46 COMPARISON OF MEDICAL AND SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE COMMUNITY SETTING

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 201046 COMPARISON OF MEDICAL AND SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE COMMUNITY SETTING Amy Krambeck, Debra Jacobson, Michaela McGree, Deborah Lightner, Michael Lieber, Steven Jacobsen, and Jennifer St. Sauver Amy KrambeckAmy Krambeck Rochester, MN More articles by this author , Debra JacobsonDebra Jacobson Rochester, MN More articles by this author , Michaela McGreeMichaela McGree Rochester, MN More articles by this author , Deborah LightnerDeborah Lightner Rochester, MN More articles by this author , Michael LieberMichael Lieber Rochester, MN More articles by this author , Steven JacobsenSteven Jacobsen Pasadena, CA More articles by this author , and Jennifer St. SauverJennifer St. Sauver Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.092AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many treatments exist for BPH and lower urinary tract symptoms (LUTS); however, data comparing the efficacy of these treatments in the general population are lacking. METHODS A randomly selected cohort of white men, aged 40-79 years in 1990, from Olmsted County, MN was enrolled in the study. Participants completed the American Urological Association Symptom Index and reported symptoms of incontinence and use of medications (including 5- α reductase inhibitors [5-ARIs] and α-adrenergic receptor inhibitors [α-ARs]). Surgical treatment for BPH was obtained from community medical records. Men were followed biennially through 2007, and categorized by the most aggressive therapy received. Symptom score slopes were calculated from baseline to last assessment prior to treatment, and from first assessment following treatment to last follow-up, using mixed models. Incontinence rates were calculated at the last assessment prior to treatment and at the first assessment following treatment. RESULTS Of 2184 men, 1574 (72%) had no treatment, 195 (9%) used 5-ARIs, 307 (14%) used α-ARs, 23 (1%) received laser vaporization, and 85 (4%) received a transurethral resection of the prostate (TURP). Median follow-up ranged from 5.4 to 6.1 years after treatment. Men undergoing vaporization or TURP had higher baseline symptom scores (p<0.001) and more rapid increases in scores over time prior to treatment (p=0.002) than those treated with medications (Figure). Incontinence prior to treatment ranged from 31.0% of the α-AR group to 64.5% of the TURP group. After intervention, the TURP group had the greatest improvement in symptoms, followed by vaporization, 5-ARIs, and α-ARs (Figure). Only the TURP group reported a decrease in incontinence (pre-TURP: 64.5%, post-TURP: 41.9%). Post intervention, symptom score increases over time did not differ between the four treatment groups (p=0.65). CONCLUSIONS In the community setting, patients with the highest symptom scores were most likely to receive surgical intervention. Further, urinary incontinence was common, coexisting with BPH/LUTS. Although symptoms stabilized after intervention for all groups, patients receiving surgical intervention had the greatest decrease in both symptoms and incontinence. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e19-e20 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Krambeck Rochester, MN More articles by this author Debra Jacobson Rochester, MN More articles by this author Michaela McGree Rochester, MN More articles by this author Deborah Lightner Rochester, MN More articles by this author Michael Lieber Rochester, MN More articles by this author Steven Jacobsen Pasadena, CA More articles by this author Jennifer St. Sauver Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...