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Lombardo R, Ghezzo N, Sarcinelli L, Turchi B, Zammitti F, Franco A, Nacchia A, Cicione A, Tema G, Pastore AL, Guarnotta G, Fuschi A, Al Salhi Y, Tubaro A, De Nunzio C. Post-Voided Residual Ratio Does Not Predict Trifecta Outcome after Transurethral Resection of Prostate. Life (Basel) 2024; 14:445. [PMID: 38672716 PMCID: PMC11051523 DOI: 10.3390/life14040445] [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: 01/31/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65-73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.
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Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Sapienza University of Rome, 00185 Rome, Italy; (N.G.); (L.S.); (B.T.); (F.Z.); (A.F.); (A.N.); (A.C.); (G.T.); (A.L.P.); (G.G.); (A.F.); (Y.A.S.); (A.T.); (C.D.N.)
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Uflacker AB, Haskal ZJ, Baerlocher MO, Bhatia SS, Carnevale FC, Dariushnia SR, Faintuch S, Gaba RC, Golzarian J, Midia M, Nikolic B, Sapoval MR, Walker TG. Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization. J Vasc Interv Radiol 2020; 31:891-898.e1. [PMID: 32340862 DOI: 10.1016/j.jvir.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andre B Uflacker
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ziv J Haskal
- Department of Radiology and Medical Imaging/Interventional Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Mark O Baerlocher
- Department of Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada
| | - Shivank S Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Salomao Faintuch
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ron C Gaba
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Mehran Midia
- Department of Radiology, McMaster University, Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Boris Nikolic
- Department of Interventional Radiology, Cooley Dickinson Hospital, Massachusetts General Hospital Affiliate, Northampton, Massachusetts
| | - Marc R Sapoval
- Department of Interventional Vascular and Oncologic Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - T Gregory Walker
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Abstract
Lower urinary tract symptoms (LUTS) are a common problem in men especially with aging. The International Continence Society (ICS) revealed an overall prevalence of LUTS of about two-thirds of men age 40 years and above. The treatment approach depends on accurate determination of the underlying etiology. LUTS is not unique to benign prostate enlargement (BPE) and can be secondary to other causes. In the era where quality of care is important, accurate diagnosis and counseling to meet patients' expectations is of extreme paramount. Thus, proper assessment of patients who present with BPE and LUTS should be an important part of the work up process. Accurate diagnosis and identification of the cause will help to improve quality of treatment, optimize counseling, and improve treatment outcomes. Pressure flow urodynamic studies (PFUDs) are not only important tools that help to identify the underlying causes of LUTS; it is considered the "gold standard" for diagnosis of bladder outlet obstruction (BOO) in patients with enlarged prostate [1, 2]. However, there is a continuous debate on the value of using PFUDs and its association with improved outcomes.
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Urodynamics in Male Lower Urinary Tract Symptoms. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0299-2] [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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Urodynamics in the Elderly. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-014-0115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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De Nunzio C, Autorino R, Bachmann A, Briganti A, Carter S, Chun F, Novara G, Sosnowski R, Thiruchelvam N, Tubaro A, Ahyai S. The diagnosis of benign prostatic obstruction: Development of a clinical nomogram. Neurourol Urodyn 2014; 35:235-40. [PMID: 25524269 DOI: 10.1002/nau.22705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/22/2014] [Indexed: 11/08/2022]
Abstract
AIMS To develop a nomogram predicting benign prostatic obstruction (BPO). METHODS We included in this study 600 men with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE) who underwent standardized pressure flow studies (PFS) between 1996 and 2000. Complete clinical and urodynamic data were available for all patients. Variables assessed in univariate and multivariate logistic regression models consisted of IPSS, PSA, prostate size, maximal urinary flow rate (Qmax) at free flow, residual urine (RU), and bladder wall thickness (BWT). These were used to predict significant BPO (defined as a Schäfer grade ≥ 3 in PFS). RESULTS A preliminary multivariate model, including IPSS, Qmax at free flow and RU, suggested that only Qmax at free flow was a statistically significant predictor of BPO (P = 0.00) with a predictive accuracy (PA) of 82%. Further development of the multivariate model showed how the inclusion of BWT did not increase PA. Only transitional zone volume (TZV) proved to be an additional statistically significant predictor for BPO (P = 0.00). The combination of Qmax at free flow and TZV demonstrated a PA of 83.2% and were included in the final nomogram format. CONCLUSIONS We developed a clinical nomogram, which is both accurate and well calibrated, which can be helpful in the management of patients with LUTS and BPE. External validation is warranted to confirm our findings.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant' Andrea Hospital "La Sapienza,", Rome, Italy
| | - Riccardo Autorino
- Department of Urology, Urology Clinic, Second University of Naples, Naples, Italy
| | - Alexander Bachmann
- Department of Urology, Urologische Klinik, Universitätsspital Basel, Basel, Switzerland
| | - Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy
| | - Simon Carter
- Department of Urology, London Clinic, London, United Kingdom
| | - Felix Chun
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Giacomo Novara
- Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy
| | - Roman Sosnowski
- Department of Urology, M. Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland
| | | | - Andrea Tubaro
- Department of Urology, Sant' Andrea Hospital "La Sapienza,", Rome, Italy
| | - Sascha Ahyai
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Abstract
In this article, the value of urodynamic studies in the evaluation of treatment of male lower urinary tract symptoms is appraised based on current evidence. The information gained by urodynamics can be a valuable tool for counseling patients considering invasive outlet reduction procedures.
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Abstract
Lower urinary tract symptoms (LUTS), overactive bladder, (OAB), and benign prostatic hyperplasia (BPH) are very commonly experienced in men. The mainstay of pharmacotherapy for OAB is the antimuscarinic class of drugs. There has been reluctance to prescribe these agents to men with BPH due to the risk of precipitating urinary retention. Several trials have supported the efficacy and safety of antimuscarinics in treating men with LUTS, alone, or in combination with α-blocker therapy. The combination of 5-α-reductase inhibitors with antimuscarinic agents or surgery are other effective treatments for men with BPH and OAB.
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Affiliation(s)
- Doreen E Chung
- Mount Sinai Hospital, University of Chicago, IL 60608, USA
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Song K, Choo MS, Lee KS, Han JY, Lee YS, Kim JC, Cho JS. The Long-term Effect of Alfuzosin in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostate Hyperplasia: Evaluation of Voiding and Storage Function With Respect to Bladder Outlet Obstruction Grade and Contractility. Urology 2011; 77:1177-82. [DOI: 10.1016/j.urology.2010.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 09/24/2010] [Accepted: 10/13/2010] [Indexed: 11/17/2022]
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Djavan B, Dianat SS, Kazzazi A. Effect of combination treatment on patient-related outcome measures in benign prostatic hyperplasia: clinical utility of dutasteride and tamsulosin. PATIENT-RELATED OUTCOME MEASURES 2011; 2:71-9. [PMID: 22915969 PMCID: PMC3417924 DOI: 10.2147/prom.s13062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Benign prostatic hyperplasia, the fourth most commonly diagnosed medical condition in the elderly, is a major underlying cause of lower urinary tract symptoms in men. Medical therapy is usually the first therapeutic option. Combination therapy is increasingly used for better symptom relief and outcome. METHODS We searched the literature using the MEDLINE database for the efficacy of combination therapy in men with benign prostatic hyperplasia in terms of symptom improvement and impact on quality of life. RESULTS Combination therapy with dutasteride and tamsulosin not only provides better symptom improvement and improved urinary flow rate, but is also associated with a more favorable impact on quality of life and patient satisfaction with treatment than monotherapy. Combination therapy also reduces the risk of events related to disease progression, such as acute urinary retention and benign prostatic hyperplasia-related surgery. CONCLUSION Combination therapy with dutasteride and tamsulosin is highly efficacious as medical therapy for benign prostatic hyperplasia in patients with moderate-to-severe lower urinary tract symptoms.
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Affiliation(s)
- Bob Djavan
- New York University, Department of Urology, New York, USA
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Djavan B, Handl MJ, Dianat S. Combined medical treatment using dutasteride and tamsulosin for lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Expert Opin Pharmacother 2010; 11:2535-47. [DOI: 10.1517/14656566.2010.516901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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