Assessment Of Benign Prostatic Hyperplasia Research Articles

Relevance of benign prostatic hyperplasia and associated conditions for urologists, health care systems, and society

The guest editors of this special issue, both members of the European Association of Urology Guidelines Office dealing with male lower urinary tract symptoms and benign prostatic hyperplasia (BPH), have been asked by the editorial board of the World Journal of Urology to collect and publish a series of articles on BPH to document the latest developments of this disease. Next to this issue solely dealing with the treatment of BPH, another special issue on basic science, epidemiology, and assessment of BPH is already in preparation and anticipated to be published later in 2010. Both special issues contain a mixture of original scientific as well as review articles on BPH and summarize the latest knowledge of the BPH disease. We thank all authors who have followed our invitation and shared their professional inside information with us. As all articles have been peer-reviewed, we would also like to thank all reviewers for their valuable time, work, and suggestions. BPH is the term used only to describe benign growth of epithelial, muscular, and/or fibrotic cells in the prostate. Microscopic changes increase with ageing and approximately 40, 70, 80, and 90% of men are affected in their sixth, seventh, eighth, and ninth decade, respectively [1]. Based on the prevalence data, BPH appears to be a physiological ageing process. BPH becomes a disease when benign prostatic enlargement (BPE), benign prostatic obstruction (BPO), or lower urinary tract symptoms (LUTS) appear. No strict correlations between these components have been found so far and, therefore, each component of the BPH disease has to be assessed and treated separately. It is estimated that one-third to one-half of men with BPH develop BPE, approximately half of men with BPH–LUTS have BPO, and up to 40% of men in a community have LUTS. LUTS is the most frequent cause of annoyance and decreased life quality in patients with BPH and associated with health-seeking behavior [2]. Although in most cases not life-threatening, BPH–LUTS has a tremendous socio-economic impact. Data from the Integrated Health Care Information Solutions National Managed Care Benchmark Database which included more than 30 health care plans between July 1997 and January 2003 and covered 25 million men aged 50 years or older demonstrated that BPE–LUTS is the fifth most commonly treated disease in the US, following cataracts, hypertension, osteoarthritis, and bursitis [3]. It was calculated from this database that medical costs of BPE–LUTS are among the seven most costly diseases. The chance of developing a significant clinical event (defined as acute urinary retention or need for prostate surgery) within 12 months after initiating medical treatment was the second highest of all diseases. Inpatient treatment of BPE–LUTS was responsible for 40% of the total costs which were only higher for cataracts, coronary artery diseases, osteoarthritis, and arrhythmias. It was concluded that improvement of the understanding of BPE (BPO or LUTS) would have the potential to significantly decrease costs. However, it is expected that the number of patients will dramatically increase as the average life expectancy increases worldwide, and therefore, further improvements in assessment and treatment of BPE, BPO, and LUTS will help in decreasing the cost related to BPH-related conditions. Assessment and treatment of BPH, BPE, BPO, or male LUTS has been and will be the “bread and butter” of urologists not only because of the pure amount of patients, but also because of the special skills necessary to treat these patients. Urology would definitely not exist as a separate specialization without BPH and BPH-specific treatments. Amazingly, the importance of this disease is not reflected by the amount of publications in peer-reviewed journals or abstracts of major urology congresses. Of 536 published articles in European Urology in 2009, only 12 articles (2.2%) dealt with BPH or male LUTS. Therefore, the number one topic of urology is clearly underrepresented in the current literature. The guest editors of this issue of the World Journal of Urology are therefore grateful to have the opportunity to draw more attention to the most frequent urological disease. We wish our readers a joyful and interesting time reading the following articles on medical or surgical treatment of clinical BPH. Yours,

Translation of benign prostatic hyperplasia guidelines into clinical practice

The aim of this article is to describe the current position of clinical practice guidelines for benign prostatic hyperplasia in daily management and identify the potential barriers that may hinder the implementation of guidelines into clinical practice. Recent studies have attempted to compare and grade benign prostatic hyperplasia clinical practice guidelines using appraisal instruments underlining the issues of quality and updates of guidelines. Surveys have evaluated the adoption of guidelines from the urological community and recent studies have made major contributions to our knowledge of the translation of evidence to daily practice. Numerous clinical practice guidelines (both national and international) for benign prostatic hyperplasia exist. High methodological quality clinical practice guidelines are likely to be the most beneficial to patients and strength of recommendations depends on available evidence. Efforts to implement guidelines are not always successful and a considerable variation especially in diagnostic assessment of benign prostatic hyperplasia has been reported. Difficulties in translation of benign prostatic hyperplasia guidelines into clinical practice are related to lack of knowledge but also to differences in routine practices, beliefs, cost, availability, and reimbursement policy. Bridging the implementation gap represents a challenging task for clinical practice guideline supporters.

The importance of patient perception in the clinical assessment of benign prostatic hyperplasia and its management

BJU InternationalVolume 95, Issue 1 p. 15-19 The importance of patient perception in the clinical assessment of benign prostatic hyperplasia and its management Sung Joon Hong, Corresponding Author Sung Joon Hong Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea,Professor Sung Joon Hong, Department of Urology, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul 120–752, Republic of Korea. e-mail: sjhong346@yumc.yonsei.ac.krSearch for more papers by this authorWalter Rayford, Walter Rayford Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA,Search for more papers by this authorLuc Valiquette, Luc Valiquette Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada, andSearch for more papers by this authorMark Emberton, Mark Emberton Institute of Urology, University College London, London, UKSearch for more papers by this author Sung Joon Hong, Corresponding Author Sung Joon Hong Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea,Professor Sung Joon Hong, Department of Urology, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul 120–752, Republic of Korea. e-mail: sjhong346@yumc.yonsei.ac.krSearch for more papers by this authorWalter Rayford, Walter Rayford Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA,Search for more papers by this authorLuc Valiquette, Luc Valiquette Department of Surgery (Urology), University of Montreal, Montreal, Quebec, Canada, andSearch for more papers by this authorMark Emberton, Mark Emberton Institute of Urology, University College London, London, UKSearch for more papers by this author First published: 20 December 2004 https://doi.org/10.1111/j.1464-410X.2005.05240.xCitations: 35Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume95, Issue1January 2005Pages 15-19 RelatedInformation

Diagnosis and Assessment of BPH: What Should Be Done? A Glance at International Clinical Practice Guidelines

Purpose: Clinical Practice Guidelines (CPGs) have gained recent popularity as they are meant to minimise the disparity between what clinicians do and what evidence there is to support them. Benign Prostatic Hyperplasia (BPH) (and associated Lower Urinary Tract Symptoms) is a typical clinical area where variations in diagnostic practice are common, and no agreed standards exist. Over the last decade a number of national and supra-national CPGs have been developed that provide advice on the management of BPH. We have subjected 2001 web-published CPGs on BPH to an appraisal against agreed methodological criteria and content analysis. Materials and methods: An electronic search (complemented by a hand-search) was used to identify 2001 web-based national and supra-national CPGs on BPH. Two independent assessors undertook content analysis and methodological appraisal of the CPGs using a validated instrument. Results: Eight CPGs were identified. There was much variation in both the CPG quality and the number and type of diagnostic tests recommended. The variation in recommendations may be explained by the differences in overall and methodological quality observed, as high-quality CPGs tended to recommend fewer diagnostic tests. All CPGs agreed that patient history and physical examination (including a DRE) should be performed on all symptomatic men and that patients’ symptoms should be assessed using a validated symptom score, e.g. IPSS. Other diagnostic tests were not unanimously recommended. Conclusion: BPH diagnostic management is a rather vague area and guidelines could be useful in setting recommendations based on the best available evidence. However, analysis of different guidelines showed a significant variation in their recommendations that could be explained by their overall and methodological quality.

Aspects of imaging in the assessment and follow up of benign prostatic hyperplasia.

For assessing patients suffering from benign prostatic hyperplasia and monitoring subsequent treatment, symptom questionnaires, uroflowmetry, prostate volume measurements, postvoiding residual urine volume measurements and pressure-flow studies may be used. This review highlights aspects of imaging in the assessment of benign prostatic hyperplasia, including volume determinations of prostate and postvoiding residual urine, texture imaging and biopsy guidance. Future developments are also briefly discussed.

Is Urethral Pressure Profilometry Useful in the Pre-operative Assessment of Benign Prostatic Hyperplasia?

Is Urethral Pressure Profilometry Useful in the Pre-operative Assessment of Benign Prostatic Hyperplasia?

Is urethral pressure profilometry useful in the preoperative assessment of benign prostatic hyperplasia?

The principal aim of this study was to provide an objective assessment of the potential role of urethral pressure profilometry as a technique for assessing prostatic size by direct comparison with endoscopic assessment of prostatic length and computed tomographic measurement of prostatic volume and length. There was a poor correlation between pre-operative prostatic length and amount resected in the operating theatre. The results obtained with urethral pressure profilometry correlated poorly with those obtained using the other techniques, and cannot therefore be relied upon in routine clinical practice. Although there was good correlation between the length of the prostate and prostatic size, assessed by pre-operative computed tomography, this correlated poorly with the amount of tissue resected at operation. Further studies need to be conducted to compare objectively the completeness of prostatic resection with the outcome following prostatectomy.

The clinical assessment of benign prostatic hyperplasia

The clinical assessment of benign prostatic hyperplasia

Scope of the problem. Indications for treatment and assessment of benign prostatic hyperplasia and its relationship to cancer.

Scope of the problem. Indications for treatment and assessment of benign prostatic hyperplasia and its relationship to cancer.

The clinical assessment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is the most common pathologic condition to afflict the aging male and the second most common cause of surgical intervention in men older than 60 years of age. Unfortunately, many men currently undergo prostatectomy without rigorous evaluation of their condition in terms of either transition zone hyperplasia or the extent to which this is causing bladder outflow obstruction. In this review, the importance of symptoms and symptom scoring systems associated with bladder outflow obstruction due to BPH were considered as well as the use of prostate specific antigen (PBS), uroflowometry, and abdominal and transrectal ultrasound studies in addition to magnetic resonance imaging (MRI). Patients undergoing surgical or non-surgical treatment for BPH should be studied by means of a formal symptom score, as well as repeated uroflowometry and abdominal ultrasound. PSA determination should also be made and those patients with values above 4 mg/ml should undergo transrectal ultrasound study and biopsy. Patients with values greater than 10 mg/ml should be considered for systematic biopsy whatever this reveals. MRI, with or without the new endorectal coil, is a promising tool for evaluation of the prostate, but more in a research than routine clinical context.

Imaging of the Prostate Gland

The advent of ultrasonography and the development of intrarectal techniques have made possible semiquantitative prostatic volumetrics for more accurate preoperative assessment of benign prostatic hyperplasia (BPH) as well as earlier diagnosis of prostatic carcinoma (PC). Computed tomography has increased the scope of prostatic imaging by including regional lymph nodes as well. Magnetic resonance imaging (MRI) has enabled viewing of the internal architecture of the prostate gland, thus allowing precise diagnosis of BPH and recognition of carcinoma. MRI is also the most exact method of staging PC.

Diagnostic assessment of benign prostatic hyperplasia

Clinical evaluations of benign prostatic hyperplasia (BPH) are based upon careful history taking, uroflowmetry, palpation of the prostate, and diagnosis of urinary infection or possible damage to the kidneys caused by outflow obstruction. Symptom assessment includes scoring by the patient of the four obstructive and five irritative symptoms of prostatic obstruction: a simple questionnaire is used. The scoring system should be reviewed with the urinary flow measurements as part of the workup. The various forms of ultrasound used for diagnosis, although invaluable, may not be assessed out of context, and the combination of digital palpation and endoscopy generally provide most information leading to a decision for operation. When available, perrectal ultrasound scanning should be used to investigate palpable abnormalities and to identify unexpected prostatic cancer.