Diagnosis Of BPH Research Articles

MP24-13 PATTERNS OF NON-SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE UNITED STATES

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms associated with BPH are highly prevalent among aging men and place a large socioeconomic burden on the US health care system. Few nationally representative datasets are available that have evaluated patterns of non-surgical care for men with BPH. To examine national practice patterns for incident BPH in men age 18þ, stratified by age 30 days apart, based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 600.x (BPH), 596.0 (bladder neck obstruction), 788.20 (urinary retention), and 788.21 (incomplete bladder emptying), were included between 7/1/2009 and 6/30/2012. Other inclusion criteria for incident BPH (vs prevalent disease) were continuous enrollment for 1 year before and 6 months after the first diagnosis date, and no BPH diagnosis during the previous year. Pts with ICD-9 diagnoses of neurologic conditions or urologic malignancy were excluded. Overall outcomes through 9/30/2013 were analyzed. Variables of interest included pt comorbidities, demographics, diagnostic tests, and medication prescriptions. RESULTS: A total of 38,252 men were included. The majority (24,814, 65%) were aged 65þ, and 41% had 1þ comorbid conditions. Diagnostic tests included post-void residual measurement in 21%, renal ultrasound in 9%, cystoscopy in 6%, prostate ultrasound in 3%, and urodynamics in 1% of pts. A total of 58% of men were prescribed BPH medications, including alpha blockers (50%) and/or 5-alpha reductase inhibitors (24%). Older men had higher rates of prescriptions for both alpha blockers and 5-alpha reductase inhibitors than younger men (Table 1). CONCLUSIONS: Men aged 65þ had higher rates of prescriptions overall, possibly due to more severe symptoms among older men. The relatively low rate of renal ultrasound and other diagnostic tests may reflect adherence to the 2010 American Urological Association BPH guidelines. Source of Funding: No financial support was received for this study.

Effects of Serenoa Repens, Selenium and Lycopene (Profluss®) on chronic inflammation associated with Benign Prostatic Hyperplasia: results of “FLOG” (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study

To evaluate the efficacy of Profluss® on prostatic chronic inflammation (PCI). We prospectively enrolled 168 subjects affected by LUTS due to bladder outlet obstruction submitted to 12 cores prostatic biopsy for suspected prostate cancer + 2 cores collected for PCI valuation. First group consisted of 108 subjects, with histological diagnosis of PCI associated with BPH and high grade PIN and/or ASAP, randomly assigned to 1:1 ratio to daily Profluss® (group I) for 6 months or to control group (group Ic). Second group consisted of 60 subjects, with histological diagnosis of BPH, randomly assigned to 1:1 ratio to daily Profluss® + a-blockers treatment (group II) for 3 months or to control group (group IIc). After 6 months first group underwent 24 cores prostatic re-biopsy + 2 cores for PCI while after 3 months second group underwent two-cores prostatic for PCI. Specimens were evaluated for changes in inflammation parameters and for density of T-cells (CD3, CD8), B-cells (CD20) and macrophages (CD68). At follow-up there were statistical significant reductions of extension and grading of flogosis, mean values of CD20, CD3, CD68 and mean PSA value in group I compared to Ic, while extension and grading of flogosis in group II were inferior to IIc but not statistical significant. A statistically significant reduction in the density of CD20, CD3, CD68, CD8 was demonstrated in group II in respect to control IIc. Serenoa repens+Selenium+Lycopene may have an anti-inflammatory activity that could be of interest in the treatment of PCI in BPH and/or PIN/ASAP patients.

Diagnosis of BPH and treatment of LUTS among GPs: a European survey

This survey was conducted in France, Germany, Italy, Spain and UK, with the aim to assess diagnosis and therapy of BPH patients in clinical practice. A selected cohort of 455 general practitioners (GPs) in Europe were asked to report information on BPH patients with lower urinary tract symptoms (LUTS), including patient characteristics, diagnostic procedures, severity of illness, symptoms duration and underlying conditions. The GPs provided data relating to 886 patients. The diagnostic work-up included description of symptoms (74.9-85.1%), rectal examination (55.4-82.1%) and the determination of PSA (79.1-94.7%). Transrectal sonography was popular in Italy and France (51.1% and 55.9%, respectively), less so in Germany (15.3%) and Spain (13.1%) and not at all in the UK (2.3%). At diagnosis, the most common symptom was nocturia (71-88%), followed by frequency (15-79%), urgency (43-68%) and weak stream (47-64%). The most common combination was the triad nocturia-frequency-feeling of incomplete emptying (22-31%). The mean ± SD LUTS severity score was similar in all countries: The main aim of treatment was the resolution of nocturia, which had an average score that reflected an important need (> 3.5) closely followed by frequency (3.3-3.9). This survey has shown that the most common LUTS is nocturia. Analyses of the symptoms' pattern revealed that the most common combination appears to be the triad nocturia-frequency-feeling of incomplete emptying. An association between LUTS and heart disease, diabetes and hypertension suggests that the pharmacological treatment should be devoid of effects on the cardiovascular system. With alpha blockers as first line treatment of LUTS, respondents were more concerned with hypotensive episodes resulting in falls, rather than about other typical side effects (e.g. ejaculation disorders and lowered libido). The survey highlights educational needs in diagnostics.

Original Paper Inflammatory changes in biopsy specimens from patients with suspected prostate cancer

IntroductionProstate cancer (PCa) is one of the most commonly diagnosed cancers in elderly men, and accounts for 30% of all newly diagnosed cases of cancer. The development of the ‘clinically insignificant’ prostate cancer into its invasive form is still unclear, and it is believed that chronic inflammation may play its role, as proposed by De Marzo in 1999. However, there is no clear opinion on the subject of existence of dependencies between changes of the inflammatory type and PCa.Material and methodsThe study involved 1,010 men, suspected of prostate cancer development by positive digital rectal examination (DRE) and/or elevated PSA value. The 10 cores, TRUS guided biopsy was performed. In those with ASAP, HG–PIN or inflammation the second biopsy was proposed.ResultsIn the first biopsy PCa was diagnosed in 336 patients (33.27%). ASAP was found in 58 (5.74%), HG–PIN in 82 (8.11%), and the coexistence of both was found in 19 (1.88%). Chronic prostatitis was diagnosed in 101 (10%) men. Of those who underwent second biopsy, PCa was diagnosed in six of 19 patients (31.57%) who were diagnosed with HG–PIN in the first biopsy, in four of 40 (10%) with BPH in the first biopsy, in four of 18 (22.22%) with ASAP or LG–PIN together with ASAP, and in two out of five (40%) with the coexistence of ASAP and HG–PIN. Malignancy was not confirmed in any of the patients in whom the diagnosis of BPH, HG–PIN, or ASAP was accompanied by chronic prostatitis.ConclusionsChronic prostatitis does not significantly increase the value of PSA in patients with benign changes (BPH). The presence of prostatitis in the first biopsy did not predict cancer in subsequent biopsy, because the second biopsy did not reveal prostate cancer in any of the patients in whom prostatitis was diagnosed in the first biopsy.

Patient Selection and Counseling before Prostatic Arterial Embolization

Prostatic arterial embolization (PAE) for relief of lower urinary tract symptoms (LUTS) in patients with prostate enlargement or benign prostatic hyperplasia (PE or BPH) is an experimental procedure with promising preliminary results. Patient evaluation and selection before PAE is paramount to improve technical and clinical results. Our inclusion criteria for PAE include: male patients, age>40 years, prostate volume>30 cm(3) and diagnosis of PE or BPH with moderate to severe LUTS refractory to medical treatment for at least 6 months (International Prostate Symptom Score [IPSS]>18, or quality of life [QoL]>3, or both) or with acute urinary retention refractory to medical therapy. Exclusion criteria include: malignancy (based on pre-embolization digital rectal and transrectal ultrasound [TRUS] examinations and prostate specific antigen [PSA] measurements with positive biopsy), large bladder diverticula, large bladder stones, chronic renal failure, tortuosity and advanced atherosclerosis of a) iliac or b) prostatic arteries on pre-procedural computed tomographic angiography (CTA), active urinary tract infection and unregulated coagulation parameters. Approximately one-third of the patients seen initially on consultation satisfy the criteria to be selected for PAE after undergoing the pre-procedural patient evaluation workflow. In the pre-procedural consultation patients are informed of all possible therapeutic options for LUTS with the investigational nature of the procedure being strongly reinforced. The major advantage of PAE relies on the minimally-invasive nature of the technique with minimal morbidity and rapid recovery,and it being performed as an outpatient procedure. However, the experimental nature and uncertain clinical outcome should also be weighed before opting for PAE. All these considerations should be explained to the patient and discussed during the informed consent before PAE.

Abstract 3592: Risk factors of prostate cancer in African American men

Abstract Background. African American men have 1.6 times the incidence and 2.4 times the mortality rate of prostate cancer, compared to Caucasian men. Thus, prostate cancer constitutes one of the most striking racial health disparities, the causation of which is not well understood. Main hypothesis. We hypothesized that select clinical and/or bio-behavioral risk factors are associated with prostate cancer in African American men. Participants and Methods. 105 African American men aged 34-80 (35 cases and 70 controls) were recruited. Univariable and multivariable logistic regression models were built to test the marginal and joint effects of the variables when predicting the cancer status. Results. In the univariable regression models, PSA (ng/ml; p<.001), smoking (cigarettes/day; p=0.011), diagnosis of benign prostatic hyperplasia (BPH, yes/no; p<.001), diagnosis of prostatitis (yes/no; p<.001) and prostatic intraepithelial neoplasia (PIN, yes/no; p=<.001) were independently associated with the prostate cancer diagnosis. However, only PSA (4.340; (1.484, 12.689)) and diagnosis of BPH (14.248; (1.132, 179.310)) remained significant in the age-adjusted multivariable logistic regression model. Conclusions. Our results suggest that, as expected, PSA levels are associated with prostate cancer in African American men. Interestingly, a history of BPH is also associated with prostate cancer in African American men. Despite the limitation of a small sample size, our data is in agreement to a recent report (Pettaway et al, 2011) in which African Americans with BPH were observed to have a much greater risk of developing prostate cancer than similar Caucasian men, highlighting differences in the biology of prostate cancer between populations. References Curtis A. Pettaway, Lois E. Lamerato, Michael T. Eaddy et al. Benign prostatic hyperplasia: racial differences in treatment patterns and prostate cancer prevalence. BJU International (1 0 8) 1 3 0 2 - 8, 2011 Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3592. doi:1538-7445.AM2012-3592

The effects of combination therapy with dutasteride plus tamsulosin on clinical outcomes in men with symptomatic BPH: 4-year post hoc analysis of European men in the CombAT study

CombAT (Combination of Avodart and Tamsulosin) was a randomised, double-blind study in men (n=4844) aged ≥ 50 years with a clinical diagnosis of BPH. Patients were randomised to daily tamsulosin 0.4 mg, dutasteride 0.5 mg or both for 4 years. The primary endpoint was time to acute urinary retention (AUR) or BPH-related surgery. Secondary endpoints included BPH clinical progression, symptoms and maximum urinary flow rate. A post hoc analysis of data from the European subgroup was conducted. A total of 2925 men were randomised to treatment in Europe as part of CombAT (tamsulosin, n=972; dutasteride, n=970; combination, n=983). Combination therapy significantly reduced the relative risk of AUR or BPH-related surgery compared with either monotherapy at 4 years, and also significantly reduced the risk of BPH clinical progression. Combination therapy also provided significantly greater symptom improvement than either monotherapy at 4 years. Safety and tolerability of dutasteride plus tamsulosin was consistent with previous experience of this combination and with the monotherapies. These data provide further evidence to support the use of long-term combination therapy (dutasteride plus tamsulosin) in men with moderate-to-severe lower urinary tract symptoms because of BPH and prostatic enlargement. The results in the European subgroup are generally consistent with those in the overall study population.

1719 RACIAL DISPARITIES IN THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

Medi-Cal is the largest of the state Medicaid programs in the US and provides care to over 7 million indigent and disabled persons every year. Males 40 years and older enrolled in Medi-Cal with an incident diagnosis of BPH and at least 12 months follow-up were studied to evaluate patterns of care for this condition. All comparisons were adjusted for age at study entry. Logistical regression was used to calculate the OR and 95% CI. RESULTS

Prostate biopsy in patients with long-term use of indwelling bladder catheter: What is the rationale?

Acute urinary retention (AUR) is expected to occur in 2% to 39% men with benign prostatic hyperplasia. To date, no study has elucidated the effect of long-term use of indwelling bladder catheter on serum prostate specific antigen (PSA) levels and on the incidence of prostate cancer (CaP). The aim of the present study is to analyze the incidence of CaP in patients with long-term use of indwelling bladder catheter and determine some practice patterns on this issue. The study comprised a retrospective analysis of data from 1,651 patients who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy from July 2004 to June 2009. Among these patients, 198 (12%) were using an indwelling bladder catheter during the biopsy for at least 1 month. The incidence of CaP was recorded according to total PSA levels. Other variables such patient age, free/total PSA rate, PSA density, prostate volume, and duration of catheter use was also analyzed. Men with a digital rectal examination suspicious for cancer were not considered for analysis. Median patient age was 71 years (37 to 89 years). Overall, 25% of patients presented a CaP diagnosis. CaP incidence according to the PSA levels was 0%, 18.9%, 24.5%, and 40.6% for patients with PSA ≤4.0, 4.1-10.0, 10.1-20.0, and >20.0 ng/ml, respectively. When prostate volume was analyzed together, we demonstrated that only 1 (2.4%) patient with PSA below 10.0 ng/ml and prostate volume >60 g had CaP. Median total PSA, PSA density, and prostate volume were statistically different between patients with and without CaP. Prostate biopsy should not be indicated for all patients with diagnosis of BPH and AUR who present an elevated PSA level. Patients with PSA below 10.0 ng/ml, and prostate volume >60 g should only undergo biopsy in selected cases. Patients with PSA >20.0 ng/ml and a prostate volume ≤60 g are at higher risk of CaP diagnosis.

The value of appropriate assessment prior to specialist referral in men with prostatic symptoms

Referrals to Urology OPD of men with a likely diagnosis of BPH are common. To review referrals to OPD of men with lower urinary tract symptoms (LUTS) to establish how many could have been managed without specialist assessment. We reviewed records of 200 male patients referred to OPD with LUTS. We assessed whether the referral source had performed digital rectal examination (DRE), International Prostate Symptom Score (IPSS), Bother Score or PSA level. 74% of patients were referred by GPs. In 31.5% of cases DRE was performed prior to referral. One GP had completed an IPSS, none a Bother Score. 96% had a PSA checked before OPD. Ultimately, 88.5% of our patients were diagnosed with BPH. With better pre-assessment in the form of DRE, IPSS and Bother Score, allied to a PSA check, many patients with LUTS could be managed in a primary care setting.

BPH combined with prostatitis:differences in clinical characters

Objective To analysis the differences of age, prostate volume, serum PSA and PSAD, IPSS between the BPH and BPH with prostatitis. Methods Clinical data of 100 patients whom received surgical treatments with a pathologic diagnosis of BPH were retrospectively analyzed. The occurrence of prostatitis was determined by pathology. The differences of age, prostate volume, serum PSA and PSAD, IPSS between the BPH cases and BPH with prostatitis cases were analyzed. The capability of B-ultrasound in diagnosis of the prostatitis combined with BPH was evaluated. Re-suits 66% BPH patients were found combined with prostatitis. There was a significant correlation between inflammatory infiltration grade and aggressiveness grade (r= 0. 772, P<0. 001). There was a moderate correlation between prostate volume and patient age(r= 0. 420, P<0. 001). There was a low correlation between serum PSA and patient age (r= 0. 258, P<0. 01) while no significant correla-tion between PSAD and age. The patient age of BPH combined with prostatitis group was significantly higher than BPH group (P<0. 05). Average prostate volume of combined with prostatitis group was significantly higher than BPH group (P<0. 05). There was a significant correlation between prostate volume and inflammatory infiltration grade(r=0. 292, P=0. 003), PSA and aggressiveness grade(r=0. 254, P=0.007). Both average PSA and PSAD of BPH combined with prostatitis group were signif-icantly higher than the BPH group (P<0. 05). When the factor of difference in age distribution was considered, the conclusion were still valid (P<0.05). On α= 0.05 level, relatively low correlations were found between PSA and inflammatory infiltration grade(r=0. 319, P=0. 001), PSA and aggres-siveness grade(r=0. 214, P=0. 032), PSAD and inflammatory infiltration grade ( r=0. 212, P=0. 034). There was no significant correlation between PSAD and aggressiveness grade(r=0.081 ,P=0.425). Average IPSS of combined with prostatitis group were significantly higher than BPH group. On diagnosis of the combined prostatitis in BPH, the sensitivity of ultrasonic was 21.2% with a speci-ficity of 82.4%. Conclusions Prostatitis is often found in more than half BPH samples. The BPH with prostatitis usually has bigger prostate volume, higher PSA, PSAD and may present relatively se-verer clinic syndromes. Key words: Benign prostate hyperplasia; Prostatitis; Clinical research

Fotovaporización prostática (FVP) mediante láser verde: Ventajas quirúrgicas en pacientes de riesgo

It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period.

The Prevalence of High Grade Prostatic Intraepithelial Neoplasia in Prostatic Biopsies Diagnosed As benign Prostatic Hyperplasia at Muhimbili National Hospital, Dar es Salaam.

Setting: The study was conducted at Muhimbili National Hospital in Dar es Salaam in the department of Histopathology and Morbid Anatomy. Study design: The study was a retrospective cohort type in which prostatic biopsy reports of patients with histological diagnosis of BPH were microscopically re-evaluated in order to reveal whether there was any presence or absence of HGPIN, which is a significant risk factor for the development of prostatic adenocarcinoma. Objective: To determine the prevalence of high-grade PIN in BPH as diagnosed at Muhimbili National Hospital and relate it to its histomorphological types as well as the ages of the patients and its distribution in different types of prostatic biopsies and also compare the distribution of HGPIN with that of adenocarcinoma in prostatic biopsies during the same period of study. Methodology: The data was retrieved from register books, histological reports and computer files. The data was used as a source of information in order to determine the number of PC and BPH histologically reported , types of prostatic biopsies, and age of the patients. H&E stained slides on which the diagnosis of PC or BPH was previously made were retrieved from archives and then microscopically reviewed for histological confirmation of the diagnosis. The slides with the diagnosis of BPH were further re-examined for the presence or absence of HGPIN. For those slides which were missing, their corresponding paraffin blocks were re-cut, stained with H&E and reported for the presence or absence of high-grade PIN. Results: Out of 687 specimens of prostatic biopsies received in 3 years (mean 229 per year), 321(46.7%) were diagnosed as adenocarcinoma and 366 (53.3%) were supposedly diagnosed as BPH. The mean age of patients with prostatic cancer (PC) was 75.6 years while that of BPH was 67 years. The number of patients with PC below 60 years was 23 (7.2%) and those with BPH was 46 (12.6%). However, 122 (38%) patients with PC were between 60-70 years of age while in those with BPH, 172 (47%) were in the same age range. Of the 366 patients who were diagnosed as having BPH, 163 (44.5%) were also found to have HGPIN. The mean age of patient with high-grade PIN in PBH was 69.6 years. In the 163 patients with HGPIN, 20(12.3%) were below 60 years of age , 83 (50.9%) were between 60-70 years and 60 (36.8%) were above 70 years. Of the 366 prostatic specimens in which the diagnosis of BPH was made, 238 (65%) were from needle biopsy (NB), 47 (12.9%) from transurethral resections of prostate (TURP) and 81(22.1%) were from open prostatectomy (OP). Similarly, out of 238 NB, 82 (34.5%) had HGPIN while in 47 TURP biopsies, 21 (44.7%) had HGPIN and in 81 RP specimens, 60 (74.1%) had HGPIN. With regard to morphological patterns of PIN, tufting was the most frequent in all types of biopsies followed in descend order by Cribriform, micropapilary, and flat. Conclusion: The study has conclusively shown that there is a high prevalence of HGPIN in prostatic biopsies diagnosed and reported solely as BPH at our hospital as has been suspected before. The age distribution of HGPIN has indicated that the lesion is an intermediate stage between BPH on one hand and PC on the other, further confirming that HGPIN is precursor or pre-invasive stage to invasive prostate carcinoma. The identification of increased number of HGPIN in biopsy specimens has an important implication for the management of the patient. Recommendations: Bearing in mind that HGPIN is strongly predictive of the presence of prostatic carcinoma, HGPIN should be included in pathology report. The finding of HGPIN in a patient should clinically be closely followed-up with serum PSA, digital rectal examination (DRE) and ultrasound, preferably trans rectal ultrasound or repeated needle biopsy for a defined period of time. Tanzania Medical Journal Vol. 23 (1) 2008: pp. 1-4

The Effect of Dutasteride on Serum Prostate-specific Antigen (PSA) in Patients with Benign Prostate Hypertrophy

Purpose: 5α reductase, dutasteride, has widely used to treat enlarged prostate (BPH). By suppressing the conversion of testosterone to dihydrotestosterone it decreases serum prostate-specific antigen (PSA) which is very important screening marker for prostate cancer. We evaluate the early serum PSA changes after dutasteride treatment to Korean BPH patients. Materials and Methods: A total 159 men with a clinical diagnosis of BPH and no evidence of prostate cancer were enrolled. They were treated with dutasteride 0.5mg daily for 12 months. Serum PSA was evaluated at 2, 6, and 12 months after the medication. Result: Dutasteride statistically significantly reduced serum PSA to 0.70±0.52, 0.64±0.35, and 0.59±0.49 from baseline level at 2, 6, and 12 months after the medication, respectively. However, there was no statistical significance among the three groups in serum PSA changes after dutasteride. There were statistically significant correlations between a high pre-treatment serum PSA level and a large reduction of follow-up PSA levels at 2, 6, and 12 months after dutasteride treatment. Conclusions: The reduction of serum PSA is variable in patients to patients at 2, 6, and 12 months after dutasteride treatment. The patient with high initial serum PSA revealed a large reduction of serum PSA level after treatment. The traditional concept that follow-up serum PSA level should be doubled for prostate cancer screening may overestimate real serum PSA level within 12 months in Korean men receiving 5α reductase inhibitors. (J Korean Continence Soc 2008;12:42-47)

Validación de la versión española del Cuestionario Benign Prostatic Hyperplasia Impact Index. “Estudio Validart”

Benign Prostatic Hyperplasia is a chronic disease that affects Health related quality of life (HRQL). In Spain there are no specific questionnaires to assess HRQL in patients suffering from BPH. The objective of this study was to validate the Spanish version of the Benign Prostatic Hyperplasia Impact Index (BII) questionnaire.Study participants were men over 49 with confirmed BPH diagnosis and evaluated in three visits. Psychometric properties of the questionnaire were analyzed in terms of validity, reliability and sensitivity to change.A total of 1,719 men with mean (SD) age 68.36 were evaluated and classified according to the BPH severity. Both longitudinal and construct validity (r>0.6) of the BII questionnaire were moderate-high. Internal consistency (alpha=0.91), test-retest reliability (CCI=0.8) and sensitivity to change (effect size=0.6) showed good results. The HRQL improved significantly during the monitoring period (p<0.01).There were no available specific HRQL questionnaires for Spanish population with BPH until now. The Spanish version of the BII questionnaire fulfils with the psychometric properties that are necessary to evaluate HRQL in patients with BPH; furthermore, it has been confirm the considerable impact of this disease in the quality of life of this patients.

Evaluación económica del tratamiento médico de la hiperplasia benigna de próstata (HBP) en España en atención especializada. Aplicación al costeefectividad de dos fármacos habitualmente utilizados en su tratamiento

To develop a pharmacoeconomic study in order to know the average cost of BPH diagnosis and follow-up in Spain in the Urology Department setting from the perspective of the public health system, considering two frequently used drugs in the Spanish Healthcare environment, an alpha-blocker (tamsulosin) and the lipido-sterolic extract of Serenoa repens (Permixon).Direct healthcare costs of BPH diagnosis and treatment were determined for each clinical stage according to the International Prostate Symptom Score (IPSS): mild, moderate and severe. Data on the usage and unit costs of healthcare resources were obtained from a semi-structured interview with clinical experts. The clinical efficacy of the medical treatments was obtained from the PERMAL clinical study, where therapeutic equivalence between the two studied drugs was observed.For patients treated in the Urology Department setting, the average annual cost of diagnostic tests and medical visits related to mild, moderate or severe BPH symptoms were, respectively, Euro 124, Euro 207, and Euro 286. The average annual cost of the drugs, including adverse effects treatment, was Euro 211 for Permixon and Euro 346 for tamsulosin.Costs of medical care of BPH increases with symptom intensity. Pharmacological treatment makes up a significant part of the disease's cost. According to the model used, treatment with Permixon is considerably more cost-effective than with tamsulosin, offering average yearly savings of Euro 135 per patient.

POD-06.01: Profile and management of patients treated for the first time for LUTS/BPH in four European countries

BPH diagnosis and management have dramatically evolved in the last decade. Recent information from real life is scarce. This study aimed at describing the profile and management of patients medically treated in primary care in four European countries.

P-581: Incidence and clinical correlates of ejaculatory dysfunction in the general urology population

Ejaculatory complaints (ECs), such as painful, retrograde, diminished ejaculation or anejaculation, are issues often overlooked in the male sexual health evaluation. Population studies in older patients (>50years) have shown ECs to be quite prevalent when specifically screened for and to be independently associated with the presence of lower tract urinary symptoms (LUTS) as measured by such studies as the IPSS. The purpose of this study was to evaluate the prevalence of ECs in a younger urology population and evaluate their relationship to patient demographic and urologic health variables. Prospective patient questionnaire. From the period of time between March 2005 and September 2005, male patients in a combined male infertility/general urology clinic were asked to participate in a voluntary, IRB-approved study. Patients were given a packet of questionnaires which were anonymous and mailed back to the clinic after completion. Questionnaires included a basic demographic and medical history questionnaire, the IPSS, and the IIEF-5 (the first 5 questions of the IIEF). Ejaculatory symptoms were measured by using the ejaculatory domain of the Male Sexual Health Questionnaire (MSHQ-EjD) which consists of 7 questions rated from 1 to 6, in which a higher score indicates more severe ECs (range 7-41). Sixty male patients completed and mailed back the questionnaires. Average age of the patients was 45 years (range 20-77). The mean MSHQ-EjD score for the entire group was 14.1. Only one patient out of 60 had no ejaculatory complaints at all. On univariate statistical analysis, history of BPH diagnosis, history of erectile dysfunction (ED) diagnosis, and IIEF-5, were all significantly correlated (p<0.05) with higher (worse) MSHQ-EjD scores. Factors not found to be statistically correlated included race, BMI, educational status, smoking, IPSS, and prior vasectomy. On multivariate analysis the only factor which was found to be independently predictive of ejaculatory symptoms was the IIEF-5. The mean IIEF-5 score was 19.4 (range 0-25), and mean IPSS score was 7.7 (0-27). Ejaculatory complaints are a common finding in the middle age male urology population. On multivariate analysis, IIEF-5 scores were found to significantly predict more severe ejaculatory complaints. As opposed to earlier studies in older men, the IPSS was not found in this study to correlate with the presence of ejaculatory problems.

Prevalence of conditions potentially associated with lower urinary tract symptoms in men

To estimate the frequency of conditions associated with lower urinary tract symptoms (LUTS, typically included when assessing benign prostatic hyperplasia, BPH), as other causes of LUTS should be excluded when diagnosing BPH, using data from the Olmsted County Study of Urinary Symptoms and Health Status among Men. During 1989-91, Caucasian men aged 40-79 years were randomly selected from the Olmsted County population. Before contact, eligibility was determined by reviewing the community medical records. Baseline exclusion criteria included comorbid pre-existing conditions or treatments, e.g. prostate, bladder or lower back surgery, bladder neck contracture or cancer, diabetes with lower extremity amputation, and neurological diseases, including Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, tabes dorsalis and stroke. Men with these conditions were excluded from the Olmsted County Study at baseline, because these conditions are potentially associated with LUTS. Of the 5100 randomly sampled men, 13.4% met at least one of the pre-existing exclusion criteria. Individually, the frequency of exclusions was 7.8% for prostate cancer or surgery, 4.8% for back surgery, 1.3% for bladder surgery and 1.4% for neurological conditions. All other conditions represented <1.0% of the study exclusions. Older men were more likely to meet at least one of the exclusion criteria, with men in their fifth to eighth decade having a total exclusion frequency of 1.4%, 5.4%, 8.5% and 32.8%, respectively. The most common reason for men in their fifth decade to be excluded was lower back surgery (0.9%), whereas the most common reason in the eighth was prostate surgery (21.8%). In men, conditions that may contribute to LUTS, other than BPH, are prevalent in the community and increase in frequency with age. It is important that other conditions associated with LUTS be excluded before a definitive diagnosis of BPH. Any oversight in this initial evaluation can potentially result in misclassification bias, misdiagnosis and incorrect treatment of patients.

Treatment of Benign Prostatic Hyperplasia and Occurrence of Prostatic Surgery and Acute Urinary Retention: A Population-Based Cohort Study in The Netherlands

To assess and compare the risk of prostatic surgery in (subsets of) patients with a diagnosis of BPH. We sought to expand on data of an earlier pharmacy-based study by obtaining more information on BPH disease parameters by using a Dutch GP-based research database. A retrospective cohort study (1994-mid-year 2002) was conducted among 1430 men aged > or =45 years with > or =6 months of registration with the GP. BPH case identification was based on review of medical records. Overall, we found that there was no difference in the risk of prostatic surgery between patients on medical treatment and watchful waiting. Patients using 5alpha-reductase inhibitors (5-ARIs) at any stage had a statistically significant reduced risk of surgery compared to patients using alpha-blockers only: adjusted hazard ratio 0.35 (95%CI: 0.13-0.96). The routine collection of BPH parameters were insufficient to be useful in the analysis. Patients using 5-ARIs seemed to have a reduced risk of prostatic surgery compared to patients using alpha-blockers. However, it was unknown whether the disease profile of 5-ARI users is different compare to non-5-ARI-treated and untreated patients with BPH, as detailed medical information necessary to characterise patients according to the BPH disease severity and development of disease parameters is not routinely recorded by GPs.