Lower Urinary Tract Symptoms Due To Benign Prostatic Hyperplasia Research Articles

Evolution of healthcare costs for lower urinary tract symptoms associated with benign prostatic hyperplasia.

With the ubiquity of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) in older men, costs related to this highly prevalent disease are likely significant but not well defined. With this study, we hoped to define costs related to LUTS/BPH care. We utilized the Optum© de-identified Clinformatics® Data Mart Database (CDM) for privately insured male enrollees aged 40-64years with LUTS/BPH (N ≈ 100,300 annually) and the Centers for Medicare and Medicaid Services Medicare 5% Sample for male beneficiaries aged 65 + years with LUTS/BPH (N ≈ 147,800 annually). Annual LUTS/BPH-related expenditures from 2004 to 2013 were age standardized and calculated overall and by age and service location. The Medicare cohort demonstrated a 23% increase in total costs over the study period with a 28% decrease in CDM costs. Decreases in inpatient hospital charges (45% for Medicare, 55% for CDM) were offset by increasing hospital-based outpatient fees (120% for Medicare, 87% for CDM). Overall, we estimated a total cost of at least $1.9 billion for treatment of men with LUTS/BPH for 2013. Per person expenditures increased with age within cohorts with an average per-person cost of $269 (CDM) and $248 (Medicare) in 2013. The distribution of healthcare expenditures for LUTS/BPH shifted across practice settings from 2004 to 2013, with increasing outpatient relative to inpatient expenditures. Total direct costs for LUTS/BPH in 2013 were at least $1.9 billion, not accounting for indirect costs or certain unmeasured populations.

Impact of disease progression on individual IPSS trajectories and consequences of immediate versus delayed start of treatment in patients with moderate or severe LUTS associated with BPH

PurposeDespite superiority of tamsulosin–dutasteride combination therapy versus monotherapy for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH), patients at risk of disease progression are often initiated on α-blockers. This study evaluated the impact of initiating tamsulosin monotherapy prior to switching to tamsulosin–dutasteride combination therapy versus immediate combination therapy using a longitudinal model describing International Prostate Symptom Score (IPSS) trajectories in moderate/severe LUTS/BPH patients at risk of disease progression.MethodsClinical trial simulations (CTS) were performed using data from 10,238 patients from Phase III/IV dutasteride trials. The effect of varying disease progression rates was explored by comparing profiles on- and off-treatment. CTS scenarios were investigated, including a reference (immediate combination therapy) and six alternative virtual treatment arms (delayed combination therapy of 1–24 months). Clinical response (≥ 25% IPSS reduction relative to baseline) was analysed using log-rank test. Differences in IPSS relative to baseline at various on-treatment time points were assessed by t tests.ResultsDelayed combination therapy initiation led to significant (p < 0.01) decreases in clinical response. At month 48, clinical response rate was 79.7% versus 74.1%, 70.3% and 71.0% and IPSS was 6.3 versus 7.6, 8.1 and 8.0 (switchers from tamsulosin monotherapy after 6, 12 and 24 months, respectively) with immediate combination therapy. More patients transitioned from severe/moderate to mild severity scores by month 48.ConclusionsCTS allows systematic evaluation of immediate versus delayed combination therapy. Immediate response to α-blockers is not predictive of long-term symptom improvement. Observed IPSS differences between immediate and delayed combination therapy (6–24 months) are statistically significant.

PD10-10 3-YEAR OUTCOMES OF SEXUAL FUNCTION AFTER WATER VAPOR THERMAL THERAPY (REZŪM®) AND MEDICAL THERAPY FOR TREATMENT OF LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC HYPERPLASIA (LUTS/BPH): RIGOROUS ASSESSMENT OF SEXUAL FUNCTION QUESTIONNAIRES WITH ITEM RESPONSE THEORY MODELING

INTRODUCTION AND OBJECTIVES:Medical therapy for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) has a negative impact on sexual function. Three year data from the random...

Effectiveness of a web-based treatment decision aid for men with lower urinary tract symptoms due to benign prostatic hyperplasia.

To evaluate the effectiveness of a web-based decision aid (DA), with values clarification exercises compared with usual care, for men with lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). Between July 2016 and January 2017, all new patients with LUTS/BPH who consulted the urologist were invited to use the DA and participate in this prospective questionnaire study. Patients who consulted the urologist between December 2015 and February 2016 served as controls. The DA was designed to support patients in making a well-informed treatment decision, corresponding with their personal preferences and values. Well-informed decision was measured by using a knowledge questionnaire. Value congruent decision was measured by the correspondence between responses on nine value statements and chosen treatment. The primary outcome, decision quality, was defined as the combination of well-informed decision and value congruent decision. Secondary outcomes were decisional conflict, involvement and received role in shared decision-making, decisional regret, and treatment choice. A total of 109 DA-users and 108 controls were included. DA-users were younger (68.4 vs 71.5 years; P = 0.003) and their education level was higher (P = 0.047) compared with the controls. Patients who used the DA made a well-informed and value congruent decision more often than the control group (43% vs 21%; P = 0.028). DA-users had less decisional conflict (score 33.2 vs 46.6; P = 0.003), experienced a less passive role in decision-making (22% vs 41%; P = 0.038), and reported less process regret (score 2.4 vs 2.8; P = 0.034). Furthermore, DA-users who had not used prior medication chose lifestyle advices more often than the control group (43% vs 11%; P = 0.002). Outcomes were adjusted for significantly different baseline characteristics. The LUTS/BPH DA seems to improve the decision quality by supporting patients in making more well-informed and value congruent treatment decisions. Therefore, further implementation of this DA into routine care is suggested.

MP27-20 CONVECTIVE RADIOFREQUENCY WATER VAPOR ENERGY PROSTATE ABLATION (REZUM®) EFFECTIVELY TREATS URINARY RETENTION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-20 CONVECTIVE RADIOFREQUENCY WATER VAPOR ENERGY PROSTATE ABLATION (REZUM®) EFFECTIVELY TREATS URINARY RETENTION Nikhil Gupta, Bradley Holland, Kristin Delfino, Danuta Dynda, J. Randolf Beahrs, Lennart Wagrell, Ahmed El-Zawahry, Tobias Köhler, and Kevin McVary Nikhil GuptaNikhil Gupta More articles by this author , Bradley HollandBradley Holland More articles by this author , Kristin DelfinoKristin Delfino More articles by this author , Danuta DyndaDanuta Dynda More articles by this author , J. Randolf BeahrsJ. Randolf Beahrs More articles by this author , Lennart WagrellLennart Wagrell More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , Tobias KöhlerTobias Köhler More articles by this author , and Kevin McVaryKevin McVary More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.812AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES New minimally invasive surgical therapies (MIST) for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) such as prostatic urethral lift and convective radiofrequency water vapor energy prostate ablation (WaVE) have shown promising intermediate-term results in improving voiding symptoms. However, the initial trials excluded men in urinary retention; thus the ability of these new technologies to achieve catheter independence has not been evaluated. This study investigated outcomes of patients with urinary retention at baseline treated with WaVE. METHODS Patients in urinary retention who underwent WaVE were retrospectively identified. Urinary retention was defined as dependence on an indwelling catheter or performance of clean intermittent catheterization (CIC) for bladder emptying. Age, duration of catheter dependence, prostate size, baseline IPSS and PVR, and number of treatments per procedure were recorded. For subjects with successful trials without catheter (TWOC), time to catheter independence and post-procedure PVR and IPSS were recorded. Baseline characteristics between subjects with successful TWOC and unsuccessful TWOC were compared using Mann Whitney U test and T-test for continuous variables and Chi-square test and Fisher′s exact test for non-continuous variables. RESULTS 30 patients were identified with urinary retention who underwent WaVE. 22 subjects had an indwelling catheter, 8 subjects performed clean intermittent catheterization (CIC). Mean age was 76 years. Relevant baseline measures included (mean): duration of catheter dependence (6.9mo), prostate size (64.3 ml), PVR (538 mL), and number of treatments per procedure (6.4). 28/30 subjects had middle lobe treatment (1 treatment per procedure). 23 of 30 subjects (77%) achieved successful TWOC post-procedure. Mean time to catheter independence was 29 days post-procedure with mean post-procedure PVR 84 mL and post-procedure IPSS 9. There were no differences between subjects with or without successful TWOC in age, duration of catheter dependence, prostate size, baseline PVR, baseline IPSS, number of treatments per procedure, or treatment of median lobe. CONCLUSIONS WaVE can effectively treat patients with urinary retention and successfully render patients catheter independent, including patients with a median lobe. Longer-term follow up is necessary to evaluate the durability of this technology. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e337 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nikhil Gupta More articles by this author Bradley Holland More articles by this author Kristin Delfino More articles by this author Danuta Dynda More articles by this author J. Randolf Beahrs More articles by this author Lennart Wagrell More articles by this author Ahmed El-Zawahry More articles by this author Tobias Köhler More articles by this author Kevin McVary More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sildenafil citrate in combination with tamsulosin versus tamsulosin monotherapy for management of male lower urinary tract symptoms due to benign prostatic hyperplasia: A randomised, double-blind, placebo-controlled trial

ObjectiveTo assess the additive effect of sildenafil citrate to tamsulosin in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) in men with or without erectile dysfunction (ED). Patients and methodsIn all, 150men with untreated LUTS/BPH with or without ED were randomised to receive sildenafil 25mg once daily (OD) or placebo OD (night time) combined with tamsulosin 0.4mg OD (day time) for 6months. Changes from pre-treatment scores in International Prostate Symptom Score (IPSS), IPSS-quality of life (QoL) score, maximum urinary flow rate (Qmax), and the five-item version of the International Index of Erectile Function questionnaire (IIEF-5) were assessed at 3 and 6months. Safety profiles were assessed by physical examination and monitoring clinical adverse events. ResultsGroup A comprised of men who received tamsulosin and sildenafil (75men), whilst those in Group B received tamsulosin and placebo (75). The IPSS was significantly improved in Group A compared to Group B, at −29.3% vs −13.7% (P=0.039) at 3months and −37% vs −19.6% (P=0.043) at 6months after treatment. Qmax significantly improved in both groups compared with before treatment (P<0.001). The IIEF-5 scores improved more in Group A than in Group B, at 58.7% vs 11.7% at 3months and 62.4% vs 12.4% at 6months after treatment (both P<0.001). ConclusionSildenafil citrate combined with tamsulosin improved LUTS, erectile function, and patient QoL more than tamsulosin monotherapy with the merit of a comparable safety profile in patients with LUTS/BPH.

Thermobalancing conservative treatment for moderate-to-low-degree lower urinary tract symptoms (LUTS) secondary to prostate enlargement

AbstractBackground: The prostate undergoes gradual growth throughout men’s lives, resulting in development of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). The aim of this review was to determine whether Thermobalancing could be used for conservative treatment of LUTS/BPH. Methods and Results: Men older than 55 with LUTS derived to BPH used Thermobalancing therapy enabled by therapeutic device as mono-therapy. The main group consisted of 124 patients with the prostate volume (PV) up to 60 ml, however, there were also men with the prostate volume (PV) over 60 ml that were studied separately. Before and after six months Thermobalancing the International Prostate Symptom Score (IPSS) lessened (p < 0.001), quality of life (QoL) index improved, ultrasound PV reduced (p < 0.001) and uroflowmetry maximum flow rate (Qmax) increased (p < 0.001). The dynamics of the same measurements in the watchful waiting or active surveillance control group have shown negative outcomes. Discussion ...

Development of a decision aid for the treatment of benign prostatic hyperplasia: A four stage method using a Delphi consensus study

ObjectiveTo develop a web-based decision aid (DA) for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). MethodsFrom February–September 2014 we performed a four-stage development method: 1: Two-round Delphi consensus method among urologists, 2: Identifying patients’ needs and expectations, 3: Development of DA content and structure, 4: Usability testing with LUTS/BPH patients. Results1 (N=15): Dutch urologists reached consensus on 61% of the statements concerning users’ criteria, decision options, structure, and medical content. 2 (N=24): Consensus was reached in 69% on statements concerning the need for improvement of information provision, the need for DA development and that the DA should clarify patients’ preferences. 3: DA development based on results from stage 1 and stage 2. 4 (N=10): Pros of the DA were clear information provision, systematic design and easy to read and re-read. ConclusionA LUTS/BPH DA containing VCEs****Values Clarification Exercises. was developed in cooperation with urologists and patients following a structured 4 stage method and was stated to be well accepted. Practice ImplicationsThis method can be adopted for the development of DAs to support other medical decision issues.

The diagnosis and treatment of lower urinary tract symptoms due to benign prostatic hyperplasia with α-blockers: focus on silodosin.

Lower urinary tract symp toms due to benign prostatic hyperplasia (LUTS/BPH) are common in aging men and can progress to acute urinary retention. Among the classes of agents recommended for patients with moderate to severe symptoms are α-adrenergic receptor (adrenoceptor) antagonists (α-blockers) and 5α-reductase inhibitors (5ARIs). This review provides a brief overview of the diagnosis and management of LUTS/BPH, focusing on the efficacy and tolerability of α-blockers approved for the treatment of LUTS/BPH, with particular emphasis on silodosin, a novel α-blocker. Of the older α1-blockers, alfuzosin, doxazosin and terazosin show little selectivity for the α1-adrenoceptor subtypes, while tamsulosin is moderately and silodosin is highly selective for the α1A subtype in preference to the α1B subtype. Highly selective α1A-receptor antagonists such as silodosin were developed specifically for the treatment of LUTS because non-selective antagonists were associated with cardiovascular adverse effects. Since α1A is predominantly expressed in the prostate, higher selectivity for α1A may account for lower blood pressure-related adverse effects. Silodosin is administered once daily and provides rapid improvements in the signs and symptoms of moderate to severe LUTS/BPH in male patients. As with other α-blockers, silodosin is generally well-tolerated and the most common adverse events seen are abnormal ejaculation, dizziness, headache, diarrhoea, nasal congestion and orthostatic hypotension. Unlike 5ARIs, α-blockers do not impair libido. Given the prevalence of LUTS/BPH and the efficacy and tolerability concerns with existing therapies, silodosin is a welcome addition to the pharmacological options for these patients.

The role of inflammation in lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and its potential impact on medical therapy.

A chronic prostatic inflammation seems to play a crucial role in benign prostatic hyperplasia (BPH) pathogenesis and progression. Therefore, inflammation could represent a new potential target for medical therapy of lower urinary tract symptoms (LUTS) due to BPH (LUTS/BPH). This review article analyzes the evidence supporting the role of inflammation in the onset and progression of BPH, and it assesses the potential impact of previous mechanisms on medical therapy of LUTS/BPH. Literature data support the role of inflammation as a relevant factor in the pathogenesis of BPH. Indeed, several data favour the role of infiltrating lymphocytes in the development and progression of prostate adenoma as an effect of a self-maintaining remodeling process. Although available drugs commonly used in the treatment of LUTS/BPH do not exhibit an anti-inflammatory activity, it seems to be obvious considering the inflammation as a new target in the treatment of LUTS/BPH. Drugs currently investigated for the treatment of prostatic inflammation include the hexanic lipidosterolic extract of Serenoa repens, nonsteroidal anti-inflammatory drugs, and vitamin D receptor agonists.

Tadalafil in the management of lower urinary tract symptoms: a review of the literature and current practices in Russia.

IntroductionStrong epidemiologic evidence supports correlation between lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) and erectile dysfunction (ED). The link has biologic plausibility given phosphodiesterase type 5 (PDE5) expression in pelvic structures. PDE5 inhibitors target pathophysiologic processes implicated in LUTS/BPH.Material and methodsThis review highlights the efficacy and safety of the daily use of a PDE5 inhibitor tadalafil in LUTS/BPH, with a focus on LUTS/BPH medical management in Russia.ResultsAlpha–blockers and phytotherapy are major components of the current LUTS/BPH therapy in Russia. Russian regulatory authorities granted approval for once–daily tadalafil for treatment of LUTS/BPH in January 2012. In a pivotal study, tadalafil 5 mg once–daily significantly improved International Prostate Symptom Score (IPSS) over 12 weeks vs. placebo (P = .004) regardless of baseline ED severity. IPSS improvement was maintained at 12 weeks. Integrated analysis of randomized studies showed that tadalafil 5 mg once–daily resulted in significant symptom improvements across a range of men with LUTS/BPH. Relief of LUTS due to tadalafil was independent of improvement in ED; improvements in IPSS and erectile function were only weakly correlated (r = –0.229). Another pooled analysis found similar improvement in LUTS/BPH between men with or without ED, with non–significant P values for treatment–by–ED–status interactions for total IPSS ( P = .73). Non–registration studies of tadalafil and alpha–blocker co–therapy in LUTS/BPH suggest an additive effect, but co–therapy is not recommended in current tadalafil prescribing instructions.ConclusionsTadalafil results in symptom improvements across a range of men with LUTS/BPH and represents a new treatment option for patients in Russia with LUTS/BPH.

Office Evaluation of Male Patients with Lower Urinary Tract Symptoms

Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) are one of the most common urologic disorders in men. Accurate history-taking and focused physical examination allows us to diagnose the majority of cases. A better understanding of risk factors helps us tailor our treatment and predict outcomes more accurately. Population studies are crucial in our understanding of LUTS/BPH natural history. Temporary prostatic urethral stents that are used for the management of urinary retention may also be used for evaluation of patients with detrusor hypo-contractility. The use of ultrasound to measure intravesical prostatic protrusion (IPP) and the Doppler study for prostate capsular artery resistive index are promising. Near-infrared spectroscopy (NIRS) examines the tissue oxygenation that may be affected by bladder outlet obstruction. The mathematical algorithm needs some fine-tuning, and its reproducibility is debatable. Serum and urinary biomarkers may help us to diagnose the disorder, and more effectively monitor patients' response to therapy. Among all, IPP is clinically more applicable at this time.

Examining the ‘gold standard’: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes

What's known on the subject? and What does the study add? Transurethral resection of the prostate (TURP) remains the dominant and definitive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS-BPH), but the widespread use of medical therapies (particularly monotherapies) for rapid symptom improvement has meant that the most common indication for TURP has shifted to moderate-severe medical therapy refractory LUTS to, coupled with abnormal objective parameters, or when complications arise. Patients undergoing TURP as part of contemporary randomised controlled trials are not older but have a larger preoperative prostate volume and reduced major morbidity compared with large cohort studies from successive past eras. Delayed surgery because of prolonged medical monotherapy may explain a higher reported failure to void rate, possibly because of negative impact on detrusor function from unrelieved obstruction. This study examined contemporary TURP for significant changes, specifically regarding prostate size, operative parameters, and outcomes, compared with two preceding decades. Electronic databases PubMed, EMBASE & Cochrane collaboration were searched for English literature on prospective randomized controlled trials, published between 1997 and 2007 using keywords "transurethral resection" and "prostate". Monopolar TURP (M-TURP) cohort data of each study were selectively pooled for analysis, weighting studies according to patient numbers. Where possible, pooled post-operative outcomes data were compared with two large cohort landmark studies of successive preceding decades. A total of 3470 patients from 67 studies were included. Mean patient age (67 years) was unchanged, while mean pre-operative prostate volume of 47.6 g was greater than previously reported. Mean resected prostate tissue (25.8 g) with a resection time of 38.5 minutes suggested improved resection efficiency. A statistically significantly reduced transfusion rate and increased urinary tract infection (UTI) rate were reported. Hospital stay (3.6 days) and initial catheterisation duration (2.5 days) were similar, but post-operative urinary retention rate was slightly higher (6.8%). Contemporary RCTs of M-TURP showed larger prostate volume, and reduced major morbidity, compared with large cohort studies from successive past eras. The higher reported failure to void rate, may possibly reflect worse detrusor function at time of TURP. Delaying surgery by prolonged medical monotherapy may compound this. Trials methodology in this area requires quality improvement and standardisation in future.

Age-stratified normal values for prostate volume, PSA, maximum urinary flow rate, IPSS, and other LUTS/BPH indicators in the German male community-dwelling population aged 50 years or older

To establish age-stratified normal values for prostate volume, serum total prostate-specific antigen (PSA) concentration, maximum urinary flow rate (Q (max)), micturition and postvoid residual urine volumes, IPSS, and quality of life. These community-derived values of healthy older men are necessary to correctly judge patients with lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). Analysis of LUTS/BPH-related determinants in community-dwelling men in the city of Herne, Germany after exclusion of subgroups with co-morbidities or co-medications with possible influence on the key items. The analysis is based on 1,763 participants. In these men aged 50-80 years, mean total prostate volume continuously increased from 24 to 38 cc and mean PSA concentration from 1.1 to 2.5 ng/ml. PSA concentration in men with a prostate volume <25 cc also showed a continuous increase with aging, starting at 0.8 in the youngest and ending at 1.9 ng/ml in the oldest age group. Mean Q (max) of free uroflowmetry (from 22.1 to 13.7 ml/s) and mean micturition volume (from 329 to 193 cc) showed a continuous decrease that was dependent on prostate size. Mean postvoid residual urine was nearly unchanged over the age groups at approximately 20-30 cc. Although IPSS increased continuously with aging (from 4 to 7), QoL remained unchanged at 2 over the age groups. Prostate size had a minor impact on IPSS. Normal values for investigated LUTS/BPH-related determinants and the influence of aging hereon should serve as references during the assessment of Caucasian patients in Europe.

Incidence et profil des patients avec hyperplasie bénigne de la prostate (HBP) symptomatique, pour lesquels les urologues instaurent une bithérapie

Since guidelines of the French Health Authority published in 2003, the management of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) benefited from large study results that confirmed the interest of prescribing combination therapy in some patients. A french survey was conducted, aiming to evaluate the frequency and reasons of the initiation of a combination therapy in LUTS/BPH patients referred to urologists by general practitioners. Beginning 2008, 105 urologists included 2588 patients who consulted them for LUTS/BPH. The initiation of the combination therapy was described, looking for related factors using logistic regression analyses (Odds ratio). Further to the urology consultation, a combination was initiated in 33,7 % of the patients, including a alpha-blocker and a 5 alpha-reductase inhibitor in 23,6 % of cases. Urologists mainly justified this therapeutic choice by the fact a previous single treatment was unsufficient (60,9 %), the patient presented severe LUTS (31,1 %) and a large prostatic volume (28,3 %). Among risk factors, a moderate (OR = 3,9) or severe (OR = 3,4) I-PSS score and a prostatic volume greater than 50 ml (OR = 4,1) were the most correlated to the initiation of a combination therapy. Thus, the initiation of a combination therapy in one out of three LUTS/BPH patients who consulted a urologist, was mainly justified by the insufficiency of a single treatment, the severity of the urinary disorders and a high prostatic volume.