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Sanchez DE, Ghoreifi A, Storino Ramacciotti L, Cai J, Maas M, Venkat A, Lee R, Abreu AL, Cacciamani GE, Doumanian L, Gill I, Liu-Chen A, Nguyen M, Sotelo R, Desai MM. The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia. J Endourol 2025; 39:50-55. [PMID: 39639800 DOI: 10.1089/end.2024.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024] Open
Abstract
Objective: Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. Patients and Methods: A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. Results: A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, p = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve vs 17% in the retreatment group, p = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] vs 2 [2-2] treatment-naïve, p = 0.037) and more additional procedures at follow-up (30% vs 8.3% treatment-naïve, p = 0.005). Conclusion: Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.
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Affiliation(s)
- Desiree E Sanchez
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alireza Ghoreifi
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jie Cai
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marissa Maas
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Abhishek Venkat
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Randall Lee
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andre Luis Abreu
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Leo Doumanian
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Inderbir Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andrew Liu-Chen
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mike Nguyen
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rene Sotelo
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mihir M Desai
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Lebdai S, Doizi S, Kassab D, Gas J, Pradere B, Robert G. Pre-therapeutical assessment of lower urinary tract symptoms in adult men: Systematic review and clinical practice guidelines. THE FRENCH JOURNAL OF UROLOGY 2024; 35:102846. [PMID: 39647566 DOI: 10.1016/j.fjurol.2024.102846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 12/03/2024] [Indexed: 12/10/2024]
Abstract
INTRODUCTION The aim was to propose initial and pre-therapeutical assessment of lower urinary tract symptoms in adult men through a systematic review and clinical practice guidelines. METHODS These guidelines were based on a systematic review performed between January 2011 and November 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The protocol was registered in the International Prospective Register of Systematic Reviews database (CRD42022336418). The recommendations and the methodology of elaboration were prospectively validated by the French Health Authority (Haute Autorité de santé [HAS]). RESULTS In total, 1662 publications were screened for eligibility and 311 met the inclusion criteria, 167 studies were retained among them 17 guidelines from French, European or International institutions. Perform on initial evaluation: identification of cardiovascular risk factors, metabolic syndrome, current medication, urinary and sexual symptoms (by structured interview or validated self-questionnaires), physical examination (lumbar fossa, pelvis, prostate, genitalia), urinalysis (dipstick or microscopy), abdominal ultrasound of the urinary tract (kidneys, bladder, prostate), post-void residual urine measurement (by ultrasound or automated measurement; under physiological conditions). Micturition flowmetry is recommended (except for general practitioners). Update and complete initial assessment before medication, interventional or surgical treatment if too old or incomplete. Perform a preoperative assessment (bleeding risk, infectious risk, geriatric risk). Urodynamic assessment, endorectal ultrasound and cystoscopy should not be systematically performed (only if additional information is needed). Perform urodynamics and urethrocystoscopy in case of failed interventional or surgical treatment. Following the initial workup, it is recommended to refer the patient to a urologist in case of: macroscopic hematuria, recurrent urinary tract infection or persistent perineal and/or suprapubic pain, persistent microscopic hematuria or leukocyturia in absence of urinary tract infection, predominant storage-phase symptoms, abnormal examination of the genitals or suspected prostate cancer, urinary retention, urinary tract stones, ureterohydronephrosis or morphological abnormalities of the prostate or the urinary tract. CONCLUSION These guidelines aimed to define the recommended investigation for LUTS in adult men at diagnosis, before medical treatment and before surgical and interventional treatments, in order to better personalize management and avoid unnecessary and/or invasive examinations.
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Affiliation(s)
- Souhil Lebdai
- Urology Department, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | | | - Diana Kassab
- Association Française d'Urologie, Paris, France.
| | - Jérôme Gas
- Urology Department, Uropole, Montauban, France.
| | - Benjamin Pradere
- Urology Department, UROSUD, Clinique La Croix du Sud, Quint-Fonsegrives, France.
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Halawani A, Paterson R, Zhong T, Du K, Ren R, Forbes CM. Risks and side effects in the medical management of benign prostatic hyperplasia. Prostate Int 2024; 12:57-64. [PMID: 39036761 PMCID: PMC11255900 DOI: 10.1016/j.prnil.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 07/23/2024] Open
Abstract
Benign prostatic hyperplasia affects up to 80% of men in their lifetime. It causes bladder outflow obstruction, leading to lower urinary tract symptoms, which can have a large impact on quality of life. Lifestyle modifications and pharmacotherapy are often offered as first-line treatments for patients. These include alpha blockers, 5-alpha-reductase inhibitors, phosphodiesterase-5 inhibitors, anticholinergics, B3-agonists, and desmopressin. While often well tolerated, these pharmacotherapies do have significant side effects, which both clinicians and patients should understand and discuss in order to make an informed treatment decision among alternatives. The purpose of this review is to provide a current overview of the risks and side effects of commonly used medications in benign prostatic hyperplasia management.
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Affiliation(s)
- Abdulghafour Halawani
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ryan Paterson
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tianshuang Zhong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Katie Du
- University of Alberta, Edmonton, Alberta, Canada
| | - Runhan Ren
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Connor M. Forbes
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
- Vancouver Prostate Centre, Vancouver, British Columbia, Canada
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Samir M, Elaal AAA, Gad KAS, Basyony MW. Two-year follow-up comparing Rezūm therapy versus bipolar transurethral resection of the prostate for treating benign prostatic hyperplasia. A prospective randomized study. Int J Urol 2024; 31:545-550. [PMID: 38291876 DOI: 10.1111/iju.15410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Comparison of the efficacy and safety of Rezūm therapy and bipolar transurethral resection of prostate (B-TURP) for the management of benign prostatic hyperplasia (BPH) of 50-120 g size. METHODS One hundred patients with BPH who met the inclusion criteria were included and split into two equal groups to undergo Rezūm therapy or B-TURP. The two groups were compared for efficacy using international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), operative time, catheter time, hospital stay, post-void residual urine (PVR), prostate-specific antigen (PSA), and residual prostate size and safety using the incidence of complications. RESULTS Rezūm significantly ameliorated IPSS from the baseline score by 55.3%, QoL by 50%, Qmax by 62.5%, International Index of Erectile Function (IIEF) by 7.1%, PVR by 50%, residual prostate size by 28.1% and PSA by 42% at 2 years. Meanwhile, the improvement in B-TURP was significantly higher than Rezūm group, Rezūm therapy had a significantly shorter duration of operative time and hospital stay. Also, it had fewer complications in comparison with B-TURP. CONCLUSIONS Rezūm is a minimally invasive procedure that provides significantly improved symptomatic relief of BPH and quality of life with preservation of erectile and ejaculatory functions. However, it is not as effective as B-TURP.
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Sharma A, Biswal D, Roy K, Rt R, Yadav P. Extraperitoneal Laparoscopic Simple Prostatectomy for large prostatic adenomas: A single-centre experience on 14 patients with significant lower urinary tract symptoms. Urologia 2024; 91:364-369. [PMID: 38062670 DOI: 10.1177/03915603231217354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
INTRODUCTION AND OBJECTIVES There are various approaches available for surgical management of large prostatic adenomas - open, laparoscopic as well as laser enucleation - but there are no available clear cut consensus or guidelines. We present our experience in Extraperitoneal Laparoscopic Simple Prostatectomy on 14 patients with large prostatic adenoma (>100 g). MATERIALS AND METHODS This is a retrospective analysis on 14 patients with large prostatic adenoma who underwent extraperitoneal laparoscopic prostatectomy (LSP) over a period of 2 years (2021-2023). All selected patients underwent extraperitoneal LSP. The case records were retrospectively reviewed and data were collected regarding age, clinical presentation, prostate size, median surgical time, intra-operative and post-operative events, pre-operative and post-operative assessment of IPSS score, Uroflowmetry and PVR values and duration of hospital stay. RESULTS A total of 14 patients underwent LSP. The median age was 64.2 years and the median prostatic size was 123.25 g. Median operative time was 150 min. None of the patients required blood transfusion; mean Post-operative day (POD) for drain removal was 2.5 days. The mean duration of hospital stay was 3.5 days. Only one patient had urinary leak and vesico-cutaneous fistula which was managed conservatively by prolonged catheterisation. At 3 months follow-up, there was significant improvement in IPSS Score (mean 7.8 vs 21.3 pre-operatively), uroflow values (mean Qmax of 27.3 vs 6.8 pre-operatively) and PVR (mean 30.5 vs 350 ml pre-operatively). CONCLUSION Laparoscopic Simple Prostatectomy is a safe and feasible approach for large prostatic adenomas with lesser morbidity and complications and satisfactory outcome.
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Affiliation(s)
- Amit Sharma
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Deepak Biswal
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Kishor Roy
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
| | - Raghavendra Rt
- Department of Urology, AIIMS, Raipur, Chhattisgarh, India
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Woo H, Levin R, Cantrill C, Zhou S, Neff D, Sutton M, Bailen J, Darson M, Horgan J, Zantek P, Marty-Roix R. Prospective Trial of Water Vapor Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia in Subjects with a Large Prostate: 6- and 12-month Outcomes. EUR UROL SUPPL 2023; 58:64-72. [PMID: 38152482 PMCID: PMC10751540 DOI: 10.1016/j.euros.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/29/2023] Open
Abstract
Background Current guidelines recommend Rezūm water vapor thermal therapy for the treatment of benign prostatic hyperplasia (BPH) for prostate glands ranging in volume from 30 to 80 cm3. Few prospective studies have specifically evaluated the use of Rezūm for larger prostates. Objective To evaluate the safety and efficacy of water vapor thermal therapy in patients with a prostate gland >80 cm3 and ≤150 cm3. Design setting and participants In this prospective, single-arm study at seven centers in the USA, subjects were males aged >50 yr with symptomatic BPH and prostate volume of >80 cm3 and ≤150 cm3. Intervention Rezūm was used to deliver sterile water vapor via a transurethral approach to ablate targeted areas of prostate tissue. Outcome measurements and statistical analysis The primary efficacy outcome was response to therapy, defined on a per-patient basis as a ≥30% improvement in International Prostate Symptom Score (IPSS) from baseline to 6 mo. The primary safety outcome was a composite of serious device-related safety events. Secondary outcomes included catheterization for device-related retention. IPSS outcomes over time were analyzed via generalized estimating equations. Results and limitations Among 47 eligible patients, prostate volume ranged from 80.8 to 148.1 cm3. All patients completed 6-mo follow-up, and 40/47completed 12-mo follow-up. At 6 mo, 83% were treatment responders according to the primary efficacy endpoint. The mean IPSS improvement at 6 mo was 11.9 ± 7.5 points, reflecting significant improvement. The primary safety outcome was met, with no occurrence of device-related composite safety events. The study is limited by the nonrandomized design and early termination, unrelated to safety or effectiveness. Conclusions Our results are consistent with previous findings for prostate glands of up to 80 cm3, and indicate the safety and efficacy of Rezūm for BPH in patients with a larger prostate. Patient summary Rezūm therapy, in which water vapor is used to treat targeted areas of the prostate, is currently recommended for patients with benign enlargement of the prostate and a prostate size of up to 80 cm3. We found that this treatment was also effective and safe in patients with a larger prostate of 80-150 cm3.
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Affiliation(s)
- Henry Woo
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
| | | | | | - Shaw Zhou
- Pinellas Urology, South Pasadena, FL, USA
| | - Donald Neff
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | - Paul Zantek
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Rezūm Clinical Trials Group
- College of Health and Medicine, Australian National University and SAN Prostate Centre of Excellence, Sydney Adventist Hospital, Sydney, Australia
- Chesapeake Urology, Baltimore, MD, USA
- Urology of San Antonio, San Antonio, TX, USA
- Pinellas Urology, South Pasadena, FL, USA
- University of Kansas Medical Center, Kansas City, KS, USA
- Houston Metro Urology, Houston, TX, USA
- First Urology, Louisville, KY, USA
- Arizona Urology Specialists, Scottsdale, AZ, USA
- Adult & Pediatric Urology, Omaha, NE, USA
- Boston Scientific Corporation, Marlborough, MA, USA
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Dean NS, Assmus MA, Lee MS, Guo JN, Krambeck AE. Benign prostatic hyperplasia surgical re-treatment after prostatic urethral lift A narrative review. Can Urol Assoc J 2023; 17:353-359. [PMID: 37494319 PMCID: PMC10581727 DOI: 10.5489/cuaj.8334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Prostatic urethral lift (PUL) accounts for approximately one-quarter of all surgical benign prostatic hyperplasia (BPH) procedures performed in the U.S. Within five years of a patient's PUL procedure, approximately 1/7 patients will require surgical BPH retreatment. We aimed to highlight the evidence of surgical BPH retreatment modalities after PUL, with a focus on safety, short-term efficacy, durability, and relative costs. METHODS A literature review was performed using PubMed, and an exhaustive review of miscellaneous online resources was completed. The search was limited to English, human studies. Citations of relevant studies were reviewed. RESULTS No study has examined the efficacy, safety, or durability of transurethral resection of the prostate (TURP) or repeat PUL in the post-PUL setting. Recently, groups have examined laser enucleation (n=81), water vapor thermal therapy (WVTT) (n=5), robotic simple prostatectomy (SP) (n=2), and prostatic artery embolization (PAE) (n=1) in the post-PUL setting. Holmium enucleation of the prostate (HoLEP) after PUL appears to be safe and has similar functional outcomes to HoLEP controls. Other treatment modalities examined appear safe but have limited efficacy evidence supporting their use. Photo-selective vaporization of the prostate (PVP) and robotic waterjet treatment (RWT) have no safety or efficacy studies to support their use in the post-PUL setting. CONCLUSIONS Despite increasing numbers of patients expected to require surgical retreatment after PUL in North America, there is currently limited evidence and a lack of recommendations guiding the evaluation and management of these patients. HoLEP is associated with the strongest evidence to support its use in the post-PUL setting.
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Affiliation(s)
- Nicholas S Dean
- Northwestern University, Department of Urology, Chicago, IL, United States
| | - Mark A Assmus
- Northwestern University, Department of Urology, Chicago, IL, United States
| | - Matthew S Lee
- Northwestern University, Department of Urology, Chicago, IL, United States
| | - Jenny N Guo
- Northwestern University, Department of Urology, Chicago, IL, United States
| | - Amy E Krambeck
- Northwestern University, Department of Urology, Chicago, IL, United States
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Neu S, Matta R, Locke J, Almeida RMD, Stoelzel M, Covernton PJO, Herschorn S. Treatment Patterns in Men Prescribed Benign Prostatic Obstruction or Overactive Bladder Medications in Canada: A Retrospective Population-based Study. Urology 2023; 180:219-226. [PMID: 37454770 DOI: 10.1016/j.urology.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To characterize first therapeutic change and healthcare resource utilization in older men initiating an overactive bladder (OAB) or benign prostatic obstruction (BPO) medication. METHODS A retrospective cohort study using health administrative data from ICES in Ontario, Canada (from April 01, 2010 to December 31, 2018) was conducted in men aged ≥66 years with ≥1 OAB (β3 agonist, antimuscarinic) or BPO (α-blocker, 5-α-reductase inhibitor) prescription and ≥1-year postindex data (index=first observed dispensation). EXCLUSIONS prescriptions for these drugs ≤1 year preindex, a related procedure ≤5 years. Patients were grouped by condition based on index prescription. Treatment changes in relation to OAB and BPO were characterized by type. Costs and healthcare resource utilization pre- and post-index were compared. RESULTS Age, geographic region, and income were similar between groups. The most common initial treatments were antimuscarinics (78.1%) in the OAB group and alpha-blockers (86.4%) in the BPO group. The OAB group was more likely to experience a therapeutic change and had a shorter time to first change in therapy (78 [30,231] vs 104 [30,350] days) and higher mean healthcare costs both pre- ($12,354 vs $11,497) and postindex ($14,423 vs $12,852). The most common first therapeutic change in both groups was discontinuing treatment (OAB: 75.6%; BPO: 69.9%). CONCLUSION Men initiating OAB medications changed therapy sooner than those initiating BPO medications. Most discontinued first-line therapy without initiating further treatment, suggesting unmet need in this population.
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Affiliation(s)
- Sarah Neu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rano Matta
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Locke
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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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] [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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Niazi T, Kaldany E, Tisseverasinghe S, Malagón T, Bahoric B, McPherson V, Rompre-Brodeur A, Anidjar M. Prophylactic A-Blockers for Radiotherapy-Induced Lower Urinary Tract Symptoms in Men with Prostate Cancer: A Phase III Randomized Trial. Cancers (Basel) 2023; 15:3444. [PMID: 37444553 DOI: 10.3390/cancers15133444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTSs in prostate cancer patients receiving external beam radiotherapy (EBRT). METHODS A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic silodosin on day one of EBRT or the occurrence of RI-LUTSs. LUTSs were quantified using the international prostate symptom score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT. RESULTS Patient demographics, baseline IPSS, and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (p = 0.40). There were no significant differences in IPSSs between the study arms in the intention-to-treat (ITT) analysis at baseline, the last day of RT, and 4 and 12 weeks post-RT. CONCLUSION Prophylactic α-blockers were not effective at significantly reducing RI-LUTSs in prostate cancer patients treated with EBRT. Treating patients with α-blockers at the onset of RI-LUTSs will avoid unnecessary drug exposure and toxicity.
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Affiliation(s)
- Tamim Niazi
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Edmond Kaldany
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Steven Tisseverasinghe
- Division of Radiation Oncology, Department of Oncology, McGill University, Gatineau, QC J8V 3R2, Canada
| | - Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Boris Bahoric
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Victor McPherson
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Alexis Rompre-Brodeur
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
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Elmansy H, Zakaria AS, Hodhod A, Shabana W, Ahmad A, Oquendo F, Fathy M, Abbas L, Abdul Hadi R, Kelly R, Kotb A, Shahrour W. Holmium Laser Xpeeda Vaporization vs GreenLight XPS Vaporization of the Prostate for Benign Prostatic Obstruction: 1-Year Results from a Randomized Controlled Clinical Study. J Endourol 2023; 37:706-712. [PMID: 37029802 DOI: 10.1089/end.2022.0727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Introduction and Objective: To compare the safety and efficacy of Holmium Laser Xpeeda Vaporization and GreenLight XPS Vaporization of the prostate in patients with prostate size ≤80 g. Methods: Ninety-two men with benign prostatic hyperplasia (BPH) and prostate size ≤80 g scheduled for laser prostatectomy were included in this prospective randomized trial. Outcome measures were collected and compared, including International Prostate Symptom Score (IPSS), quality of life (QoL), flow rate, postvoid residual urine volume (PVR), International Index of Erectile Dysfunction (IIEF)-15, prostate-specific antigen (PSA), transrectal ultrasound prostate volume, and catheterization time. Perioperative complications were also recorded. Patients were offered a trial of void (TOV) 3 hours after their procedures. All patients were followed-up at 1, 3, 6, and 12 months. Results: There were no significant differences in preoperative baseline data between the two surgical groups. Operative parameters and postoperative outcomes were comparable. Effective same-day TOV was noted in 73.1% and 72.7% of the Xpeeda and GreenLight XPS patients, respectively (p = 0.98). All patients were discharged home within 24 hours of their surgeries. The laser energy and postoperative complications were significantly lower in the Xpeeda group (p = 0.002 and p = 0.026, respectively). At 3 months, the PSA levels significantly dropped in both groups (p = 0.002 and p < 0.001). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. Conclusions: Holmium Laser Xpeeda Vaporization and GreenLight XPS Vaporization are safe and effective in the treatment of BPH. Same-day discharge with early TOV is a feasible option. Clinical Trials.gov Identifier: NCT04386941.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Waleed Shabana
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Abdulrahman Ahmad
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Fabiola Oquendo
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Moustafa Fathy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
- Urology Department, Menoufia University, Shebin Elkom, Egypt
| | - Loay Abbas
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ryan Kelly
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Canada
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12
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Assmus MA, Krambeck AE. Moses Laser Enucleation of the Prostate (MoLEP): Use of Pulse Modulated Holmium Laser Technology for Prostate Enucleation. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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13
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Zoppo CT, Taros T, Harman A. Top 50 most cited articles on prostatic artery embolization for benign prostatic hyperplasia: A bibliometric review. World J Clin Urol 2023; 12:1-9. [DOI: 10.5410/wjcu.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Bibliometric analysis can be used to assess the current state of the literature and publication trends on a given topic. There has not been a review of this kind on prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH). PAE is a relatively new and somewhat controversial treatment option for BPH. Given the novelty and controversy, there has been much research published on the topic recently.
AIM To survey the current state of research on PAE for BPH by using bibliometric analysis to analyze the top 50 most highly cited articles.
METHODS A cross-sectional study was performed using the Web of Science database to identify the most cited articles published on PAE for BPH as of June 2022. Articles that did not primarily focus on PAE or BPH as an indication were eliminated. The 50 most cited articles were carried forward for analysis.
RESULTS All but 6 articles were published in the last decade with contributions from 15 countries. Fifty-two percent of the studies had a C level of evidence. The majority were published in the Journal of Vascular and Interventional Radiology and Cardiovascular and Interventional Radiology. Twenty percent (n = 10) of the articles were published in urologic journals. On average, articles published in urologic journals tended to be more recent. The mean year of publication for an article in a urological journal was 2016.6 compared to 2013.9 in a non-urologic journal (P = 0.02). Seventy percent of the articles focused on clinical outcomes, while only 2% focused on practice guidelines. Self-citations accounted for 11.4 citations per article on average, corresponding to 14.7% of all citations analyzed.
CONCLUSION The most influential papers on this topic represent a fairly recent body of work with contributions from a wide variety of countries and journals. The fact that articles in urologic journals were published significantly more recently than articles on the list in non-urologic journals may suggest that the field of urology is starting to accept PAE for a wider range of indications. Finally, while there has been much high-quality research published, more influential studies on practice guidelines and technique may be beneficial.
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Affiliation(s)
- Christopher Thomas Zoppo
- Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA 01604, United States
| | - Trenton Taros
- Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA 01604, United States
| | - Aaron Harman
- Interventional Radiology, Prostate Laser Center, Houston, TX 77030, United States
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14
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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: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [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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15
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Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database. World J Urol 2023; 41:529-536. [PMID: 36534154 DOI: 10.1007/s00345-022-04260-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates (< 80 cc). METHODS Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). CONCLUSIONS Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.
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16
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Bouhadana D, Lu XH, Luo JW, Assad A, Deyirmendjian C, Guennoun A, Nguyen DD, Kwong JCC, Chughtai B, Elterman D, Zorn KC, Trinh QD, Bhojani N. Clinical Applications of Machine Learning for Urolithiasis and Benign Prostatic Hyperplasia: A Systematic Review. J Endourol 2022; 37:474-494. [PMID: 36266993 DOI: 10.1089/end.2022.0311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Previous systematic reviews related to machine learning (ML) in urology often overlooked the literature related to endourology. Therefore, we aim to conduct a more focused systematic review examining the use of ML algorithms for benign prostatic hyperplasia (BPH) or urolithiasis. In addition, we are the first group to evaluate these articles using the STREAM-URO framework. METHODS Searches of MEDLINE, Embase, and the Cochrane CENTRAL databases were conducted from inception through July 12, 2021. Keywords included those related to ML, endourology, urolithiasis, and BPH. Two reviewers screened the citations that were eligible for title, abstract and full-text screening, with conflicts resolved by a third reviewer. Two reviewers extracted information from the studies, with discrepancies resolved by a third reviewer. The data collected was then qualitatively synthesized by consensus. Two reviewers evaluated each article according to the STREAM-URO checklist with discrepancies resolved by a third reviewer. RESULTS After identifying 459 unique citations, 63 articles were retained for data extraction. Most articles consisted of tabular (n=32) and computer vision (n=23) tasks. The two most common problem types were classification (n=40) and regression (n=12). In general, most studies utilized neural networks as their ML algorithm (n=36). Among the 63 studies retrieved, 58 were related to urolithiasis and five focused on BPH. The urolithiasis studies were designed for outcome prediction (n=20), stone classification (n=18), diagnostics (n=17), and therapeutics (n=3). The BPH studies were designed for outcome prediction (n=2), diagnostics (n=2), and therapeutics (n=1). On average, the urolithiasis and BPH articles met 13.8 (SD 2.6), and 13.4 (4.1) of the 26 STREAM-URO framework criteria, respectively. CONCLUSIONS The majority of the retrieved studies successfully helped with outcome prediction, diagnostics, and therapeutics for both urolithiasis and BPH. While ML shows great promise in improving patient care, it is important to adhere to the recently developed STREAM-URO framework to ensure the development of high-quality ML studies.
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Affiliation(s)
- David Bouhadana
- McGill University Faculty of Medicine and Health Sciences, 12367, 3605 de la Montagne, Montreal, Quebec, Canada, H3G 2M1;
| | - Xing Han Lu
- McGill University School of Computer Science, 348406, Montreal, Quebec, Canada;
| | - Jack W Luo
- McGill University Faculty of Medicine and Health Sciences, 12367, Montreal, Quebec, Canada;
| | - Anis Assad
- University of Montreal Hospital Centre, 25443, Urology, Montreal, Quebec, Canada;
| | | | - Abbas Guennoun
- University of Montreal Hospital Centre, 25443, Urology, Montreal, Quebec, Canada;
| | | | | | - Bilal Chughtai
- Weill Cornell Medical Center, Urology, New York, New York, United States;
| | - Dean Elterman
- University of Toronto, 7938, Urology, Toronto, Ontario, Canada;
| | | | - Quoc-Dien Trinh
- Brigham and Women's Hospital, Urology, Boston, Massachusetts, United States;
| | - Naeem Bhojani
- University of Montreal Hospital Centre, 25443, Urology, Montreal, Quebec, Canada;
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17
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Garbens A, Kominsky H, Dai J, Steinberg RL, Trivedi H, Kusin S, Roehrborn C, Gahan J. Evaluating Surgical Outcomes of Robot Assisted Simple Prostatectomy in the Retreatment Setting. Urology 2022; 170:111-116. [PMID: 35988733 DOI: 10.1016/j.urology.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To report perioperative and postoperative outcomes in men who undergo salvage RASP (sRASP) following some other endoscopic outlet procedure for benign prostate enlargement (BPE) compared to those undergoing RASP for primary treatment (pRASP). METHODS A prospectively maintained database consisting of all RASP surgeries (December 2014 - October 2019) performed at our institution by three different urologists was used. Patients who had received an endoscopic procedure for BPE prior to their RASP (sRASP) were compared to those who had not had a prior outlet procedure (pRASP). RESULTS In total, 310 men underwent RASP during the study period. Of those, 30 (9.7%) had undergone an endoscopic procedure prior to surgery. There were no significant differences in age, race, ASA, BMI, prostate volume, PSA or rates of preoperative retention (p>0.05 for all). Men who were treatment-naive had significantly higher preoperative International Prostate Symptom Scores (IPSS) than men who had a prior procedure (18.3 ±7.7 vs. 13.6 ±6.2, p=0.008). However, there were no significant differences in functional or quality of life outcomes between the two groups (p>0.05 for all). There were no significant differences in perioperative or post-operative outcomes between the two groups. Furthermore, rates of post-operative complications and incontinence were similar between groups (11% vs. 10%, p=0.9 and 2% vs. 0%, p=1 respectively). CONCLUSION Performing a RASP after prior endoscopic procedure for BPE was found to be safe and effective. Success and complication rates were similar to patients with no prior procedures.
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Affiliation(s)
- Alaina Garbens
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Hal Kominsky
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jessica Dai
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Ryan L Steinberg
- University of Iowa, Department of Urology, Iowa City, Iowa, USA.
| | - Hersh Trivedi
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Sam Kusin
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Claus Roehrborn
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
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18
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Nguyen LN, Randhawa H, Nadeau G, Cox A, Hickling D, Campeau L, Li J, Welk B, Carlson K. Canadian Urological Association best practice report: Diagnosis and management of nocturia. Can Urol Assoc J 2022; 16:E336-E349. [PMID: 35819914 PMCID: PMC9328849 DOI: 10.5489/cuaj.7970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
- Laura N. Nguyen
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Harkanwal Randhawa
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Geneviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec, QC, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Juliana Li
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kevin Carlson
- Department of Surgery, University of Calgary, Calgary, AB, Canada
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19
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Lichy I, Law K, Tholomier C, Nguyen DD, Sadri I, Bouhadana D, Couture F, Zakaria AS, Bhojani N, Zorn KC, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Reimann M, Cash H. Global experience and progress in GreenLight-XPS 180-Watt photoselective vaporization of the prostate. World J Urol 2022; 40:1513-1522. [PMID: 35499590 PMCID: PMC9166849 DOI: 10.1007/s00345-022-03997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. METHODS 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011-2019) and prostate volume (PV) group (< 80 ml vs. 80-150 ml vs. > 150 ml). RESULTS The median age was 70 years (interquartile range 64-77), the median PV was 64 ml (IQR 47-90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45-83) and LT was 33 min (IQR 23-46). Median energy use was 253 kJ (IQR 170-375) with an energy density of 3.94 kJ/ml (IQR 2.94-5.02). The relative probability of perioperative AEs decreased by 17% each year (p < 0.001). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). CONCLUSION These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.
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Affiliation(s)
- Isabel Lichy
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Kyle Law
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Côme Tholomier
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David-Dan Nguyen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Iman Sadri
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Félix Couture
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Ahmed S. Zakaria
- Division of Urology, Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, ON Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Kevin C. Zorn
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - 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
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees France
| | - Dean Elterman
- Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, ON Canada
| | - Maximilian Reimann
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany
- Department of Urology, University of Magdeburg, Magdeburg, Germany
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
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20
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Wang Q, Alshayyah R, Yang B. The efficacy and safety of desmopressin acetate applied for nocturia in benign prostatic hyperplasia patients: A systematic review and meta-analysis. Low Urin Tract Symptoms 2022; 14:155-162. [PMID: 35034423 DOI: 10.1111/luts.12423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Desmopressin acetate was recommended for nocturia in benign prostatic hyperplasia (BPH) patients recently, but its effect and safety is still controversial. We aimed to establish a systematic review and meta-analysis to confirm its effect on symptom relief and adverse effects. METHODS A systematic search was performed in PubMed, Cochrane Library, EMBASE, Medline, Web of Science and Science Direct databases from January 2000 to October 2021 for controlled trials of BPH patients comparing oral desmopressin with control groups. The mean difference (MD) and odds ratio (OR) were meta-analyzed. RESULTS Four articles with 500 patients were included. Significantly greater benefit was detected for the desmopressin group in the improvement of nocturia (P = .004), international prostate symptom score - storage (IPSS-S) (P = .03), and quality of life (QoL) (P = .04) scores. Patients treated with desmopressin were at higher risk than the control group for short-term adverse events (P < .001), including nausea (4.71%, P = .04), headache (20%, P < .00001), dizziness (5.88%, P = .02) and hyponatremia (4.71%, P = .04), but the long-term incidence might decrease. CONCLUSION Desmopressin acetate can reduce nocturia frequency and improve the IPSS-S and QoL score in BPH patients. Some adverse reactions of desmopressin, such as hyponatremia, headache, dizziness and nausea, may be mild and short-term. No significant difference of desmopressin was found in improving the overall IPSS score and maximum urine flow.
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Affiliation(s)
- Qihua Wang
- Third Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rami Alshayyah
- Third Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bo Yang
- Third Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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21
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Gauhar V, Lim EJ, Khan TY, Law YXT, Choo ZW, Castellani D, Teoh JYC, Bhojani N, Chughtai B, Zorn K, Elterman D. Rezum to the rescue: Early outcomes of Rezum on patients with recurrent lower urinary tract symptoms after surgical interventions for benign prostatic enlargement. Andrologia 2022; 54:e14450. [PMID: 35474587 DOI: 10.1111/and.14450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022] Open
Abstract
We aim to report the short-term outcomes of patients undergoing Rezum as a re-treatment intervention for recurrent lower urinary tract symptoms after prior surgical treatment for benign prostate enlargement. Data from two institutions for baseline International Prostatic Symptom Score with Quality of life item, prostate size, and maximum flow-rate was acquired. Patients were assessed 3-month post-treatment. Outcomes were compared with unpaired t-tests and Fisher's exact tests. Nineteen patients were included. Prior surgical interventions included transurethral resection of the prostate (31.6%, n = 6), Urolift (26.3%, n = 5), transurethral bladder neck incision (15.8%, n = 3), prostate artery embolization (10.5%, n = 2), transurethral needle ablation, greenlight photovaporization of prostate and Rezum (5.3%, n = 1 each). Median age was 69.0 years (IQR 14; range 59-87 years) with a median prostate volume of 65.0 ml (IQR 63; range 22-160 ml). The median time to Rezum treatment was 48 months (IQR 78; range 9-240 months). 63.1% (n = 12) were re-started on benign prostatic enlargement medication and 36.8% (n = 7) had recurrent bothersome symptoms before re-treatment with Rezum. At 3-month follow up, median International Prostatic Symptom Score decreased from 23 to 9 (p < 0.001) and Quality of life from 4 to 2 (p < 0.001). Median maximum flow-rate improved after treatment from 8.6 to 14.8 ml/s (p < 0.001). None of the patients were required to restart medication for benign prostate enlargement.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Tan Yung Khan
- Yungkhan Tan Urohealth Medical Clinic, Mt Elizabeth Novena Hospital, Singapore, Singapore
| | - Yu Xi Terence Law
- Department of Urology, National University Hospital, NUHS, Singapore, Singapore
| | - Zen Wei Choo
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Daniele Castellani
- Faculty of Medicine, School of Urology, Polytechnic University of Le Marche, Ancona, Italy
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Naeem Bhojani
- 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
| | - Kevin Zorn
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian, New York, New York, USA
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Canada.,University of Montreal Hospital Center, Université de Montréal, Montreal, Canada
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22
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Elterman D, Bhojani N, Vannabouathong C, Chughtai B, Zorn KC. Rezūm therapy for ≥ 80 ml benign prostatic enlargement: a large, multi-center cohort study. BJU Int 2022; 130:522-527. [PMID: 35466513 DOI: 10.1111/bju.15753] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy and safety of Rezūm therapy in benign prostatic hyperplasia (BPH) patients with prostates ≥ 80 ml. METHODS A prospective registry was established at two high-volume Canadian centers. Patients had baseline medical history documented, and uroflowmetry and questionnaires recorded over 12 months. RESULTS 83 patients (median age: 69.2 years, IQR 63.2, 74.8) with a prostate size ≥ 80 ml were included. Median prostate volume was 100.0 ml (IQR 88.5, 115.0) and 65% had a median lobe. 21 patients had prior urinary retention. Median number of injections was 13 (IQR 11, 15). Median catheterization length was 9 days (IQR 7, 14). IPSS improved by 24%, 57%, and 59% at 1, 3, and 12 months, respectively (p<0.001). QoL scores improved by 27%, 56%, and 70% at these same timepoints (p<0.001). Qmax improved by 55% at 3 months (p=0.002) and 59% at 12 months, and PVR improved by 58% at 3 months (p=0.006). BPHII scores improved by 57% at 3 months and 71% at 12 months. IIEF-15 scores improved by 15% at 6 months, and MSHQ-EjD function scores improved by 22.4% at 1 month. 3 (3.6%) men observed reduced/anejaculation. No Clavien-Dindo events ≥ Grade III occurred. CONCLUSION This study demonstrates for the first-time safety and efficacy of Rezum in large glands >80mL. IPSS improved by 59% and QoL improved by 70% at 12 months. Objective maximum flow measures improved at 12 months by 59%, while erectile and ejaculatory function remained preserved.
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Affiliation(s)
- Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Université de Montréal, Montreal, Canada
| | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York Presbyterian, New York, USA
| | - Kevin C Zorn
- University of Montreal Hospital Center, Université de Montréal, Montreal, Canada
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23
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Zeng XT, Jin YH, Liu TZ, Chen FM, Ding DG, Fu M, Gu XQ, Han BM, Huang X, Hou Z, Hu WL, Kang XL, Li GH, Li JX, Li PJ, Liang CZ, Liu XH, Liu ZY, Liu CX, Liu JM, Luo GH, Luo Y, Qin WJ, Qiu JH, Qiu JX, Shang XJ, Shi BK, Sun F, Tian GX, Tian Y, Wang F, Wang F, Wang YH, Wang YJ, Wang ZP, Wang Z, Wei Q, Xiao MH, Xu WH, Yi FX, Zhu CY, Zhuang QY, Zhou LQ, Zou XF, Xing NZ, He DL, Wang XH. Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition). Mil Med Res 2022; 9:14. [PMID: 35361280 PMCID: PMC8974007 DOI: 10.1186/s40779-022-00371-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 02/08/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline "2018 Standard Edition". However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons' surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons' skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
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Affiliation(s)
- Xian-Tao Zeng
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Tong-Zu Liu
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fang-Ming Chen
- Department of Urology, Tianjin Third Central Hospital Affiliated To Nankai University, Tianjin, 300170, China
| | - De-Gang Ding
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, 450003, China
| | - Meng Fu
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Xin-Quan Gu
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Bang-Min Han
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xing Huang
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhi Hou
- Department of Urology, Qinghai University Affiliated Hospital, Xi'ning, 810012, China
| | - Wan-Li Hu
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xin-Li Kang
- Department of Urology, People's Hospital of Hainan Province, Hainan Affiliated Hospital of Hainan Medical University Haikou, Haikou, 570311, China
| | - Gong-Hui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Jian-Xing Li
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Pei-Jun Li
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, 750003, China
| | - Chao-Zhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xiu-Heng Liu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhi-Yu Liu
- Department of Urology, The Second Hospital of Dalian Medical University, Dalian, 116023, Liaoning, China
| | - Chun-Xiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510282, China
| | - Jiu-Min Liu
- Department of Urology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Guang-Heng Luo
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China
| | - Yi Luo
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Wei-Jun Qin
- Department of Urology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, China
| | - Jian-Hong Qiu
- Department of Urology, The 980St Hospital of the PLA Joint Logistics Support Force (Bethune International Peace Hospital of PLA), Shijiazhuang, 050082, China
| | - Jian-Xin Qiu
- Department of Urology, Tangdu Hospital, The Air Force Military Medical University, Xi'an, 710038, China
| | - Xue-Jun Shang
- Department of Andrology, Jinling Hospital Affiliated to Nanjing University School of Medicine, Nanjing, 210002, China
| | - Ben-Kang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Fa Sun
- Department of Urology Surgery, Guizhou Province People's Hospital, Guiyang, 550002, China
| | - Guo-Xiang Tian
- Department of Geriatrics, The Seventh Medical Center of Chinese, PLA General Hospital, Beijing, 100027, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Feng Wang
- Department of Urology, People's Hospital of Tibet Autonomous Region, Lhasa, 850000, China
| | - Feng Wang
- Department of Urology, South China Hospital, Shenzhen University, Shenzhen, 518111, Guangdong, China
| | - Yin-Huai Wang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yu-Jie Wang
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Zhi-Ping Wang
- Department of Urology, Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Urological Diseases in Gansu Province, Lanzhou, 730030, China
| | - Zhong Wang
- Department of Urology, Shanghai 9Th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 88 South Keyuan Road, Chengdu, 610041, China
| | - Min-Hui Xiao
- Department of Urology, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming, 650041, China
| | - Wan-Hai Xu
- Department of Urology, The Fourth Hospital of Harbin Medical University, Heilongjiang Key Laboratory of Scientific Research in Urology, Harbin, 150001, China
| | - Fa-Xian Yi
- Department of Urology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010059, China
| | - Chao-Yang Zhu
- Department of Urology, Huaihe Hospital of Henan University, Kaifeng, 475000, Henan, China
| | - Qian-Yuan Zhuang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, The Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, China
| | - Xiao-Feng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China
| | - Nian-Zeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Da-Lin He
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Xing-Huan Wang
- Department of Urology, Institute of Urology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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24
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Role of Pelvic Organ Crosstalk in Dysfunction of the Bowel and Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Das S, Roychoudhury S, Roychoudhury S, Agarwal A, Henkel R. Role of Infection and Leukocytes in Male Infertility. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:115-140. [DOI: 10.1007/978-3-030-89340-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Franco JVA, Garegnani L, Escobar Liquitay CM, Borofsky M, Dahm P. Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia: An Updated Cochrane Review. World J Mens Health 2022; 40:127-138. [PMID: 34448377 PMCID: PMC8761240 DOI: 10.5534/wjmh.210115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To assess the effects of transurethral microwave thermotherapy (TUMT) for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS We performed a comprehensive search using multiple databases up to May 2021, with no language or publication status restrictions. We included parallel-group randomized controlled trials of participants with BPH who underwent TUMT. We used standard Cochrane methods, including a GRADE assessment of the certainty of the evidence (CoE). RESULTS In this update of a previous Cochrane review, we included 16 trials with 1,919 participants. TUMT probably results in little to no difference in urologic symptom scores at short-term follow-up compared to transurethral resection of the prostate (TURP). There is likely to be little to no difference in the quality of life. TUMT likely results in fewer major adverse events. TUMT, however, probably results in a large increase in the need for retreatment. There may be little to no difference in erectile function between these interventions. However, TUMT may result in fewer cases of ejaculatory dysfunction compared to TURP. The overall CoE was moderate to low. CONCLUSIONS TUMT provides a similar reduction in urinary symptoms compared to TURP, with fewer major adverse events and fewer cases of ejaculatory dysfunction at short-term follow-up. However, TUMT probably results in a large increase in retreatment rates. Study limitations and imprecision reduced the confidence we can place in these results.
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Affiliation(s)
- Juan Victor Ariel Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Luis Garegnani
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
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27
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Bouhadana D, Nguyen DD, Raizenne B, Schwarcz J, Gordon H, Chughtai B, Elterman DS, Lavallée LT, Martin P, McAlpine K, Paterson R, Razvi H, Zorn KC, Bhojani N. Evaluating the acceptability of an online patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Can Urol Assoc J 2021; 15:247-254. [PMID: 34895444 DOI: 10.5489/cuaj.7492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The growing number of surgical options available to treat benign prostatic hyperplasia (BPH), may overwhelm patients and urologists when deciding on an optimal treatment. Therefore, we developed an online patient decision aid (PtDA) that includes all guideline-approved surgical modalities. The objective of this study was to assess the acceptability of the PtDA among former BPH surgery patients and urologists that treat BPH surgically. METHODS The International Patient Decision Aids Standards were used to develop a PtDA that includes monopolar transurethral resection of the prostate (TURP), bipolar TURP, GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open retropubic prostatectomy, and robotic simple prostatectomy as management options. Eleven urologists that regularly treat BPH and 19 patients who received BPH surgery were recruited. Alpha-testing was performed using a validated acceptability scoring system. RESULTS For all sections of the PtDA, most urologists agreed that the language used was easy to follow (91.9%), that the amount of information provided was adequate (63.6%), that the length of the PtDA was appropriate (63.6%), and that the outcomes reported were correct (81.8%). All 19 patient participants agreed that the language used was easy to follow, and most found that the amount of information provided was adequate (84.2%), that the length of the PtDA was appropriate (84.2%), and that the outcomes reported were well-explained (89.5%). CONCLUSIONS Our PtDA was found to be acceptable among urologists and patients. These results demonstrate that most of the participants either recommend the use of this tool or plan to incorporate it in their clinical practice.
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Affiliation(s)
- David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Brendan Raizenne
- Division of Urology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Harvey Gordon
- 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, NY, United States
| | - Dean S Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Luke T Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Kristen McAlpine
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Paterson
- Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, 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
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28
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Johnstone J, Lusty A, Tohidi M, Whitehead M, Tranmer J, Nickel JC, Siemens DR. The association of new-onset diabetes mellitus and medical therapy for benign prostatic hyperplasia: A population-based study. Can Urol Assoc J 2021; 15:240-246. [PMID: 34895443 DOI: 10.5489/cuaj.7489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms are highly prevalent in the aging male. Similarly, the prevalence of metabolic syndrome is increasing worldwide, with mounting evidence that these two common conditions share more than age as a predisposing factor. The objective of this study was to determine if medical management of BPH is associated with an increased risk of new-onset diabetes mellitus (DM) in routine care. METHODS This population-based, retrospective cohort study expands on a parent study of linked administrative databases identifying patients diagnosed and treated for BPH between 2005 and 2015. The primary outcome of this secondary analysis was a new diagnosis of DM after the index date of BPH diagnosis. Covariates included age, dyslipidemia, hypertension, and vascular diseases. A Cox proportional hazards regression model was used for inferential statistical analysis. RESULTS A total 129 223 men were identified with a BPH diagnosis and no prior history of DM. Of those men, 6390 (5%) were exposed to 5-alpha-reductase inhibitor (5-ARI), 39 592 (31%) exposed to alpha-blocker (AB), and 30 545 (24%) exposed to combination therapy. Compared to those men with no BPH medication use, those exposed to drugs had an increased risk of new DM. Men treated with combination therapy of 5-ARI and AB (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.25-1.35), 5-ARI monotherapy (HR 1.25, 95% CI 1.17-1.34), or AB monotherapy (HR 1.17, 95% CI 1.13-1.22) all were at higher risk of new DM diagnosis after adjusting for important covariates. When calculating the risk of a new diabetes diagnosis measured from the start of drug exposure, men treated with 5-ARIs had an increased risk of DM compared to AB monotherapy as the reference, with HR 1.12 (95% CI 1.03-1.21) for 5-ARI monotherapy and HR 1.20 (95% CI 1.14-1.25) for combination therapy. CONCLUSIONS In this large, long-term, retrospective study of men with a BPH diagnosis in routine practice, the risk of a new diagnosis of DM was greater in patients receiving medical management compared to controls. This modest but significant increased risk was highest in men treated with any 5-ARIs, in combination as well as monotherapy, compared to the ABs.
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Affiliation(s)
| | - Avril Lusty
- Department of Urology, Queen's University, Kingston, ON, Canada.,Division of Urology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Mina Tohidi
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Joan Tranmer
- ICES-Queen's, Queen's University, Kingston, ON, Canada
| | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - D Robert Siemens
- Department of Urology, Queen's University, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada
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29
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Zerafatjou N, Amirzargar M, Biglarkhani M, Shobeirian F, Zoghi G. Pumpkin seed oil (Cucurbita pepo) versus tamsulosin for benign prostatic hyperplasia symptom relief: a single-blind randomized clinical trial. BMC Urol 2021; 21:147. [PMID: 34666728 PMCID: PMC8527717 DOI: 10.1186/s12894-021-00910-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is very common in aging men. We aimed to compare the effects of tamsulosin and pumpkin (Cucurbita pepo) seed oil on BPH symptoms. METHODS This single-blind randomized clinical trial included patients with BPH aged ≥ 50 years referred to the Urology Clinic of Shahid Beheshti Hospital, Hamadan, Iran, from August 23, 2019 to February 19, 2020. Patients were randomized into two groups. One group received 0.4 mg tamsulosin every night at bedtime and the other received 360 mg pumpkin seed oil twice a day. Patients' age, weight, height, and body mass index (BMI) were recorded. The International Prostate Symptom Score (IPSS) was filled out by the patients at baseline and then 1 month and 3 months after the initiation of treatment. The BPH-associated quality of life (QoL), serum prostate-specific antigen, prostate and postvoid residual volume, and maximum urine flow were also assessed at baseline and 3 months later. Drug side effects were also noted. RESULTS Of the 73 patients included in this study with a mean age of 63.59 ± 7.04 years, 34 were in the tamsulosin group and 39 in the pupkin seed oil group. Patients were comparable with respect to age, weight, height, BMI, and baseline principal variables in both groups. Also, there was no significant difference between groups in terms of principal variables at any time point. However, there was a significant decrease in IPSS and a significant improvement in QoL in both groups. Although the decrease in IPSS from baseline to 1 month and 3 months was significantly higher in the tamsulosin group compared to the pumpkin group (P = 0.048 and P = 0.020, respectively), the decrease in IPSS from 1 to 3 months was similar (P = 0.728). None of the patients in the pumpkin group experienced drug side effects, while dizziness (5.9%), headache (2.9%), retrograde ejaculation (2.9%), and erythema with pruritus occurred in the tamsulosin group. CONCLUSIONS Pumpkin (Cucurbita pepo) seed oil relieved BPH symptoms with no side effects, but was not as effective as tamsulosin. Further studies are required to confirm the role of pumpkin seed oil as an option for the treatment of BPH symptoms. Trial registration Iranian Registry of Clinical Trials, IRCT20120215009014N340. Registered 19.02.2020. Retrospectively registered, https://en.irct.ir/trial/45335 .
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Affiliation(s)
- Nikan Zerafatjou
- Department of Urology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mohammadali Amirzargar
- Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Biglarkhani
- Department of Persian Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Shobeirian
- Department of Radiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Chavarriaga J, Prada J, Olejua P, López-Ramos H, Manjarrez M, Silva JM. Complete study for erectile dysfunction (CompED) improving diagnosis and treatment decision-making. Andrologia 2021; 53:e14212. [PMID: 34374105 DOI: 10.1111/and.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 01/27/2023] Open
Abstract
Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Data were collected and analysed prospectively. The primary end point was to determine whether treatment decision-making was eased by the CompED test. Secondary end points were to establish which clinical variables prior to the study could impact the results of the CompED test, to finally improve patient selection for the study. 187 patients were recruited, 31.2% of the patients had an axial rigidity below 50%, 28.5% had a peak systolic velocity <25 cm/s, 13.2% had an end-diastolic velocity >5cm/s and 27.5% had an abnormal biothesiometry. The factors that best predicted an abnormal result in any of the tests were age >70 years, IIEF domain A < 14 points, and previous radical prostatectomy or radiotherapy. The CompED test stands as a new alternative for the evaluation of patients with erectile dysfunction, being less time consuming, aiding in a more accurate determination of the aetiology and guiding treatment decision-making.
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Affiliation(s)
- Julian Chavarriaga
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia.,Division of Urology, Clínica Imbanaco - Quiron Salud, Cali, Colombia
| | - Juan Prada
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Peter Olejua
- Department of Epidemiology and Biostatistics. Hospital, Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Hugo López-Ramos
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Maryori Manjarrez
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José-Miguel Silva
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
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Franco JV, Garegnani L, Escobar Liquitay CM, Borofsky M, Dahm P. Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev 2021; 6:CD004135. [PMID: 34180047 PMCID: PMC8236484 DOI: 10.1002/14651858.cd004135.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) has been the gold-standard treatment for alleviating urinary symptoms and improving urinary flow in men with symptomatic benign prostatic hyperplasia (BPH). However, the morbidity of TURP approaches 20%, and less invasive techniques have been developed for treating BPH. Transurethral microwave thermotherapy (TUMT) is an alternative, minimally-invasive treatment that delivers microwave energy to produce coagulation necrosis in prostatic tissue. This is an update of a review last published in 2012. OBJECTIVES To assess the effects of transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Web of Science, and LILACS), trials registries, other sources of grey literature, and conference proceedings published up to 31 May 2021, with no restrictions by language or publication status. SELECTION CRITERIA We included parallel-group randomized controlled trials (RCTs) and cluster-RCTs of participants with BPH who underwent TUMT. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion at each stage and undertook data extraction and risk of bias and GRADE assessments of the certainty of the evidence (CoE). We considered review outcomes measured up to 12 months after randomization as short-term and beyond 12 months as long-term. Our main outcomes included: urologic symptoms scores, quality of life, major adverse events, retreatment, and ejaculatory and erectile function. MAIN RESULTS In this update, we identified no new RCTs, but we included data from studies excluded in the previous version of this review. We included 16 trials with 1919 participants, with a median age of 69 and moderate lower urinary tract symptoms. The certainty of the evidence for most comparisons was moderate-to-low, due to an overall high risk of bias across studies and imprecision (few participants and events). TUMT versus TURP Based on data from four studies with 306 participants, when compared to TURP, TUMT probably results in little to no difference in urologic symptom scores measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms at short-term follow-up (mean difference (MD) 1.00, 95% confidence interval (CI) -0.03 to 2.03; moderate certainty). There is likely to be little to no difference in the quality of life (MD -0.10, 95% CI -0.67 to 0.47; 1 study, 136 participants, moderate certainty). TUMT likely results in fewer major adverse events (RR 0.20, 95% CI 0.09 to 0.43; 6 studies, 525 participants, moderate certainty); based on 168 cases per 1000 men in the TURP group, this corresponds to 135 fewer (153 to 96 fewer) per 1000 men in the TUMT group. TUMT, however, probably results in a large increase in the need for retreatment (risk ratio (RR) 7.07, 95% CI 1.94 to 25.82; 5 studies, 337 participants, moderate certainty) (usually by repeated TUMT or TURP); based on zero cases per 1000 men in the TURP group, this corresponds to 90 more (40 to 150 more) per 1000 men in the TUMT group. There may be little to no difference in erectile function between these interventions (RR 0.63, 95% CI 0.24 to 1.63; 5 studies, 337 participants; low certainty). However, TUMT may result in fewer cases of ejaculatory dysfunction compared to TURP (RR 0.36, 95% CI 0.24 to 0.53; 4 studies, 241 participants; low certainty). TUMT versus sham Based on data from four studies with 483 participants we found that, when compared to sham, TUMT probably reduces urologic symptom scores using the IPSS at short-term follow-up (MD -5.40, 95% CI -6.97 to -3.84; moderate certainty). TUMT may cause little to no difference in the quality of life (MD -0.95, 95% CI -1.14 to -0.77; 2 studies, 347 participants; low certainty) as measured by the IPSS quality-of-life question on a scale from 0 to 6, with higher scores indicating a worse quality of life. We are very uncertain about the effects on major adverse events, since most studies reported no events or isolated lesions of the urinary tract. TUMT may also reduce the need for retreatment compared to sham (RR 0.27, 95% CI 0.08 to 0.88; 2 studies, 82 participants, low certainty); based on 194 retreatments per 1000 men in the sham group, this corresponds to 141 fewer (178 to 23 fewer) per 1000 men in the TUMT group. We are very uncertain of the effects on erectile and ejaculatory function (very low certainty), since we found isolated reports of impotence and ejaculatory disorders (anejaculation and hematospermia). There were no data available for the comparisons of TUMT versus convective radiofrequency water vapor therapy, prostatic urethral lift, prostatic arterial embolization or temporary implantable nitinol device. AUTHORS' CONCLUSIONS TUMT provides a similar reduction in urinary symptoms compared to the standard treatment (TURP), with fewer major adverse events and fewer cases of ejaculatory dysfunction at short-term follow-up. However, TUMT probably results in a large increase in retreatment rates. Study limitations and imprecision reduced the confidence we can place in these results. Furthermore, most studies were performed over 20 years ago. Given the emergence of newer minimally-invasive treatments, high-quality head-to-head trials with longer follow-up are needed to clarify their relative effectiveness. Patients' values and preferences, their comorbidities and the effects of other available minimally-invasive procedures, among other factors, can guide clinicians when choosing the optimal treatment for this condition.
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Affiliation(s)
- Juan Va Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Garegnani
- Research Department, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | | | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Prostatic Artery Embolization for Benign Prostatic Hyperplasia: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2021; 21:1-139. [PMID: 34188733 PMCID: PMC8202600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate that commonly affects older people with prostates and may lead to obstructive urinary symptoms. Symptoms may initially be mild but tend to worsen over time. Prostatic artery embolization (PAE) is an endovascular procedure to treat BPH, wherein an interventional radiologist inserts a catheter into the patient to inject tiny particles intended to reduce blood flow to the enlarged prostate, causing it to shrink in size. We conducted a health technology assessment on PAE for people with BPH, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding PAE, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tool for observational studies. We assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic review of the economic literature. We then assessed the cost-effectiveness of PAE compared with alternative treatments (i.e., transurethral resection of the prostate [TURP] or open simple prostatectomy [OSP]) using a Markov microsimulation model. The analysis was conducted from the Ontario Ministry of Health perspective over a time horizon of 6.5 years. We also analyzed the budget impact of publicly funding PAE in people with moderate to severe BPH in Ontario. RESULTS We included six studies in our systematic review. Four RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. All studies had considerable risk-of-bias concerns. PAE may improve BPH symptoms and urodynamic measures, but we are uncertain whether PAE achieves better results than TURP (GRADE: Very low to Low). Compared with TURP, PAE may result in higher patient satisfaction and fewer adverse events (GRADE: Not assessed). Compared with OSP, PAE may result in smaller improvements in BPH symptoms and urodynamic measures and may lead to fewer adverse events, but the evidence is very uncertain (GRADE: Very low).We did not find any published cost-effectiveness studies in the economic literature review. Our primary economic evaluation showed that, compared with TURP, PAE has an incremental cost of $328 (95% CrI: -$686 to $1,423) and a very small incremental quality-adjusted life-year (QALY) of 0.007 (95% CrI: -0.004 to 0.018). The resulting incremental cost-effectiveness ratio (ICER) of PAE versus TURP is $44,930 per QALY gained. At the commonly used willingness-to-pay values of $50,000 and $100,000 per QALY, the cost-effectiveness of PAE is uncertain (52% and 68% probability, respectively, of being cost-effective compared with TURP). In a scenario analysis, we compared PAE with OSP for individuals with large prostates (who may be ineligible for TURP). We found that PAE is less costly (-$1,231; 95% CrI: -$2,457 to $69) and less effective (-0.12 QALYs; 95% CrI: -0.18 to -0.04). The resulting ICER of PAE versus OSP is $10,241 saved per QALY lost. At the commonly used willingness-to-pay value of $50,000 per QALY, PAE is unlikely to be cost-effective (2% probability of being cost-effective compared with OSP). Assuming a low uptake (i.e., an additional 10 to 50 procedures per year in years 1 to 5), we estimated that publicly funding PAE in Ontario would lead to an additional cost of about $11,400 over the next 5 years.People we spoke with who have lived experience with BPH reported on the negative impact it can have on their quality of life. Those who had received PAE reported a positive experience with the procedure and meaningful improvement in their symptoms. CONCLUSIONS Prostatic artery embolization may improve BPH symptoms and urodynamic measures, but we are uncertain if the procedure results in similar outcomes to those of TURP. Based on one observational study, PAE may result in smaller improvements compared with OSP, but we are very uncertain of the evidence. Compared with TURP and OSP, PAE may result in fewer adverse events. Longer-term comparative studies are needed to assess the durability and long-term adverse events of PAE, the potential need for reintervention after PAE, and how PAE compares with other available BPH treatment options.We found the cost-effectiveness of PAE compared with TURP to be uncertain. Also, PAE is unlikely to be cost-effective compared with OSP. If PAE is publicly funded in Ontario, the budget impact is estimated to be small over the next 5 years.People who have lived experience with BPH reported that PAE improves quality of life and reduces negative symptoms of BPH.
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Bouhadana D, Nguyen DD, Schwarcz J, Gordon H, Elterman DS, Lavallée LT, Martin P, McAlpine K, Paterson R, Razvi H, Zorn KC, Bhojani N. Development of a patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. BJU Int 2021; 127:131-135. [PMID: 33369078 DOI: 10.1111/bju.15307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | | | - Harvey Gordon
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Luke T Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Kristen McAlpine
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Ryan Paterson
- Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, The University of Western Ontario, London, ON, Canada
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
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Franz J, Suarez-Ibarrola R, Pütz P, Sigle A, Lusuardi L, Netsch C, Lehrich K, Herrmann TRW, Gratzke C, Miernik A. Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices. Eur Urol Focus 2021; 8:532-544. [PMID: 33858810 DOI: 10.1016/j.euf.2021.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Although several studies have compared different morcellators and enucleation techniques for the management of benign prostatic hyperplasia (BPH), there is sparse literature on morcellation, so further experimental and clinical research is required for its optimization. OBJECTIVE To critically appraise the contemporary literature on prostate morcellation and to evaluate the safety and efficiency of currently available morcellators for endoscopic enucleation of the prostate (EEP) in the context of BPH. EVIDENCE ACQUISITION A comprehensive review of the English and French literature relevant to prostate morcellation was performed using the PubMed-MEDLINE, Cochrane Library, Web of Science, and Wiley Online Library database from 1998 to 2020 using PICOS (patient population, intervention, comparison, outcome, and study design) criteria. EVIDENCE SYNTHESIS We retrieved 26 studies involving 5652 patients treated with a morcellator that were eligible for data extraction and analysis. The mean patient age was 67.4 (range 61.4-72.8) yr. The weighted mean efficiency of Piranha, VersaCut, and DrillCut morcellators was 5.29, 3.95, and 5.3 g/min, respectively. Several approaches, such as en bloc, two-lobe, inverse, and improved techniques, may increase morcellation efficiency and safety. The lowest weighted mean rate of bladder wall injury was 1.24% for Piranha, followed by 1.98% for DrillCut, and 5.23% for VersaCut, while the VersaCut morcellator had the lowest weighted mean rate of device malfunction at 0.74%, compared to 2.07% for Piranha and 7.86% for DrillCut. CONCLUSIONS All three morcellators are efficient and safe for prostatic morcellation after EEP. Further development of devices and techniques may improve the efficiency and safety profile of morcellation. To increase safety, surgeon expertise, technical equipment, and patient characteristics should be considered. Therefore, interdisciplinary exchange of knowledge and further technological innovations are strongly encouraged. PATIENT SUMMARY We reviewed the safety and efficacy of devices called morcellators. These devices cut tissue into small pieces that are easier to remove from the body, and are used during laser surgery for benign enlargement of the prostate. Three morcellators are currently available on the market and are comparable in safety and efficacy.
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Affiliation(s)
- Julia Franz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Philipp Pütz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Karin Lehrich
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany.
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Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC. Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety. World J Urol 2021; 39:4389-4395. [PMID: 33837819 DOI: 10.1007/s00345-021-03688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.
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Affiliation(s)
- Kyle W Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
| | | | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Félix Couture
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Ahmed S Zakaria
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Hannes Cash
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,PROURO, Berlin, Germany.,Department of Urology, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees, France
| | - Dean Elterman
- Division of Urology, Department of Surgery, University. Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada.
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Moussaoui G, Zakaria AS, Negrean C, Nguyen DD, Couture F, Tholomier C, Sadri I, Arezki A, Schwartz RN, Elterman DS, Misrai V, Bhojani N, Herrmann TRW, Zorn KC. Accuracy of Clarius, Handheld Wireless Point-of-Care Ultrasound, in Evaluating Prostate Morphology and Volume Compared to Radical Prostatectomy Specimen Weight: Is There a Difference between Transabdominal vs Transrectal Approach? J Endourol 2021; 35:1300-1306. [PMID: 33677990 DOI: 10.1089/end.2020.0874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Prostate size estimation is a valuable clinical measure widely utilized in urology. This study evaluated the accuracy of preoperative transabdominal ultrasound (TAUS) compared to radical prostatectomy specimens and transrectal ultrasound (TRUS) in estimating prostate volume and identifying presence of median lobe, across different size groups, using the standard ellipsoid formula. The effect of median lobe on accuracy was also assessed. Materials and Methods: Ninety-eight men undergoing robot-assisted radical prostatectomy were enrolled in this study. Preoperative evaluation of prostate volume was done using measurements obtained from TAUS using the Clarius C3 handheld wireless point-of-care ultrasound (POCUS) and from TRUS Clarius EC7. Participants were grouped based on prostate size (<30, 30-60, and >60 g). Mean absolute percentage of error was used to evaluate accuracy. Mean percentage of error determined if there was an overestimation or underestimation. Correlation between each TAUS size group, true prostate weight and TRUS was assessed. Results: Irrespective of body mass index, TAUS accurately identified median lobe in all men. No statistically significant difference was found between specimen weight and TAUS prostate size for the >60 g group. Among this same group, a strong correlation was noted between specimen weight and TAUS prostate size (r = 0.911, p < 0.001). There was also a strong correlation between TAUS and TRUS measurements for this group (r = 0.950, p < 0.001). Presence of median lobe did not have an impact on measurement accuracy. Conclusions: Bedside handheld wireless POCUS provides rapid, inexpensive, noninvasive, and clinically accurate TAUS prostate assessments for larger prostates. Such features as identifying median lobes and measuring prostate volumes are valuable tools, whereas patient counseling on lower urinary tract symptoms, elevated prostate-specific antigen, and benign prostate hyperplasia are surgical options.
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Affiliation(s)
| | - Ahmed S Zakaria
- Division of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, Canada
| | - Cristina Negrean
- Division of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, Canada
| | | | - Félix Couture
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, Canada
| | - Côme Tholomier
- Division of Urology, Department of Surgery, McGill University, Montreal, Canada
| | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Adel Arezki
- Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Dean S Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, Canada
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland.,Department of Urology and Urological Oncology, Hanover Medical School, Hanover, Germany
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, Canada
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Law KW, Zakaria AS, Elterman DS, Rijo E, Misrai V, Nguyen DD, Lai C, Byrne E, Tarasidis J, Baker J, Langan R, Fedas N, Mejia AM, O'Neill P, Hasenberg T, Zorn KC. A Novel Method for GreenLight MoXy Laser Fiber Irrigation System to Improve Performance and Durability: A New Standard of Care? J Endourol 2021; 35:1378-1385. [PMID: 33397193 DOI: 10.1089/end.2020.0860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives: The GreenLight™ MoXy® laser fiber has been used since 2010 for benign prostatic hyperplasia procedures. We tested a novel principle to increase the saline irrigation flow rates beyond the current standard of gravity drip (∼22 cc/minutes) within the fiber-attached cooling system to potentially prevent excessive tissue adherence and to eliminate the likelihood of degradation due to abnormal overheating. The objective was to assess differences between the ordinary and active pumping methods with ≥2 times flow rate after conditioning of the laser fiber. Materials and Methods: A controllable full, tissue-contact system was utilized for conditioning in a porcine model, applying 180 W of vaporization mode of GreenLight XPS console for 30 continuous minutes. Four groups were evaluated using different saline flow rates; the nominal flow rate (control group, 22 mL/minute), digital pump set (35 mL and 50 mL/minute), and a manual pressure cuff with hand pump set using a 3-L saline bag with pressure of 300 mmHg (35-80 mL/minute). At the end of the conditioning process, a mechanical pull force test was executed on the fiber metal cap to evaluate the bonding strength. A failed event was defined as the natural detachment of the metal cap during the conditioning process or a cap pull force smaller than 22.24 N resulting in detachment. Additional physical parameters, including fiber tip temperature information and laser beam power transmission efficiency, were analyzed. Results: Detachment of the cap occurred less frequently when using the 300 mmHg pressure cuff saline bag compared to the nominal flow rate (6.67% vs 50%, respectively). The average operating fiber tip temperatures were lower in the higher flow rate groups compared to nominal, measured at 315°C and 305°C. compared to 442°C. Moreover, a significantly lower FiberLife Event count and an ∼5% increase of the average final laser transmission efficiency were observed in the higher flow rate groups. Conclusions: Our study demonstrates superior results when using active pumping or high-pressure systems to increase saline flow rates in terms of laser fiber durability without any additional cost. More specifically, use of a manual pressure cuff with starting pressure at 300 mmHg, a system that is readily available in most operating rooms, increases MoXy fiber durability. Further studies are required to assess if this technique will improve user experience, clinical outcomes, and procedure costs.
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Affiliation(s)
- Kyle W Law
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ahmed S Zakaria
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - David-Dan Nguyen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Changyi Lai
- Division of Urology and Pelvic Health, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Earol Byrne
- Division of Urology and Pelvic Health, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - John Tarasidis
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - James Baker
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Ray Langan
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Nick Fedas
- Division of Urology and Pelvic Health, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Ana Maria Mejia
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Paul O'Neill
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Thomas Hasenberg
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
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Chen Z, Ge M. Discovering pathways in benign prostate hyperplasia: A functional genomics pilot study. Exp Ther Med 2021; 21:242. [PMID: 33603850 PMCID: PMC7851599 DOI: 10.3892/etm.2021.9673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/13/2020] [Indexed: 11/06/2022] Open
Abstract
Benign prostate hyperplasia (BPH) is one of the well-known urological neoplasms common in males with an increasing number of associated deaths in aging males. It causes uncomfortable urinary symptoms, including urine flow blockage, and may cause bladder, urinary tract or kidney problems. The histopathological and clinical knowledge regarding BPH is limited. In the present study, an in silico approach was applied that uses genome-scale microarray expression data to discover a wide range of protein-protein interactions in addition to focusing on specific genes responsible for BPH to develop prognostic biomarkers. Various genes that were differentially expressed in BPH were identified. Gene and functional annotation clusters were determined and an interaction analysis with disease phenotypes of BPH was performed, as well as an RNA tissue specificity analysis. Furthermore, a molecular docking study of certain short-listed gene biomarkers, namely anterior gradient 2 (AGR2; PDB ID: 2LNT), steroid 5α-reductase 2 (PDB ID: 6OQX), zinc finger protein 3 (PDB ID: 5T00) and collagen type XII α1 chain (PDB ID: 1U5M), was performed in order to identify alternative Chinese herbal agents for the treatment of BPH. Data from the present study revealed that AGR2 receptor (PDB ID: 2LNT) and berberine (Huang Bo) form the most stable complex and therefore may be assessed in further pharmacological studies for the treatment of BPH.
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Affiliation(s)
- Zheling Chen
- Department of Traditional Chinese Medicine, Zhenxin Community Health Service Center, Shanghai 201824, P.R. China
| | - Minyao Ge
- Department of Urology Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R. China
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Johnson TM, Goode PS, Hammontree L, Markland AD, Vaughan CP, Ouslander JG, Falk K, McGwin G, Burgio KL. An Exploratory Analysis of Tamsulosin for Overactive Bladder (OAB) in Men With Varying Voiding Symptom Burden. Urology 2021; 153:42-48. [PMID: 33482134 DOI: 10.1016/j.urology.2021.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate tamsulosin (α-blocker therapy) for male overactive bladder (OAB) and to examine if indicators of concomitant benign prostatic hyperplasia are associated with OAB symptom improvement. MATERIALS AND METHODS This was a planned, exploratory analysis of a 4-week, α-blocker (tamsulosin 0.4 mg) run-in phase of the Male Overactive Bladder Trial in Veterans (MOTIVE). Participants with urinary urgency and urinary frequency (> 8 voids/24 hours) completed bladder diaries, answered symptom questionnaires (AUA-7 SI), and had post-void residual and noninvasive uroflowmetry measurement. RESULTS A total of 116 male Veterans aged 42-88 years with OAB participated. There were statistically significant reductions in voiding frequency (11.3 > 10.0 voids/24 hours, P < .0001), urgency scores (mean 2.5-2.2 points, P < .0001), and nightly nocturia (2.1 > 1.8, P < .001). Only baseline AUA-7 SI total and voiding subscale categories (mild, moderate, severe) were associated with significant reduction in AUA-7 SI total score. For continuous variables, only AUA-7 SI baseline total score was associated with AUA-7 SI storage symptom changes. No other baseline measures were associated with changes in urgency, frequency, or nocturia. CONCLUSION Initiation of short course tamsulosin therapy in men was associated with statistical reduction in OAB symptoms. Baseline post-void residual, uroflow rate, and the voiding symptom subscore of the AUA-7 SI were not predictive of OAB symptom improvement with tamsulosin. These findings merits further exploration.
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Affiliation(s)
- Theodore M Johnson
- Birmingham/Atlanta Department of Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, and Decatur, GA; Emory University, Atlanta, GA.
| | - Patricia S Goode
- Birmingham/Atlanta Department of Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, and Decatur, GA; University of Alabama at Birmingham, Birmingham, AL
| | | | - Alayne D Markland
- Birmingham/Atlanta Department of Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, and Decatur, GA; University of Alabama at Birmingham, Birmingham, AL
| | - Camille P Vaughan
- Birmingham/Atlanta Department of Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, and Decatur, GA; Emory University, Atlanta, GA
| | - Joseph G Ouslander
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Miami, FL
| | | | - Gerald McGwin
- Birmingham/Atlanta Department of Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, and Decatur, GA; University of Alabama at Birmingham, Birmingham, AL
| | - Kathryn L Burgio
- Birmingham/Atlanta Department of Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, and Decatur, GA; University of Alabama at Birmingham, Birmingham, AL
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40
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Nguyen DD, Sadri I, Law K, Bhojani N, Elterman DS, Zakaria AS, Arezki A, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database. World J Urol 2021; 39:3881-3889. [PMID: 33388918 DOI: 10.1007/s00345-020-03529-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database. METHODS Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score. RESULTS A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. CONCLUSIONS Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.
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Affiliation(s)
| | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Kyle Law
- Faculty of Medicine, McGill University, 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
| | - Ahmed S Zakaria
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Adel Arezki
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Modena, Italy
| | | | | | | | | | - Hannes Cash
- 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, QC, Canada.
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Nguyen DD, Marchese M, Cone EB, Paciotti M, Basaria S, Bhojani N, Trinh QD. Investigation of Suicidality and Psychological Adverse Events in Patients Treated With Finasteride. JAMA Dermatol 2021; 157:35-42. [PMID: 33175100 PMCID: PMC7658800 DOI: 10.1001/jamadermatol.2020.3385] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance There is ongoing controversy about the adverse events of finasteride, a drug used in the management of alopecia and benign prostatic hyperplasia (BPH). In 2012, reports started emerging on men who had used finasteride and either attempted or completed suicide. Objective To investigate the association of suicidality (ideation, attempt, and completed suicide) and psychological adverse events (depression and anxiety) with finasteride use. Design, Setting, and Participants This pharmacovigilance case-noncase study used disproportionality analysis (case-noncase design) to detect signals of adverse reaction of interest reported with finasteride in VigiBase, the World Health Organization's global database of individual case safety reports. To explore the strength of association, the reporting odds ratio (ROR), a surrogate measure of association used in disproportionality analysis, was used. Extensive sensitivity analyses included stratifying by indication (BPH and alopecia) and age (≤45 and >45 years); comparing finasteride signals with those of drugs with different mechanisms but used for similar indications (minoxidil for alopecia and tamsulosin hydrochloride for BPH); comparing finasteride with a drug with a similar mechanism of action and adverse event profile (dutasteride); and comparing reports of suicidality before and after 2012. Data were obtained in June 2019 and analyzed from January 25 to February 28, 2020. Exposures Reported finasteride use. Main Outcomes and Measures Suicidality and psychological adverse events. Results VigiBase contained 356 reports of suicidality and 2926 reports of psychological adverse events (total of 3282 adverse events of interest) in finasteride users (3206 male [98.9%]; 615 of 868 [70.9%] with data available aged 18-44 years). A significant disproportionality signal for suicidality (ROR, 1.63; 95% CI, 1.47-1.81) and psychological adverse events (ROR, 4.33; 95% CI, 4.17-4.49) in finasteride was identified. In sensitivity analyses, younger patients (ROR, 3.47; 95% CI, 2.90-4.15) and those with alopecia (ROR, 2.06; 95% CI, 1.81-2.34) had significant disproportionality signals for increased suicidality; such signals were not detected in older patients with BPH. Sensitivity analyses also showed that the reports of these adverse events significantly increased after 2012 (ROR, 2.13; 95% CI, 1.91-2.39). Conclusions and Relevance In this pharmacovigilance case-noncase study, significant RORs of suicidality and psychological adverse events were associated with finasteride use in patients younger than 45 years who used finasteride for alopecia. The sensitivity analyses suggest that these disproportional signals of adverse events may be due to stimulated reporting and/or younger patients being more vulnerable to finasteride's adverse effects.
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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, McGill University, Montreal, Québec, Canada
| | - Maya Marchese
- 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
| | - Marco Paciotti
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shehzad Basaria
- Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, Québec, 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
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42
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Bhojani N, Zorn KC, Elterman D. A shared decision: Bipolar vs. monopolar transurethral resection of the prostate for benign prostatic hyperplasia. Can Urol Assoc J 2020; 14:431. [PMID: 33259285 DOI: 10.5489/cuaj.6563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Naeem Bhojani
- Department of Surgery, Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Surgery, 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
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43
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Wu Y, Ding Y, Cao QF, Qian SB, Wang C, Duan HQ, Gu J, Shen HB. The relationship between glucose homeostasis status and prostate size in aging Chinese males with benign prostatic hyperplasia. World J Urol 2020; 38:2923-2931. [PMID: 31965286 PMCID: PMC7644519 DOI: 10.1007/s00345-020-03084-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/06/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Increasing evidence shows that many metabolic factors are involved in the progression of benign prostatic hyperplasia (BPH). We aimed to assess the relationship between the status of glucose homeostasis and prostate size in aging Chinese males undergoing transurethral resection of the prostate (TURP) for BPH. METHODS A total of 1006 medical records of BPH patients undergoing TURP were reviewed. Prostate size was measured by transrectal ultrasound. Annual total prostate (TP) and transitional zone (TZ) growth rates were calculated. According to the American Diabetes Association criteria, the patients were categorized as normoglycemic, prediabetic, or diabetic. Levels of glucose homeostasis and other variables were considered independent variables in an effort to evaluate any potential correlations using non-adjusted and multivariate-adjusted regression models. RESULTS A total of 659 individuals were included in the study. BPH patients < 70 years old and ≥ 70 years old in the normoglycemic group had a stable prostate growth rate. The change in prostate size in those younger than 70 years, however, was faster in the prediabetic and diabetic group. Further analysis revealed that abnormal glucose homeostasis was positively correlated with prostate size. In those younger than 70 years, compared with the normal glucose group, the adjusted odds ratio (OR) for TP and TZ enlargement in the prediabetic group was 2.27 (95%CI 1.29-4.00) and 3.19 (95%CI 1.78-5.72), respectively, and the adjusted ORs were 4.74 (95%CI 2.18-10.30) and 6.16 (95%CI 2.70-14.06), respectively, for men with diabetes. However there was no significant difference among men aged ≥ 70 years. CONCLUSIONS Among patients undergoing TURP, the prostate volume and growth rate were affected by different status of glucose homeostasis. Hyperglycemia may play an important role in prostate growth.
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Affiliation(s)
- Y Wu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Y Ding
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Q F Cao
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - S B Qian
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - C Wang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - H Q Duan
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - J Gu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - H B Shen
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
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Morton A, Gordon L, Fowler R, Esler R, Dunglison N, Roberts MJ. Images - Acute urinary retention due to urethral steinstrasse. Can Urol Assoc J 2020; 15:E299-E300. [PMID: 33119499 DOI: 10.5489/cuaj.6725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew Morton
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Lachlan Gordon
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Ross Fowler
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Rachel Esler
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Nigel Dunglison
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Queensland, Australia.,The University of Queensland Centre for Clinical Research, Herston, Australia
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45
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Bobrowski A, Nayan M, Heimrath O, Goche D, Ludzu E, Singal RK. Supply the demand: Assessment of the feasibility of local nonurologists in relieving the burden of chronic indwelling catheters in a low-income country. Can Urol Assoc J 2020; 15:E261-E266. [PMID: 33939602 DOI: 10.5489/cuaj.6576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite the high prevalence rates of urinary retention in sub-Saharan Africa, regional deficiencies in urological care have culminated in inadequate medical management and a backlog of urology cases. Our study examined the efficacy and safety of a surgical camp enlisting local non-urologists performing simple open prostatectomy on the rate of chronic catheter usage secondary to urinary retention. METHODS We reported on a prospective case series of patients with chronic indwelling catheters who underwent open simple prostatectomy during a one-week urology camp in the Machinga District of Malawi. All operations were performed by a locally trained general surgeon and a clinical officer. RESULTS Twenty-three (47.9%) of 48 male patients with urinary retention assessed for eligibility for open simple prostatectomy were deemed eligible and underwent the procedure. Of the patients who underwent an open simple prostatectomy, histopathological findings demonstrated benign prostatic hyperplasia in 19 patients (82.6%), while six patients (26.1%) had coincidental malignancy. At postoperative followup, the entire cohort was catheter-free and reported regular sexual activity and the ability to return to work, while 87.0% noted improvements in social integration and 34.8% cited higher self-esteem. Two patients required treatment for infection and one patient experienced fascial dehiscence. Two months following prostatectomy, all patients were catheter-free and able to void independently. CONCLUSIONS Local surgical practitioners without formal urology training can successfully perform open simple prostatectomy to relieve patients of chronic indwelling catheters and assist in addressing the disease burden in a low-resource setting.
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Affiliation(s)
- Adam Bobrowski
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madhur Nayan
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada
| | - Olivier Heimrath
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Michael Garron Hospital, Toronto, ON, Canada
| | - Duncan Goche
- Department of Surgery, Zomba Central Hospital, Zomba, Southeastern Region, Malawi
| | - Enok Ludzu
- Department of Surgery, Zomba Central Hospital, Zomba, Southeastern Region, Malawi
| | - Rajiv K Singal
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Michael Garron Hospital, Toronto, ON, Canada
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Schwartz RN, Couture F, Sadri I, Arezki A, Nguyen DD, Zakaria AS, Law K, Elterman D, Rieken M, Cash H, Zorn KC. Reasons to believe in vaporization: a review of the benefits of photo-selective and transurethral vaporization. World J Urol 2020; 39:2263-2268. [PMID: 32930847 DOI: 10.1007/s00345-020-03447-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In the current review, we will discuss the state of the literature of vaporization of the prostate for the treatment of benign prostatic enlargement (BPE). We discuss two methods of vaporization of the prostate: Transurethral Vaporization of the Prostate (TUVP) and Greenlight Photo-selective Vaporization of the Prostate (PVP). METHODS A comprehensive review of the literature was performed on TUVP and PVP. The literature on transurethral resection of the prostate (TURP) was also extensively reviewed as a comparative surgical method. RESULTS The evidence shows that TUVP appears to be the safer choice, as compared to TURP due to less intra- and peri-operative complications. PVP was associated with less bleeding complications than TURP with outpatient discharge. Importantly, PVP was not associated with serious bleeding events requiring blood transfusions or medical treatment in patients under anticoagulation or antiplatelet therapies. PVP was also shown to be a cost-effective option compared to TURP. CONCLUSION Prostate vaporization for the treatment of BPE appears to be an efficient and safer alternative to TURP. Vaporization techniques, particularly Greenlight PVP, should be offered to most men, especially those under anticoagulation therapy, as well as patients at risk of bleeding complications.
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Affiliation(s)
| | - Felix Couture
- Département d'Urologie, Centre Hospitalier de l'Université de Sherbrooke, Montreal, Canada
| | - Iman Sadri
- McGill University, Faculty of Medicine, Montreal, Canada
| | - Adel Arezki
- McGill University, Faculty of Medicine, Montreal, Canada
| | | | - Ahmed S Zakaria
- Département d'Urologie, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Kyle Law
- McGill University, Faculty of Medicine, Montreal, Canada
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, Canada
| | - Malte Rieken
- alta uro AG, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hannes Cash
- Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kevin C Zorn
- Département d'Urologie, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
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Ayele HT, Reynier P, Azoulay L, Platt RW, Cabaussel J, Benayoun S, Filion KB. Trends in the pharmacological treatment of benign prostatic hyperplasia in the UK from 1998 to 2016: a population-based cohort study. World J Urol 2020; 39:2019-2028. [PMID: 32909173 DOI: 10.1007/s00345-020-03429-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/30/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe trends in the pharmacological treatment of BPH in the United Kingdom (UK) from 1998 to 2016. METHODS We created a cohort of men with a diagnosis of BPH between 1998 and 2016 using the Clinical Practice Research Datalink. Using Poisson regression, we estimated annual prescription rates of 5αRIs, α-blockers, and combination therapy (5αRIs + α-blockers). Adherence was defined by a proportion of days covered > 80%. RESULTS Our cohort included 192,640 men with BPH who generated 1,176,264 person-years (PYs) of follow-up. The mean age was 68.0 (standard deviation: 10.7) years. The prescription rate of all BPH medications during the study period was 347.6 per 100 PYs (95% CI 347.2-347.9). α-Blockers had the highest prescription rate (222.9 per 100 PYs, 95% CI 222.7-223.2); prescription rates of 5αRIs and combination therapy were 69.1 per 100 PYs (95% CI 69.0-69.3) and 55.5 per 100 PYs (95% CI 55.4-55.7), respectively. The prescription rate for combination therapy was 19 times greater in 2013-2016 than in 1998-2000 (rate ratio: 19.2, 95% CI 18.6-19.7), while the prescription rates for 5αRIs and α-blockers each doubled during this period (rate ratio: 1.86, 95% CI 1.84-1.88 and rate ratio: 2.02, 95% CI 2.01-2.04, respectively). The proportion of patients who were adherent at 1 year to 5αRIs (32.3%), α-blockers (44.0%), and combination therapy (45.6%) was low. CONCLUSION The prescription rate of BPH medications increased substantially between 1998 and 2016 in the UK, with the greatest relative increase observed with combination therapy. Adherence to BPH medications was low in this population-based study.
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Affiliation(s)
- Henok Tadesse Ayele
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montréal, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada.,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada.,Department of Pediatrics, McGill University, Montréal, Canada
| | - Josselin Cabaussel
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada
| | - Serge Benayoun
- Department of Surgery, Urology Unit, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - Kristian B Filion
- Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montréal, Canada. .,Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Canada. .,Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, 3755 Cote Ste Catherine, Suite H410.1, Montreal, QC, H3T 1E2, Canada.
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Patel NR, Elterman DS, Thulasidasan N, Altman R, Tai E, Zener R, Stella SF, Annamalai G, Mafeld S, Simons ME. Initial Canadian Experience of Prostate Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: Midterm Outcomes. Can Assoc Radiol J 2020; 72:876-882. [PMID: 32673069 DOI: 10.1177/0846537120939930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study aimed to assess the midterm outcomes and safety of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH). METHODS A single-center, retrospective review of PAE performed for BPH was performed. Validated International Prostate Symptom Score (IPSS), quality of life (QoL) index, and International Index for Erectile Function (IIEF-5) questionnaires were completed at baseline and at least 12 months post-procedure. Prostate imaging was performed preprocedure as well as 3 months and 12 months post-procedure to assess prostate volume (PV). Uroflowmetry was also performed at baseline and 12 months post-procedure to assess urine flow rate (Qmax) and post-void residual (PVR) volume. Adverse events were graded according to Society of Interventional Radiology (SIR) guidelines. RESULTS Eighty male patients underwent the PAE procedure (mean age 69 years). Prostate volume decreased significantly from a mean volume 156 to 107 mL after 12 months post-procedure, commensurate with a mean reduction of 27.5% (P < .05). Significant improvements were seen in IPSS (21.8 vs 10.5) and QoL (4.5 vs 2.0) from baseline to 12 months post-procedure (P < .05). There was no significant change in IIEF-5 score. There was a significant reduction in PVR (202 vs 105 mL) and improvement in Qmax (5.9 vs 10.0 mL/s) between baseline and 12 months post-procedure (P < .05). No major complications occurred; 4 minor complications occurred (SIR grade A or B). CONCLUSION Prostate artery embolization achieved a clinically and statistically significant prostate volume reduction, symptom and QoL improvement, and enhanced uroflowmetry parameters in patients with BPH.
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Affiliation(s)
- Neeral R Patel
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Dean S Elterman
- Department of Urology, 7989University Health Network, Toronto, Ontario, Canada
| | - Narayanan Thulasidasan
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Rachel Altman
- Department of Urology, 7989University Health Network, Toronto, Ontario, Canada
| | - Elizabeth Tai
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Rebecca Zener
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Steffan F Stella
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Ganesan Annamalai
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
| | - Martin E Simons
- Division of Interventional Radiology, 7989University Health Network, Toronto, Ontario, Canada
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Pierce H, Goueli R, Al Hussein Al Awamlh B, Goel S, Meskawi M, Zorn K, Te A, Chughtai B. Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate. J Endourol 2020; 35:39-45. [PMID: 32475163 DOI: 10.1089/end.2020.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction: Obesity can lead to increased risk of perioperative complications in surgical patients, but evidence is lacking regarding the impact of obesity on bladder outlet surgery outcomes. We sought to assess the safety and efficacy of GreenLight photoselective vaporization of the prostate (PVP) in obese patients by comparing functional outcomes and complications in men, stratified according to the body mass index (BMI). Materials and Methods: A retrospective analysis was undertaken of 424 men who underwent 180W GreenLight PVP between 2012 and 2016 at two tertiary medical centers. Patients were stratified based on the World Health Organization (WHO) classification of obesity as determined by BMI. Normal weight men had BMI <25 kg/m2, overweight men had BMI between 25 and 30 kg/m2, and obese men had BMI greater than 30 kg/m2. Primary endpoints examined were differences in intraoperative outcomes and incidence of intraoperative and postoperative complications between BMI groups. Secondary endpoints were improvements in the International Prostate Symptom Score, quality of life score, and the uroflowmetry variables, maximum urinary flow rate and postvoid residual. Results: The BMI groups did not differ regarding operative time or lasing time after matching for prostate volume, but overweight patients in the matched cohort still required higher mean energy use than normal weight men (258.6 kJ vs 233.9 kJ; p = 0.017). No significant differences between BMI groups were observed for intraoperative complications, postoperative complications, or readmission rates. All functional parameters were significantly improved at 24 months for each group, with no differences in improvement between groups. On multivariable analysis, BMI was not a significant predictor for outcomes following PVP. Conclusions: Increased BMI has a negligible effect on intraoperative parameters and does not affect postoperative complication rates or functional outcomes. GreenLight XPS 180W PVP is a safe and effective procedure in overweight and obese men.
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Affiliation(s)
- Hudson Pierce
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York, USA
| | - Ramy Goueli
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York, USA
| | | | - Shokhi Goel
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York, USA
| | - Malek Meskawi
- CHUM Department of Urology, University of Montréal, Montreal, Canada
| | - Kevin Zorn
- CHUM Department of Urology, University of Montréal, Montreal, 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
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DeZeeuw J, O'Regan NB, Goudie C, Organ M, Dubrowski A. Anatomical 3D-Printed Silicone Prostate Gland Models and Rectal Examination Task Trainer for the Training of Medical Residents and Undergraduate Medical Students. Cureus 2020; 12:e9020. [PMID: 32775100 PMCID: PMC7405975 DOI: 10.7759/cureus.9020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The current generation of graduating medical students is entering into practice with minimal exposure to the digital rectal examination (DRE), a necessary component of a complete physical examination. Simulation-based medical education (SBME) using anatomical silicone models and task trainers can provide hands-on training opportunities for medical students to rehearse DREs. However, there is a scarcity of affordable, validated, and anatomically correct silicone prostate models and task trainers for rehearsing DREs. This technical report describes and validates evidence for silicone prostate models and a DRE task trainer created from three-dimensional (3D)-printed molds for medical student- and resident-training and clinical skills maintenance. A pre-existing 3D human model and five different prostate models from open-source, royalty-free websites were converted using Fusion360™ (Autodesk Inc., San Rafael, CA) into stereolithography files and altered to produce negative molds. The prostate molds were filled with silicone and polylactic acid filament “nodules”. The buttocks were isolated from the human model and an anal canal was designed with a larger cavity on the interior to hold the silicone prostate models to simulate a real DRE. Five practicing urologists were recruited to evaluate the 3D-printed silicone prostate models and the DRE task trainer. The participants were provided with a qualitative survey and asked to rate the perceived realism and educational effectiveness of the prostate models and task trainer. The silicone models and task trainer were found to be useful for simulation training when attempting DRE techniques. The feedback from the participants was positive overall and provided recommendations for improvement including stabilizing the prostate models in the task trainer, smoothening the transition between the rectum and the prostate, and adding an additional “normal” prostate model. Silicone prostate models and DRE task trainers created from 3D molds are economical and anatomically and tactically accurate training tools to teach and maintain DRE skills as compared to commercially available, cost-prohibitive models. After making the suggested and appropriate modifications, the prostate models and DRE task trainer could potentially be used as tools for clinical skills training and maintenance and for patient education in the future.
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Affiliation(s)
- Jasmine DeZeeuw
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Noel B O'Regan
- Anesthesiology, Memorial University of Newfoundland/Janeway, St. John's, CAN
| | - Christine Goudie
- Medical Education and Simulation, Memorial University of Newfoundland, St. John's, CAN
| | - Michael Organ
- Urology, Memorial University of Newfoundland, St. John's, CAN
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