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Lebdai S, Ben Boujema M, Benard A, Barry Delongchamps N, Benchikh A, Bruyere F, Della Negra E, Descazeaud A, Doizi S, Fourmarier M, Mallet R, Misrai V, Pelegrin T, Rouscoff Y, Ruffion A, Villers A, Saillour F, Robert G. Standardized technique for ejaculation preservation during prostatic endoscopic ablative surgery. World J Urol 2023; 41:3041-3049. [PMID: 37715788 DOI: 10.1007/s00345-023-04592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE Ejaculatory dysfunction is the most common side effect of benign prostatic hyperplasia surgery. Modified techniques have emerged with the aim of preserving antegrade ejaculation without compromising obstruction relief. None are standardized or validated. The PARTURP study is a randomized study investigating partial versus complete prostate resection. We conducted an investigator consensus meeting to define the ideal surgical technique to achieve both correct obstruction relief with ejaculation preservation. METHODS An expert consensus meeting involving all investigators of the PARTURP study took place to define a common technique using the nominal group methodology. The objectives were to define the areas to be resected and the areas to be preserved; to define the criteria for proper obstruction relief; to define the criteria for proper ejaculation preservation. RESULTS All investigators (n = 15) attended the consensus meeting, and agreement between all the participants was obtained. The anatomical landmarks to be preserved are located around the verumontanum and along the posterior part of the prostatic urethra. These structures must be preserved up to 2 cm from the verumontanum. The participants agreed on the need to preserve the urethral mucosa in all the areas to be preserved and to reach the enucleation plane in the areas of resection. CONCLUSIONS Anatomical landmarks for ejaculation-sparing surgery have been defined by the investigators of the PARTURP randomized study. These landmarks will be used during the study, and the clinical outcomes of this ejaculation-sparing technique will be compared with complete resection with up to 3 years follow-up.
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Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
| | - Méric Ben Boujema
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Benard
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Amine Benchikh
- Urology Department, Clinique Des Franciscaines, Versailles, France
| | - Franck Bruyere
- Urology Department, University Hospital of Tours, Tours, France
| | | | | | - Steeve Doizi
- Urology Department, Hôpital Tenon, APHP, Paris, France
| | | | - Richard Mallet
- Urology Department, Hôpital Prive Francheville, Périgueux, France
| | | | | | - Yohan Rouscoff
- Urology Department, Polyclinique Saint Georges, Nice, France
| | - Alain Ruffion
- Urology Department, University Hospital of Lyon, Lyon, France
- EA 3738-CICLY EMR UCBL Lyon 1, Lyon, France
| | - Arnaud Villers
- Urology Department, University Hospital of Lille, Lille, France
| | - Florence Saillour
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Urology Department, University Hospital of Bordeaux, Bordeaux, France
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Laanani M, Weill A, Jollant F, Zureik M, Dray-Spira R. Suicidal risk associated with finasteride versus dutasteride among men treated for benign prostatic hyperplasia: nationwide cohort study. Sci Rep 2023; 13:5308. [PMID: 37002313 PMCID: PMC10066399 DOI: 10.1038/s41598-023-32356-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Finasteride, a 5α-reductase inhibitor used in benign prostatic hyperplasia and androgenetic alopecia, has been associated with an increased suicidal risk, whereas it is unclear whether such risk is similar to that for another 5α-reductase inhibitor, dutasteride. We aimed to assess the risk of suicidal behaviours with finasteride relative to dutasteride. A nationwide cohort study was conducted using the French National Health Data System (SNDS). Men aged 50 years or older initiating finasteride 5 mg or dutasteride 0.5 mg in France between 01-01-2012 and 30-06-2016 were included and followed until outcome (suicide death identified from death certificate or self-harm hospitalisation), treatment discontinuation or switch, death, or 31-12-2016. Self-harm by violent means or resulting in admission to an intensive care unit were also examined. Cox proportional hazards models controlled for age and psychiatric and non-psychiatric conditions by inverse probability of treatment weighting (IPTW). Analyses were stratified according to psychiatric history. The study compared 69,786 finasteride new users to 217,577 dutasteride new users (median age: 72.0 years [Q1-Q3 = 64.5-80.2] vs. 71.1 [Q1-Q3 = 65.0-79.2]). During follow-up, 18 suicide deaths (0.57/1000 person-years) and 34 self-harm hospitalisations (1.08/1000) occurred among finasteride users versus 47 deaths (0.43/1000) and 87 hospitalisations (0.79/1000) among dutasteride users. Overall, finasteride was not associated with an increased risk of any suicidal outcome (IPTW-adjusted Hazard Ratio = 1.21 [95% Confidence Interval .87-1.67]), suicide death or self-harm hospitalisation. However, among individuals with a history of mood disorders, finasteride was associated with an increased risk of any suicidal outcome (25 versus 46 events; HR = 1.64 [95% CI 1.00-2.68]), suicide death (8 versus 10 events; HR = 2.71 [95% CI 1.07-6.91]), self-harm by violent means (6 versus 6 events; HR = 3.11 [95% CI 1.01-9.61]), and self-harm with admission to an intensive care unit (7 versus 5 events; HR = 3.97 [95% CI 1.26-12.5]). None of these risks was significantly increased among individuals without a psychiatric history. These findings do not support an increased risk of suicide with finasteride used in the treatment of benign prostatic hyperplasia. However, an increased risk cannot be excluded among men with a history of mood disorder, but this result based on a limited number of events should be interpreted with caution.
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Affiliation(s)
- Moussa Laanani
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France.
- French National Health Insurance (CNAM), Paris, France.
| | - Alain Weill
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
| | - Fabrice Jollant
- Université Paris-Saclay & CHU Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- Nîmes University Hospital (CHU), Nîmes, France
- Department of psychiatry, McGill Group for Suicide Studies, McGill University, Montréal, Canada
- Moods Team, INSERM UMR-1018, CESP, Le Kremlin-Bicêtre, France
| | - Mahmoud Zureik
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
| | - Rosemary Dray-Spira
- Epiphare (French National Medicines Agency ANSM and French National Health Insurance CNAM), Saint-Denis, France
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de la Taille A, Chalret du Rieu Q, Dialla O, Bardin L. [Alpha-blockers or hexanic extract of Serenoa repens for 6 months: sub-analysis of the PERSAT study]. Prog Urol 2023; 33:66-72. [PMID: 36207246 DOI: 10.1016/j.purol.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this sub-analysis of the PERSAT study was to evaluate the efficacy of hexanic extract of S. Repens (HESr) and alpha-blockers (AB), at 6 months in patients with moderate to severe LUTS/BPH. METHODS The PERSAT observational study was conducted in France by general practitioners on patients with BPH with an IPSS≥12 score. The primary endpoint was the percentage of responders (decrease in total IPSS score ≥ 3) at 6 months. Improvement in quality of life (IPSS-QoL) as well as patient satisfaction were also measured. RESULTS Of the 759 patients in the study, 324 treated with HESr and 309 with AB were reviewed at 6 months, with no change in treatment during follow-up. Characteristics at inclusion were globally similar with a mean IPSS of 18.2±4.9. The response rates at 6 months (IPSS-total decrease ≥ 3) were 93.7% and 94.8% for patients treated with HESr and AB, with a mean decrease in IPSS score of 10.1±5.6 points, which reached 13.6 and 14.8 points respectively, in severe patients (IPSS>19), without major difference between groups. More than 95% of HESr or AB patients reported a significant overall improvement in their LUTS/BPH. The most frequently reported adverse events with AB were ejaculation disorders (4.9%) and hypotension (4.2%) and with HESr digestive disorders (1.5%). CONCLUSION This sub-analysis of the PERSAT cohort reported the clinical efficacy of HESr and AB as a first-line treatment in the management of moderate or severe LUTS/BPH patients. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Alexandre de la Taille
- Département de chirurgie urologique, CHU de Henri-Mondor, Assistance Publique Hôpitaux de Paris, 94010 Créteil, France.
| | - Quentin Chalret du Rieu
- Direction médicale pharmaceutical dermato, consumer care France, péraudel, 17, avenue Jean Moulin, 81100 Castres, France
| | - Olivia Dialla
- Direction RWE valorisation médicale et manifestations scientifiques, laboratoires Pierre Fabre, 33, avenue Emile Zola, 92012 Boulogne, France
| | - Laurent Bardin
- Direction médicale pharmaceutical dermato, consumer care France, péraudel, 17, avenue Jean Moulin, 81100 Castres, France
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Prise en charge de l’hypertrophie bénigne de la prostate. ACTUALITES PHARMACEUTIQUES 2022. [DOI: 10.1016/j.actpha.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lebdai S, Chevrot A, Doizi S, Pradère B, Barry Delongchamps N, Baumert H, Benchikh A, Della Negra E, Fourmarier M, Gas J, Misraï V, Rouscoff Y, Theveniaud PE, Vincendeau S, Wilisch J, Descazeaud A, Robert G. [Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]. Prog Urol 2021; 31:249-265. [PMID: 33478868 DOI: 10.1016/j.purol.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France.
| | - A Chevrot
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - S Doizi
- Service d'urologie, hôpital européen Georges-Pompidou, Paris, France
| | - B Pradère
- Service d'urologie, CHU de Tours, Tours, France
| | | | - H Baumert
- Service d'urologie, hôpital Ambroise-Paré, Paris, France
| | - A Benchikh
- Service d'urologie, Clinique les Martinets, Versailles, France
| | - E Della Negra
- Service d'urologie, hôpital des Côtes d'Armor, Saint-Brieuc, France
| | - M Fourmarier
- Service d'urologie, hôpital Aix-en-Provence, Aix-en-Provence, France
| | - J Gas
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - V Misraï
- Service d'urologie, clinique Pasteur, Toulouse, France
| | - Y Rouscoff
- Service d'urologie, polyclinique Saint-Georges, Nice, France
| | - P E Theveniaud
- Service d'urologie, CHR de Metz Thionville, Metz, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, Rennes, France
| | - J Wilisch
- Service d'urologie, hôpital privé Natecia, Lyon, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, Limoges, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
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Liu Z, Chen T, Shen M, Li K, Ma C, Ketlhoafetse A, Liu X. A Pilot Study on the Effects of Yi Jin Jing Exercise for Older Men with Benign Prostatic Hyperplasia. J Aging Phys Act 2020; 28:822-827. [PMID: 32434151 DOI: 10.1123/japa.2019-0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 11/18/2022]
Abstract
Benign prostatic hyperplasia and its associated lower urinary tract symptoms seriously affect both the physical and mental health of older men. In order to determine the efficiency of Chinese Qigong Yi Jin Jing on prostate health in older individuals, thirty participants were randomized into either an Yi Jin Jing group (n = 15) or a control group (n = 15). After the 6-month intervention, the Yi Jin Jing group showed a significant decrease in international prostate symptom score and a significant increase in maximal urinary flow rate (compared with the control group p = .005, p = .001, respectively). Also, testosterone level increased and estrogen/testosterone ratio decreased in the Yi Jin Jing group (compared with the baseline p = .004, p = .002, respectively); estrogen level and estrogen/testosterone ratio were lower in the Yi Jin Jing group (compared with the control group p = .029, p = .012, respectively). The results showed that Yi Jin Jing is a promising way to reduce the risk of benign prostatic hyperplasia-lower urinary tract symptoms in older men.
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Phé V, Gamé X. [Male non-neurogenic overactive bladder]. Prog Urol 2020; 30:880-886. [PMID: 33220816 DOI: 10.1016/j.purol.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Male lower urinary tract symptoms (LUTS) and in particular overactive bladder (OAB) are a frequent reason for consultation in urology and have a significant functional impact in patients. OBJECTIVE To synthesize current knowledge on non-neurogenic OAB in male patients. METHOD A systematic literature review based on Pubmed, Embase, Google Scholar was conducted in June 2020. RESULTS The prevalence of OAB and benign prostatic hyperplasia increases with age. Symptoms of OAB, on the one hand, and symptoms of prostatic bladder outlet obstruction, on the other hand, can be concomitant and the causal link between the two types of symptoms is difficult to establish. In case of mixed symptoms, it is recommended to treat the most troublesome type of symptoms first and to inform the patient of the risks of failure or deterioration. Indeed, many patients remain symptomatic after prostate surgery and the predictive factors for failure remain to be defined. Thus, preoperative urodynamics is not routinely performed even in case of OAB. De novo detrusor overactivity after radical prostatectomy can reach 77% and persists in the majority of cases. The overall relative risk of storage symptoms after radiotherapy and brachytherapy is higher than that after prostatectomy. The etiology of OAB after prostate surgery is multifactorial. While drug treatments have proven to be effective, little data exists on second-line treatments for OAB after prostate surgery. CONCLUSION OAB in men is often linked to a prostatic bladder outlet obstruction. It is essential to inform patients about the possibility of persistence, deterioration, or occurrence of OAB after prostate surgery while the predictors of surgical failure are not clearly defined.
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Affiliation(s)
- V Phé
- Sorbonne université, hôpital Pitié-Salpêtrière, service d'urologie, assistance publique-hôpitaux de Paris, Paris, France.
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, université Paul-Sabatier, Toulouse, France
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Gamé X, Phé V. [First-line treatment for non-neurogenic overactive bladder]. Prog Urol 2020; 30:904-919. [PMID: 33220819 DOI: 10.1016/j.purol.2020.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim was to synthesize current knowledge on overactive bladder (OAB) first-line treatments. METHOD A systematic literature review based on PubMed, Embase and Google Scholar was conducted in June 2020. RESULTS Behavioral treatments are based on bladder training and timed voiding using a bladder diary. Lifestyle modifications should be suggested. They include reduction of fluid intake, consumption of caffeine, sodas, weight loss, avoidance of acidic fruit juices and of spicy and acidic salty diet, alkalization of urine by diet and possibly, vitamin D supplementation. Pelvic floor muscle training is mainly based on manual techniques, electrostimulation and/or biofeedback. It has been shown to be effective in treating OAB. In menopausal women, local hormone therapy improves all OAB symptoms. Oral drugs include anticholinergics and beta-3-agonists. Their efficacy is quite similar and superior to placebo. In case of failure of monotherapy, they may be combined. CONCLUSION Apart from some lifestyle modifications, the efficacy of first-line treatments for OAB has been demonstrated by prospective controlled studies. They may be prescribed individually or in combination.
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Affiliation(s)
- X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, université Paul-Sabatier, TSA50032, 31059 Toulouse, France.
| | - V Phé
- Service d'urologie, AP-HP, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
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de la Taille A, Bardin L, Castagné C, Auges M, Capronnier O, Chalret du Rieu Q. [Alpha-blockers or phytotherapy as first-line treatment of LUTS/BPH in general medicine: The PERSAT non-interventional study]. Prog Urol 2020; 30:522-531. [PMID: 32753297 DOI: 10.1016/j.purol.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of the PERSAT study was to evaluate first-line treatment of BPH-associated LUTS in real-life conditions. METHODS This prospective observational study was conducted in France by general practitioners (GP) on patients with moderate to severe LUTS (IPSS ≥12). GPs freely decided to prescribe either an alpha-blocker (AB) or phytotherapeutic treatment (PT). The main criterion was the percentage of responding patients (decrease in total IPSS score ≥3) at 6 months. RESULTS Of the 849 patients included, 759 were analysed (381 treated with AB and 378 with PT); 718 were followed up at 6 months, 90% of which had no treatment modification. Their inclusion characteristics were similar between the AB and PT groups (mean IPSS: 18.6±4.5 and 17.8±4.1, respectively). Treatment response rates at 6 months were 94.2% [91.2%; 96.4%] in AB and 92.5% [89.2%; 95.1%] in PT. The IPSS decreased by 10.0±5.6 points, with no difference between groups. The proportion of patients bothered by their LUTS (IPSS-QoL ≥4) evolved from 88.5% to 6.5% at 6 months. The improvement of LUTS was perceived by more than 94% of patients (PGI-I) and doctors (CGI-I), 93% of patients were satisfied with the treatment at 6 months, regardless of the treatment initiated. The most reported adverse reactions were ejaculation disorder (3.9% for AB and 0.9% for PT). CONCLUSION PERSAT confirms in current practice the effectiveness of AB and PT treatments, recommended as first-line treatment in LUTS/BPH. LEVEL OF PROOF 3.
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Affiliation(s)
- A de la Taille
- Département de chirurgie urologique, CHU Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France.
| | - L Bardin
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
| | - C Castagné
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
| | - M Auges
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
| | | | - Q Chalret du Rieu
- Direction médicale, Pierre-Fabre médicament, 81106 Castres cedex, France
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Cornu JN. Hyperplasie bénigne de la prostate et incontinence urinaire. Prog Urol 2020; 30:3S10-3S20. [DOI: 10.1016/s1166-7087(20)30194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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[Benign prostatic hyperplasia surgery and patient's information: What do patients understand and remember?]. Prog Urol 2020; 30:97-104. [PMID: 31959569 DOI: 10.1016/j.purol.2019.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Preoperative information is a key to adherence to treatment for the patients, but may be misunderstood because of its density and complexity. The aim of this study was to assess comprehension and satisfaction of patients about preoperative information of benign prostatic hyperplasia (BPH) surgery. Factors influencing patient understanding were also studied. PATIENTS AND METHODS It was a monocentric study on questionnaires including every patients planned for BPH surgery, whatever the surgical technique. A survey was sent at patient's home after the preoperative consultation. RESULTS One hundred and six of 210 patients (50,5 %) returned the questionnaire. 38,68 % (n=41) found the quality of information excellent (9 or 10 out of 10), and 45,28 % (n=48) found the quality of information good (7 or 8 out of 10). The main recalled complications were retrograde ejaculation (39.6 %, n=42/106), and bleeding (29,2 %, n=31/106). 57.6 % of patients (n=61) remembered receiving the written information sheet of the French Association of Urology. 5.7 % (n=6) hesitated having the procedure. Only patient's age was significantly associated with difference of comprehension (p<0.005). CONCLUSION Information given before a BPH surgery seems satisfactory although it was poorly understood, notably about complications. Providing complete oral information, insisting on complications, and giving the written information sheet are essential for a good doctor-patient relationship and a forensic serenity. LEVEL OF EVIDENCE 3.
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Mouton M, Michel C, Bourgi A, Baumert H. [Holmium laser enucleation of the prostate: Analysis of early complications. Patient selection for day-case surgery]. Prog Urol 2020; 30:89-96. [PMID: 31959571 DOI: 10.1016/j.purol.2019.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/30/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the complications and the risk factors of Holmium LASER Enucleation of the prostate (HoLEP) and to propose selection criteria for day-case surgery. MATERIAL AND METHODS We included retrospectively all consecutive single-center HoLEP procedures performed between January 1, 2012 and December 31, 2016. We reported the pre-operative characteristics of the patients (age, BMI, ASA score, estimated prostate volume, presence of a preoperative catheter, operative indication, antiplatelet or anticoagulant intake) and the peri operative data (duration of intervention, catheterization, hospitalization, transfusion, histopathological findings, 30-day postoperative complications given to Clavien-Dindo classification, presence of a catheter at discharge, urologist experience). Uni- and multi-variate analyzes were performed to investigate risk factors for complications. RESULTS One thousand two hundred and one patients were included. The overall complication rate was 19.15 %. The transfusion rate was 3.7%. We demonstrated that the age at procedure (P=0.019), an ASA score>2 (P=0.0019), a high prostatic volume (P=0.011), an anticoagulant intake (P=<0.0001), a poor-urologist experience (P=0.048) and a long operative time (P=0.0144) were at risks of complications. CONCLUSION The identification of postoperative complication risk factors after HoLEP could help to better select patients who are offered day-case surgery and minimize the risk of failure or early readmission. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Mouton
- Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - C Michel
- Service d'urologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Bourgi
- Service d'urologie, hôpital français du Levant, rue Fouad Chehab, Sin El-Fil, Beyrouth, Liban
| | - H Baumert
- Service d'urologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Iatrogénie médicamenteuse et troubles de la prostate. ACTUALITES PHARMACEUTIQUES 2020. [DOI: 10.1016/j.actpha.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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[Interest of a systematic assessment of the treatment of the lower urinary tract symptoms in the management of benign prostatic hypertrophy in general practice (1380 patients) - Study EVALURO]. Prog Urol 2019; 29:116-126. [PMID: 30665818 DOI: 10.1016/j.purol.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/22/2018] [Accepted: 12/01/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a modification or initiation of treatment by a α-blocker in patients already medically treated for BPH-related LUTS, with persistent urinary symptoms. METHODS This is a prospective observational study among general practitioners in France. Included patients were over 60 years of age with BPH-related LUTS who had been medically treated for at least 6 months. A treatment by an α-blocker was initiated or modified if the PGI-I (Patient Global Impression of Improvement) did not objective any improvement under treatment and the IPSS (International Prostate Symptom Score) was≥8. Patients were followed up between 1 and 3 months after inclusion. The primary endpoint was the frequency of unsatisfactory progression of patients, assessed by persistence of urinary symptoms under treatment (IPSS≥8 and PGI-I unchanged or worsened). Progress of LUTS (IPSS and PGI-I) following modification of treatment with α-blocker was also assessed at the follow-up visit. RESULTS Three hundred and fifty-three physicians included 1449 patients between February 2, 2016 and March 9, 2017 (1380 patients were analyzed): the average age was 70.0±6.9 years ; the duration of the LUTS was 4.1±4.2 years; at inclusion, they received mainly plants (n=744; 53.9%) and α-blockers (n=463; 33.6%); the mean IPSS score was 16.4±6.7, it was not correlated with duration of SBAU; the mean PGi-I was 2.6±1.2. In total, 48.8% (612/1255) of patients had a non-satisfactory evaluation of the LUTS; 42.8% (591/1380) of patients had a modification of treatment according to the protocol: 385 (65.6%) had an initiation of a α-blocker, 202 (34.4%) had a modification of treatment by α-blocker (4 missing data). The α-blocker was monotherapy for 484 (81.9%) patients. At the follow-up visit (1 to 3 months), the average IPSS score was 7.7±4.8, significantly lower (18.7±6.1 at inclusion); the average PGI-I of 1.2±0.7 was significantly lower (3.5±0.8 at inclusion); the quality of life (Q8-IPSS) was significantly improved. For the 345 patients under plant extracts having changed for one α-blocker, as well as for the 67 patients under α-blocker having changed for another α-blocker, the 3 scores had decreased significantly. CONCLUSION A systematic evaluation of medical treatment for BPH showed that 48.8% of patients medically treated for at least 6 months were not improved. A modification of treatment by an α-blocker (initiation or modification) can then significantly improve the LUTS.
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Gas J, Liaigre-Ramos A, Caubet-Kamar N, Beauval JB, Lesourd M, Prudhomme T, Huyghe E, Soulié M, Charpentier S, Gamé X. Evaluation of the impact of a clinical pathway on the progression of acute urinary retention. Neurourol Urodyn 2018; 38:387-392. [PMID: 30418678 DOI: 10.1002/nau.23873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022]
Abstract
AIMS The management of acute urinary retention (AUR) revolves around trial without catheter (TWOC) after prescription of an alpha-blocker. This study evaluates the implementation of a clinical pathway for AUR. METHODS Specific clinical pathways for AUR was established between the Emergency Department and the Department of Urology in order to reduce the duration of bladder drainage that included standard prescriptions, an information sheet, and a note to be faxed to scheduling nurses to organize the trial without catheter (TWOC). The main endpoint was the reduction in the time between the AUR episode and TWOC, without decreasing urination. RESULTS Between April 2015 and December 2016, 248 patients were treated in the Emergency Department, and externally, for AUR. One hundred and seventy patients were enrolled in the pathway group and 78 in the control group. The mean duration of urinary catheterization decreased by 5.5 days as did the number of patients lost to follow-up (32% vs 76%), without decreasing the successful voiding (46% vs 36%). The duration of the urinary catheterization was not related to the chance of successful voiding regardless of the urine volume and a drainage time of over 10 days significantly reduced the chance of success (68%, n = 26 versus 42%, n = 76; P = 0.0038). CONCLUSION The implementation of a clinical pathway for AUR reduced the number of patients lost to follow-up and the catheterization duration, thus optimizing the management of these patients.
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Affiliation(s)
- Jérôme Gas
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Aline Liaigre-Ramos
- Urgent Care Admissions Department, Toulouse University Hospital, Toulouse, France
| | - Natacha Caubet-Kamar
- Urgent Care Admissions Department, Toulouse University Hospital, Toulouse, France
| | - Jean Baptiste Beauval
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Marine Lesourd
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Eric Huyghe
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Michel Soulié
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Sandrine Charpentier
- Urgent Care Admissions Department, Toulouse University Hospital, Toulouse, France
| | - Xavier Gamé
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
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Prise en charge de l’obstacle sous vésical lié à une HBP chez les patients à terrain particulier et/ou ayant une complication. Prog Urol 2018; 28:868-874. [DOI: 10.1016/j.purol.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022]
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de la Taille A, Robert G, Descazeaud A. [Consequences of prostatic obstruction on bladder function, impact of removal, and management of recurrence after surgery]. Prog Urol 2018; 28:813-820. [PMID: 30262261 DOI: 10.1016/j.purol.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Our objective was to evaluate bladder outlet obstruction (BOO) consequences on the detrusor activity, to analyze the impact of medical and surgical treatments, and to study the reasons for recurrence of urinary symptoms after surgical treatment. METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications between 2000 and July 2018 with the keywords: BPH, bladder obstruction, bladder instability, surgery, and reoperation. A first research was crossed with the results of the reviews of literature already published and was enriched by the contributions of the various authors. A synthesis has been proposed. RESULTS The consequences of bladder outlet obstruction (BOO) on the detrusor may be detrusor overactivity (DOA) or detrusor hypocontractility. DOA is found in about 50% of patients at the time of their surgery and its evolution is most often favorable after surgical treatment (resolved or reduced in 2/3 of cases). Bladder hypocontractility is responsible for acute or chronic urinary retention. It can be the cause for poor postoperative micturition recovery requiring self-catheterization which the patient must have been informed before surgical treatment. Surgery reduces urinary symptoms with a low but significant surgical revision rate (10 to 30% depending on the surgical technique). The less efficient technique with regard to surgical revision rates are prostatic radiofrequency or cervico-prostatic incision, followed by laser vaporization techniques, TURP and adenomectomy (surgical or endoscopic). Adenomectomy is the surgical technique that has the lowest recurrence rate. The identified risk factors for surgical revision are the surgeon's experience, the power of the laser (in case of photovaporization), the surgical technique employed, the length of operative time, the low or excessive volume of the prostate, the significant pre-operative post-void residual volume, and the slight decrease of postoperative PSA level. Prior to any surgical revision for recurrence of urinary symptoms, the assessment should include the review of previous surgical report, the evaluation of the resected prostatic volume and the residual prostatic volume, the IPSS score, the calendar of micturition, the urethrocystoscopy and the urodynamic assessment. CONCLUSION BOO can lead to bladder dysfunction such as DOA or detrusor hypocontractility. Resolution of BOO by a suitable surgical treatment allows, in the majority of the cases, to resolve bladder dysfunctioning. In case of failure, the assessment must be complete to define the causes and to find the most suitable solution.
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Affiliation(s)
- A de la Taille
- Service de chirurgie urologique, CHU Henri-Mondor, AP-HP, 94000 Créteil, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, 30000 Bordeaux, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 87042 Limoges, France
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de la Taille A, Descazeaud A, Robert G. [How to prevent LUTS due to BPH development and progression]. Prog Urol 2018; 28:821-829. [PMID: 30262262 DOI: 10.1016/j.purol.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/15/2018] [Accepted: 08/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to define potential risk factors for lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH). METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to extract the most relevant scientific publications between 2000 and July 2018 and cross them with the recommendations of the AFU and the EA by combining the keywords HBP with diet, diet, physical activity, spa treatments, tobacco, alcohol, cardiovascular risk factors, testosterone or inflammation. A synthesis has been proposed in order to identify the important elements to proscribe or modify in order to limit the development and progression of LUTS/BPH. RESULTS LUTS due to BPH are clearly associated with erectile dysfunction, cardiovascular diseases and metabolic syndrome. Some reversible risk factors have been identified such as low physical activity, overweight and hypercaloric nutrition. Interventions such as increased physical activity, weight-loss, and a diet including vegetables, tomatoes, carrots, vitamin E, lycopene, selenium, carotene, correction of the metabolic syndrome, stress reduction, and a suitable urinary behavior may impact progression of the disease. CONCLUSION Education of the patients on reversible risk factors for LUTS due to BPH is crucial and should be included in everyday practice. Physical activity and weight-loss are the most important factors to take into account. LEVEL OF EVIDENCE 5 consensus d'experts.
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Affiliation(s)
- A de la Taille
- Service de chirurgie urologique, CHU Henri-Mondor, AP-HP, 94000 Créteil, France.
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 87042 Limoges, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, 30000 Bordeaux, France
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[How to evaluate BPH-related SBAUs in clinical practice and research?]. Prog Urol 2018; 28:830-838. [PMID: 30220536 DOI: 10.1016/j.purol.2018.07.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the useful explorations in the clinical evaluation of the symptoms of the lower urinary tract symptoms possibly related to BPH (LUTS/BPH), and to list the information necessary to allow an evaluation of an instrumental or surgical intervention in the treatment of the hypertrophy and benign prostatic obstruction. METHOD Bibliographic research in English using the European, American and French recommendations on the evaluation of BPH, supplemented by a Pubmed search. RESULTS AND CONCLUSIONS A number of systematic investigations into the evaluation of a man with LUTS/BPH include interrogation, clinical examination with rectal examination, urinalysis, flowmeter and post-micturition residual volume. The voiding catalog is necessary to understand the mechanism of a nocturia. PSA has a triple potential of interest: evaluation of the risk of progression, evaluation of the prostatic volume and diagnosis of a cancer of the prostate. Creatinine is needed only when chronic retention is observed and before surgery. Urethrocystoscopy is essential in case of hematuria, suspicion of stenosis of the urethra or bladder tumor. Ultrasound for evaluation of prostate volume is essential before surgery, and may be helpful in guiding the decision to prescribe a 5 alpha reductase inhibitor. No non-invasive technique has proven its possible substitution for pressure flow studies when indicated. When a researcher is considering evaluating a surgical or instrumental treatment for BPH, preoperative, perioperative and follow-up parameters are expected from readers to get a fair idea of the technique being evaluated. LEVEL OF EVIDENCE 5: Consensus d'experts.
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Descazeaud A, Robert G, de La Taille A. [Sexual consequences of BPH treatments]. Prog Urol 2018; 28:839-847. [PMID: 30195716 DOI: 10.1016/j.purol.2018.07.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the literature on the sexual adverse effects of pharmacological, instrumental and surgical treatments of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH). METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. RESULTS AND CONCLUSION Sexual dysfunction and SBAU/BPH are intimately linked by a cross-over effect in the population of men over 50, a possible common pathophysiology and treatments for BPH with sexual consequences. Evaluating the sexuality of patients in care for SBAU/BPH is therefore essential. Patients should be informed of potential adverse drug effects of BPH, including ejaculation disorders with alpha blockers and loss of libido and erectile dysfunction with 5 alpha reductase inhibitors. After BPH surgery, loss of antegrade ejaculation is common, although preservation possibilities exist. The improvement of urinary function and the decrease of possible ejaculatory pains have a beneficial effect on the sexuality of the BPH patients operated. More rarely, patients may experience orgasmic dysfunction or even erectile dysfunction with a possible thermal effect on the vasculo-nerve bundles. LEVEL OF EVIDENCE Consensus d'experts.
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Affiliation(s)
- A Descazeaud
- Service de chirurgie urologique, CHU de Limoges, 87042 Limoges, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, 33000 Bordeaux, France
| | - A de La Taille
- Service d'urologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
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Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol 2018; 37:299-308. [DOI: 10.1007/s00345-018-2368-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022] Open
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Marquette T, Comat V, Robert G. [Endoscopic enucleation of the prostate: Indication, technique and results]. Prog Urol 2017; 27:836-840. [PMID: 28965711 DOI: 10.1016/j.purol.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Laser prostatic enucleation is an increasingly popular technique among surgical urology. It is now gradually becoming a contender for gold standard surgical treatments, trans-urethral resection of the prostate (TURP) and open prostatectomy (OP). MATERIALS AND METHODS This study is based on data collected from sources published between June 1995 and June 2017. Medline and Embase database have been used to research the following keywords: Holmium; Thulium; Greenlight; Laser; Prostate; Enucleation; Benign prostatic obstruction; Surgical technique. RESULTS With HoLEP process, catheterization time varies from 17,7hrs to 46,4hrs with 2 to 2.5 hospitalization days. With ThuLEP process, catheterization time varies from 2 to 2.5 days with 2.15 to 6.5 hospitalization days. With GreenLEP process, catheterization and hospitalization times are both 2 days. IPSS score after a year varies from 12.7 to 19.1 points in different publications. CONCLUSION Convincing results of Laser prostatic enucleation make it a valid alternative to existing treatments.
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Affiliation(s)
- T Marquette
- Service de chirurgie urologique, CHU de Bordeaux, 33000 Bordeaux, France.
| | - V Comat
- Service de chirurgie urologique, CHU de Bordeaux, 33000 Bordeaux, France.
| | - G Robert
- Service de chirurgie urologique, CHU de Bordeaux, 33000 Bordeaux, France.
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Description de la typologie de patients masculins répondeurs aux anticholinergiques : une étude observationnelle. Prog Urol 2017; 27:551-558. [DOI: 10.1016/j.purol.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/11/2017] [Accepted: 06/02/2017] [Indexed: 11/21/2022]
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Baldini A, Fassi-Fehri H, Duarte RC, Crouzet S, Ecochard R, Abid N, Martin X, Badet L, Colombel M. Holmium Laser Enucleation of the Prostate versus Laparoscopic Transcapsular Prostatectomy: Perioperative Results and Three-Month Follow-Up. Curr Urol 2017; 10:81-86. [PMID: 28785192 DOI: 10.1159/000447156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Symptomatic benign prostatic hypertrophy greater than 70 cc used to be treated by invasive procedures. Holmium laser enucleation of prostate (HoLEP) and laparoscopic transcapsular prostatectomy (LTP) are two techniques whose efficacy has been demonstrated compared to standard onesmore invasive standard procedures. The objective was to evaluate and compare perioperative results from these two techniques for the treatment of benign prostatic hypertrophy greater than 70 cc. METHODS This was a non-randomized retrospective study comparing the HoLEP technique with LTP. From January 2012 to January 2015, 39 patients had HoLEP and 28 had LTP. Perioperative outcomes, complications, and functional results at 3 months were compared. A chi-2 squared test and Student's t test were used for statistical analysis. RESULTS In multivariate analysis, there was a statistically significant difference in favor of HoLEP for the duration of catheterization (1.9 vs. 3.7 days; p = 0.004) and the average length of stay (2.8 vs. 4.0 days, p = 0.010). There was a trend towards a greater decrease in postoperative hemoglobin levels in LTP (138 vs. 218 g/l; p = 0.082), which was statistically significant in univariate analysis (p = 0.033). Other endpoints were not significant, particularly the enucleated prostate volume compared to the total prostate volume (61.8 vs. 68.4%; p = 0.319) and postoperative complications. CONCLUSION There was no increased morbidity for LTP compared to the HoLEP technique. However, the HoLEP technique appeared to be a less invasive technique, reducing the duration of catheterization, blood loss, and the average length of stay while maintaining good efficacy for the enucleated prostate volume.
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Affiliation(s)
| | | | | | | | - René Ecochard
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
| | - Nadia Abid
- Edouard Herriot Hospital, Urology, Lyon, France
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Thoulouzan M, Perrouin-Verbe MA, Calves J, Deruelle C, Joulin V, Valeri A, Fournier G. [Outcomes of GreenLight XPS-180W laser photovaporization for BPH larger than 80mL]. Prog Urol 2017; 27:489-496. [PMID: 28483481 DOI: 10.1016/j.purol.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/13/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the results of GreenLight XPS photovaporization (PVP/XPS) with intraoperative transrectal ultrasonographic monitoring for the treatment of large Benign Prostatic Hyperplasia (BPH) (>80mL). PATIENTS AND METHODS Operative and perioperative data of 82 patients were collected prospectively. Complications and functional outcomes (IPSS, quality of life (QoL) score, maximal flow rate and post-void residual (PVR)) were evaluated at 1, 3, 12 months post-operatively prostate volume and PSA were assessed at 3 and 12 months post-operatively. RESULTS Median patient age was 68.5years (50-85). Twenty percent had an indwelling catheter and 5%/22% were on anticoagulant/antiplatelet therapy. Median prostate volume and PSA were 103mL (80-220) and 6.4ng/mL (0.66-44.0). Median operative time and energy delivered were 107min (46-219) and 581kJ (212-1193). Energy delivered/prostate volume was 5.4kJ/mL (1.6-10.5). Transurethral catheter was removed at day 1 or 2 in 96% of cases. Patients were discharged as outpatient, p.o. day 1 or day 2 in 4%, 55% and 21% of cases, respectively. Transfusion and Clavien≥3 complication rates were 1.2% and 3.7%. Significant improvement of IPSS (4 vs 19.5), QoL (1 vs 5), maximum flow rate (19.1 vs 8.2mL/s) and PVR (26 vs 100mL) was observed (P<0.001) at 12-months evaluation. PSA and prostate volume were decreased by 61 and 62%. Late complications were urethral strictures (6%), stress incontinence (1.2%). Eighty-five percent of patients had no antegrade ejaculation. CONCLUSION The treatment of large BPH with PVP/XPS is safe and effective, with a long operative time. The functional outcomes are good and stable at mid-term evaluation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Thoulouzan
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France.
| | - M-A Perrouin-Verbe
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - J Calves
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - C Deruelle
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - V Joulin
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - A Valeri
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - G Fournier
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
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Mathieu R, Lebdai S, Cornu J, Benchikh A, Azzouzi A, Delongchamps N, Dumonceau O, Faix A, Fourmarier M, Haillot O, Lukacs B, Misrai V, de La Taille A, Robert G, Descazeaud A. Perioperative and economic analysis of surgical treatments for benign prostatic hyperplasia: A study of the French committee on LUT. Prog Urol 2017; 27:362-368. [DOI: 10.1016/j.purol.2017.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 10/02/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
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Evrard PL, Mongiat-Artus P, Desgrandchamps F. [Morbi-mortality of transurethral resection of the prostate in patients aged 75 and over]. Prog Urol 2017; 27:312-318. [PMID: 28377079 DOI: 10.1016/j.purol.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Monopolar transurethral resection of the prostate is one of standard surgical treatment of benign prostatic hyperplasia. The objective of this study was to evaluate early postoperative complications in patients aged 75 years old and more using a standardized classification. MATERIAL AND METHODS We included all patients aged at least 75 on the day of surgery between 1 January 2008 and 31 December 2013. The reporting of complications was carried from the Clavien-Dindo classification. RESULTS One hundred and seventy-six patients were included in this study. A total of 47.2% of patients experienced at least one complication. The majority of patients (79.5%) had complications grade 1 or 2 according to Clavien-Dindo classification. One patient died postoperatively at day 27. Most complications were urological (55%). A high Charlson score and low plasma hemoglobin levels have been identified as a risk factor for complications. CONCLUSION Monopolar transurethral resection of the prostate is followed by significant morbidity in older patients, higher than in the general population. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- P-L Evrard
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France.
| | - P Mongiat-Artus
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France
| | - F Desgrandchamps
- Service urologie, hôpital Saint-Louis, 1, avenue Claude-Velfaux, 75010 Paris, France
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Meyer P. [Algorithms and urinary incontinence in the elderly. Assessment, treatment, recommendations and levels of evidence. Review]. Prog Urol 2017; 27:111-145. [PMID: 28284822 DOI: 10.1016/j.purol.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/08/2017] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Search processing algorithms in a primary care setting, analyzing the specifics of care management for seniors suffering from urinary incontinence (UI), described the recommendations and levels of evidence of treatment. METHODS A literature review carried out via PubMed® and websites of scientific societies with search keywords classified according to an algorithm. RESULTS One hundred algorithms have been discovered in the field of evaluation and treatment of UI. Screening for UI risk factors began early on in the treatment of reversible or chronic comorbidities, avoiding iatrogenic. Specific clinical features (red flags) required specialized advice. Non-pharmacological conservative treatment should be offered first in line for seniors: behavioral therapy, changes in lifestyle, walk, treatment of constipation. For women, pelvic floor muscle training combined biofeedback and functional electrical stimulation. After failure and persistence of UI with urgency, the information of the risk of a possible urinary retention or cognitive impairments preceded the prescription of an anticholinergic and the measurement of post-voiding residue done by ultrasounds. Older age is not a cons-indication for surgery UI least invasive. The cough test and Bonney maneuver can confirm a masked stress urinary incontinence and/or an associated prolapse. Cases of failure of UI, doubtful diagnosis or programmed surgery required urodynamic assessment. CONCLUSION Algorithms and recommendations of UI should remain a valuable aid to the clinical assessment, diagnosis and treatment of UI in the elderly.
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Affiliation(s)
- P Meyer
- Service de réadaptation neurologique, centre de médecine physique et de réadaptation de L'ADAPT, 25, avenue de la Paix, 92320 Chatillon, France.
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Troubles du bas appareil urinaire et de la statique pelvienne chez les candidats et receveurs d’une transplantation rénale. Prog Urol 2016; 26:1114-1121. [DOI: 10.1016/j.purol.2016.09.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022]
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Baron M, Nouhaud FX, Delcourt C, Grise P, Pfister C, Cornu JN, Sibert L. [HoLEP learning curve: Toward a standardised formation and a team strategy]. Prog Urol 2016; 26:492-9. [PMID: 27614386 DOI: 10.1016/j.purol.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/02/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022]
Abstract
AIM Holmium laser enucleation of prostate (HoLEP) is renowned for the difficulty of its learning curve. Our aim was to evaluate the interest of a three-step tutorial in the HoLEP learning curve, in a university center. METHODS It is a retrospective, monocentric study of the 82 first procedures done consecutively by the same operator with a proctoring in early experience and after 40 procedures. For all patients were noted: enucleation efficiency (g/min), morcellation efficiency (g/min), percentage of enucleated tissue (enucleated tissue/adenome weigth evaluated by ultrasonography. g/g), perioperative morbidity (Clavien), length of hospital stay, length of urinary drainage, functional outcomes at short and middle term (Qmax, post-void residual volume [PVR], QOL scores and IPSS at 3 and 6months). RESULTS Enucleation and morcellation efficiency were significantly higher after the second proctoring (0.87 vs 0.44g/min; P<0.0001 and 4.2 vs 3.37g/min, P=0.038, respectively) so as the prostatic volume (43.5 vs 68.1mL, P=0.0001). Percentage of enucleated tissue was higher in the second group, however, the difference was not significant (69.5% vs 80.4%, P=0.03). Per- and postoperative complications, hospital length of stay, urinary drainage length and functional results at 3 and 6months were not significantly different. CONCLUSION The learning curve did not interfere with functional results. The second proctoring was essential to us in order to grasp the technique. These data underlined the necessity of a pedagogic reflexion in order to built a standardized formation technique to the HoLEP. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Baron
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - F-X Nouhaud
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - C Delcourt
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - P Grise
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - C Pfister
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - J-N Cornu
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
| | - L Sibert
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
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Pradere B, Peyronnet B, Leonard G, Misrai V, Bruyère F. Photovaporisation prostatique au laser Greenlight® : évaluation des pratiques françaises en 2015. Prog Urol 2016; 26:168-75. [DOI: 10.1016/j.purol.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/19/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
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[Evaluation of postoperative symptoms after Greenlight™ photovaporization of the prostate through a dedicated questionnaire]. Prog Urol 2015; 26:108-14. [PMID: 26611569 DOI: 10.1016/j.purol.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/17/2015] [Accepted: 10/03/2015] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate postoperative symptoms after Greenlight™ photovaporisation of the prostate (PVP), through a dedicated questionnaire. METHODS A retrospective study has been conducted between 2008 and 2014. The questionnaire had 5 sections about pain while voiding, hematuria, urgency, incontinence and urinary stream, and was filled at one-month postoperative. The main outcome criterion was pain while voiding. Descriptive statistical analyses were done to identify predictive factors for pain while voiding. RESULTS Out of 169 patients, 22% had no pain while voiding, 37% had moderate pain, 30% acceptable pain and 11% intense pain. Patients with pain were significantly older, (P=0.012), had more urgency (P=0.01) and more often hematuria (P=0.0001). Only 7% of patients had no symptoms of urgency, and urgency was painful or bothering in 57% of cases. Hematuria was frequent, with clots in 21% of cases. Ninety three percent felt improvement of urinary stream. CONCLUSIONS Systematic evaluation of symptoms through a dedicated questionnaire one month after PVP has shown that 41% of patients felt pain while voiding, 57% had urgency and 39% significant hematuria. These results should encourage a more accurate patient information and further studies to better understand postoperative healing after PVP.
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Descazeaud A, Barry Delongchamps N, Cornu JN, Azzouzi A, Buchon D, Benchikh A, Coloby P, Dumonceau O, Fourmarier M, Haillot O, Lebdai S, Mathieu R, Misrai V, Saussine C, de La Taille A, Robert G. Guide de prise en charge en médecine générale des symptômes du bas appareil urinaire de l’homme liés à une hyperplasie bénigne de la prostate. Prog Urol 2015; 25:404-12. [DOI: 10.1016/j.purol.2015.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 02/17/2015] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
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Berquet G, Corbel L, Della Negra E, Huet R, Trifard F, Codet Y, Boulière F, Verhoest G, Vincendeau S, Bensalah K, Mathieu R. Prospective evaluation of ambulatory laser vaporization of the prostate for benign prostatic hyperplasia. Lasers Surg Med 2015; 47:396-402. [DOI: 10.1002/lsm.22363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Gaetan Berquet
- Department of Urology; Rennes University Hospital; University of Rennes 1; Rennes France
| | - Luc Corbel
- Department of Urology; Saint Brieuc private hospital; St Brieuc France
| | | | - Romain Huet
- Department of Urology; Rennes University Hospital; University of Rennes 1; Rennes France
| | - François Trifard
- Department of Urology; Saint Brieuc private hospital; St Brieuc France
| | - Yann Codet
- Department of Urology; Saint Brieuc private hospital; St Brieuc France
| | - Fabien Boulière
- Department of Urology; Saint Brieuc private hospital; St Brieuc France
| | - Grégory Verhoest
- Department of Urology; Rennes University Hospital; University of Rennes 1; Rennes France
| | - Sébastien Vincendeau
- Department of Urology; Rennes University Hospital; University of Rennes 1; Rennes France
| | - Karim Bensalah
- Department of Urology; Rennes University Hospital; University of Rennes 1; Rennes France
| | - Romain Mathieu
- Department of Urology; Rennes University Hospital; University of Rennes 1; Rennes France
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Descazeaud A, de La Taille A, Giuliano F, Desgrandchamps F, Doridot G. [Negative effects on sexual function of medications for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia]. Prog Urol 2015; 25:115-27. [PMID: 25605342 DOI: 10.1016/j.purol.2014.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/21/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this review is to discuss the negative effects on sexual function of medications for lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS-BPH). METHODS An international non-systematic literature review was performed. It included randomized trials of seven drugs of interest and the summaries of the characteristics of these products. This work did not aim comparison between the drugs. RESULTS Only maximal reported frequencies are presented in this abstract. With prolonged-release alfuzosin, they were 2.8% vs. 1.3% for erectile dysfunction, compared to placebo and 1% vs. 0% for ejaculatory dysfunction. With doxazosin, the incidence was 5.8% vs. 3.3% for erectile dysfunction, 3.6% vs. 1.9% for reduced libido and 0.4% vs. 1.4% for ejaculatory disorders. The incidence of ejaculatory disorders with tamsulosin, was 11% vs. <1% with the placebo and with silodosin, it was 28.1% vs. 1.1%. With finasteride, at 12 months, the highest frequency was 9% vs. 5% for erectile dysfunction, 4.4% vs. 1.5% for ejaculatory disorders and 6.4% vs. 3.4% for reduced libido. At 24 months, for dutatsteride, frequencies were 7.3% vs. 4.0% for erectile dysfunction, 2.2% vs. 0.8% for ejaculatory disorders and 4.2% vs. 2.1% for reduced libido. For tadalafil, a phosphodiesterase-5 inhibitor, and tolerodine, an anticholinergic drug, no negative effect on ejaculation or libido has been reported. For plant extracts, no sexual adverse effects (AEs) were reported among the most common AEs. CONCLUSION The medications for LUTS-BPH may alter erection, ejaculation or libido. A greater knowledge of the adverse effects of each of these drugs could guide physicians in the clinical management of men with BPH-LUTS.
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Affiliation(s)
- A Descazeaud
- Service de chirurgie urologique, CHU de Limoges, 87042 Limoges cedex, France.
| | - A de La Taille
- Service d'urologie, faculté de médecine de Créteil, groupe hospitalier Henri-Mondor, 94000 Créteil, France
| | - F Giuliano
- Service de médecine physique et de réadaptation, faculté des sciences de la santé, université de Versailles Saint-Quentin en Yvelines, hôpital Raymond-Poincaré, 92380 Garches, France
| | - F Desgrandchamps
- Service d'urologie et de transplantation, hôpital Saint-Louis, université Paris 7, institut des maladies émergentes et des thérapies innovantes (iMETI), 75010 Paris, France
| | - G Doridot
- 24, boulevard Vital-Bouhot, 92521 Neuilly-Sur-Seine cedex, France
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Gabbay G, Bernhard JC, Renard O, Ballanger P, Ferriere JM, Fallot J, Comat V, Robert G. Énucléation de la prostate au laser Holmium en chirurgie ambulatoire : évaluation prospective des 30 premiers patients. Prog Urol 2015; 25:34-9. [DOI: 10.1016/j.purol.2014.09.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/17/2014] [Accepted: 09/24/2014] [Indexed: 02/02/2023]
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Lebdai S, Rahmène Azzouzi A, Delongchamps NB, Benchikh A, Campeggi A, Cornu JN, Dumonceau O, Faix A, Fourmarier M, Haillot O, Lukacs B, Mathieu R, Misrai V, Robert G, de La Taille A, Descazeaud A. [Evaluation of the impact of CTMH guidelines on the management of benign prostatic hyperplasia]. Prog Urol 2014; 25:47-53. [PMID: 25453357 DOI: 10.1016/j.purol.2014.09.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The French guidelines on the management of benign prostatic hyperplasia (BPH) have been published in 2012 by the LUTS committee of the French Urological Association. The aim of this study was to evaluate the impact of these guidelines on the BPH management by French urologists. MATERIAL AND METHODS A questionnaire has been distributed by email to 1141 urologists members of the French Association of Urologists in November 2013. RESULTS We collected 222 responses (response rate: 19%). The guidelines have been read by 73% of the urologists. The guidelines were followed most of the time by 76% of them, 11% followed them systematically and 4.5% did not follow them. The new terminology was used by 28 to 52% according to the items. The symptoms were evaluated by the IPSS score (33%), by interrogatory alone (64%) or by neither of them (3%). Prostate volume was not systematically taken for account in the treatment strategy by 57% of the urologists. Sexual function was assessed systematically by 28% of the urologists, 11% used a questionnaire (IIEF: 92%). PSA was tested respectively by 70 and 51% of the urologists at the initial evaluation and the follow-up. After introduction of a monotherapy, 56% of the urologists evaluated the efficacy at 3 months. CONCLUSION The French guidelines for the management of benign prostatic hyperplasia (BPH) by the LUTS committee of the French Urological Association were well known and used by French urologists. Some improvements can be expected for the use of the IPSS score, the evaluation of the sexual function, and the use of the new terminology. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - A Rahmène Azzouzi
- Service d'urologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | | | - A Benchikh
- Service d'urologie, hôpital Bichat - Claude-Bernard, groupe des hôpitaux universitaires Paris-Nord-Val-de-Seine, université Denis-Diderot, Paris-VII, 75018 Paris, France
| | - A Campeggi
- Service d'urologie, CHU Mondor, 75000 Paris, France
| | - J N Cornu
- Service d'urologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, université Pierre-et-Marie-Curie - Paris-6, 75020 Paris, France
| | - O Dumonceau
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - A Faix
- Clinique mutualiste Beausoleil, 34070 Montpellier, France
| | - M Fourmarier
- Service d'urologie, centre hospitalier d'Aix-en-Provence, 13616 Aix-en-Provence, France
| | - O Haillot
- Service d'urologie, CHU de Tours, 37044 Tours, France
| | - B Lukacs
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - R Mathieu
- Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 35000 Rennes, France
| | - V Misrai
- Service d'urologie, clinique Pasteur, 31300 Toulouse, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, université Bordeaux-Segalen, 33076 Bordeaux, France
| | | | - A Descazeaud
- Service de chirurgie urologique, CHU de Limoges, 87042 Limoges, France
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Lebdai S, Descazeaud A. Prise en charge des symptômes du bas appareil urinaires liés à l’hypertrophie bénigne de prostate. Prog Urol 2014; 24:929-33. [DOI: 10.1016/j.purol.2014.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 07/16/2014] [Accepted: 07/22/2014] [Indexed: 11/25/2022]
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39
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Corbel L, Della Negra E, Berquet G, Codet Y, Boulière F, Braguet R, Trifard F. Vaporisation laser prostatique par GreenLight (180 W) en ambulatoire : évaluation prospective sur 115 patients. Prog Urol 2014; 24:733-7. [DOI: 10.1016/j.purol.2014.08.238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 06/10/2014] [Accepted: 08/24/2014] [Indexed: 11/16/2022]
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40
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Droupy S. Sexualité et pathologies urologiques. Presse Med 2014; 43:1106-10. [DOI: 10.1016/j.lpm.2014.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 11/25/2022] Open
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L’adénomectomie selon Millin à l’heure de l’énucléation laser : résultats d’une série de 240 cas. Prog Urol 2014; 24:379-89. [DOI: 10.1016/j.purol.2013.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 09/23/2013] [Accepted: 09/29/2013] [Indexed: 11/20/2022]
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42
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Droupy S. L’hyperplasie bénigne de la prostate. SEXOLOGIES 2014. [DOI: 10.1016/j.sexol.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Peyronnet B, Pradère B, Bruyère F. Prise en charge de la nycturie : une entité nosologique au sein des troubles mictionnels de l’homme. Prog Urol 2014; 24:80-6. [DOI: 10.1016/j.purol.2013.08.310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/24/2013] [Accepted: 08/01/2013] [Indexed: 11/24/2022]
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Lahlaidi K, Ariane MM, Fontaine E. [Up-to-date on the treatment of benign prostatic hyperplasia. Which adenoma to treat and how to do it?]. Rev Med Interne 2013; 35:189-95. [PMID: 24262410 DOI: 10.1016/j.revmed.2013.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022]
Abstract
Benign prostatic hyperplasia is a state of the nature rather than a disease. It affects mainly men over 50 years and represents a public health problem. A literature review on the therapeutic management of benign prostatic hyperplasia was carried out from a selection of publications with the highest level of evidence. Medical treatment is based on herbal medicine, alpha-blockers and 5-alpha-reductase inhibitors. Surgical treatment is used in case of complications or failure of medical management. Surgical options are numerous. Transurethral prostate resection and prostate adenomectomy are the most usual procedures. Due to their significant morbidity, other less invasive procedures have recently been developed. The choice of treatment will depend on prostate volume and anatomy and patient's comorbidities.
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Affiliation(s)
- K Lahlaidi
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - M M Ariane
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - E Fontaine
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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Game X, Cornu JN, Robert G, Descazeaud A, Droupy S, Benard-Laribiere A, Bastide C, Guy L, Bruyére F, Karsenty G. [Drug therapy of urethral diseases]. Prog Urol 2013; 23:1287-98. [PMID: 24183087 DOI: 10.1016/j.purol.2013.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/16/2013] [Indexed: 02/02/2023]
Abstract
AIM To describe drugs targeting urethra and prostate to treat dysfunctions such LUTS related to BPH, primary bladder neck obstruction (PBNO), detrusor sphincter dyssynergia (DSD) or sphincter deficiency (SD). METHOD Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM). RESULTS To treat LUTS related to BPH alpha-blockers (AB) and 5-alpha reductase inhibitors (5ARIs) have a clearer efficacy than plant extract. Daily Phosphodiesterase 5 inhibitors (PDE5Is) alone or in association with AB also demonstrate efficacy in this indication. AB are an option in PBNO and DSD related to multiple sclerosis. Although Botulinum toxin A derived molecules decrease urethral pressure in patient with DSD related to spinal cord injury or multiple sclerosis, efficiency remains to be demonstrated. Duloxetine a serotonin reuptake inhibitor increases urethral sphincter pressure and reduce stress urinary incontinence in women and men. Nevertheless, moderate efficacy combine with frequent side effects lead French regulation agency to reject its agreement. CONCLUSION Armamenterium to treat urethral dysfunctions has recently increases. Two new therapeutic classes emerge: PDE5Is to treat LUTS related to BPH and an SRIs (Duloxetine) to treat stress urinary incontinence. Efficacy and safety evaluation of all the possible associations between drugs targeting urethra and/or bladder is needed to a subtler and more efficient pharmacologic modulation of lower urinary tract dysfunction.
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Affiliation(s)
- X Game
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA 50032, 31059 Toulouse, France
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Les médicaments de la vessie. Prog Urol 2013; 23:1271-86. [DOI: 10.1016/j.purol.2013.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 12/27/2022]
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Misraï V, Faron M, Guillotreau J, Bruguière E, Bordier B, Shariat SF, Rouprêt M. Assessment of the learning curves for photoselective vaporization of the prostate using GreenLight™ 180-Watt-XPS laser therapy: defining the intra-operative parameters within a prospective cohort. World J Urol 2013; 32:539-44. [PMID: 24072009 DOI: 10.1007/s00345-013-1163-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/27/2013] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To assess the learning curves for the intra-operative parameters of the GreenLight™ 180-W XPS for photoselective vaporization of the prostate (PVP). METHODS A prospective study was conducted on 200 men who underwent PVP using the GreenLight™ 180-W XPS over 20 months. The population was divided into four consecutive equal groups. Evolution of lasing parameters was the main endpoint to reach an average energy of 5 kJ per prostate volume and to reach a lasing time/operative time (LT/OT) ratio of 66-80 %. Changes in the IPSS and prostate volume were also evaluated 12 weeks later. RESULTS Total energy delivered (energy/ml of prostate) and the LT/OT ratio significantly increased over time (p < 0.05). Urinary function significantly improved from baseline in all groups. The first lasing parameter endpoint was reached after the 75th patient (group 1) and the second endpoint (LT/OT ratio) after the 125th patient (group 3). Only the PSA level (p = 0.04) and prostate volume (p < 0.0001) decreased significantly in the 3rd and the 4th group. Post-operative complications occurred in 20 % of patients, which were primarily Clavien-Dindo grades 1 and 2, though there were no statistical differences between the four groups (p = 0.62). In-hospital stay and time to catheter removal were significantly shorter in the 3rd and 4th group. CONCLUSIONS The current study assessed the PVP learning curves within multiple intra-operative parameters. The PVP learning curves required at least 120 procedures until it met all intra-operative parameters of experts in this field.
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Affiliation(s)
- Vincent Misraï
- Urology Department, Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France,
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