Surgical Treatment Of Benign Prostatic Hyperplasia Research Articles

Changes in diagnosis rate and treatment trends of benign prostatic hyperplasia in Korea: A nationwide population-based cohort study.

PurposeThis study aimed to evaluate benign prostatic hyperplasia (BPH) diagnosis rate and the changing landscape of medical and surgical management of BPH over the last decade using national population data of South Korea.MethodsThe present study analyzed data of patients diagnosed with BPH (N40) who underwent medical treatment or surgery in 3% of the national patient sample of the Health Insurance and Review Assessment database each year between 2012 and 2018. The primary outcome was the proportion of medical and surgical treatment for BPH. It was evaluated each year between 2012 and 2018. Secondary outcomes included total BPH diagnosis rate in each year of the study period. BPH diagnosis rate by age group was evaluated. The proportion of medical and surgical treatment for BPH according to the type of medical institution was investigated.ResultsThe proportion of surgical treatment was 1.2% in 2012, 1.0% in 2013, 1.0% in 2014, 0.9% in 2015, 0.8% in 2016, 0.7% 2018, and 0.8% 2018, showing a progressive overall decrease from 2012 to 2018. The rate of surgical treatment for BPH increased with increasing age during the study period, showing a progressive overall increase (from 9,202 per 100,000 men in 2012 to 11,610 per 100 000 men in 2018). The number of patients with BPH was increased steadily from 2012 to 2018 in all age groups. The rate of surgical treatment in tertiary referral hospitals was the highest during the study period, followed by that in general hospitals, hospitals, and clinics.ConclusionsIn Korea, the diagnosis rate of BPH was steadily increasing during the study period. Overall surgical treatment gradually decreased compared with an increase in medical treatment among all treatments for BPH. Thus, a comprehensive treatment plan for BPH should be established considering this trend.

Risk factors, morbidity rates and long-term prognosis in benign hyperplasia and prostate cancer (literature review)

Diseases of the urological profile are one of the most important medical and social issues of the modern world. According to various sources, from 50 % to 75 % of men over 50 years old have benign prostatic hyperplasia (BPH), and by the age of 80, BPH is detected in 90 % of the male population. BPH manifests itself with lower urinary tract symptoms (LUTS) in most patients. Prostate cancer ranks 2nd or 3rd in the structure of malignant neoplasms in men, and the prevalence of this pathology continues to grow. This trend is associated with an increase in average life expectancy, improved diagnosis of pathologies and early detection of the disease. Risk factors affecting the development of both prostate cancer and BPH include the patient’s age, race, family history, eating habits, the presence or absence of bad habits, and a sedentary lifestyle. Surgical methods for treating prostate cancer include open retropubic prostatectomy and laparoscopic adenomectomy. The «gold standard» of surgical treatment of BPH is transurethral resection of the prostate (TURP), but the emergence of new endovideosurgical methods (bipolar TURP, transurethral enucleation of the prostate (TUEP) allows to expand the scope of their use and reduce possible complications in the early and late postoperative period.

Changes in Prevalence and Treatment Pattern of Benign Prostatic Hyperplasia in Korea

PurposeBenign prostatic hyperplasia (BPH) is associated with lower urinary tract symptoms and negatively affects the quality of life. We aimed to investigate the treatment pattern of BPH in South Korea.MethodsInformation on treatment modalities and diagnoses of BPH was obtained from the Health Insurance Review and Assessment Service-Aged Patient Sample. Data on BPH patients aged ≥60 years from 2012 to 2016 were obtained. We surveyed the treatment pattern of BPH, including the types of drugs used and surgeries performed, according to the type of institution.ResultsIn this study, 18,260–24,657 BPH patients treated between 2012 and 2016 were included. The number of patients showed an increasing pattern, and drug therapy was the major treatment method used for BPH (98.77%). Moreover, the pattern of increased pharmacotherapy use for BPH was reinforced by the increasing number of patients. Prescription of α-blockers only was dominant in this cohort (45.7%). Transurethral resection of the prostate (TURP) was the most commonly used surgical treatment for BPH (53.6%), but it showed a decreasing pattern over time. In contrast, holmium laser enucleation of the prostate (HoLEP) showed an increase from 19.4% to 39.7%.ConclusionsThe most common treatment for BPH was drug therapy, predominantly only α-blocker therapy. The surgical treatment trend has changed from TURP to HoLEP.

СТРУКТУРА ОКАЗАНИЯ УРГЕНТНОЙ И ПЛАНОВОЙ ОПЕРАТИВНОЙ ПОМОЩИ БОЛЬНЫМ ДОБРОКАЧЕСТВЕННОЙ ГИПЕРПЛАЗИЕЙ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ В РЯЗАНСКОЙ ОБЛАСТИ

Aim. To study the status of provision of planned and urgent care to patients with benign prostate hyperplasia (BPH) in round-the-clock urological hospitals of the Ryazan region in recent 5 years. Materials and Methods. Statistical processing of the data for 2015-2020 obtained from medical statistics services of urological hospitals of Ryazan was performed. The following parameters were studied: the average age of patients who turned to emergency room with the diagnosis of acute retention of urine; the amount of surgical interventions (cystectomies) per months and years of the reporting period: open adenomectomy (in the following modifications: transvesical ade-nomectomy, retropubic adenomectomy), transurethral resection of prostate. Results. A high amount of referral of patients with BPH with clinical symptoms of acute reten-tion of urine was identified. The quantity and the share of palliative surgeries in the structure of patients with BPH stays at a high level. A tendency to growth in the amount of minimally inva-sive operations in surgical treatment for BPH is noted. Conclusion. The analysis of statistical data indicates the need for improvement of the quality of dispensary observation of patients with BPH, and improvement of methods of minimally inva-sive surgical treatment of BPH.

Experience in the use of MOSES technology for endoscopic treatment of benign prostatic hyperplasia

Introduction. The development of laser technologies in medicine and their introduction into everyday clinical practice determine the trend of using this type of energy in the treatment of patients with lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). In the last decade, holmium laser enucleation (HoLEP) of the prostate has been claiming to be «the gold standard» in the BPH treatment. The advantages of HoLEP over alternative technologies (transurethral resection, bipolar enucleation) in the BPH treatment have been demonstrated in randomized trials. These advantages include the reduction of the patient's hospital stay, safety of manipulation and high quality of life for the patient after surgery. The use of electrical energy in resection techniques for the BPH treatment in most cases is limited by the prostate volume (80 cm3). A better understanding of the effect of laser radiation and its clinical efficacy has led to increased interest and widespread adoption of laser systems. The constant search and improvement of existing approaches encourages urologists and surgical equipment companies to research new laser systems. One type of improvement is a software update for laser pulse modulation that has been developed to improve the efficiency of laser equipment. For the further development of new laser technologies and widespread use in routine clinical practice, it is necessary to compare them with standard methods of BPH surgical treatment with an assessment of the effectiveness, as well as the pros and cons of the compared methods.Purpose of the study. To evaluate the results of laser endoscopic treatment of patients with prostatic hyperplasia.Materials and methods. The study included 50 patients with prostatic hyperplasia who underwent two different types of surgery — HoLEP (group I; n = 25) and HoLEP with MOSES (HoLEP-M) technology (group II; n = 25). Inclusion criteria were: the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume > 40 cm3, maximum urine flow (Q-max) < 12 ml/sec. Exclusion criteria were: the presence of cystostomy drainage, an oncological process of the urinary system, an active inflammatory process of the genitourinary system, previous surgical interventions on the urinary system. I-PSS, QoL and IIEF questionnaires data, the level of prostate-specific antigen (PSA), the maximum flow of the urine stream (Q-max) and the post-void residual volume were assessed at baseline and 3 months after the operation. The main indicators of the compared methods, the number and nature of complications were studied.Results. Both methods of laser enucleation allow achieving a good functional result with a minimum number of complications. When comparing both methods in the group II of patients who underwent HoLEP-M, there was a statistically significant difference in terms of characteristics: the time of enucleation in group I (HoLEP) — 46.7 ± 15.0 min (31 - 80) vs group II (HoLEP-M) — 38.9 ± 7.6 min (30 - 60) (p = 0.03), but this did not affect the total time of surgery (p = 0.21), the level of haemoglobin postoperative changes in group I (HoLEP) — 7.5 ± 5.4 g/l (2 - 18) vs group II (HoLEP-M) — 5.0 ± 2.9 g/l (2 - 13) (p = 0.04) and irrigation time in the postoperative period, group I (HoLEP) — 17.6 ± 3.6 h (11 - 26) vs group II — 14.0 ± 4.3 h (5 - 21) (p < 0.001). Thus, the results of the study suggest that the HoLEP with the modified pulse MOSES technology has advantages over the standard HoLEP technique. HoLEP-M allows you to perform the enucleation stage faster, with better hemostasis and minimizes the effect of the laser on the surrounding tissues. Complications above level 2 were not observed in both groups according to the Clavien-Dindo scale.Conclusion. HOLEP-M is a safe method of surgical treatment of prostatic hyperplasia from the point of view of surgical safety, efficacy, as well as the duration of the patient's recovery period and can serve as an alternative to the HoLEP standard technique.

Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials.

Traditional benign prostatic hyperplasia treatment options, such as transurethral resection of the prostate and laser, have focused on addressing urinary symptoms for men; however, these options are associated with a high risk of sexual dysfunction. The objective of this study was to assess newer technologies (Aquablation therapy, UroLift, and Rezum) for the treatment of benign prostatic hyperplasia and the impact of preserving sexual function compared with transurethral resection of the prostate. A comprehensive review of Food and Drug Administration randomized studies from each of the technologies was carried out. A comparison of 3-year outcomes for International Index of Erectile Function-5 and Male Sexual Health Questionnaire Ejaculatory Function domain short form was analyzed. Aquablation and prostatic urethral lift were the only therapies to show permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. For prostates less than 80 cc, Aquablation and prostatic urethral lift were able to demonstrate permanent sexual function preservation in both Male Sexual Health Questionnaire Ejaculatory Function domain short form (ejaculatory function) and International Index of Erectile Function-5 (erectile function) at 3 years after treatment. Bhojani N, Yafi FA, Misrai V, etal. Review of Sexual Preservation After Novel Benign Prostatic Hyperplasia Surgical Treatment Modalities From Food and Drug Administration Clinical Trials. Sex Med Rev 2021;9:169-173.

Морфологическая характеристика ткани гиперплазированной предстательной железы при хроническом простатите

Introduction. Benign prostatic hyperplasia (BPH) is a common disease wich is characterized by the proliferation of periurethral prostate glandular tissue. Infectious and inflammatory processes in the prostate play an important role in proliferation and hyperplasia, causing a significant deterioration in prostate metabolism and proliferation acceleration. This leads to progressive growth of the hyperplastic tissue in the prostate gland (PG). Тhe aim of study was to perform a comparative analysis of morphological changes in prostate hyperplastic tissue in patients with chronic prostatitis, who underwent various types of surgical treatment for BPH. Materials and methods. A comparative analysis of morphological changes in prostate tissue was performed, using a material from 276 patients with chronic prostatitis and BPH, who underwent various types of surgical treatment. The patients were divided into three groups: group I (n = 50) - patients who underwent surgical transvesical adenomectomy, group II (n = 76) - patients who underwent transurethral resection of the prostate (TURP) and group III (n = 150) - men who underwent holmium laser enucleation of the prostate. Fragments of the removed prostate tissue were fixed with neutral 10% formalin. The tissue samples were numerated automatically, using DIAPATH Donatello processor. Microscopic examination was carried out using a light microscope ZEISS «Axioskop 40» (eyepiece x 10, objectives x 5, x 10, x 20, x 40, 100). Results. Morphological features of resected prostate from patients with BPH and from patients with its combination with chronic bacterial inflammation were analyzed. The morphological picture varies from acute purulent inflammation to pronounced chronic lymphoplasmacytic inflammation around the acini. The features of morphological changes in the prostate after transvesical adenomectomy, TURP and laser enucleation were also studied. It was shown, that against the background of a chronic infectious and inflammatory process as well as a gross cicatricial process in the prostate, the organ anatomy, as well as the architectonics of vessels are disrupted, which can lead to a decrease in surgical treatment effectiveness. Discussion. In the majority of patients with BPH histological examination reveals a lymphoplasmacytic reaction of varying severity, which causes anatomical abnormalities and microcirculation deterioration. This condition significantly increases the risk of postoperative complications, requiring long-term conservative therapy and sometimes another surgical intervention. Conclusions. Against the background of a chronic infectious and inflammatory process, a gross cicatricial process in the prostate, its anatomy as well as vessel architectonics become disrupted, leading to a decrease in the effectiveness of surgical treatment. In the comparative study of morphological characteristics after various types of surgical procedures, it was revealed that the least significant changes were detected after laser enucleation of prostatic hyperplasia.

Bulbomembranous Urethral Strictures Repair After Surgical Treatment of Benign Prostatic Hyperplasia. Experience From a Latin American Referral Centre

To evaluate stricture recurrence and urinary incontinence (UI) rates in patients who underwent bulbomembranous anastomosis for management of short (≤ 2cm) bulbomembranous urethral stricture (BMS) after benign prostatic hyperplasia (BPH) surgical treatment. In addition, we studied if there was any relation between post urethroplasty UI and the method employed for BPH surgical treatment. A retrospective study was conducted between January 2011 and October 2019. We included all patients who developed BMS after undergoing Transurethral Resection of the Prostate, Holmium Laser Enucleation of the Prostate or Open Simple Prostatectomy (OSP). We excluded patients with UI after BPH surgical treatment as well as patients who underwent a dorsal or ventral onlay oral graft urethroplasty for longer proximal bulbar strictures, and also patients with associated bladder neck contracture or other strictures locations. We defined failure as the need for any intervention to restore the urethral caliber. Overall, 77 patients were included in the study with mean age 70 years (sd 8). Median BMS length was 1.5 cm (IQR 1-2). Median follow-up was 53 months (IQR 24 to 82). Of the patients, 74/77 (96.1%) were classified as success and 3/77 (3.9%), as failure. Out of the 6/77 (7.8%) patients who had postoperative UI, 5 of them had been treated for their BPH with OSP (p 0.001). Bulbomembranous anastomosis is a suitable reconstructive option for short proximal bulbar urethral strictures after BPH surgical treatment. OSP was associated with postoperative UI more frequently than endoscopic treatments modalities.

V07-06 PROSTATO-NEOVAGINAL FISTULA REPAIR IN A PATIENT WITH PRIOR TRANSURETHRAL RESECTION OF THE PROSTATE

You have accessJournal of UrologyLower-Tract Reconstruction II: ED/Infertility & Transgender Surgery (V07)1 Apr 2020V07-06 PROSTATO-NEOVAGINAL FISTULA REPAIR IN A PATIENT WITH PRIOR TRANSURETHRAL RESECTION OF THE PROSTATE Rebecca Sager*, Daniela Kaefer, Natasha Ginzburg, and Dmitriy Nikolavsky Rebecca Sager*Rebecca Sager* More articles by this author , Daniela KaeferDaniela Kaefer More articles by this author , Natasha GinzburgNatasha Ginzburg More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000897.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vaginoplasties for gender affirmation are becoming increasingly common and are reported to carry a risk of serious urological complications such as urethro-neovaginal fistulae. Our objective was to demonstrate a technique for repair of prostatic urethro-neovaginal fistula in a transgender female with prior transurethral resection of the prostate (TURP). METHODS: A 65-year-old transgender female presented with a complaint of severe incontinence and was diagnosed with a prostato-neovaginal fistula. She had undergone TURP for symptomatic benign prostatic hyperplasia (BPH) prior to penile inversion vaginoplasty at another institution. Following vaginoplasty, she had severe incontinence of urine after the initial vaginal packing removal. Cystoscopy and vaginoscopy identified fistulae from the urethra, just proximal to the verumontanum, to the neovagina. The options for repair were considered ensuring that the neovagina remained patent. Surgical technique: The urethra was dissected laterally away from neovagina, and the prostatic and membranous urethral plate was incised dorsally. An Asopa-type dorsal inlay urethroplasty with buccal mucosa graft was performed. The lateral urethral edges were rotated ventrally, approximated and the adjacent tissue flaps were brought over in layers to cover ventral urethral anastomosis. A 16 French urethral catheter and vaginal packing were left in place at the conclusion of the case. Patient was followed with imaging, cystoscopy and questionnaires. RESULTS: Voiding cystourethrogram was performed 3 weeks post-operatively with no evidence of fistula. On follow up visits at 4- and 8-months patient reported no recurrent incontinence, no difficulty with vaginal dilations or penetrative vaginal intercourse. Cystoscopy and pelvic exam at the 8-months follow-up demonstrated no evidence of fistula or stricture and no stress incontinence with cough or Valsalva. CONCLUSIONS: Surgical treatment of BPH by TURP prior to gender affirmation surgery in transgender female patients may lead to complicated fistulae in a setting of incompetent bladder neck. The close proximity of the neovaginal dissection to a thinned prostate capsule and external sphincter may predispose this group of patients to fistula formation and incontinence. Traditional interposition flaps such as gracilis could create significant bulk compromising the neovaginal space. Asopa-type urethroplasty with dorsal inlay of buccal mucosa graft and ventral urethral closure can be used for a novel application in repair of complex prostato-neovaginal fistula. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e644-e645 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca Sager* More articles by this author Daniela Kaefer More articles by this author Natasha Ginzburg More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Can surgical treatment for benign prostatic hyperplasia improve sexual function? A systematic review

Introduction Erectile dysfunction is an established, well known risk of any operative management of benign prostatic hyperplasia (BPH). However, there are some cases reported in which surgical treatment has paradoxically improved erectile function. Here, we present a systematic review of the literature pertaining to the effect of surgery on sexual function, focusing on reports of improvement in erectile function following surgery. Materials and methods We searched PUBMED, EMBASE, Web of Knowledge, and SCOPUS databases for the following keywords: ((“sexual function” OR “erectile function”) AND “improvement” AND “benign prostatic hyperplasia” AND “surgery”). Results Sixteen studies (total n = 2087) were reviewed which reported a significant improvement in any aspect of erectile function. Ten of these studies had a follow-up period of 12 months or more while five had a follow up less than 12 months. Various surgical methods were included in the 16 studies; however, five reported TURP outcomes specifically. Eleven studies reported outcomes using the International Index of Erectile Function (IIEF). Overall, a further 87 studies showed no significant change and 8 studies showed a significant reduction. Conclusions The majority of studies report no change in erectile function following surgical intervention for BPH. There seems to be no obvious correlating factor between the studies reporting an improvement in erectile function. Further research is needed to guide us in how to consent our patients for erectile function outcomes for BPH surgery.

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

ObjectiveTo provide the first large single-operator case series of patients who undergo “en bloc” thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience. MethodsWe prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent “en bloc” ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered. ResultsA total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40–85 min). Median enucleation time was 17.4 min (IQR: 15–21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2–0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148). ConclusionWe believe that further attention is needed for these new “en bloc” prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment.

National trends in surgical therapy for benign prostatic hyperplasia in Australia.

To determine national trends in the utilization of surgical procedures for the treatment of benign prostatic hyperplasia (BPH) in Australia over the last 20 years. The Medicare Australia and Australian Institute of Health and Welfare databases were used to determine the annual number of surgical procedures and hospital admissions for BPH. From 1998 to 2017, surgical procedures for BPH have increased by 79% which is largely commensurate with population growth. From 1998 to 2008, transurethral resection of the prostate (TURP) was the predominant surgical therapy, accounting for 96% of all surgical treatments. From 2008 to 2017, TURP use reduced to 70% and in the last 5 years has been replaced with photoselective vaporization (16%), UroLift (8%) and holmium laser prostatectomy (6%). UroLift is used significantly more in younger men (P < 0.001). There has been a substantial increase in surgical treatments for BPH over the last 20 years. In the last 5 years, TURP use has declined due to an increase in laser prostatectomy and UroLift procedures.

Частота и факторы риска развития инфравезикальной обструкции вследствие хирургического лечения доброкачественной гиперплазии предстательной железы

Benign prostatic hyperplasia (BPH) is one of the most common diseases of men elderly and senile age. The main surgical methods of treatment for BPH are transurethral resection and open prostatectomy. In some cases surgical treatment of BPH is accompanied by the development of postoperative complications leading to recurrence of the infravesical obstruction. Currently, there are no strict guidelines for selection of an optimal method of correction of late obstructive complications. This study highlights the main existing theories concerning development of urethral strictures and bladder neck contracture.

Naftopidil for the treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common condition in ageing men that may cause lower urinary tract symptoms (LUTS). Treatment aims are to relieve symptoms and prevent disease-related complications. Naftopidil is an alpha-blocker (AB) that has a high affinity for the A1d receptor that may have advantages in treating LUTS in this setting. This is an update of a Cochrane Review first published in 2009. Since that time, several large randomised controlled trials (RCTs) have been reported, making this update relevant. To evaluate the effects of naftopidil for the treatment of LUTS associated with BPH. We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, LILAC, and Web of Science), trials registries, other sources of grey literature, and conference proceedings with no restrictions on the language of publication or publication status up to 31 May 2018 SELECTION CRITERIA: We included all parallel RCTs. We also included cross-over design trials. Two review authors independently classified and abstracted data from the included studies. We performed statistical analyses using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were urological symptom scores, quality of life (QoL) and treatment withdrawals for any reason; secondary outcomes were treatment withdrawals due to adverse events, acute urinary retention, surgical intervention for BPH, and cardiovascular and sexual adverse events. We considered outcomes measured up to 12 months after randomisation as short term, and later than 12 months as long term. We rated the certainty of the evidence according to the GRADE approach. We included 22 RCTs with 2223 randomised participants across four comparisons for short-term follow-up. This abstract focuses on only two of four comparisons for which we found data since two comparators (i.e. propiverine and Eviprostat (phytotherapy)) are rarely used. One study comparing naftopidil to placebo did not report any relevant outcomes and was therefore excluded. There were no trials that compared to combination therapy with naftopidil or any 5-alpha reductase inhibitors (5-ARIs) to combination therapy with other ABs and any 5-ARIs.All included studies were conducted in Asian countries. Study duration ranged from four to 12 weeks. Mean age was 67.8 years, prostate volume was 35.4 mL, and International Prostate Symptom Score was 18.3. We were unable to perform any of the preplanned subgroup analyses based on age and baseline symptom score.Naftopidil versus tamsulosinBased on 12 studies with 965 randomised participants, naftopidil may have resulted in little or no difference in urological symptom score (mean difference (MD) 0.47, 95% confidence interval (CI) -0.09 to 1.04 measured on a scale from 0 to 35 with higher score representing increased symptoms), QoL (MD 0.11, 95% CI -0.09 to 0.30; measured on a scale from 0 to 6 with higher scores representing worse QoL), and treatment withdrawals for any reason (risk ratio (RR) 0.92, 95% CI 0.64 to 1.34; corresponding to 7 fewer per 1000 participants, 95% CI 32 fewer to 31 more). Naftopidil may have resulted in little to no difference in sexual adverse events (RR 0.54, 95% CI 0.24 to 1.22); this would result in 26 fewer sexual adverse events per 1000 participants (95% CI 43 fewer to 13 more). We rated the certainty of evidence as moderate for urological symptom score and low for the other outcomes.Naftopidil versus silodosinBased on five studies with 652 randomised participants, naftopidil may have resulted in little or no difference in the urological symptom scores (MD 1.04, 95% CI -0.78 to 2.85), QoL (MD 0.21, 95% CI -0.23 to 0.66), and treatment withdrawals for any reason (RR 0.80, 95% CI 0.52 to 1.23; corresponding to 26 fewer per 1000 participants, 95% CI 62 fewer to 32 more). We rated the certainty of evidence as low for all these outcomes. Naftopidil likely reduced sexual adverse events (RR 0.15, 95% CI 0.06 to 0.42; corresponding to 126 fewer sexual adverse events per 1000 participants, 95% CI 139 fewer to 86 fewer). We rated the certainty of evidence as moderate for sexual adverse events. Naftopidil appears to have similar effects in the urological symptom scores and QoL compared to tamsulosin and silodosin. Naftopidil has similar sexual adverse events compared to tamsulosin but has fewer compared to silodosin.

Ejaculatory dysfunction in the treatment of lower urinary tract symptoms

The link between lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and sexual dysfunction is well established. Sexual dysfunction can encompass both ejaculatory dysfunction (EjD) and erectile dysfunction (ED). Ejaculatory dysfunction can consist of premature ejaculation, delayed ejaculation, retrograde ejaculation, anejaculation, decreased force of ejaculation and pain upon ejaculation. The impact of different medical and surgical therapies on ejaculatory function will be reviewed. We reviewed the various categories of LUTS treatment including the canonical epidemiology and pathophysiology as well as the surgical and medical treatments for LUTS/BPH. We note that most surgeries and several medical treatments have a certain but ill-defined negative impact on ejaculatory function. Several MISTs and selected medical therapies appear to have little impact on EjD. Both EjD and BPH are very common disorders in men under the care of an urologist. It is well documented that there is a clinical association between these two entities. Unfortunately many of the medical treatments and almost all surgical treatment impact the ejaculatory function of the patient. The surgical treatment of BPH often leads to retrograde ejaculation while medical treatment leads to anejaculation.

Benign Prostatic Hyperplasia Treatment Options and Their Effects on Sexual Function

Abstract Introduction The goal of any medical or surgical treatment for benign prostatic hyperplasia (BPH) is to improve quality of life. It is important to consider the sexual side effects of these treatments, which can directly affect quality of life. Aim To review the published literature on the sexual side effects of different medical and surgical treatments for BPH. Methods A literature review was performed of the various approved medical and surgical treatments for BPH and their respective sexual side effects. Main Outcome Measures The main outcome measure was sexual dysfunction associated with different treatments in the form of ejaculatory dysfunction, erectile dysfunction, decreased libido, and sexual dissatisfaction. Results The most common side effect for medical and surgical treatments of BPH is ejaculatory dysfunction, although its prevalence after any individual treatment varies greatly. Surgical therapies have a greater relative impact on erectile dysfunction compared with medical therapies; the exact mechanism of this erectile dysfunction has yet to be fully elucidated. The degree of decreased libido and sexual dissatisfaction associated with most treatments is poorly described in the literature and often contradictory. Conclusion There are numerous medical and surgical therapies available for treating BPH. Most of these therapies have sexual side effects that can negatively affect a patient's quality of life. It is important for physicians to consider these sexual side effects and to discuss them with their patients before initiating treatment.

Prevention of complications after surgery for benign prostatic hyperplasia

The aim of the study: to evaluate the clinical efficacy of monotherapy with drugs of herbal medicine and -adrenergic receptors and their combinations in patients with benign prostatic hyperplasia (BPH) stage II-III after transurethral resection of the prostate (TURP). Materials and methods. All patients (n=145) were divided into four clinical groups depending on methods of therapy. Patients of the 1st group (n=42) were not prescribed medications after the TURP for them was established active surveillance. Patients of the 2nd group (n=38) received monotherapy with the drug Prostamol Uno. Patients of the 3rd group (n=31) received the drug Flosin. Patients of the 4th group (n=34) received combination therapy drugs Prostamol Uno and Flosin. Results. There were defined the criteria of the effectiveness of medical therapy after surgical treatment of BPH: increased RV by 25%, increased volume by 50%, reducing the average speed of urination, frequency of nighttime urination, IPSS and QoL data. During the year after the TURP the condition of the patients improved markedly, but significant difference in the performance of active surveillance and the groups receiving monotherapy and combined treatment. Conclusion. The early postoperative period after TURP is an indication for long-term combination therapy with drugs Prostamol Uno and Flosin, which is pathogenetically a highly effective and safe, contributes to the rapid elimination of irritative and obstructive symptoms improved quality of life of the patient.

LAPAROSCOPIC ADENOMECTOMY (PRELIMINARY RESULTS)

Bladder outlet obstruction due to benign prostatic hyperplasia (BPH) remains one of the most common problems of men in the advanced age group. Open prostatectomy for patients with large BPH is still the standard treatment recommended by the European Association of Urology and is performed quiet often. Disadvantages of this method of treatment are significant surgical trauma and high rate of perioperative complications . Laparoscopic modification of simple prostatectomy presents a worthy minimal invasive alternative to open surgical treatment of BPH. From November 2014 to December 2015, laparoscopic adenomectomy was performed for 16 patients. 7 (43.5%) patients had transperitoneal (TP) and 9 (56.25%) patients had extraperitoneal (EP) laparoscopic simple prostatectomy. None of the cases required conversion . All patients were discharged in satisfactory condition with complete restoration of free micturation. Laparoscopic prostatectomy as a method of surgical treatment for BPH can be easily reproducible. It can be adopted as a routine urological practice for large-sized BPH with the aim of minimizing operative trauma and achieving short hospital stay.

Does Prostate Size Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from the REDUCE Trial

BackgroundIt has been shown that increased prostate size is a risk factor for lower urinary tract symptom (LUTS) progression in men who currently have LUTS presumed due to benign prostatic hyperplasia (BPH). ObjectiveTo determine if prostate size is a risk factor for incident LUTS in men with mild to no symptoms. Design, setting, and participantsWe conducted a post hoc analysis of the REDUCE study, which contained a substantial number of men (n=3090) with mild to no LUTS (International Prostate Symptom Score [IPSS] <8). Outcome measurements and statistical analysisOur primary outcome was determination of the effect of prostate size on incident LUTS presumed due to BPH defined as two consecutive IPSS values >14, or receiving any medical (α-blockers) or surgical treatment for BPH throughout the study course. To determine the risk of developing incident LUTS, we used univariable and multivariable Cox models, as well as Kaplan-Meier curves and the log-rank test. Results and limitationsAmong men treated with placebo during the REDUCE study, those with a prostate size of 40.1–80ml had a 67% higher risk (hazard risk 1.67, 95% confidence interval 1.23-2.26, p=0.001) of developing incident LUTS compared to men with a prostate size 40.0ml or smaller. There was no association between prostate size and risk of incident LUTS in men treated with 0.5mg of dutasteride. The post hoc nature of our study design is a potential limitation. ConclusionsMen with mild to no LUTS but increased prostate size are at higher risk of incident LUTS presumed due to BPH. This association was negated by dutasteride treatment. Patient summaryBenign prostatic hyperplasia (BPH) is a very common problem among older men, which often manifests as lower urinary tract symptoms (LUTS), and can lead to potentially serious side effects. In our study we determined that men with mild to no current LUTS but increased prostate size are much more likely to develop LUTS presumed due to BPH in the future. This association was not seen in men treated with dutasteride, a drug approved for treatment of BPH. Our study reveals that men with a prostate size of 40.1–80ml are potential candidates for closer follow-up.

Use of Medical Therapy and Success of Laser Surgery and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

To assess the impact of surgery for benign prostatic hyperplasia (BPH) on use of medication (5-alpha reductase inhibitors, alpha blockers, antispasmodics), we assessed preoperative and postoperative medication utilization among surgically treated men. Using the Truven Health Analytics MarketScan Commercial Claims Database, we defined a cohort of men aged<65years who had surgical therapy for BPH with either transurethral resection of the prostate (TURP) or laser procedures from 2007 through 2009. Primary outcomes included freedom from medical or surgical intervention by 4months after surgery (chi-square and multivariable logistic regression) and subsequent use of medical or surgical intervention in initial responders (Kaplan-Meier and multivariable Cox regression). We identified 6430 patients treated with either TURP (3096) or laser procedure (3334) for BPH. Presurgical antispasmodic use was associated with the highest risk of medication use at 4months after surgery (odds ratio, 5.19; 95% confidence interval (CI), 3.16-8.53 vs no medication use before surgery). At 3years after surgery, 6% (95% CI, 4%-8%) of laser-treated and 4% (95% CI, 2%-5%) of TURP-treated patients had repeat surgical intervention, and both laser- and TURP-treated patients had an estimated new use of medication rate of 22% (95% CI, 18%-25% laser and 20%-25% TURP). The strongest predictor of intervention after surgery was preoperative antispasmodic use (hazard ratio, 2.49; 95% CI, 1.41-4.43). Our results show a need for effective patient counseling about continued or new use of medical therapy after laser and TURP procedures. However, most patients experience durable improvement after surgical intervention for BPH.