, PUL, and WVTT appeared similar to those for TURP, whereas TURP was found to have the most clinically significant improvement in flow rate. TUMT was less efficacious than TURP but provided similar results on quality of life. Comparisons of ejaculatory function favoured WVTT and PUL compared with TURP. The relative efficacy of iTIND was less clear because of the risk of bias in the respective trial. CONCLUSIONS PAE, PUL, and WVTT appear favourable from a risk-benefit perspective despite probably having less efficacy than TURP for objective outcomes. These findings warrant confirmation through long-term randomised controlled trials. PATIENT SUMMARY This paper has summarised the evidence from 63 clinical trials on minimally invasive surgical therapies for men with symptoms of an enlarged prostate, including water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device, and transurethral microwave thermotherapy (TUMT). Improvement in symptoms for each of PAE, PUL, TUMT, and WVTT in short-term follow-up was similar to that for the standard surgical treatment, although standard surgery appeared to provide the greatest increase in urine flow. Men who had WVTT or PUL were less likely to have problems with sexual function than those who had standard surgery.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France.
| | | | | | | | | | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
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25
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Zhang TR, Thorogood SL, Sze C, Fisch R, Chughtai B, Te A, Lee RK, Hu JC. Current Practice Patterns in the Surgical Management of Benign Prostatic Hyperplasia. Urology 2023; 175:157-162. [PMID: 36863599 DOI: 10.1016/j.urology.2023.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To use American Board of Urology (ABU) case log data to elucidate practice patterns for benign prostatic hyperplasia (BPH) surgery. Several surgical modalities have been introduced in recent decades causing significant practice variation. MATERIALS AND METHODS We retrospectively analyzed ABU case logs from 2008-2021 to assess trends in BPH surgery. We created logistic regression models to identify surgeon-sided factors associated with utilization of each surgical modality. RESULTS We identified 6,632 urologists who logged 73,884 surgeries for BPH. Transurethral resection of the prostate (TURP) was the most commonly performed BPH surgery in all but 1 year, and odds of performing a TURP increased year-over-year (OR 1.055, 95% CI [1.013,1.098], P = .010). The use of holmium laser enucleation of the prostate (HoLEP) did not change over time. HoLEP was more likely to be performed by urologists with higher BPH surgical volume (OR 1.017, CI [1.013, 1.021], P < .001) and with endourology subspecialization (OR 2.410, CI [1.45, 4.01], P = .001). Prostatic urethral lift (PUL) utilization increased significantly since its introduction in 2015 (OR 1.663, CI [1.540, 1.796], P < .001). PUL currently comprises over one third of all BPH surgeries logged. CONCLUSION In the face of newer technologies, TURP remains the most common surgery for BPH in the United States. PUL has been rapidly adopted while HoLEP comprises a consistent minority of cases. Surgeon age, patient age, and urologist subspecialization were associated with use of certain BPH surgical approaches.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Samantha L Thorogood
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Christina Sze
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Robert Fisch
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Alexis Te
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical Center, New York, NY.
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Codelia-Anjum A, Lerner LB, Elterman D, Zorn KC, Bhojani N, Chughtai B. Enterococcal Urinary Tract Infections: A Review of the Pathogenicity, Epidemiology, and Treatment. Antibiotics (Basel) 2023; 12:antibiotics12040778. [PMID: 37107140 PMCID: PMC10135011 DOI: 10.3390/antibiotics12040778] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Urinary tract infections (UTIs) are among the most common causes of infections worldwide and can be caused by numerous uropathogens. Enterococci are Gram-positive, facultative anaerobic commensal organisms of the gastrointestinal tract that are known uropathogens. Enterococcus spp. has become a leading cause of healthcare associated infections, ranging from endocarditis to UTIs. In recent years, there has been an increase in multidrug resistance due to antibiotic misuse, especially in enterococci. Additionally, infections due to enterococci pose a unique challenge due to their ability to survive in extreme environments, intrinsic antimicrobial resistance, and genomic malleability. Overall, this review aims to highlight the pathogenicity, epidemiology, and treatment recommendations (according to the most recent guidelines) of enterococci.
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Affiliation(s)
- Alia Codelia-Anjum
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Lori B Lerner
- Department of Urology, VA Boston Healthcare System, Boston, MA 02132, USA
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON M5T 2SB, Canada
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Monstréal, Montreal, QC H2X 0A9, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Monstréal, Montreal, QC H2X 0A9, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
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27
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Sze C, Brant A, Johnson JP, Singh Z, DeMeo G, Moryousef J, Zorn KC, Bhojani N, Elterman DS, Margolis D, Chughtai B. The role of quantitative MRI-based prostate zonal parameters in predicting clinically significant prostate cancer: A U.S. cohort. Can Urol Assoc J 2023:cuaj.8195. [PMID: 37068148 PMCID: PMC10382215 DOI: 10.5489/cuaj.8195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
INTRODUCTION We aimed to investigate the clinical utility of quantitative prostatic zonal measurements on in multiparametric magnetic resonance imaging (mpMRI) for the predication of clinically significant prostate cancer (csPCa). METHODS A retrospective, single-institution study included 144 men who underwent mpMRI from 2015- 2017. Prostate zone parameters were measured on mpMRI. Correlation and multivariable analysis evaluated relationship between prostate zone parameters and the presence of csPCa. RESULTS The mean age was 66.9±7.8 years old. The median (interquartile range [IQR]) prostate volume and prostate-specific antigen (PSA) were 51.6 ml (37.1-74.5) and 6.1 ng/ml (4.5-8.2), respectively. Men with csPCa had significantly smaller total prostate volume (TPV), transitional zone volume (TZV), and transitional zone thickness (TZT), and larger transitional zone density (TZD) compared to those without PCa; however, on multivariate variable analysis, only TZD maintained significance. TZD had a comparable area under the curve to PSA density (PSAD) and PSA (0.74 vs. 0.73 vs. 0.60, respectively). Subgroup analysis of men with PCa, PSAD and TZD were significantly higher in men with Gleason grade group (GG) ≥2 compared to those with GG <2 (p=0.002); however, this significance is not maintained on logistic regression in predicting GG. CONCLUSIONS Quantitative features of prostate zones on MRI may aid in identifying better predictors of csPCa. Zonal-based PSA density (TZD) may be a useful marker in identifying csPCa. Further exploration is needed to understand the clinical application of larger TZV in men with csPCa compared to those with insignificant disease.
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Affiliation(s)
- Christina Sze
- Department of Urology, Weil Cornel Medicine/New York Presbyterian Hospital, New York, NY, United States
| | - Aaron Brant
- Department of Urology, Weil Cornel Medicine/New York Presbyterian Hospital, New York, NY, United States
| | - Jeffery P Johnson
- Department of Urology, Weil Cornel Medicine/New York Presbyterian Hospital, New York, NY, United States
| | | | - Gina DeMeo
- Weil Cornell Medical College, New York, NY, United States
| | | | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Daniel Margolis
- Department of Radiology, New York Presbyterian Hospital, New York, NY, United States
| | - Bilal Chughtai
- Department of Urology, Weil Cornel Medicine/New York Presbyterian Hospital, New York, NY, United States
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28
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Elsherbini T, Bouhadana D, Sadri I, Nguyen DD, Law KW, Arezki A, Deyirmendjian C, Ibrahim A, Bhojani N, Elterman DS, Chughtai B, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. The impact of 5-ARI on perioperative and functional outcomes of GreenLight PVP: an analysis of the Global GreenLight Group database. Can J Urol 2023; 30:11473-11479. [PMID: 37074746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION In this study, we sought to investigate the impact of 5-alpha reductase inhibitors (5-ARI) on the perioperative and functional outcomes of 180-Watt XPS GreenLight photovaporization of the prostate (PVP) using a large international database. MATERIALS AND METHODS Data were obtained from the Global GreenLight Group (GGG) database, which includes eight high-volume, experienced surgeons from seven international centers. All men with established benign prostatic hyperplasia (BPH) with known 5-ARI status who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on the preoperative use of 5-ARI. Analyses were adjusted for patient age, prostate volume, and American Society of Anesthesia (ASA) score. RESULTS We included 3,500 men, of which 1,246 (36%) had preoperative 5-ARI use. Patients in both groups were similar with regards to age and prostate size. On multivariable analysis, total operative time was slightly shorter (-3.26 min 95% CI: 1.20 - 5.32, p < 0.01) and required 35.6kJ less laser energy (95% CI: -48.0kJ - -23.3kJ, p < 0.01) for patients on 5ARI compared to those without 5-ARI. However, no clinically significant difference was appreciated regarding postoperative transfusion rates [OR 0.048 (95% CI -0.82-0.91; p = 0.91)], hematuria rates [OR 0.96 (95% CI 0.72-1.3; p = 0.81)], 30-day readmission rates [OR 0.98 (95% CI 0.71-1.4; p = 0.90)], or overall functional outcomes. CONCLUSION Our findings suggest that preoperative 5-ARI is not associated with any clinically significant different perioperative or functional outcomes for GreenLight PVP using the XPS-180W system. There is no role for the initiation or discontinuation of 5-ARI prior to GreenLight PVP.
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Affiliation(s)
- Tawfik Elsherbini
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Iman Sadri
- Division of Urology, McGill University, Montreal, Quebec, Canada
| | - David-Dan Nguyen
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Kyle W Law
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Adel Arezki
- Division of Urology, McGill University, Montreal, Quebec, Canada
| | | | - Ahmed Ibrahim
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | | | | | | | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany and Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Maximillian Reimann
- Department of Urology, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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Sahakyan Y, Erman A, Bhojani N, Chughtai B, Zorn KC, Sander B, Elterman DS. Pharmacotherapy vs. minimally invasive therapies as initial therapy for moderate-to-severe benign prostatic hyperplasia: a cost-effectiveness study. Prostate Cancer Prostatic Dis 2023; 26:113-118. [PMID: 35689083 DOI: 10.1038/s41391-022-00561-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recently, minimally invasive therapies (MITs), such as water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL) have become an alternative to surgery or pharmacotherapy to manage benign prostatic hyperplasia (BPH), offering symptom relief with a favorable safety profile. The objective of this study was to evaluate the cost-utility of MITs (WVTT and 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 US public payer perspective) per quality-adjusted life year (QALY), discounted at 3% annually. Various clinical scenarios were evaluated given that most men undergo several lifelong therapies up to surgical intervention and potentially thereafter. As such, in the study model men could receive up to three lines of therapy: (1) initial pharmacotherapy with MIT as second-line, and transurethral resection of the prostate (TURP) or pharmacotherapy as third-line; (2) initial MIT (WVTT or PUL) with MIT again, TURP or pharmacotherapy as second-line, and TURP as third-line. Model was populated using data from the published literature. Probabilistic analyses were performed. RESULTS Initial treatment with WVTT led to the highest QALYs (13.05) and the lowest cost ($15,461). The cumulative QALYs and lifetime costs were 12.92 QALYs and $20,280 for pharmacotherapy followed by WVTT, 12.87 QALYs and $22,424 for pharmacotherapy followed by PUL, 12.86 QALYs and $20,930 for initial treatment with PUL. In the cost-utility analysis, WVTT as initial treatment dominated all three strategies, i.e., generated more QALYs at a lower cost. CONCLUSION WVTT is an effective and cost-saving procedure, and may be an appropriate first-line alternative to pharmacotherapy for moderate-to-severe BPH patients 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
- University of Montreal Hospital Center, Montreal, QC, Canada
| | | | - Kevin C Zorn
- University of Montreal Hospital Center, 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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Chapple CR, Rosenberg MT, Mueller ER, Chughtai B, Weiss JP, Juul K, Brooks AB, Bacci ED, Andersson FL, Coyne KS, Bosch JR. The patient burden of nocturnal polyuria in the United States: Results from the epidemiology of nocturnal polyuria (EpiNP) study. Neurourol Urodyn 2023; 42:573-585. [PMID: 36655731 DOI: 10.1002/nau.25126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To explore the impact of nocturnal polyuria (NP) on health-related quality of life (HRQoL), work productivity, mental health, fatigue, bother, and daytime sleepiness. MATERIALS AND METHODS This large-scale, US population-representative epidemiologic study was conducted in two parts: a web-based survey and 3-day bladder diary. Consenting participants completed the baseline Epidemiology of NP (EpiNP) survey online (Lower Urinary Tract Symptoms [LUTS] Tool, comorbidities, burden, and multiple HRQoL measures). Participants who reported ≥2 voids/night, and a random sample of 100 respondents each reporting 0 or 1 void/night, were sent urine measurement containers and asked to complete the 3-day bladder diary. NP was defined as Nocturnal Polyuria Index >0.33 (NPI33) or nocturnal urine production >90 ml/h (NUP90). Five subgroups were created: Idiopathic NP (NP with no underlying cause), NP associated with symptoms of overactive bladder (NPOAB) or bladder outlet obstruction (NPBOO; men only), NP associated with other comorbidities (NPCOM; e.g., diabetes, hypertension, heart disease, sleep apnea), and no NP (did not meet NP criteria). RESULTS A total of 4893 men and 5297 women completed the EpiNP survey; mean age was 54.4 (SD = 14.7). Significantly greater patient burden (p < 0.0001) was evidenced in the nocturia group (≥2 voids/night) versus no nocturia group (0-1 void/night) on daily impact of nocturia, LUTS Bother, prostate symptoms (men only), work productivity, physical and mental health component scores, depression, fatigue, and daytime sleepiness. NP subgroup analyses showed men in the NPBOO group and women in the NPOAB group reported the greatest impact on LUTS bother, fatigue, physical health, work productivity impairment, daytime sleepiness, and depression (women only). CONCLUSION This was the first large-scale, epidemiologic study to explore the impact of different forms of NP on patients' HRQoL. Findings demonstrate that NP associated with other urologic or comorbid conditions appears to have greater patient burden than idiopathic NP, in particular for women.
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Affiliation(s)
- Christopher R Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Matt T Rosenberg
- Department of Family Medicine, Mid Michigan Health Center, Jackson, Michigan, USA
| | - Elizabeth R Mueller
- Departments of Obstetrics/Gynecology & Urology, Division Female Pelvic Medicine & Reconstructive Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York City, New York, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kristian Juul
- Global Value and Access, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Anne B Brooks
- Patient Centered Research, Former employee at Evidera, Bethesda, Maryland, USA
| | | | | | - Karin S Coyne
- Patient Centered Research, Evidera, Bethesda, Maryland, USA
| | - Jlh Ruud Bosch
- Department of Urology, Franciscus G&V Hospital, Rotterdam, The Netherlands
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Deyirmendjian C, Nguyen DD, Law KW, Nguyen ALV, Sadri I, Arezki A, Bouhadana D, Ibrahim A, Bhojani N, Elterman DS, Chughtai B, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database. World J Urol 2023; 41:1133-1140. [PMID: 36821011 DOI: 10.1007/s00345-023-04334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians. METHODS The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80. RESULTS Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01). CONCLUSIONS GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.
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Affiliation(s)
| | | | - Kyle W Law
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Iman Sadri
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Adel Arezki
- Division of Urology, McGill University, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ahmed Ibrahim
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | | | | | | | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany.,Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Maximillian Reimann
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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Sze C, Singh Z, Punyala A, Satya P, Sadinski M, Narayan R, Nacev A, Kumar D, Adams J, Nicholas K, Margolis D, Chughtai B. Feasibility and preliminary clinical tolerability of low-field MRI-guided prostate biopsy. Prostate 2023; 83:656-662. [PMID: 36808735 DOI: 10.1002/pros.24499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE We evaluate the clinical feasibility of a portable, low-field magnetic resonance imaging (MRI) system for prostate cancer (PCa) biopsy. METHODS A retrospective analysis of men who underwent a 12-core systematic transrectal ultrasound-guided prostate biopsy (SB) and a low-field MRI guided transperineal targeted biopsy (MRI-TB). Comparison of the detection of clinically significant PCa (csPCa) (Gleason Grade [GG] ≥ 2) by SB and low field MRI-TB, stratified by Prostate Imaging Reporting & Data System (PI-RADS) score, prostate volume, and prostate serum antigen (PSA) was performed. RESULTS A total of 39 men underwent both the MRI-TB and SB biopsy. Median (interquartile range [IQR]) age was 69.0 (61.5-73) years, body mass index (BMI) was 28.9 kg/m2 (25.3-34.3), prostate volume was 46.5 cc (32-72.7), and PSA was 9.5 ng/ml (5.5-13.2). The majority (64.4%) of patients had PI-RADS ≥ 4 lesions and 25% of lesions were anterior on pre-biopsy MRII. Cancer detection rate (CDR) was greatest when combining SB and MRI-TB (64.1%). MRI-TB detected 74.3% (29/39) cancers. Of which, 53.8% (21/39) were csPCa while SB detected 42.5% (17/39) csPCa (p = 0.21). In 32.5% (13/39) of cases, MRI-TB upstaged the final diagnosis, compared to 15% (6/39) of cases in which SB upstaged the final diagnosis (p = 0.11). CONCLUSION Low-field MRI-TB is clinically feasible. Although future studies on the accuracy of MRI-TB system are needed, the initial CDR is comparable to those seen with fusion-based prostate biopsies. A transperineal and targeted approach may be beneficial in patients with higher BMI and anterior lesions.
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Affiliation(s)
- Christina Sze
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
| | - Zorawar Singh
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
- New York Medical College, New York, New York, USA
| | - Ananth Punyala
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
| | | | | | | | | | | | - John Adams
- Mississippi Urology, Jackson, Mississippi, USA
| | | | - Daniel Margolis
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
| | - Bilal Chughtai
- New York Presbyterian - Weil Cornell Medicine, New York, New York, USA
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Katz R, Sze C, Punyala A, Ahmed MA, Safadi A, Roizman S, Zisman A, Aharoni S, Baniel J, Chughtai B. Characterization of the histological response to the Butterfly Prostatic Retraction Device in patients with benign prostatic hyperplasia. World J Urol 2023; 41:1141-1146. [PMID: 36797501 DOI: 10.1007/s00345-023-04319-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/28/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE The Butterfly Prostatic Retraction Device ("Butterfly") is a permanent nitinol implant for benign prostatic hyperplasia. This study examines the chronic response of prostate tissue to the Butterfly in histological specimens from patients in the Butterfly pilot clinical study. METHODS Retrospective qualitative and semi-quantitative review of histological specimens of seven (7) patients who participated in the Butterfly pilot clinical study. Patients had at least 1-month implantation with the Butterfly prior to implant removal and TURP. Tissue samples were graded by two pathologists. RESULTS Four out of six patients had IPSS decreased from baseline. All seven patients' samples had signs of chronic inflammation; one demonstrated acute inflammation and one demonstrated fibrosis. In three cases, intraglandular calcification was identified. There was no ischemic necrosis induced by the implant, and no encrustation, urethral edema, or cellular atypia was noted. CONCLUSION The Butterfly demonstrated an overall favorable safety profile in terms of tissue response. This study demonstrates that there is no significant tissue reaction in the prostatic urethra due to presence of Butterfly device.
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Affiliation(s)
- Ran Katz
- Ziv Medical Center, Safed, Israel
| | - Christina Sze
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 E. 68Th Street, New York, NY, 10021, USA
| | - Ananth Punyala
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 E. 68Th Street, New York, NY, 10021, USA
| | | | | | | | | | | | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 E. 68Th Street, New York, NY, 10021, USA.
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Rojanasarot S, Cutone B, Durand K, Zorn KC, Chughtai B, Bhojani N, Elterman D. Patients' perspectives on attributes while choosing minimally invasive surgery for benign prostatic hyperplasia procedures: Experience from men undergoing water vapor thermal therapy. J Endourol 2023; 37:575-580. [PMID: 36762936 DOI: 10.1089/end.2022.0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Objective To understand which attributes patients consider important when selecting treatment options for benign prostatic hyperplasia (BPH) given differences in clinical and economic outcomes. Methods Men (n=170) with lower urinary tract symptoms due to BPH who underwent water vapor thermal therapy (WVTT) between April 2019 and November 2020 in a Toronto urological clinic were invited to participate in an online survey. The survey included eight attributes of BPH surgical procedures and five attributes of WVTT. Patients were asked how important each attribute was to them before they selected a BPH procedure and decided to undergo WVTT. Results In total, 128 respondents (75%) completed the survey. A majority of the respondents were White (88%), married (83%), and aged 60-69 years old (45%). Approximately 97% of respondents rated the ability to avoid further BPH treatments as "very important" or "extremely important", followed by duration to return to normal activities (79%), and wait times to receive the procedure (57%). Only 47% of patients reported post-procedural catheterization was important. For WVTT, 98% of the respondents rated avoiding more invasive surgical treatments and 88% rated a quick recovery as important attributes. Conclusions Among men with moderate-to-severe BPH undergoing WVTT, the most important attributes for selecting a BPH surgical procedure were avoiding further BPH treatments, returning quickly to normal activities, and reducing treatment wait times. The majority of men chose WVTT to avoid more invasive procedures and had a quick recovery.
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Affiliation(s)
- Sirikan Rojanasarot
- Boston Scientific, Health Economics & Market Access, 300 Boston Scientific Way, Marlborough, Massachusetts, United States, 01752;
| | - Ben Cutone
- Boston Scientific, Marlborough, Massachusetts, United States;
| | - Kathryn Durand
- Boston Scientific, Marlborough, Massachusetts, United States;
| | | | - Bilal Chughtai
- Weill Cornell Medical Center, Urology, 425 East 61st Street, 12th Floor, new york, New York, United States, 10065;
| | - Naeem Bhojani
- Centre Hospitalier de L'Universite de Montreal, 25443, Urology, 900 St. Denis street, Pavillon R, R08.474, Montreal, Quebec, Canada, H2X 0A9;
| | - Dean Elterman
- University Health Network, 7989, Urology, 399 Bathurst Street, MP-8-317, Toronto, Ontario, Canada, M5T2S8.,Surgery (Urology), 399 Bathurst Street, MP-8-317, Toronto, Ontario, Canada, M5T2S8;
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Moryousef J, Sze C, Elterman D, Zorn KC, Bhojani N, Chughtai B. Prostatic zonal parameters and lower urinary tract symptoms as quantified via magnetic resonance imaging. Can Urol Assoc J 2023; 17:E104-E109. [PMID: 36758183 PMCID: PMC10132375 DOI: 10.5489/cuaj.8139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is a common diagnosis among aging males; however, the relationship between prostate volume and lower urinary tract symptoms (LUTS) severity is imperfect. The goal of this study was to comprehensively investigate the relationship between various prostate zone-based parameters measured using magnetic resonance imaging (MRI) and LUTS. METHODS Data were retrospectively collected for 144 patients who underwent MRI between 2015 and 2017 at a single institution. Prostate volumes were measured on sagittal and axial T2 weighted using the prostate ellipsoid formula. RESULTS Only transition zone thickness (TZT) correlated with International Prostate Symptom Score (IPSS) (Pearson's=0.33; p=0.007). The intraprostatic protrusion (IPP) component (rho 0.261; p=0.036), transitional zone volume (TZV) (rho 0.264; p=0.034), and TZT (Pearson's correlation 0.422; p<0.001) all correlated with worsening QoL scores. In total, 97.9% of men had the presence of an IPP (>0 mm) and larger IPPs were found in older men with higher postvoid residual volumes. Larger peripheral zone volume (PZV) (odds ratio [OR] 3.62, 95% confidence interval [CI] 1.07-12.30, p<0.05), TZV (OR 6.00, 95% CI 1.69-21.35, p<0.05), and TZT (OR 4.00, 95% CI 1.17-13.69, p<0.05) were predictive of developing severe LUTS; however, IPP (p=0.122) was not. CONCLUSIONS TZV, TZT, and IPP all demonstrated a role in the evaluation of LUTS with predictive capabilities. IPP is very common but not always clinically significant. Clarifying more precise zonal parameters and their relationship with LUTS may ultimately help clinicians guide the need for surgical intervention more precisely.
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Affiliation(s)
| | - Christina Sze
- Department of Urology, Weil Cornell Medicine/New York Presbyterian Hospital, New York, NY, United States
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weil Cornell Medicine/New York Presbyterian Hospital, New York, NY, United States
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Te AE, Sze C, Kaplan SA, Chughtai B. Surgical treatment for BPH refractory to medication: robotic water jet ablation vs. TURP functional outcomes from two FDA clinical trials. Can J Urol 2023; 30:11408-11413. [PMID: 36779946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION A common indication for benign prostate hyperplasia (BPH) therapies is failure to improve with medical therapy. However, pivotal Federal Drug Administration (FDA) registered randomized clinical trials (RCTs) for minimally invasive surgical therapies (MISTs) are designed to be compared to either sham or placebo while off medical therapy at baseline, and as an alternative to medical therapy. There are few if any RCTs reporting the MISTS efficacy in patients with true medical therapy failure. We report on the efficacy of robotic water jet ablation therapy (RWT) and TURP in patients who have failed to improve with medical therapy. MATERIALS AND METHODS Data was obtained from the WATER and WATER II clinical trials. Both clinical trials did not implement a drug washout period. Only patients with reported BPH medical therapy such as alpha-blockers (AB) and 5-alpha-reductase inhibitors (5-ARIs) usage were included. Functional outcomes as post-void residual volume (PVR), peak urinary flow rate (Qmax), internal prostate symptom score (IPSS), and quality of life score (QoL) were analyzed. RESULTS AB and/or 5-ARIs usage at baseline were reported in 146 and 39 patients who underwent RWT (prostate sizes up to 150 cc) and transurethral resection of the prostate (TURP, prostate sizes up to 80 cc) respectively. Baseline median (IQR) IPSS, QoL, Qmax and PVR were 24 (18,28), 5 (4,5), 8.9 (6.4,11.5), and 95 (36,172), respectively. Functional outcomes did not statistically differ between Aquablation and TURP at baseline and at 36-month. In cohort of true medical failure, both RWT and TURP demonstrated group statistical improvements in PVR, Qmax, IPSS, and QoL at 36-month compared to baseline. CONCLUSIONS RWT and TURP are effective BPH therapy in patients who truly failed medical therapy, and RWT demonstrated this in a much broader prostate size range.
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Affiliation(s)
- Alexis E Te
- Department of Urology, Weill Medical College of Cornell University/New York Presbyterian , New York, New York, USA
| | - Christina Sze
- Department of Urology, Weill Medical College of Cornell University/New York Presbyterian , New York, New York, USA
| | - Steven A Kaplan
- Department of Urology, Mount Sinai School of Medicine, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Medical College of Cornell University/New York Presbyterian , New York, New York, USA
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Corsi N, Nguyen D, Arezki A, Sadri I, Law K, Bouhadana D, Deyirmendjian C, Elterman D, Bhojani N, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher E, Cash H, Reimann M, Rijo E, Misrai V, Chughtai B, Zorn K. Perioperative and functional outcomes of Greenlight 180-W photovaporization in large (>80 cc) prostates: An analysis from 7 centers in the international Global Greenlight Group. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Cerrato C, Nguyen M, Elterman D, Zorn K, Bhojani N, Chughtai B, Bechis S. Less is more REZUM: A propensity score matched comparison. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Elsherbini T, Bouhadana D, Sadri I, Nguyen DD, Law K, Arezki A, Deyirmendjian C, Ibrahim A, Oumedjbeur K, Bhojani N, Elterman D, Chughtai B, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher E, Cash H, Reimann M, Rijo E, Misrai V, Zorn K. The impact of 5-alpha reductase inhibitors on perioperative and functional outcomes of Greenlight photovaporization of the prostate: An analysis of the Global Greenlight Group database. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Nguyen DD, Bouhadana D, Murad L, Stoddard M, Zheng X, Mao J, Zorn KC, Elterman DS, Bhojani N, Chughtai B. Effect of Surgeon and Facility Volume on Outcomes of Benign Prostatic Hyperplasia Surgery: Implications of Disparities in Access to Care at High-Volume Centers. Urology 2023; 172:97-104. [PMID: 36410527 DOI: 10.1016/j.urology.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report the effect of surgeon and facility volume on outcomes of transurethral resection of the prostate (TURP) and laser treatment of benign prostatic hyperplasia (BPH). We also investigate disparities in access to care by identifying demographic predictors of receipt of treatment at high-volume facilities. METHODS We used New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) data. We included 18,041 (41.4%) and 25,577 (58.6%) adult patients that underwent TURP and laser procedures in the outpatient setting between January 2005 and December 2018, respectively. Average annual surgeon and facility volumes were broken down by tertile. The effect of volume on short-term outcomes (30-day and 90-day readmission) was examined using mixed-effect logistic regression models. Cox-proportional-hazard models were used to assess the association between volume and long-term stricture development and reoperation. Demographic predictors of treatment at high-volume facilities were assessed using multinomial logistic regression. RESULTS High-volume facilities were more likely to offer laser procedures compared to low-volume facilities. Higher facility and surgeon volume were associated with lower odds of 30 and 90-day readmissions compared to low-volume facilities. There was no difference in reoperation and stricture development between surgeon volume groups. Medicaid insurance, Hispanic ethnicity, and Black race were inversely associated with treatment at high-volume facilities. CONCLUSION Higher surgeon and facility volumes were associated with lower odds of readmission. Higher facility volume was associated with lower hazards of reoperation and developing strictures. Medicaid insurance and non-white race were associated with lower odds of treatment at high-volume facilities, highlighting racial and socioeconomic disparities in access to high-volume BPH surgery facilities.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Michelina Stoddard
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network (UHN), Toronto, Ontario, Canada
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY.
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Umbehr MH, Wagg A, Habib MH, Antonelli JA, Chughtai B, Jang TL, Kaldany A, Saraiya B, Stephenson RD, Sze C, Wiedemann A, Jones CA, Schlögl M. Top Ten Tips Palliative Care Clinicians Should Know About Urological Care. J Palliat Med 2023; 26:264-269. [PMID: 36579919 DOI: 10.1089/jpm.2022.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patients receiving palliative care (PC) can present with or develop a host of urological needs or complications. These needs can include attention to sexual health, urinary incontinence, genitourinary bleeding, and urinary tract obstruction by benign, malignant, or urinary stone diseases. These varied conditions require that PC clinicians understand invasive and noninvasive medical, surgical, and radiation options for treatment. This article, written by a team of urologists, geriatricians, and PC specialists, offers information and guidance to PC teams in an accessible "Top Ten Tips" format to increase comfort with and skills around assessment, evaluation, and specialist referral for urological conditions common in the PC setting.
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Affiliation(s)
- Martin H Umbehr
- Department of Urology, Municipal Hospital of Zurich, Zurich, Switzerland
| | - Adrian Wagg
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Muhammad Hamza Habib
- Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Jodi A Antonelli
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Bilal Chughtai
- Department of Urology, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York, USA
| | - Thomas L Jang
- Division of Urology and Section of Urologic Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alain Kaldany
- Division of Urology and Section of Urologic Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Biren Saraiya
- Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ryan D Stephenson
- Cancer Institute of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Christina Sze
- Department of Urology, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York, USA
| | - Andreas Wiedemann
- Faculty of Health, Department of Humane Medicine, University of Witten/Herdecke, Witten, Germany.,Department of Urology, Evangelic Hospital of Witten, Witten, Germany
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mathias Schlögl
- Division of Geriatric Medicine, Clinic Barmelweid, Barmelweid, Switzerland.,University Clinic for Acute Geriatrics City Hospital Waid, Zurich, Switzerland
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43
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Ferreira R, Zorn KC, Bhojani N, Chughtai B, Elterman DS. How I Do It: Penthrox in Urology. Can J Urol 2023; 30:11448-11452. [PMID: 36779953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Penthrox is a portable handheld inhaler that delivers a low dose of methoxyflurane - an anesthetic with analgesic effects, rapid onset of action, and a favorable side-effect profile. It has been widely used for acute pain management in Australia for the past 40 years. Currently, it is approved for use in over 55 countries, including Canada. Prospective randomized studies highlight Penthrox analgesic effectiveness and safety profile for emergency, prehospital and outpatient settings. In addition, the use of multimodal analgesia, specifically Penthrox, can play an important role in the analgesic management of urological procedures, such as prostatic biopsies and office-based minimally invasive surgical therapies. Herein readers will familiarize themselves with Penthrox, significant studies, and technique used for outpatient urological procedures.
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Affiliation(s)
- Roseanne Ferreira
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kevin C Zorn
- University of Montreal Hospital Center, Universite de Montreal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Universite de Montreal, Montreal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, New York, USA
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Nguyen DD, Herzog P, Cone EB, Labban M, Zorn KC, Chughtai B, Basaria S, Elterman DS, Trinh QD, Bhojani N. Disproportional signal of sexual dysfunction reports associated with finasteride use in young men with androgenetic alopecia: A pharmacovigilance analysis of VigiBase. J Am Acad Dermatol 2023; 88:179-181. [PMID: 35351540 DOI: 10.1016/j.jaad.2022.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- David-Dan Nguyen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Peter Herzog
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eugene B Cone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, New York
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dean S Elterman
- Division of Urology, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada.
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Raizenne BL, Zheng X, Oumedjbeur K, Mao J, Zorn KC, Elterman D, Bhojani N, McClure T, Te A, Kaplan S, Sedrakyan A, Chughtai B. Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study. World J Urol 2023; 41:179-188. [PMID: 36463348 DOI: 10.1007/s00345-022-04218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/04/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND There are growing interests for minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Prostatic artery embolization (PAE) uses selective angioembolization of prostatic arteries, thereby reducing size to improve LUTS/BPH. However, real-world data comparing surgical outcomes between MISTs and tissue resective techniques are lacking. We assessed the differences in surgical outcomes between PAE, transurethral resection of the prostate (TURP), and prostatic urethral lift (PUL) in a real-world population for LUTS/BPH. METHODS We present an observational population-based study of 12,902 men with BPH in New York State who received PAE, TURP, and PUL in outpatient and ambulatory surgery settings from 2014 to 2018. For short-term outcomes, we report 30-day and 90-day risks of readmission to inpatient and emergency room (ER) with/without complications and compared them across groups using χ2 tests and mixed-effect logistic regressions. For long-term outcomes, we report surgical retreatment and stricture rates using Kaplan-Meier failure curves and compared them using Log rank tests and Cox regression models. RESULTS Of 12 902 men, 335 had PAE, 11,205 had TURP, and 1362 had PUL. PAE patients had the highest 30-day (19.9%) and 90-day (35.6%) risks of readmission to inpatient or ER (p < 0.01). Non-specific abdominal pain was the main diagnosis associated with 30-day and 90-day readmissions to inpatient or ER after PAE (14.3% and 26.8%, respectively). After 2 years of follow-up, PAE patients had the highest retreatment rate of 28.5% (95%CI 23.7-34.2%) compared to TURP (3.4% (95%CI 3.1-3.8%)) and PUL (8.5% (95%CI 5.6-12.9%)) (p < 0.001). CONCLUSION In a real-world population, PAE was associated with the most frequent 30-day and 90-day readmission to inpatient or ER and the highest retreatment rate among all surgical techniques even when controlled for individual patient comorbidities and surgical volume.
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Affiliation(s)
- Brendan L Raizenne
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | | | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Timothy McClure
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA
| | - Steven Kaplan
- Department of Urology, Mount Sinai Hospital, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Bilal Chughtai
- Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA. .,Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA.
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Elterman D, Alshak MN, Martinez Diaz S, Shore N, Gittleman M, Motola J, Pike S, Hermann C, Terens W, Kohan A, Gonzalez R, Katz A, Schiff J, Goldfischer E, Grunberger I, Tu L, Kaminetsky J, Chughtai B. An Evaluation of Sexual Function in the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia in Men Treated with the Temporarily Implanted Nitinol Device. J Endourol 2022; 37:74-79. [PMID: 36070450 PMCID: PMC9810348 DOI: 10.1089/end.2022.0226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: To document the effect of the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel) on sexual function from a multicenter, randomized, single-blinded, sham-controlled trial. Materials and Methods: Men were randomized 2:1 between iTind and sham procedure arms. The iTind was placed for 5-7 days and an 18F Foley catheter was inserted and removed for the iTind and sham group, respectively. Patients were assessed at baseline, 3, and 12 months postoperatively using the Sexual Health Inventory for Men (SHIM) and International Index of Erectile Function (IIEF). Unblinding occurred at 3 months. Results: We studied 185 men with a mean age of 61.1 ± 6.5 years. There was no difference in SHIM or total IIEF between iTind and sham at 3 months or in the iTind arm at 12 months compared with baseline. Men in the iTind arm without erectile dysfunction at baseline showed an improvement in total IIEF score of +6.07 ± 21.17 points (p = 0.034) at 12 months, in addition to an improvement in ejaculatory function. SHIM scores remained unchanged in all groups, regardless of age, prostate volume, or baseline erectile function. Conclusion: No changes were observed in sexual and ejaculatory function of patients with iTind regardless of a man's age, prostate volume, and baseline sexual function. Clinicaltrials.gov: NCT02506465.
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Affiliation(s)
- Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Canada
| | - Mark N. Alshak
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | | | - Neal Shore
- Department of Urology, Carolina Urology Research Center, Myrtle Beach, South Carolina, USA
| | - Marc Gittleman
- Department of Urology, South Florida Medical Research, Miami, Florida, USA
| | - Jay Motola
- Department of Urology, Mt Sinai Hospital, New York, New York, USA
| | - Sheldon Pike
- Department of Urology, St John's Episcopal, New York, New York, USA
| | - Craig Hermann
- Department of Urology, Clinical Research Center of Florida, Miami, Florida, USA
| | - William Terens
- Department of Urology, Premier Urology Group, Edison, New Jersey, USA
| | - Alfred Kohan
- Department of Urology, Integrated Medical Professionals, Long Island, New York, USA
| | - Ricardo Gonzalez
- Department of Urology, Houston Metro Urology, Houston, Texas, USA
| | - Aaron Katz
- Department of Urology, NYU Winthrop Hospital, Long Island, New York, USA
| | - Jeffrey Schiff
- Department of Urology, NYU Winthrop Hospital, Long Island, New York, USA
| | - Evan Goldfischer
- Department of Urology, Premier Medical Group of the Hudson Valley, Poughkeepsie, New York, USA
| | - Ivan Grunberger
- Department of Urology, New York Methodist Hospital, Brooklyn, New York, USA
| | - Le Tu
- Department of Urology, Sherbrooke University Hospital, Sherbrooke, Canada
| | - Jed Kaminetsky
- Department of Urology, Manhattan Medical Research, Manhattan, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, USA.,Address correspondence to: Bilal Chughtai, MD, Department of Urology, Weill Cornell Medicine, 425 East 61st Street, 12th Floor, New York, NY 10065, USA
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Deyirmendjian C, Nguyen DD, Andonian S, Aubé-Peterkin M, Letendre J, Elterman D, Zorn KC, Chughtai B, Miernik A, Gross AJ, Bhojani N. Simulation-based prostate enucleation training: Initial experience using 3D-printed organ phantoms. Can Urol Assoc J 2022; 16:409-416. [PMID: 36656697 PMCID: PMC9851226 DOI: 10.5489/cuaj.7838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Anatomical endoscopic enucleation of the prostate (AEEP) is an effective treatment for benign prostatic hyperplasia (BPH); however, there is controversy regarding the difficulty of learning such a technique. Simulation-based training can mimic real-life surgeries and help surgeons develop skills they can transfer to the operating room, thereby improving patient safety. This study aimed to evaluate the validity of a novel organ phantom for use in AEEP simulation training. METHODS Participants performed AEEP on organ phantom simulators during a Masterclass using one of three energy modalities: holmium:YAG laser, thulium fiber laser, or bipolar energy. The organ phantom is composed of hydrogels and uses 3D molds to recreate prostatic tissue. Participants completed a questionnaire assessing content validity, face validity, feasibility, and acceptability of using the prostate organ phantom. RESULTS The novice group consisted of 13 urologists. The median number of AEEP previously performed was 0 (interquartile range [IQR] 0-2). Two experts in AEEP (surgeons having performed over 100 AEEP interventions) also participated. All participants agreed or strongly agreed that there is a role for simulators in AEEP training. Participants positively rated the overall operative experience (7.3/10). Morcellation (4.7/10) and hemostasis (3.1/10) were deemed the least realistic steps. All participants considered it feasible to incorporate this organ phantom into training programs and 92.9% agreed that it teaches skills transferrable to the operating room. CONCLUSIONS This study has established content and face validity for AEEP with three different energy sources for an organ phantom. Participants considered its use both feasible and appropriate for AEEP training purposes.
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Affiliation(s)
| | | | - Sero Andonian
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Julien Letendre
- Division of Urology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Dean Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Kevin C. Zorn
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, United States
| | | | - Andreas J. Gross
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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Elterman DS, Zorn KC, Bhojani N, Chughtai B. Efficacy and safety of methoxyflurane (Penthrox) for pain control during water vapor thermal therapy (Rezum) for benign prostatic enlargement. Can J Urol 2022; 29:11355-11360. [PMID: 36495576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The safety and efficacy of low dose methoxyflurane disposable inhaler (Penthrox) was assessed in this study of men undergoing Rezum water vapor thermal therapy (WVTT). MATERIAL AND METHODS An open-labeled, single-center study was conducted to demonstrate the safety and efficacy of using methoxyflurane inhaler during a Rezum procedure. Patients assessed current pain intensity using a 10-point Visual Analog Scale (VAS) of Pain at 4 timepoints including (1) before any medication, (2) initially after insertion of the rigid cystoscope and before any Rezum treatment, (3) immediately after final injection of Rezum treatment and (4) at discharge. Patients were asked to fill out the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) and one question about pain relief at discharge. Treating physician also completed the TSQM 1.4. RESULTS Ten patients were recruited. Median prostate volume was 53.4 cc (range 24-158 cc). Patients received a median of 10.5 Rezum injections, with a median procedure time of 4.5 minutes. Median VAS scores were 0, 0.1, 0 (primary efficacy outcome) and 0 (out of scale of 10) at the 4 timepoints, respectively. TSQM scores on effectiveness, side effects, convenience and global median satisfaction rated by patients were respectively 69.4, 100.0, 77.8 and 82.1 (out of scale of 100). Treatment satisfaction on pain relief was rated as 4.0 (very good). There were no observed adverse events. CONCLUSIONS Methoxyflurane inhaler (Penthrox) was low cost, rapid, feasible and easy to administer as a pain management strategy for Rezum therapy. Further data from a larger comparative study will be conducted.
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Affiliation(s)
- Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kevin C Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, New York, USA
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Baird CE, Chughtai B, Bradley CS, Kobashi K, Jung M, Sedrakyan A, Andrews S, Ferriter A, Cornelison T, Marinac-Dabic D. Development of a coordinated registry network for pelvic organ prolapse technologies. BMJ Surg Interv Health Technologies 2022; 4:e000076. [PMID: 36393893 PMCID: PMC9660621 DOI: 10.1136/bmjsit-2020-000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The accumulation of data through a prospective, multicenter Coordinated Registry Network (CRN) could be a robust and cost-effective way to gather real-world evidence on the performance of pelvic organ prolapse (POP) technologies for device-based and intervention-based studies. To develop the CRN, a group of POP experts consisting of representatives from professional societies, the Food and Drug Administration, academia, industry, and the patient community, was convened to discuss the role and feasibility of the CRN and to identify the core data elements important to assess POP technologies. Design A Delphi method approach was employed to achieve consensus on a core minimum dataset for the CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated, and analyzed by the study design team from Weill Cornell Medicine. Questions for the next round were based on the analysis process and discussed with group members via conference call. This process was repeated twice over a 6-month time period during which consensus was achieved. Results Twenty-one experts participated in the effort and proposed 120 data elements. Participation rates in the first and second round of the Delphi survey were 95.2% and 71.4%, respectively. The working group reached final consensus among responders on 90 data elements capturing relevant general medical and surgical history, procedure and discharge, short-term and long-term follow-up, device factors, and surgery and surgeon factors. Conclusions The CRN successfully developed a set of core data elements to support the study of POP technologies through convening an expert panel on POP technologies and using the Delphi method. These standardized data elements have the potential to influence patient and provider decisions about treatments and include important outcomes related to efficacy and safety.
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Affiliation(s)
- Courtney E Baird
- Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Kathleen Kobashi
- Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
| | - Mary Jung
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Art Sedrakyan
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sharon Andrews
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ann Ferriter
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Terri Cornelison
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA
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50
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Elterman D, Chughtai B, Zorn KC, Bhojani N. Re: Rezūm therapy for ≥80-mL benign prostatic enlargement: a large, multicentre cohort study. BJU Int 2022; 130:697. [PMID: 36263585 DOI: 10.1111/bju.15857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Kevin C Zorn
- University of Montreal Hospital Center, Montreal, QC, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Montreal, QC, Canada
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